A 68 year old retired physician with no previous cardiac history presented with a four hour history of central crushing chest pain. His pulse was 90 beats/min, blood pressure 170/90 mm Hg, with no evidence of heart failure. His ECG demonstrated right bundle branch block, and the troponin T was raised at 0.4 μg/ml (normal < 0.1 μg/ml). Over the next 24 hours he had further chest pain. Cardiac x ray angiography …