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A 75 year old female patient with a four year history of aortic valve replacement with mechanical prosthesis (Medtronic Hall 20) was admitted to the cardiology department with a one month history of progressing dyspnoea and coughing episodes. She denied having chest pain. Admission ECG showed signs of hypertrophy and overload of the left ventricle and 1 mm ST segment elevations in leads II, …