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A 67-year-old male with a history of hypertension, dyslipidaemia, diabetes mellitus type 2, obstructive sleep apnoea and obesity was referred for evaluation of an abnormal ECG. At presentation, the patient was asymptomatic and denied prior cardiac symptoms. Resting 12-lead ECG demonstrated marked ST and T-wave abnormalities consistent with anterolateral ischaemia (Figure 1A). On single-photon emission CT myocardial perfusion (SPECT) wall motion images, the left ventricular chamber was noted to have a peculiar ‘spade-shaped’ contour (Figure 1B,C, online supplementary media clip 1). On this basis, a transthoracic …
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