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An unusual cause of a non-ST segment elevation myocardial infarction
  1. Rebecca D Levit1,
  2. Marek Polomsky2,
  3. J David Vega2,
  4. David R Martin3,
  5. Gautam Kumar1,4
  1. 1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
  1. Correspondence to Dr Gautam Kumar, Cardiology Division (111C/D), Atlanta Veterans Affairs Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA; gautam.kumar{at}

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clinical introduction

A 66-year-old man presented with dull, left-sided chest pain for 1 week occurring mainly at rest. The symptoms had been present for 1 month but had increased in frequency over the preceding 3 days. He became acutely short of breath with substernal chest pain while climbing a flight of stairs the day of admission. The pain was pressure-like, did not radiate and was associated with presyncope, but not syncope, diaphoresis, nausea nor vomiting. He had no past medical history of cardiac disease but did have risk factors for coronary artery disease (CAD) including hypertension, history of smoking and the metabolic syndrome. His past medical history was also significant for non-Hodgkin's stage IV marginal zone B cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) 4 years earlier. Vital signs and physical exam were normal without murmurs, …

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