Three weeks ago (26 April, p 920), we presented the case of Peter Hartl, a 42 year old man who presented to his local emergency department with severe retrosternal chest pain. Initial investigation ruled out myocardial ischaemia (3 May, p 974). He had spiral computed tomography to exclude a pulmonary embolus because of his persistent dyspnoea and suggestive findings on echocardiography and chest radiography. To …