Our first thought on reading this case was, “That's just too unusual. We can't possibly send every 28 year old woman with a bit of chest pain off for echocardiography.”1 In thinking that, we were using pattern recognition—a common approach to clinical diagnosis. We assumed that a young woman could not have note-worthy ischaemic heart disease.

But is there more to this case? If we were to substitute a 28 year old woman for a 50 year old man in the same scenario, most clinicians would recognise a familiar …