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doi:10.1136/bmj.a2897

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Stephen Malnick, director, Department of Internal Medicine C,
Sorel Goland, senior cardiologist, Heart Institute, Kaplan Medical Center, Rehovot 76100, Israel

stevash{at}trendline.co.il

A 50 year old man presented with retrosternal burning while walking up a slight incline, which resolved on resting. His medical history included, and he had a family history of coronary artery disease and was taking drugs for hypertension and hyperlipidaemia. Five years earlier he had had angioplasty to the marginal artery and a bare metal stent had been inserted.

On this occasion physical examination was unremarkable and …