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The best way to a woman's heart?
  1. David N Porter1,
  2. Claire Emerson2,
  3. Patricia Ward1
  1. 1Department of Emergency Medicine St. Mary's Hospital London Imperial College Healthcare, NHS Trust, London, UK
  2. 2Department of Emergency Medicine Chelsea & Westminster Hospital, London, UK
  1. Correspondence to Dr David Porter, Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, South Wharf Road, London W2 1NY, UK; davidnporter{at}gmail.com

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A 65-year-old female attended the emergency department complaining of epigastric discomfort with diarrhoea and vomiting over the previous 24 h, with no fever, no haematemesis, no malaena and no history of foreign travel. She was on treatment for hypertension, peptic ulcer disease and hypercholesteraemia. Clinical examination and investigations were unremarkable, including ECG and chest x-ray, and she was discharged home with gaviscon, a proton pump inhibitor and advised to return if she deteriorated.

She re-presented to the emergency department 24 h later with worsening epigastric pain, and stated that she had vomited 20 times overnight. She was moved to a cubicle and a routine ECG was performed, demonstrating an inferior myocardial infarction (figure 1). The cardiology team …

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