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A previously fit 43-year-old man presented with sudden onset, severe, tearing intrascapular chest pain one day after visiting an amusement park where he had engaged in a number of high-speed rides. Examination was unremarkable apart from a prominent diastolic murmur; blood pressure was 144/61 mm Hg. There was biochemical evidence of acute renal failure and microscopic haematuria. His electrocardiogram showed non-specific infero-lateral T-wave changes. Urgent trans-thoracic echocardiography (figure 1) demonstrated evidence of a …
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