This 53 year old man with a past history of hypertension presented with a 2 month episode of severe central chest pain, radiating down both arms. He had had similar episodes of less severe pain over the previous three weeks. On examination, his BP was 200/130 mm Hg, apex beat was not displayed and an apical impulse was palpable. ECG showed anterior myocardial infarction. CK rose 1578 _/l. He died 3 weeks after presentation as a result of a cerebrovascular accident.