• Adam Smith is a 37 year old man who works as a banker in the city. He is usually fit and well and a very athletic individual, exercising regularly (including cycling to work and football on the weekends) for around 8-10 hours per week.
• He presents to A&E after developing breathlessness and chest pain whilst rushing to a meeting after lunch and sprinting up some stairs. At the top of the stairs whilst still running, he develops palpitation, feels dizzy and loses consciousness for 1 minute. He is found on the floor by colleagues passing by and recalls the chest pain as left-sided and both sharp and dull in character.
• He has also noticed exertional breathlessness over the last 6-12 months.
• He used to smoke 15 cigarettes per day in his 20s, but gave up 13 years ago.