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A 53-year-old man working on an overseas Ministry of Defence (MOD) base with no known prior cardiac history presented to the military primary care facility with an 18-month history of progressive shortness of breath, orthopnoea, chest pain and reduced exercise tolerance. Relevant medical and social history consisted of previous smoking and substantial alcohol consumption. He was referred to the local civilian hospital for investigation. A transthoracic echocardiogram revealed severe left ventricular systolic dysfunction (ejection fraction 20%–25%); cardiac CT and invasive coronary angiography revealed severe triple-vessel coronary artery disease. A diagnosis of heart failure was made, and he was treated with diuretics and commenced on standard prognostic medications for presumed ischaemic cardiomyopathy. There was no evidence of cardiogenic shock at presentation.