A 23-year-old ski lift attendant in Telluride, a skiing village in southern Colorado, was awakened one morning with chest pains that lessened when he sat up. The symptoms persisted and the young man decided to see an internist in Durango, Colo, a larger town several miles south of Telluride, because medical facilities in the village were limited to treatment of skiing injuries. On detailed questioning by the internist, the patient admitted to having had a mild “cold” the day before and that the chest pains were precordial with radiation to the area of the trapezia. On auscultation over the precordium with the stethoscopic diaphragm, which is preferred when auscultating high-frequency sounds, a biphasic or “to and fro” precordial friction rub was heard and was most apparent along the left mid to lower sternal edge. The electrocardiogram revealed the classic...

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