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580 Copyright © 2012 The Korean Society of Cardiology Korean Circulation Journal



A 33-year-old female presented with the typical angina symp-toms of dyspnea on exertion. Five years prior, the patient had been diagnosed with familial hypercholesterolemia, as had her living siblings (a brother and a sister). The patient’s family history included 2 brothers and 2 sisters that died in childhood due to unknown etiol-ogy. Although she was being treated with 80 mg atorvastatin and 10 mg ezetimibe, her total cholesterol level was 607 mg/dL, her low den-sity lipoprotein (LDL) level was 555 mg/dL, her high density lipopro-tein (HDL) level was 26 mg/dL, and her triglyceride level was 126 mg/dL. Monthly LDL apheresis was started as an adjunct to drug th-erapy.1) On physical examination, she had xanthelasma and plantar xanthomas. Cardiac examination revealed sinus tachycardia of 120 bpm, blood pressure of 110/75 mm Hg, and grade 3/6 systolic ejec-tion murmur that was most prominent over the second intercostal space on the right sternal border. Electrocardiography showed S

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