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CASE ILLUSTRATION 1Jeffrey Borzak, a patient I knew well, seemed to be recovering from coronary artery bypass surgery. On rounds, I sensed that there was something that was wrong, but I could not put my finger on it. In retrospect, his color was not quite right—he was grayish-pale, his blood pressure was too easily controlled, he was even hypotensive on one occasion, and he seemed more depressed than usual. He reported no chest pain or shortness of breath, and had no pedal edema, elevated jugular venous pressure, or other abnormalities on his physical examination. But still I did not feel comfortable, and although there were no “red flags,” I ordered an echocardiogram which showed a new area of ischemia. An angiogram showed that one of the grafts had occluded. After angioplasty, Mr. Borzak looked and felt better, and he again required his usual antihypertensive medications.