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CASE PRESENTATION: A 36-year-old African American female with a 3-year history of SLE (+ANA/anti-Smith/anti-dsDNA/RNP, low C3/C4, +anticardiolipin IgM/Lupus anticoagulant, +Coombs, +pericarditis, +synovitis, +nephritis) on prednisone and plaquenil but noncompliant with medical therapy, recent lupus flare, and newfound aortic valvular thickening refusing further workup presented with left chest pressure. Patient was hemodynamically stable. On exam, she had a positive systolic murmur. EKG showeddoi:10.26226/morressier.5ebc261fffea6f735881a21b fatcat:lvmhqdn7ovflpcw3kuidqw6fqe