The Sandwich Line presents as a thick line sandwiched between two thinner lines. It represents vascular plaque and fatty build-up, and almost always has a direct relation to poor diet and lifestyle behaviours, and lack of exercise. This sign may also be seen in those with a family history of coronary heart disease, showing a possible genetic tendency for CV and heart disease. A focus on positive diet and lifestyle behaviours with incorporation of regular exercise is extremely important in someone presenting with this sign.