A 68 year old man was referred to the cardiology outpatient department for investigation of deteriorating angina control. Three years earlier he had sustained an inferoposterior myocardial infarction complicated only by a transient episode of hypotension and bradycardia.

Clinical examination was unremarkable apart from the finding of a soft systolic murmur at the apex and axilla. Investigations included an ECG, which confirmed an old inferior infarction, and chest radiography, which showed a normal cardiac silhouette and lung fields. An exercise tolerance test was abnormal at a low cardiac workload. Transthoracic echocardiography suggested an inferoposterior false aneurysm with otherwise normal left ventricular function. An abnormal structure of uncertain cause was also noted within the left …