Clinical introduction A 72-year-old patient presented with recurrent syncope 1 year after a myocardial infarction. Two recent falls resulted in fractures to the femur. Serial troponins were negative and ECG demonstrated fixed inferior ST-segment elevation and pathological Q waves. A Holter monitor recorded non-sustained ventricular tachycardia. A subsequent echocardiogram was abnormal, and further investigation with a three-dimensional (3D) cardiac CT coronary angiogram was performed (figure 1).

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Figure 1

Cardiac CT coronary angiogram—three-dimensional reconstruction.

Question What is the most likely diagnosis?

1. Cardiac tumour

2. Hypertrophic obstructive cardiomyopathy

3. Ventricular aneurysm

4. Ventricular diverticulum

Question