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A 76 year old man with no prior cardiac history was admitted after three episodes of syncope. With symptoms, telemetry revealed a rapid monomorphic rhythm (panel A) consistent with ventricular tachycardia (VT). ECG and cardiac markers were unremarkable. Echocardiography revealed an apical defect emptying into a large thin-walled chamber (panels B, C, D). Doppler interrogation revealed bidirectional flow between the left ventricle (LV) and this chamber, consistent with true aneurysm of the LV apex versus contained rupture of the LV apex with pseudoaneurysm formation. Cardiac catheterisation showed a 40% plaque …