A 52-year-old-man was referred following complaints of dyspnoea, and eructation. An exercise myocardial perfusion scan showed a small fixed inferior wall perfusion defect with normal left ventricular systolic function. Following a pre-syncopal episode he was admitted to hospital where serial cardiac markers, ECGs, full blood count and electrolytes were all normal.

Coronary angiography was performed which showed a rare …