A 72-year-old male with recurrent syncope.

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).

QUESTION: What is the most likely diagnosis? Cardiac tumourHypertrophic obstructive cardiomyopathyVentricular aneurysmVentricular diverticulum heartjnl;103/10/800/HEARTJNL2016309670F1F1HEARTJNL2016309670F1Figure 1Cardiac CT coronary angiogram-three-dimensional reconstruction.