title: A 72-year-old male with recurrent syncope.
abstract: 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).
  
  
  
  What is the most likely diagnosis? Cardiac tumourHypertrophic obstructive cardiomyopathyVentricular aneurysmVentricular diverticulum heartjnl;103/10/800/HEARTJNL2016309670F1F1HEARTJNL2016309670F1Figure 1Cardiac CT coronary angiogram-three-dimensional reconstruction.
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Dhanuka
authors.initials: D
authors.lastname: Perera
authors.affiliation: Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Uppal
authors.affiliation: Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Hogan
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006322:Heart Aneurysm / Q000150:complications* / Q000175:diagnosis; D006352:Heart Ventricles; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D012008:Recurrence; D013575:Syncope / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed