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An 80-year-old man, non-diabetic, non-hypertensive and smoker presented with history of shortness of breath on exertion for last 3–4 months. There was no history suggestive of an acute coronary event. ECG revealed significant Q waves in inferior leads with minimally elevated, ‘coved’ ST segment.
Echocardiogram revealed hypokinesia of inferior wall and a large basal aneurysm (4.9×4.4 cm) with a thrombus in it (size ∼2.6×4.4 cm; figures 1 and 2, and video 1). There was ‘spontaneous echo contrast’ in left ventricle (LV) near the aneurysm (video 2).