Hydatid cyst is an infection caused by the larval form of Echinococcus tapeworm. A cardiac presentation of the cyst is a rare scenario. This is a case of an elderly female who presented with dyspnoea, angina and heaviness of chest, and was found to have ischemic heart disease on electrocardiography. Her echocardiography showed global left ventricular hypokinesia and a pericardial cystic lesion. Cardiac magnetic resonance imaging revealed a loculated mass lesion along the free wall of the left ventricle and triple vessel disease was seen on coronary angiogram. Serum IgG antibodies against Echinococcus were positive. Anaphylaxis and cardiac tamponade due to cyst rupture were the main concerns. Since our patient had two life threatening conditions, a combined surgical and medical approach was opted. She underwent coronary artery bypass grafting along with cyst excision and albendazole therapy; and recovered uneventfully.
