Anterior wall myocardial infarction, left ventricular aneurysm and pulmonary hypertension (venous and arterial). There is cardiomegaly with a bulge along the left cardiac border above the apex, indicating a left ventricular aneurysm. Clinically there was a dyskinetic pulsation in this region over the chest. Main pulmonary artery is prominent and right pulmonary artery is large due to pulmonary hypertension. Prominent upper lobe vessels are seen, especially on the left side, suggesting pulmonary venous hypertension secondary to left ventricular failure and elevated left ventricular end diastolic pressure which is common in left ventricular aneurysm.