Cardiac leiomyoscarcomas is a rare subset of the already infrequent primary malignant cardiac neoplastic spectrum. The most common site for a primary leiomyosarcoma is the right ventricle with fewer than five globally reported cases in the left ventricle. Most present with non-specific symptoms but attention is usually sought after the appearance of compressive symptoms or arrhythmias. We present the case of a left ventricular leiomyosarcoma that had a delayed diagnosis and its subsequent surgical management.