Early interest in myocardial tumors was directed primarily at their pathology. Today, however, interest must be in early diagnosis and planned operation utilizing cardiopulmonary bypass since such tumours, both benign and malignant, are potentially lethal due to their location and since most are resectable. The case of a patient with myocardial fibroma presented here offers an expanded pathological picture: the tumor contained fibrous tissue, cardiac muscle, vascular elements, adipose tissue, and smooth muscle. Smooth muscle has not been previously reported. A review of the literature reveals disagreement and confusion over proper nomenclature for the entity. Perhaps its varied histological presentation is better described as fibrous hamartoma than fibroma.