Synchronous cardiac metastasis from transitional cell carcinoma of bladder is extremely rare. Almost all reported cases in the literature showed metachronous cardiac metastases. The prognosis of patients with cardiac metastases is extremely poor with survival ranging from a few days to months. We report a case of synchronous interventricular septal cardiac metastasis from transitional cell carcinoma of bladder treated with platinum-based palliative chemotherapy and had a lethal outcome. Diagnosis of synchronous cardiac metastasis from transitional cell carcinoma of bladder is extremely rare and shows a poor prognosis even after palliative chemotherapy.