A patient presented to the ED with 2 days of chest pain radiating to the back. Symptoms were associated with dyspnea and diaphoresis. The patient had a significant history of self-inflicted stab wounds and retained foreign bodies. He was status-post multiple endoscopic removals and laparotomies. The patient was recently admitted to the hospital secondary to an abdominal foreign body removed by general surgery. The day of presentation the patient denied any new injuries. He had no history of cardiac disease or venous thromboembolic events. Review of systems was negative other than noted. His vital signs showed an initial BP 120/55, pulse rate 118, temperature 36.9 C, respiration rate of 20, and peripheral capillary oxygen saturation 97% on room air. His general appearance was significant for an ill-appearing, diaphoretic man. Cardiovascular examination was notable for sinus tachycardia with intact distal pulses and no detectable abnormal heart sounds. Respiratory examination revealed clear lungs and normal work of breathing. Abdominal examination revealed multiple well-healed scars without tenderness or peritoneal signs. The rest of his physical examination was unremarkable.On arrival to the ED, two large-bore IV lines were established. ST changes were noted on the monitor, prompting an ECG that revealed diffuse ST segment elevations. Troponin was elevated to 2.01. A bedside cardiac ultrasound was performed (Video 1).