SUMMARYAsthma exacerbations are a fairly common presentation to emergency departments. However, a careful history, clinical examination and interpretation of investigations may uncover a more serious pathology. We present an interesting case of a 44-year-old man with symptoms suggestive of an asthma exacerbation, who was found to have Churg-Strauss vasculitis/eosinophilic granulomatosis with polyangitis. He had clinical features of a vasculitis, ECG changes and a troponin T level of 7562 ng/L. Renal biopsy confirmed Churg-Strauss vasculitis. Cardiac involvement in Churg-Strauss Syndrome (CSS) is one of the leading causes of mortality. We describe the successful diagnosis and management of a patient with CSS.