This case report discusses a patient who had subtle EKG abnormalities that were indicative of a pathological amount of coronary artery disease resulting in occlusion of the right coronary artery (RCA) even though ST-elevation criteria for STEMI were not initially present. In the proper clinical setting, focal repolarization abnormalities in conjunction with cardiac risk factors and cardiac symptoms may indicate a high probability of a pathological amount of coronary disease that warrants emergent intervention. We report a case of a 54-year-old male with cardiac risk factors and cardiac symptoms who presented to the emergency department (ED). Initial EKG, while technically abnormal, was not diagnostic. The point of care troponin was elevated at 0.10 ng/mL. Patient ultimately went to the catheterization lab where he was found to have an occlusion of the RCA and left circumflex artery which required stenting.TopicsElectrocardiogram, ECG, cardiology, myocardial infarction.