A previously healthy 33-year-old white male presented with sudden onset substernal chest pain that started while exercising on a treadmill one hour before. He described a left sided sharp, nonradiating pain that persisted till he presented to the ER. He had associated nausea, diaphoresis, and shortness of breath. Nothing made it better. He denied heartburn, vomiting, cough, fever, and recent travel. He had no personal or family history of heart disease. On physical examination, he was a young athletic male with normal vital signs, and he appeared in distress from the pain. His cardiovascular examination was normal with no murmurs or pericardial rubs. He had an elevated troponin I at 21.9 ng/ml and an EKG ST segment elevation in the inferior leads (Figure 1). All other baseline laboratory tests were within normal limits. A STEMI alert was placed, and patients had an emergent left cardiac catheterization that reported normal coronary anatomy with no obstructing coronary stenosis (Figures 2 and 3). A left ventriculogram was also normal. He was started on a heparin drip and transferred to the coronary care unit. A plain chest X-ray did not reveal any pulmonary lesions or consolidation, and a chest CT angiogram ruled out pulmonary embolism. A transthoracic echocardiogram done reported a normal left ventricular ejection fraction (EF 50-55%) and a slight enlargement of the right ventricle without any wall motion abnormalities. Two days after presentation, the patient still reported continued chest pain and had an episode of nonsustained ventricular tachycardia (NSVT). At this point, a cardiac MRI was done (Figures 4-7) that demonstrated epicardial and midmyocardial enhancement in the inferior wall, sparing of the subendocardial region, and overlying focal pericardial enhancement, consistent with EKG changes. He was started on indomethacin; his symptoms improved in the following 5 days, and he was discharged.