An 83-year-old gentleman with a past medical history of diet-controlled diabetes mellitus type 2, gout, and hypertension presented to our institution with a 4-hour history of upper abdominal pain and lower chest tightness associated with dyspnoea, which was partially relieved by intravenous morphine and sublingual glyceryl trinitrate administered by ambulance paramedics. On arrival in the emergency department, a 12-lead ECG showed minimal anterior ST elevation (); therefore, a bedside echocardiogram was performed. This demonstrated hypokinesis of the apical third of the anterior, inferior, and lateral walls. Given the borderline ECG changes and regional wall motion abnormalities on echo, the patient was taken for emergency cardiac catheterisation. Angiography revealed an occluded obtuse marginal 2 (OM2) branch of the circumflex artery () with minor disease in the other major epicardial arteries. Flow was restored following passage of the guidewire, and thrombus was clearly identifiable in the vessel. The lesion was treated with one 2.5 mm × 15 mm drug-eluting stent resulting in TIMI III flow (). Ventriculogram done in the RAO projection revealed mid and apical hypokinesis and ballooning with preserved basal function. Ventriculogram from the LAO projection showed posterior wall hypokinesis more in keeping with the ischaemic territory affected by acute plaque rupture. A venous blood gas revealed haemoglobin of 145 g/L (ref 120-170 g/L), normal electrolytes, and blood glucose of 8.7 mmol/L (ref 3.5-7.7 mmol/L). The patient's initial troponin I was 365 ng/L (ref <26 ng/L) and peaked at 17,180 ng/L the following day. His ECG evolved to show deep symmetrical T wave inversion across the anterolateral and limb leads, clearly more extensive than the distribution of the infarct artery () associated with the prolongation of the QT interval. Formal echocardiogram performed 6 hours following percutaneous coronary intervention (PCI) showed severe apical ballooning and hypokinesis extending to mid cavity with preservation of basal function, consistent with TTS. The posterolateral wall was also noted to be akinetic in keeping with a region of infarction. There was mild LV systolic dysfunction (EF 45%). The patient was commenced on perindopril and atorvastatin in addition to dual antiplatelet therapy with aspirin and clopidogrel. On further questioning, no acute emotional triggers in the patient's life could be identified. On day 3 of the patient's admission, troponin was down trending at 8907 ng/L. He was discharged 4 days after presentation, following an uncomplicated inpatient stay. Follow-up echocardiography performed 6 weeks after discharge demonstrated restoration of normal LV systolic function and resolution of the previously seen regional wall motion abnormalities ().