A 65-year-old man with known metastatic lung cancer was transferred to our emergency department due to typical angina pectoris lasting ∼8 h. The patient first received a diagnosis of lung cancer two years ago, which was classified based on the TNM system (tumour, nodes, metastases) as cT4cN1cM1. The palliative treatment involved a combination of surgery, adjuvant chemotherapy, and three rounds of radiation therapy to address the bone metastasis in the left scapula. Until his current presentation, the patient had no history of chest pain, either at rest or during exertion, and no history of coronary artery disease. His coronary risk factors included hypertension and former smoking. On admission, the patient was haemodynamically stable without any signs of cardiac decompensation (Killip I). ECG showed ST-segment elevation in the anterolateral leads V2, V3, I, and aVL (). A blood test conducted externally revealed elevated levels of high-sensitivity troponin and creatine kinase (CK), measured at 154 ng/L and 300 U/L, respectively. ST-elevation AMI was diagnosed, and the patient was transferred for emergency catheterization. The coronary angiogram revealed a total occlusion of the distal LCA (). It was conspicuous that no cardiac motion was detectable at the left ventricular apex and the mid-LCA (see, ). Several wiring attempts of the occluded vessel were unsuccessful and were not forced due the risk of perforation and bleeding under the suspicion of tumour invasion into the myocardium. Due to the palliative situation, other revascularization strategies weren’t considered. The performed transthoracic echocardiography (TTE) study showed an invasion of the apex of the heart by the metastatic tumour, which was manifested by localized thickening of the apical left ventricular wall along the site of tumour attachment, a localized wall motion asynergy was also observed (,, ). A review of previous CT images showed evidence of tumour infiltration and contrast enhancement into the left ventricular apex (). The localized thickening and wall motion asynergy observed on TTE corresponded well with the identified area of tumour involvement. In the synopsis of the collected findings, our diagnosis hypothesis of occlusion due to tumour metastasis in the left ribs could be confirmed. The patient underwent radiotherapy once more, but unfortunately passed away a few days later.