Lung cancer involvement of the heart is silent, carries a poor prognosis, and is most commonly identified at autopsy. A patient with lung cancer presented with symptoms and ECG findings suggestive of an acute coronary syndrome. Persistent symptoms and normal creatine phosphokinase (CPK) levels led to use of MRI and radionuclide scintigraphy to diagnose neoplastic infiltration of the myocardium. Palliative care was established with significant symptom relief. Assessment for cardiac metastases should be considered in patients with advanced lung cancer presenting with chest pain, new ECG findings, and normal CPK levels.