CASE PRESENTATION: Patient is an 84-year-old male with past medical history of hypertension, and remote history of adenocarcinoma of colon status post resection, and radiation, who presents with one-month history of progressive, exertional dyspnea, and orthopnea. He experienced occasional episodes of lightheadedness during this time but denied any syncopal event. He denied any palpitations, chest pain, nausea, emesis, or diaphoresis. On arrival, patient was noted to be in acute hypoxic respiratory failure. He had a heart rate of 44 with otherwise normal vital signs. Rest of the physical exam was found to be unremarkable. Complete heart block was noted on ECG. Significant lab findings included troponin of 0.21 ng/ml and pro-BNP of 9121 pg/ml. Stat echocardiogram showed an acute reduction in left ventricular ejection fraction of 30-35%, a severely hypokinetic apex, with preservation of the rest of the segments. Patient was taken for emergent coronary catheterization, which showed non-obstructive coronaries and findings consistent with TCM. Patient underwent pacemaker placement and was discharged 2 days later.