CASE PRESENTATION: 15 year old adolescent male, competitive swimmer with no past medical history presented with acute stabbing non-irradiating central chest pain while swimming practice.Pain worsened when he laid flat or took deep breaths.No fever, palpitations, syncope or other associated symptoms.Family history positive for diabetes and hypertension. No history of bleeding disorders, no illicit drug use, alcohol or tobacco use.Physical examination remarkable for tachycardia, rest of exam was normal. EKG showed non-specific ST-T changes. Initial Troponin level was 6.46, CKMB 27, CK 586. ECHO showed regional apex wall abnormality LVEF 61%. Within the next day cardiac enzymes started to rise withTroponin I at 92.1, CKMB at 81.4 and CK 615. Cardiac MRI showed preserved LV function, abnormal enhancement of subendocardial apical anterior and anteroseptal LV. CT angiogram showed 90% stenosis in the lumen of LAD artery and the second diagonal vessel. Coagulation studies were positive for homozygous mutation of MTHFR with normal homocysteine levels.