Secondary neoplastic involvement of the heart is common but usually asympto
matic. Malignancy rarely presents as acute pericarditis, cardiac tamponade,
and myocardial infarction in the same patient. We report a patient with un
suspected metastatic pancreatic adenocarcinoma who presented with acute per
icarditis and cardiac tamponade and subsequently developed a myocardial inf
arction due to coronary artery occlusion secondary to a metastatic deposit
around the left anterior descending artery.