Sara Negrotto, MD, from Parkwest Medical Center presents a case of a 60-year-old male with a history of HTN, DM, hyperlipidemia, family history of CAD and smoker. He presented to outlying community hospital with three-day history of dyspnea, back pain radiating to neck with diagnoses of NSTEMI, cardiogenic shock second to acute decompensated heart failure and AKI.