Chest pain with focal ST elevation in the presence of elevated cardiac markers is usually believed to be secondary to acute myocardial infarction. Moreover, widespread ST elevation is believed to be a hallmark sign of acute pericarditis. However, we present the case of a young male who presented with chest pain, elevated troponins, and focal ST elevations; however, left heart catheterization showed patent coronary arteries. The patient was treated for acute myo-pericarditis with ibuprofen and colchicine. This case illustrates the fact that focal ST elevation in a patient with chest pain and elevated markers of cardiac injury is not always secondary to an acute myocardial infarction.