A 37-year-old man is admitted to the hospital for retrosternal chest pain lasting more than 30 min and nonspecific ECG findings. Serial assays of cardiac biomarkers reveal an isolated elevation of creatine kinase-MB and negative troponin levels. A coronary angiography shows normal vessels in the presence of a Thrombolysis in Myocardial Infarction (TIMI) 2 flow. How should this patient be managed and treated? Is it a myocardial infarction? We here provide a review of the relevant literature and suggest that such a strange condition, for which several explanations are possible, involves a worse prognosis than for normal creatine kinase-MB and troponins.