A 50-year-old man presented with chest pain described as sharp and substernal that was improved by sitting forward. He had a history of a heart attack 2 weeks prior and also had a mild fever. His ECG showed signs of a previous heart attack and chest X-ray showed signs of heart failure. The provisional diagnosis was recurrent chest pain likely due to heart failure or recurrent ischemia. Management included oxygen, aspirin, morphine, nitrates, diuretics, and cardiology referral.