This case involves a 70-year-old woman with a history of heart bypass graft surgery and several coronary stent procedures who developed a sudden onset of chest pain. She presented to the emergency room pale, sweating heavily, and had high blood pressure. An IV was started along with supplemental oxygen. The patient’s blood pressure began to drop shortly after arriving and 4 liters of IV fluid were ordered. A portable chest x-ray revealed a widened mediastinum. CT scans of the chest, abdomen, and pelvis were also performed. Following the imaging, Radiology erroneously reported that the patient’s aorta was of normal caliber without dissection or an aneurysm. It was later discovered the imaging taken actually revealed a slow leaking aneurysm and large right upper lobe mass. The patient was then discharged to the medical/surgical floor with a diagnosis of mediastinal mass and chest pain. Under the care of the hospitalist and PA-C, the patient was assessed and noted to have coronary artery disease with possible congestive failure. Furthermore, it was noted the patient may have not tolerated the 4 liters of IV fluid. The patient was given an anticoagulant. The following morning, radiologist correctly read the chest CT angiogram reporting that there was an aneurysm extending off the superior aspect of the ascending aorta at the beginning of the arch. The patient then required a transfer to another facility. Even though there was a cardiac unit within 30 minutes of the hospital, the patient was transferred to another facility approximately 2 hours away. At the other facility, the patient was thought to have an anastomotic rupture at the site of an old vein graft. In the catheterization lab, studies revealed three-vessel coronary disease and an occluded LAD, 60 to 70% mid-right coronary lesions and diffuse narrowing of the left main circumflex artery. The patient was taken to surgery immediately. A transesophageal echocardiogram probe was introduced and revealed that the left ventricle of the heart was empty. The patient eventually went into ventricular fibrillation and could not be revived.