Secondary neoplastic involvement of the heart is common but usually asymptomatic. Malignancy rarely presents as acute pericarditis, cardiac tamponade, and myocardial infarction in the same patient. We report a patient with unsuspected metastatic pancreatic adenocarcinoma who presented with acute pericarditis and cardiac tamponade and subsequently developed a myocardial infarction due to coronary artery occlusion secondary to a metastatic deposit around the left anterior descending artery.