We present the case of a 78-year-old woman who presented with acute anterior myocardial infraction. An intraoperative transesophageal echocardiogram revealed an akinetic apex with hyperkinesis of the basal segments causing systolic anterior motion of the mitral valve. The patient was immediately placed on cardiopulmonary bypass. Her postoperative course was uneventful. We present transesophageal and transthoracic echocardiographic videos showing this unique complication and describing the challenge of managing a patient who required opposing therapies.