44 Year old Male Presented to Er with Breathing difficulty, Sweating, altered mental status. Patient was tachypneoic and Hypotensive and drowsy, Responding to painful stimuli. Patient blood gas analysis revealed severe metabolic and lactic acidosis and patient was intubated and resuscitated aggresively in Er. Ecg was obtained which showed global St/ T changes and hence cath lab was activated and Echo was done in Er which didn’t reveal any wall motion abnormalities. Lab reports revealed severe anemia and patient was transfused with prbcs and patient condition improved and Ecg changes were also reverted.