Improvements in CT technology, specifically with respect to the development of multi-row detector CT, have increased the ability to detect acute myocardial ischaemia. This case report details the finding of decreased myocardial enhancement on CT in a patient who complained of acute chest symptomalogy and was diagnosed with acute myocardial infarction, which was subsequently confirmed by cardiac catheterization. Given the variability of the clinical presentation of acute myocardial infarction, greater attention should be paid by radiologists to myocardial enhancement in patients with significant coronary risk factors, as evidence of acute myocardial infarct or ischaemia may be detected.