The scenario is not new—elderly patient, myocardial infarction, cardiac shock, new systolic murmur, rising enzymes—but the cause may not be common. Mechanical problems are probably at the root of the complications, but transthoracic echocardiography is not pinpointing the cause. Where to turn next? This patient's diagnosis of partial papillary muscle rupture is facilitated by multiplane transesophageal echocardiography.