Introduction : This case report seeks to highlight an atypical presentation of a young male with multivessel CAD after presenting with Acute Pericarditis. Emphasize the importance to recognize risk factors to develop CAD in young adults. Reviewed screening strategies for the detection of CAD in asymptomatic young individuals. Case Description: 34 yo male with a PMH of HTN, current smoker (> 12 pack-year), and Obesity presented with retrosternal chest pain for 2 days, alleviated by sitting forward. On physical examination friction rub heard. Initial workup showed troponin 1.74 and EKG: Sinus Tachycardia. Patient was admitted and treated for Acute Pericarditis. Colchicine and Naproxen started and symptoms resolved. Serology Coxsackie B positive. Troponin continued trending up to 15.0. No new EKG changes, neither active chest pain. NSTEMI treatment started. Patient was taken to cardiac catheterization and found to have triple vessel disease. CTS was consulted and CABGx3 procedure performed. Discussion: Case report highlights an atypical presentation of a young adult with severe CAD. This patient presented with acute pericarditis. Even though Troponin increase is roughly related to the extent from pericardial to myocardial inflammatory response, this case exposed an underlying triple vessel CAD. Many studies have demonstrated that young CAD contributes to 2% to 6% of all acute coronary events. This patient has strong risk factors like HTN, smoking and obesity to develop CAD. Screening asymptomatic young adults is controversial. Coronary artery calcification quantification seems to be a reliable risk predictor tool that could be used to screen this population.