Cardiac metastases are rare, but more frequent than primary tumors of the heart, and present usually with pericardial effusion. We present the case of a 67 year old male with acute coronary syndrome as first manifestation of a heart metastasis from renal cell carcinoma. The patient was investigated with echocardiography, coronarography, cardiac magnetic resonance and computed tomography, revealing a contralateral recurrence of renal cell carcinoma with a myocardial metastasis which exerted external compression on the left anterior descending coronary artery (LAD), mimicking myocardial bridging. This case underlines the importance of complementary examination in the differential diagnosis of oncologic patients.