Shock is a life-threatening condition of circulatory failure that most commonly presents with hypotension. “Undifferentiated shock” refers to the situation where the shock is recognized, but the cause is unclear. Patients often have more than one form of shock (multifactorial shock). We describe a patient with the acute coronary syndrome who presented with heart failure-like symptoms caused by a large infected hepatic cyst obstruction of the right atrial and ventricular inflow tract.