Cardiogenic shock in the setting of myocardial infarction continues to represent a high proportion of immediate mortality in this patient population, despite ongoing advances in thrombolytics, PCI, and medical management of AMI. We present a case of peri-MI cardiogenic shock necessitating deployment of a percutaneous ventricular assist device (pVAD). TEE guidance played a crucial role in optimal positioning of the venous cannula in the left atrium.