Stress cardiomyopathy presents very similarly to acute coronary syndrome and its multiple inciting stressors make the decision to obtain angiography challenging. Here we describe two cases of stress cardiomyopathy presenting with a rare variant ECG pattern of a starfish. The first case presented after an emotional stressor with a history of diabetes and hypothyroidism. The second case presented after a traumatic brain injury with presumed underlying primary idiopathic hypercalciuria. We discuss the implications of calcium metabolic abnormalities on stress cardiomyopathy in classic presentations and morphologic variants.