A 74-year-old man with a history of heart transplant presented with altered mental status. On admission, his blood pressure was 96/63 mm Hg and his heart rate was 72/min. On examination, he was in no immediate distress and had clear lung fields. There were no gallops on examination, and he had no focal neurological deficits. A median sternotomy scar and a left upper chest medical device were noted. The patient was unable to provide any history. His relatives confirmed prior heart transplant.