Essential thrombocytosis (ET) is an uncommon myeloproliferative disorder. This disease may have both occlusive thrombotic as well as hemorrhagic complications throughout the body. We report a young man with severe thrombocytosis, clinically thought to be unknown ET, who had massive myocardial infarction requiring bypass surgery, ventricular assist device and ultimately cardiac transplantation. ET may have devastating cardiovascular consequences and should be considered as a rare cause of myocardial infarction in the young.