Pectus excavatum (PE) is not always benign. In this case report, a 19 year old with severe PE was found to have obstruction of the right ventricular outflow tract (RVOT). The right ventricle is a chamber of the heart that sends blood to the lungs. Clinicians had a suscpicion of this when the patient had increased heart rate when switching from laying to sitting, along with a drop in blood pressure. An EKG showed right axis deviation, a common finding for individuals with PE. In this unique case report, the authors highlight that the patient showed clinical signs associated with cardiac abnormalities when sitting, but not when supine. That is, it is important for clinicians to assess PE patients in several positions. This may partly explain why many patients with PE feel sypmtomatic but are found to be physiologically normal upon evaluation.