Myocardial infarction (MI) more commonly known as a “heart attack” is a relatively common occurrence with a wide array of potential etiologies. Many if not most MIs result in typical symptoms of angina (chest pain) or anginal equivalents which often is the primary driver to the diagnosis. In patients who are unable to communicate symptoms, such as those who are intubated and sedated, this can be challenging. In this case we discuss a patient who was intubated and sedated who develops a myocardial infarction in the setting of a pneumoperitoneum.