Typical episodes of acute myocardial infarction (AMI) easily attract attention, however, some acute myocardial infarction is not the onset of retrosternal or precordial pain, but the main manifestation of acute abdominal pain, such symptoms are not easy to attract people’s attention, do not go to the doctor, or to non-cardiovascular medicine, resulting in delayed condition and dangerous, so it should cause patients and healthcare professionals to be alert. Mr. Zhang, a 70-year-old retired cadre, suddenly felt pain in his upper abdomen for one hour after a full meal and went to the hospital. Two hours later, Mr. Zhang developed palpitations, chest tightness with vomiting and cold sweats, and an emergency electrocardiogram indicated acute myocardial infarction. In addition, we have also encountered patients who were diagnosed with acute appendicitis due to pressure and rebound pain in the right lower abdomen, however, they showed symptoms such as dyspnea, cough, cyanosis and arrhythmia that could not be explained by this disease during the treatment, and as a result, the consultation for ECG confirmed acute heart infarction. Therefore, if middle-aged and elderly people have acute abdominal pain with other symptoms that are difficult to be explained by gastrointestinal diseases, they need to do ECG examination in time to prevent misdiagnosis, and people should not delay the best time for treatment because they are afraid to go to the hospital to see a doctor. Acute myocardial infarction is one of the more common critical type of coronary heart disease. According to the current level of rescue at home and abroad, the survival rate is much higher than in the past, but the prerequisite is early and correct diagnosis, if diagnosed within 6 hours after the onset, the chance of successful rescue is much higher. Clinically, about 2.7% to 17.6% of patients with acute myocardial infarction can present with sudden abdominal pain with nausea and vomiting, and such conditions are called atypical acute myocardial infarction. Therefore, “caution makes all the difference”, please do not forget to check cardiovascular disease in acute abdominal pain.