Gastric volvulus is an uncommon and potentially life-threatening condition in which the stomach rotates upon itself resulting in ischemia to the gastric mucosa, potentially resulting in shock and death if untreated. Symptoms vary depending upon chronicity, duration of ischemia, and degree of rotation. A 61-year-old female presented with complaints of substernal and left-sided chest pain, similar to a previous myocardial infarction. Her pain was exacerbated by eating and associated with retching and emesis. Aspirin and sublingual nitroglycerin provided no relief. She was recently hospitalized in another state for similar complaints and underwent a stress test and subsequent cardiac catheterization that were unremarkable for acute cardiac disease, and showed only mild to moderate stenosis of the left anterior descending artery and a patent stent. Her medical history consisted of coronary artery disease, chronic kidney disease, and a hiatal hernia with reflux disease. Surgical history consisted of angioplasty and hysterectomy. Family history was notable for breast cancer. She was a life-long nonsmoker and seldom consumed alcohol. Her vital signs and physical exam were unremarkable except for vague epigastric tenderness. Her EKG and cardiac biomarkers were normal. A chest xray showed a large hiatal hernia without acute cardiopulmonary process. Her complete blood count and comprehensive metabolic profile were normal except for a creatinine of 1.38mg/dL which was near her baseline. A D-dimer and lipase were both unremarkable. After a night of uneventful cardiac monitoring, IV hydration and proton pump inhibitor therapy, she underwent an esophagogastroduodenoscopy that showed a large paraesophageal hernia and gastric volvulus. An upper gastrointestinal series with small bowel follow through showed an organoaxially positioned stomach without evidence of volvulus, confirming the intermittent nature of the volvulus. General surgery performed a reduction of the hiatal hernia followed by a Nissen fundoplication and noted 80% of the stomach herniated through the defect. Post-operatively, the patient improved rapidly and tolerated serial advancement of diet without further pain, nausea, or emesis. This case illustrates an intermittent gastric volvulus that was elusive to diagnose. Its ability to mimic a cardiac chest pain may complicate the diagnostic process and lead to unnecessary and potentially invasive evaluation if suspicion for gastric volvulus is not maintained.Figure 1Figure 2Figure 3