That acute abdomen has a myriad of causes is a well-known fact. The unusual presentation of cardiac illnesses as acute abdomen often puzzles the physicians. Here we report a case of an 18 year-old female who presented at the emergency room with complaints of colicky pain in both flanks of the abdomen, burning epigastrium and decreased urine output for 24 hours. Abdominal examination and imaging did not yield any working diagnosis. The cardiac workup showed features of atrial fibrillation. Surgeons must be aware of the fact that pain abdomen may be the first presentation of cardiac diseases like myocardial infarction, atrial fibrillation.