Acute seizures represent 1% of all visits to emergency departments in the United States. While many acute seizures are correctly attributable to underlying epilepsy, approximately one-third of acute seizures are provoked by underlying and potentially life-threatening acute conditions. Many clinical syndromes associated with seizure-like activity are well-established and readily identified in the acute setting. Cardiac dysrhythmias are known causes of acute seizure-like activity and, if transient and not captured by electrocardiogram tracings during acute episodes, may be incorrectly diagnosed as epileptic seizures. We report a case of acute ST-segment elevation myocardial infarction presenting with acute symptomatic seizure due to occult transient cardiac dysrhythmia.