We present the case of a 34-year-old woman with cocaine-associated chest pain and hypersomnulence, who, because of her inability to report chest pain, and her comfortable appearance, was admitted to telemetry for a diagnosis of low-probability rule-out myocardial infarction. Her chest pain was incompletely relieved, and she subsequently was transferred to the intensive care unit and ruled in for myocardial infarction. We discuss the clinical syndrome of cocaine-related depressed level of consciousness, and its relationship to evaluation of cocaine-related chest pain.