Introduction: While rare in pregnancy, acute coronary syndrome (ACS) does happen. It has been found to be more common in individuals with risk factors. A case of chest pain in a previously healthy female in her third trimester demonstrates the importance of keeping ACS high on the differential list.

Case Report: A 26-year-old pregnant female gravida five, para three at 37 weeks gestation with a past medical history of diet-controlled gestational diabetes, obesity, and family history of myocardial infarction (MI) presented to an outside hospital for chest pain and was transferred to the closest ST-elevation myocardial infarction (STEMI) receiving emergency department (ED) after she was found to have an electrocardiogram (ECG) concerning for acute STEMI. On arrival to the ED, STEMI protocol was activated based on ST-segment elevations on inferior and antero-lateral leads on the ECG. Bedside assessment of the fetus by obstetrics showed a viable intrauterine pregnancy, and the patient was taken to the cardiac catheterization lab. She was found to have a 100% thrombotic occlusion in the ostium of the right posterolateral artery, and percutaneous coronary intervention was performed. The patient was discharged with plans for cesarean section at 39 weeks.

Conclusion: This case highlights the need for early STEMI activation and consultation with obstetrics when a pregnant patient presents with an ECG suggestive of STEMI. It also emphasizes the importance of maintaining a high level of suspicion for STEMI in pregnant patients presenting with chest pain. Although rare—0.6 in 10,000 pregnancies—mortality rates range from 5.1-37% throughout pregnancy and postpartum. It is important to remember that pregnancy does not preclude a patient from undergoing standard treatment of acute MI.