Ischemic heart disease in the young woman is rare, and even more so in the pregnant woman, but it is reasonable to expect an increase with the increasing average age of children bearing. The etiology of acute coronary syndrome during pregnancy can be divided into two main groups: atherosclerotic mechanisms, more common in older mothers, and non-atherosclerotic mechanisms like dissection, coronary spasm and thrombosis. Management of these patients remains difficult; the treatment should follow the usual principles of care for acute coronary syndrome but taking in account that many standard treatments, such the angiotensin converting enzyme inhibitors, are contraindicated. There is also little experience with many of the newer treatments such as clopidogrel and IIb/IIIa glycoprotein inhibitors or percutaneous coronary intervention. We describe a case of a 38-week pregnant woman who suffered an acute myocardial infarction without ST segment elevation and review the literature.