We describe the case of a 73 year-old woman presenting with symptoms compatible with myocardial ischemia/injury and left bundle branch block in whom the electrocardiogram fulfilled Sgarbossa criteria for ST-elevation myocardial infarction. Coronary angiography revealed an acute coronary occlusion and she was successfully revascularized. The value and limitations of the Sgarbossa criteria are discussed and the importance of considering ST-elevation myocardial infarction in patients presenting with chest discomfort and new left bundle branch block is emphasized.