Acute myocardial infarction has an incidence in pregnancy of 1 in 10,000, with a mortality ranging from 37-50%. Mortality is increased if the infarct occurs in the third trimester, if the patient is under age 35 yr, if she delivers within 2 wk of her infarct, and if she has a cesarean section. We present a case involving all four prognostically poor factors. The patient was treated emergently in the cardiac catheterization laboratory with intracoronary thrombolysis and primary PTCA of an occluded LAD. She had an uncomplicated recovery and subsequent delivery of a healthy child with no peripartum cardiac complications. A review of myocardial infarction in pregnancy follows.