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Chest pain is a common emergency department complaint, but a small percentage of patients with this complaint experience acute coronary syndrome, with a still smaller percentage having ST-elevation myocardial infarction (STEMI) with hemodynamic instability and arrhythmia.  A 56-year-old female presented to our emergency department with acute chest pain. She was diagnosed with inferior wall STEMI, had complete heart block and hemodynamic instability, and underwent emergent reperfusion via coronary catheterization.  This combination of signs and symptoms required thoughtful assessment and treatment along with diagnostic accuracy and proper disposition. This case offers a review of this uncommon presentation, including pathophysiology and treatment.

A 56-Year-Old Female With Acute ST-Segment Elevation Myocardial Infarction, Complete Heart Block, and Hemodynamic Instability