BACKGROUND Acute myocardial infarction during pregnancy is rare, but is associated with a high mortality rate, particularly during labor and delivery. This article concerns a 23-year-old woman with a history of insulin-treated gestational diabetes and hypothyroidism treated with levothyroxine presenting at 32 weeks of pregnancy with acute chest pain and coronary artery occlusion requiring angioplasty followed by cesarean delivery. The aim of this report is to outline the diagnostic difficulties of acute coronary syndromes during pregnancy and to present their treatment. CASE REPORT A 23-year-old female patient at 32 weeks' gestation treated for insulin-dependent diabetes mellitus and hypothyroidism was admitted to the hospital due to acute chest pain. The ECG showed ST-segment elevation in leads I, aVL, and V4-V6 and elevated troponin T. Based on this, the patient was diagnosed with myocardial infarction and given low-molecular heparin, followed by primary coronary angioplasty with revascularization. After the procedure, she received dual antiplatelet therapy (DAPT) with acetylsalicylic acid and clopidogrel. The pregnancy was terminated at 38 weeks by cesarean section, delivering a healthy baby. CONCLUSIONS This report shows the importance of rapid and accurate diagnosis and management of acute myocardial infarction during pregnancy, and delivery by cesarean section, to ensure survival of the mother and the child.