In the presence or absence of atherosclerosis, young adults can experience a myocardial infarction. Notably, young patients are at increased risk to be misdiagnosed since they do not frequently have traditional coronary risk factors. We describe a 19-year-old woman with chest pain and ST elevation on electrocardiogram who was initially suspected to have pericarditis. History revealed hormonal contraception and marked elevation of troponins, which later led to the diagnosis of myocardial infarction. Angiography displayed an occlusion of the right coronary artery that resolved with anticoagulation treatment. She recovered uneventfully. Differential diagnoses of ST elevation and various causes of acute coronary syndromes among young patients are reviewed.