Usually, therapeutic decisions in patients with acute chest pain are based on the 12-lead electrocardiogram because ST-segment elevation is highly specific for myocardial infarction, but the presence of pacing-induced repolarization changes makes electrocardiogram interpretation difficult. The authors report an acute myocardial infarction patient with ventricular paced rhythm successfully treated by thrombolytic therapy. The aim of this work aims to highlight the difficulty with electrocardiographic diagnosis and timely treatment of myocardial infarction in the presence of ventricular pacing.