We describe the case of a patient who developed an acute myocardial infarction (MI) with ST segment elevations simultaneously in anterior and inferior leads during exercise testing. The patient became hypotensive and unconscious, and an anterior MI was suspected. After systemic thrombolytic therapy, blood pressure improved, and the electrocardiogram (ECG) showed no further ST deviations. Thirty minutes later, chest pain and ST segment elevations recurred. A second thrombolytic bolus was administered, after which the electrocardiographic signs of MI promptly resolved. Coronary angiography revealed two severe complex stenotic lesions in the right coronary artery and one in the left anterior descending coronary artery. Percutaneous coronary intervention and stent implantation were performed in both affected coronary vessels. Interpretation of the ECG indicated clear evidence of an acute inferior wall MI. In this particular case, ST segment elevations in V1–V4 were due to the right ventricular involvement.