We report the case of a 22-year-old male survivor of myocardial infarction as the first symptom of systemic lupus erythematosus and antiphospholipid syndrome. The diagnosis of myocardial infarction was based on typical ECG and enzymatic chanches and subsequently confirmed by technetium 99 scintigraphy. However, coronary arteries appeared to be normal at angiography. The authors conclude that myocardial infarction in SLE could be caused by a combination of cardiac microvascular thrombosis and inflammation accompanying the antiphospholipid syndrome.