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<p>Abstract</p> <p>Introduction</p> <p>Myocardial infarction and coronary artery disease in people under 40 years of age are relatively uncommon. To establish a diagnosis, physicians need a high degree of clinical suspicion.</p> <p>Case presentation</p> <p>We report the case of a 33-year-old Caucasian man presenting with classical signs and symptoms of acute pulmonary embolism. Subsequent investigations interestingly revealed right ventricular mural thrombus with no obvious underlying pathology triggering it. On cardiac magnetic resonance imaging, he was found to have a right ventricular infarct with secondary thrombus formation. Coronary angiography confirmed ostial occlusion of the right coronary artery.</p> <p>Conclusion</p> <p>This is an unusual case of premature myocardial infarction presenting primarily with secondary complications.</p>