Although coronary heart disease (CHD) primarily occurs in patients over the age of 40, younger men and women can be involved. Majority of studies have used an age cut-off of 40 to 45 years to define "young" patients with CHD or acute myocardial infarction (MI). The same age definition will be used in this article. The prevalence of CHD in younger subjects is difficult to establish accurately since it is frequently a silent process. Acute Myocardial infarction in young females is an uncommon occurrence and even if we see cases, very few of them have shown to have greater than one vessel coronary artery disease. When a young female present with acute MI, the presentation is very vague and can be easily missed so, presence or absence of cardiovascular risk factors regardless of age should be the key factor in making a decision to perform coronary angiography and full cardiovascular workup. We report here 31 year old female with multiple cardiovascular risk factors who presented with an atypical chest pain with normal EKG in emergency room and was ultimately diagnosed with triple vessel coronary artery disease. In this paper we will describe a case to describe the importance of early coronary angiography and cardiovascular workup in presence of significant risk factors despite atypical presentation and younger age of patient.