Typically, myocardial bridging (MB) is considered a relatively benign condition; however, serious complications such as angina pectoris, myocardial infarction (MI), and sudden cardiac death may occur. The diagnosis and appropriate treatment of this pathology are important. We report a case of acute anterior wall ST-elevation MI occurring as a complication of MB involving the mid segment of the left anterior descending artery in a young, otherwise healthy woman who underwent a primary stenting procedure. Pathophysiologic mechanisms underlying the process leading from MB to acute MI vary, and so should the therapy for those patients. Coronary angiography, intravascular ultrasound, and, potentially, optical coherence tomography should be used to assist in establishing an accurate diagnosis in these complex patients and should guide the therapeutic decision in acute settings.