Systemic lupus erythematosus (SLE) is a vasculitic disorder with potential for multisystem organ dysfunction. Among the organ systems affected is the cardiovascular system. Patients with SLE are prone to premature atherosclerosis; this premature atherosclerosis places the patient at risk for myocardial infarction with onset at a relatively young age. We present 4 patients with SLE who experienced myocardial infarction; these patients also experienced diagnostic and treatment delays because of their relatively young age at presentation. Relevant pathophysiology and diagnostic strategies are discussed.