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Mitral valve prolapse (MVP), described for the first time by JB Barlow in 1966 as the displacement of abnormally thickened mitral valve leaflets into the left atrium during systole, is the most frequently valvulopathy in clinical practice. Usually asymptomatic and predominantly in woman, MVP could associate atypical chest pain. Electrocardiogram (ECG) is normal in majority of cases but sometimes ST segment depression and negative T waves in inferior leads could occur. Previous ECG and the absence of coronary risk factors are the key of differential diagnosis for acute coronary syndrome. We present the case of a 48 year-old female known with MVP, hospitalized for persistent atypical anterior chest pain, ST-T segment depression and T-wave inversion in inferior and lateral leads suggesting an acute coronary syndrome. Patient's symptoms and ECG changes have disappeared 12 hours after admission under specific treatment. MDCT coronary angiography done after 1 month showed normal coronary arteries and the treatment was stopped. This case confirms that MVP diagnosis, a rare cause of ST segment depression, must be differentiated from an acute coronary syndrome. [ABSTRACT FROM AUTHOR]