A 59 years female, known case of Non-Insulin Dependent Diabetes Mellitus (NIDDM) for 10 years with a strong family  history  of coronary  artery disease (both  parents & siblings have CAD),  presente with severe  agonizing precordial chest discomfort, radiating to left shoulder associated with profuse sweating for last 3 hours.In emergency room,patient was restless,pulse=100/min.,BP=170/100mm Hg,O2 saturation 98%.There was no sign of cardiac failure.ECG recorded in emergency room revealed ST elevation of 5to 6 mm in lead I,aVL, 4 mm ST elevation in lead II, V2 and shuttle ST segment sagging in lead II, 4 mm ST segment depression in lead III & Avf (South African Flag Sign) (Fig 1).

Keywords: Case report South African Flag Sign, Acute occlusion of diagonal branch, pecific EKG pattern, Coronary Artery Disease, ST elevation in Lead I, avL&V2, ST depression in inferior leads.