Ischaemic heart disease and coronary artery disease is the commonest cause of death globally in multiple populations and multiple age groups. This presentation focuses on patients without the traditional risk factors for coronary artery disease and acute coronary syndromes. It discusses epidemiology and talks about the co-morbid conditions and risk factors for IHD. The combination of reproductive years increasing over time and earlier onset of CAD is dicussed. Dr Pandie provides an approach to ACS in pregnancy and the considerations required for therapies. He looks at SCAD in pregnancy; embolic ACS and Takotsubo syndrome. The presentation also covers information on aetiology and pathophysiologies such as epicardial spasm. Dr Pandie concludes by providing an approach to management in the context of pregnancy and information on outcomes and complications.