We report a case of a 50-year-old male who presented to emergency medical services (EMS) with acute chest pain, pallor, and diaphoresis. A prehospital diagnosis of ST-elevation myocardial infarction (STEMI) was made following electrocardiogram (ECG) lead reversal by the paramedics secondary to a reported history of situs inversus totalis, a congenital condition with complete reversal or mirroring of the thoraco-abdominal visceral organs. Paramedics initiated a STEMI alert to the emergency department (ED) from the scene, and the patient underwent emergent cardiac catheterization following transport to the hospital. A stent was placed in the left coronary artery, and the patient's symptoms resolved. He was discharged on hospital day three with no complications. This case highlights the need for pre-hospital clinicians to recognize and adapt when encountering rare conditions like dextrocardia and situs inversus.