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The South African Flag Sign (SAFS) is a rare electrocardiographic pattern observed in cases of acute occlusion of the right coronary artery (RCA) or ostial RCA. It is characterised by ST elevation in leads I, aVL and V2 and ST depression in inferior leads [1]. The following report details a series of five cases, each of which illustrates an atypical ECG pattern and its respective implications. The patients in question presented with symptoms of angina and an electrocardiogram (ECG) that revealed the presence of the ST-elevation acute coronary syndrome (ACS) sign.<br>It was evident that all cases exhibited the hallmark Y-shaped STE pattern, though clinical outcomes were found to vary.<br>The present series of cases serves to emphasize the significance of SAFS as a warning sign.<br>The South African flag sign has been identified as a critical electrocardiographic marker of D1 artery occlusion. Its recognition enables clinicians to rapidly diagnose high lateral myocardial infarctions that might otherwise be missed due to the characteristically non-contiguous distribution of ST-segment elevations. The timely identification of this pattern is of crucial importance, as it results in immediate referral for emergency reperfusion therapy – a decisive intervention that has the capacity to significantly influence patient outcomes and long-term prognosis.