Impending Danger: Evolution of Hyperacute T Waves to Cardiac Arrest

Acute coronary syndrome (ACS) is a leading cause of cardiac arrest, and although historically seen in an older patient population, recent decades have shown an increase in prevalence among younger individuals. Emergency reperfusion or percutaneous coronary intervention (PCI) has been the standard of care for patients with electrocardiograms (ECGs) that meet the criteria for ST-elevation myocardial infarction (STEMI). Several ECG STEMI equivalents have also been introduced and implemented in emergency cardiac care, including the presence of hyperacute T waves. This case describes a 45-year-old previously healthy male with a history of anabolic steroid and pre-workout supplementation use who presented with chest pain. Initial ECG showed hyperacute T waves, and the patient's clinical status rapidly deteriorated, leading to ventricular fibrillation and cardiac arrest. Post-return of spontaneous circulation, the patient's ECG met clear STEMI criteria. Emergency physicians must be familiar with standard STEMI criteria, as well as STEMI equivalents, in order to appropriately involve interventional cardiology consultants early for consideration of coronary reperfusion. Emergency physicians should also maintain a higher clinical suspicion for ACS in individuals with anabolic steroid or unregulated pre-workout supplements.