A 23-year-old man with previous history of alcohol abuse and use of marijuana and cocaine was in a nightclub, drinking alcohol and smoking marijuana, when he developed severe anterior chest pain, dyspnea, nausea and vomiting. He is brought by ambulance to the emergency department where he collapsed on arrival:

• Ventricular fibrillation

CPR was immediately carried our and the patient was defibrillated and intubated:

• Sinus rhythm
• Marked ST elevation, acute anterolateral infarction

The patient was taken to the Cardiac Catheterization Laboratory for emergency investigation and treatment. The following ECG is recorded immediately before transfer:

• Sinus tachycardia
• Left axis deviation
• Left anterior fascicular block
• Right bundle branch block
• (Bifascicular Block)
• Acute anterolateral infarction

The patient underwent emergency coronary angiography that demonstrated total occlusion of the proximal anterior descending branch. The lesion was successfully crossed and dilated. A stent was placed and there was no residual stenosis. The patient remained hemodynamically stable and required no inotropic or vasopressor drugs.