Exogenous testosterone abuse and myocardial infarction in a young bodybuilder

A 25-year-old man presented with new-onset substernal chest pain. The pain was dull, and radiated to his neck and left jaw. ECG showed diffuse ST elevation without reciprocal changes (Figure 1A). Troponin level was 4.76 ng/mL (normal: 0 – 0.09). He was started on colchicine and aspirin for the treatment of suspected pericarditis. Repeat troponin level in six hours was greater than 50 ng/mL. Contrast echocardiography showed left ventricular (LV) ejection fraction of 45% and akinesis of all apical segments without left ventricular thrombus.