This is a 70-year-old male patient, who was admitted to the emergency department of the Hospital Pablo Tobón Uribe, with symptoms of approximately one hour of evolution consisting of chest tightness, general malaise, asthenia and diaphoresis; which began after having ingested 100 mg of sildenafil, denies ingestion of another sexual stimulant or cocaine and without sexual intercourse after its consumption. The patient's only clinical history was arterial hypertension, pharmacologically controlled, and he denies previous episodes of angina or nitrate consumption. The clinical examination and vital signs were normal; however, after the initial assessment he presented cardiorespiratory arrest secondary to ventricular fibrillation with response to a single defibrillation of 200 joules.
The initial electrocardiogram showed ST-segment elevation in the inferior (II, III and aVF) and anterior (V2-V4) leads with reciprocal changes in aVL, with no electrocardiographic extension to the right ventricle.

Cardiac enzymes on admission revealed a creatine kinase (CK) of 170 and a creatine phosphokinase-MB fraction (CK-MB) of 6. Electrolytes, coagulation tests and blood cell counts were normal.
Initial management was with aspirin 100 mg, lovastatin 40 mg daily, metoprolol 25 mg every 12 hours, enoxaparin 60 mg every 12 hours, oxygen at 3 lt/min and streptokinase 1'500,000 units administered over 30 minutes. No changes secondary to reperfusion were demonstrated. The patient was transferred to the intensive care unit, where episodes of complete A-V block with spontaneous resolution were documented during the first hours of evolution.
The EKG taken at 24 hours of evolution revealed QS in the inferior face and a late progression of the R wave in the anterior face. Enzyme monitoring showed increased CK and MB fraction at 6 hours (4476 and 165) and 12 hours (3839 and 136).
The next day coronary angiography showed diffuse disease of the anterior descending artery with 50% lesion in the distal third and 40% lesion in the proximal third of the first diagonal branch. The circumflex artery had a 50% lesion in the middle third and diffuse disease of its obtuse marginal branches. The right coronary artery had an irregular lesion suggestive of a partially resolved thrombus producing a maximum stenosis of 50%; distally the posterior descending artery had two 40% lesions.

The patient evolved satisfactorily without further complications and pain-free. He was discharged for outpatient follow-up.