What lies behind the extensive ST-segment changes in cardiac arrest?

Interpretation of electrocardiographic changes after cardiac arrest is critical. If the electrocardiogram is consistent with ST-segment elevation myocardial infarction, primary coronary angiography is indicated. However, the presence of ST-segment depression in eight or more surface leads, together with ST-segment elevation in the aVR and/or V1, could be a sign of multivessel ischaemia or left main coronary artery disease if haemodynamic instability is present. However, acute neurological disorders may mimic electrocardiographic changes of acute coronary syndromes. Here we report a young man with cardiac arrest, extensive ST-segment changes in the electrocardiogram and normal coronary arteries.