coronary artery disease ( cad ) is a leading cause of death throughout the world ( 1 ) . over the four decades , a significant decrease has been observed in age - related mortality caused by cardiovascular disease ( 2 ) . people in developing countries suffer from cad at a relatively younger age and about half of mi occurs under the age of fifty years ( 3 ) . inadequate perfusion due to atherosclerosis is a common cause of coronary artery stenosis ( 2 ) . ischemic chest pain in young adults is usually related to hypertrophic cardiomyopathy , congenital coronary abnormalities , tachyarrhythmia , myocarditis , aortic stenosis , dissection , or coarctation ( 4 ) . age , male sex , hypertension , smoking , diabetes , dyslipidemia , and obesity are considered as established risk factors for cardiovascular diseases and atherosclerosis ( 5 , 6 ) . these agents are used currently to increase protein synthesis and muscle growth in athletes ( 7 ) . since the use of anabolic steroids has been increased , different types of them produced ( 8) . mostly people start using the anabolic steroids in school time ( 9 ) . according to the statistics , 0.9% of men and 0.1% of women use these agents during their lifetime ( 10 ) . in this review , a 23-year - old male body builder was reported , with myocardial infarction ( mi ) following use of trenbolone acetate . a 23-year - old man was referred to the emergency room with epigastric pain since the last day . he was an athlete and his previous medical history was negative . due to the absence of risk factors for heart disease , symptomatic treatment was done for him and his pain decreased so that the patient was discharged from the emergency department . but , after 3 days the patient presented again to ed with the same complaint . the pain radiated to the left arm accompanied by nausea . after obtaining the accurate history of the patient , it was elucidated that he has been using the trenbolone acetate in his daily diet since last year . the patient 's vital signs were included blood pressure 130/80 mmhg , heart rate 105 per minute , respiratory rate 25 per minute , o2 sat 98% ( on room air ) . in physical examination , the patient had sweated and the lungs were clear on auscultation . s1 and s2 sounds of heart were normal and s3 sound was heard , too . the abdomen was soft but not tender . according to the examination and history of the patient , electrocardiogram ( ecg ) cardiac markers ( creatine kinase mb and troponin i ) were elevated . due to the unavailability of a heart center for doing an emergency percutaneous coronary intervention ( pci ) , he was admitted to the cardiology ward and after a week , angiography was done for him . the patient s angiography showed the stenosis of the left anterior descending ( lad ) and left circumflex ( lcx ) arteries ( figure 2 ) . anabolic steroids can cause many problems such as cardiovascular which includes hypertension , left ventricular hypertrophy , impaired diastolic filling , polycythemia and thrombosis ( 7 ) . the effects of steroids on lipid profile include decreasing in high density lipoprotein ( hdl ) , increasing in low density lipoprotein ( ldl ) and total cholesterol . these changes are leaded to increase the risk of atherosclerosis in the coronary arteries ( 11 - 13 ) . indirectly , increasing the concentrations of ldl due to the abuse of anabolic steroids may lead to an increase in sensitivity of platelets ( 14 ) . long - term effects of these agents can be observed in the cardiovascular system , mental health , and increasing the risk of neoplasm ( 15 ) . a ) upper arrow : left anterior descending artery ( lad ) , lower arrow : left circumflex artery ( lcx ) ; b ) after percutaneous coronary intervention ( pci ) and stent placement in lad . trenbolone acetate is a synthetic anabolic steroid ( 16 ) often referred to as " fina " by users , because the injectable trenbolone acetate was originally adapted for use by bodybuilders from the dissolution of finaplix h pellets ; it is an ear implant used by cattle ranchers to maintain the weight of cattle during shipping to slaughter . trenbolone is a steroid used by veterinarians on livestock to increase muscle growth and appetite ( 17 , 18 ) . because these drugs have remarkable effects on bulking muscle mass and burning fats , illicit use of them therefore , it seems to be necessary that a comprehensive history of steroid consumption in young patients present to the emergency department with the chief complaint of chest pain or its equivalents should adjunct to other cardiac risk factors . when young athletes with a history of anabolic drugs refer to the emergency department with complaints of chest pain , ischemic heart issues must be considered . without the necessary symptoms to exclude ischemic heart problems , lower all authors passed four criteria for authorship contribution based on recommendations of the international committee of medical journal editors .