We read with interest the report by Fisher et al on myocardial infarction with an intracoronary thrombus induced by anabolic steroids.1 We would like to draw attention to an additional previously unreported cardiac complication of anabolica abuse. A 21-year-old body builder was admitted unconscious to our cardiac care unit in severe cardiorespiratory distress. Apart from a history of anabolica abuse, his medical history was inconspicuous; ECG and chest X-ray had been normal two years ago in the army. Immediately after admission, the patient suffered cardiac arrest — the ECG showed pulseless electrical activity. Resuscitation was performed according to the protocol of the American Heart Association.2 No spontaneous circulation was at first restorable. Echocardiography revealed cardiac tamponade.3 Subxiphoid drainage was performed, and immediately afterwards spontaneous circulation was restorable. Invasive cardiac examination revealed dilatative cardiomyopathy. Apart from proven anabolica abuse no possible causes were detected. The patient is enrolled in a rehabilitation programme, and neurological outcome is promising. The use of anabolic steroids has been associated with a variety of cardiac events, including myocardial infarction and dilatative cardiomyopathy.4-6 Our patient developed cardiac tamponade and was successfully reanimated. Clinical circumstances suggest a causal relationship to anabolica abuse. To our knowledge. this is the first report on cardiac tamponade in a body builder probably related to anabolica abuse.