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Morphine is considered as a traditional and safe medication to relieve pain and dyspnea in the setting of acute coronary syndrome and cardiogenic pulmonary edema. [1,2] It is also attributed to dispose an antiarrhythmic effect.[3] We report a case of morphine-induced ventricular fi brillation in the prehospital emergency treatment. The patient presented acute myocardial infarction with ST segment elevations complicated with uncontrolled hypertension and cardiogenic pulmonary edema. CASEA physician-staffed Emergency Medical Service team was sent to a 42-year-old man for shortness of breath. He was found sitting in a chair, dyspneic at rest, pale and sweaty, complaining for chest pain for 30 minutes. Medical history showed arterial hypertension and smoking, chronic treatment with perindopril 4 mg and amlodipine 5 mg once daily in the morning. However, at least 3 days before the patient did not take any medication. He was evaluated as pulmonary edema with hypertension, presenting with tachypnoea (25/ minute), hypoxia (peripheral oxygen saturation of 85%), sinus tachycardia (110/minute) and hypertension (blood pressure of 220/130 mmHg). High-flow oxygen therapy by face mask, 3 mg of isosorbiddinitrate and furosemide 40 mg i.v. followed by 4 mg of morphine sulphate i.v. were administered. Fifteen seconds after morphine administration, ventricular fibrillation (VF) developed. The sequence of two immediate defibrillation shocks led to the return of spontaneous circulation and restoration of consciousness. The twelve lead electrocardiogram revealed acute anteroseptal myocardial infarction with ST segment elevations (STEMI, Figure 1). Appropriate therapy was IaVF IV2 IV1 IV3 II I III IV5 IV4 IV6