Anabolics and Cardiomyopathy in a Bodybuilder: Case Report and Literature Review

Drug-Induced Cardiomyopathies

“…Potential sequelae include hypertension, acute myocardial infarction, sudden cardiac death, abnormal cardiac repolarisation with QT interval prolongation, ventricular fibrillation triggered by exercise, atrial fibrillation, cardiac tamponade, development of dilative cardiomyopathy, and heart failure at a dose-dependent manner (Hausmann et al 1998;Stolt et al 1999;Du Toit et al 2005;Karila et al 2003;Figueredo 2011). Several case reports have linked adverse cardiac events and anabolic-androgenic steroids abuse in healthy young athletes (Stergiopoulos et al 2008;Ahlgrim and Guglin 2009). Recently, 49 reports describing a total of 1,467 athletes has been extensively reviewed (Achar et al 2010).…”

“…This increase of intracellular calcium may be directly responsible for the development of cardiac hypertrophy as well as for the activation of apoptosis (Lieberherr and Grosse 1994;Zaugg et al 2001). Postmortem histopathological findings of young anabolic-androgenic steroid abusers include cardiac hypertrophy, what seems to be dose-dependent and reversible (Ahlgrim and Guglin 2009). In addition, several other complications have been described, such as myocardial and endocardial fibrosis, cardiac steatosis, myocardial coagulation necrosis, decreased inotropic capacity of the myocardium,…”

“…Indeed, a clinical study suggests a distinct form of left ventricular hypertrophy, as the abuse of anabolic-androgenic steroids in weight-lifters determines some alterations of the myocardial textural parameters when analyzed by videodensitometry (Di Bello et al 1999). In contrast to these definite findings, studies comparing echocardiographic variables between anabolicandrogenic steroids using and nonusing strength athletes have not yielded unequivocal results (Ahlgrim and Guglin 2009). Some studies have not demonstrated any structural difference with abuse (Thompson et al 1992) or showed that the myocardial remodeling is independent from anabolic-androgenic steroid use in power athletes (Dickerman et al 1998).…”

“…Considering the high prevalence of anabolic-androgenic steroids abuse in population, the number of cases featuring associated cardiac illness reported in current literature appears rather small. Thus the type or the intensity of training might play an important role (Ahlgrim and Guglin 2009). It remains open, whether the use of anabolic-androgenic steroids is causally related to these events or is just coincidental.…”

Adverse cardiovascular effects of anabolic steroids: pathophysiology imaging

“…Cardiovascular adverse effects of AAS abuse have been reported sporadically as case reports of hypertension [6], myocardial infarction (MI) and stroke [6], dysrhythmia [7], cardiomyopathy [8], and sudden cardiac death [9] in body builders with long-term AAS abuse in the recent years. Case reports on hard atherosclerotic endpoints (sudden cardiac death, MI or stroke) comprise young AAS abusers without preexistent cardiac risk factors, suggesting that a high AAS dose imposes additional independent risk to conventional cardiovascular risk factors.…”