Strong muscles, weak heart: testosterone-induced cardiomyopathy

Authors

Sarah Doleeb, Advocate Aurora HealthFollow
Ann Kratz, Advocate Aurora HealthFollow
Monica Salter, Advocate Aurora HealthFollow
Vinay Thohan, Advocate Aurora HealthFollow

Recommended Citation

Doleeb S, Kratz A, Salter M, Thohan V. Strong muscles, weak heart: testosterone-induced cardiomyopathy. ESC Heart Fail. 2019; 6(5):1000-1004. doi: 10.1002/ehf2.12494.

Affiliations

Department of Internal Medicine, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers

Abstract

Exogenous anabolic androgen steroid use is associated with adverse cardiovascular outcomes. A 53-year-old bodybuilder presented with 3 months of exertional dyspnoea. Physical examination showed tachycardia and pan-systolic murmur; an echocardiogram showed a left ventricular ejection fraction (EF) of 15%. Evaluations included normal coronary angiogram, iron panel and thyroid studies, a negative viral panel (human immunodeficiency virus, Lyme disease, and hepatitis), and urine toxicology. He admitted to intramuscular anabolic steroid use; his testosterone level was 30 160.0 ng/dL (normal 280-1100 ng/dL). In addition to discontinuation of anabolic steroid use, he was treated with guideline-directed heart failure medical therapy. Repeat echocardiogram at 6 months showed an EF of 54% and normalized testosterone level of 603.7 ng/dL. Anabolic steroid use is a rare, reversible cause of cardiomyopathy in young, otherwise healthy athletes; a high index of suspicion is required to prevent potentially fatal side effects.

Document Type

Article

PubMed ID

31287235