Copyright@ G Angelini | Biomed J Sci & Tech Res | BJSTR. MS.ID.003648. 16106 Case Report ISSN: 2574 -1241 Irreversible Dilated Cardiomyopathy After Abuse of Anabolic Androgenic Steroids: A Case Report and Literature Review G Angelini*, P Pollice, ME Lepera, S Favale and C Caiati Institute of Cardiovascular Disease, Department of Emergency and Organs Transplantations, Italy *Corresponding author: Gianmarco Angelini MD, Department of Emergency and Organs Transplantations, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, P.zza G. Cesare 11, CAP 70122, Bari, Italy DOI: 10.26717/BJSTR.2019.21.003648 Introduction Numerous athletes make use of anabolic-androgenic steroids (AASs), the synthetic derivatives of the male hormone testosterone, to increase and strengthen muscle mass, even if this is illegal but impossible to control. The effect of abuse of these hormones on the body and in particular on the heart is still not entirely known. These substances can produce adverse effects on various organs, and in literature several cases of cardiac disease have been reported in athletes after previous abuse of AASs [1-13] documenting dilated cardiomyopathy (DCM). However only few of them have shown irreversible DCM [1,6,8,13]. We report the case of a 31-year- old white male, bodybuilder, who had previously used AASs. He presented to our attention with dilated cardiomyopathy and severe irreversible left ventricular systolic dysfunction. We focused on the mechanism on AASs induced irreversible LV dysfunction. Case Report The patient was a 31-year-old man, bodybuilder, with no family history of cardiac disease and no cardiovascular risk factors. When the patient came to our attention, he had received a diagnosis of dilated cardiomyopathy (undocumented) about one year before and started treatment with beta-blockers and diuretics; he then spontaneously suspended the therapy after a few months. He admitted having previously taken high doses of various AASs to increase his muscle mass, including stanozolol, boldenonem, Received: September 23, 2019 Published: October 03, 2019 Citation: G Angelini, P Pollice, ME Lepera, S Favale and C Caiati. Irreversible Dilated Cardiomyopathy After Abuse of Anabolic Androgenic Steroids: A Case Report and Literature Review. Biomed J Sci & Tech Res 21(4)-2019. BJSTR. MS.ID.003648. Keywords: Dilated Cardiomyopathy; Heart Failure; Anabolic Androgenic Steroids; Diastolic Dysfunction; Cardiotoxicity ARTICLE INFO Abstract Illicit usage in athletes of androgenic anabolic steroids, such as testosterone and its derivatives, can cause myocardial dysfunction, that is usually reversible after the end of the abuse. However, in some cases myocardial dysfunction can be severe and irreversible for reasons that are not clear. We report the case of a 31-year-old patient, bodybuilder, who came to our attention for acute heart failure secondary to a dilated cardiomyopathy, with severe and irreversible left ventricular systolic dysfunction (LVEF 23%). Instrumental and laboratory examinations excluded myocarditis and coronary artery disease as a possible etiology of the left ventricular systolic dysfunction. The patient had previously taken different types of androgenic anabolic steroids (testosterone and derivatives), for almost twelve years and also growth hormone (GH) for 1 year, and never stopped hard exercise training throughout in order to improve his performance as a bodybuilder. He had been diagnosed with left ventricular systolic dysfunction, symptomatic for heart failure (NYHA class II-III), about six months after cessation of the abuse and the severe LV dysfunction did not reverse. We believe that the abuse of steroids may be the cause of our patient’s left ventricular dysfunction, that became worse and irreversible due to many years of usage, in association with intense physical training and GH; our hypothesis is strengthened by experimental studies in animals and autopsy immunohistochemical studies demonstrating a direct cardiotoxicity of anabolic androgenic steroids . The possible etiologic mechanism underlying acute and chronic cardiotoxicity in humans of these substances in humans warrants closer clinical investigation.