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Anabolic steroids, acute myocardial infarction and polycythemia: a case report and review of the literature.

Stergiopoulos K, Brennan JJ, Mathews R, Setaro JF, Kort S - Vasc Health Risk Manag (2008)

Bottom Line: The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women.The patient underwent successful percutaneous intervention of the right coronary artery.We suggest that the chronic and recent "stacked" use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794-8167, USA. kathleen.stergiopoulos@stonybrook.edu

ABSTRACT
The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women. However, several cardiovascular complications including hypertension, cardiomyopathy, stroke, pulmonary embolism, fatal and nonfatal arrhythmias, and myocardial infarction have been reported with supraphysiologic doses of anabolic steroids. We report a case of an acute ST-segment elevation myocardial infarction in a patient with traditional cardiac risk factors using supraphysiologic doses of supplemental, intramuscular testosterone. In addition, this patient also had polycythemia, likely secondary to high-dose testosterone. The patient underwent successful percutaneous intervention of the right coronary artery. Phlebotomy was used to treat the polycythemia acutely. We suggest that the chronic and recent "stacked" use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors. Physicians and patients should be aware of the clinical consequences of anabolic steroid abuse.

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Related in: MedlinePlus

The patient’s electrocardiogram on presentation.
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f1-vhrm-4-1475: The patient’s electrocardiogram on presentation.

Mentions: A 44-year-old male without prior cardiac history presented with one day of intermittent exertional, substernal chest pain culminating in rest angina. He described associated features of left shoulder pain, shortness of breath and diaphoresis. He was taking high-dose intramuscular testosterone for the previous six weeks, and intermittently for two years. In addition, he was taking sildenafil occasionally. He was a recreational weight-lifter. His cardiac risk factors included tobacco abuse and family history of early coronary artery disease. There was no family history of lipid disorder. His physical examination was remarkable for his muscular appearance and a blood pressure of 190/100. He was in mild distress with no signs of heart failure. His blood chemistry revealed a creatinine of 1.3 mg/dl and elevated liver enzymes (aspartate aminotranferease 86 units/L, and alanine aminotransferase 79 units/L). Hematologic studies noted an hemoglobin of 22 g/dl and hematocrit of 63%. His platelet count was normal with a mildly elevated white blood count. His creatinine kinase (CK), CK-MB, and troponin were within normal limits on presentation. An electrocardiogram revealed sinus bradycardia, left ventricular hypertrophy, an acute inferior injury pattern with ST-segment elevation, and anterolateral ischemia. Ventricular bigeminy was also noted (Figure 1). Emergent cardiac catheterization was then performed via the right femoral artery. Selective left coronary angiography revealed a diffusely diseased left anterior descending artery (LAD) with a 95% lesion after the takeoff of a small septal branch (Figure 2). The circumflex artery was free of significant disease. Selective right coronary angiography revealed a total occlusion at the mid-portion of the vessel with intracoronary thrombus (Figure 3). The patient underwent percutaneous transluminal coronary angioplasty (PTCA) and stent placement in the mid and distal right coronary artery vessel. The right coronary artery was notably a large, dominant vessel (Figure 4). The procedure was complicated by distal embolization, treated with intracoronary adenosine and glycoprotein IIb/IIIa inhibitor, which resulted in some angiographic improvement. Clopidogrel (300 mg loading dose and 75 mg thereafter) was initiated immediately. The patient’s peak CK and CK-MB were 8830 units/L and 1800 units/L, respectively. A transthoracic echocardiogram demonstrated that the patient’s left ventricular systolic function was moderately reduced with inferior and inferoseptal akinesis, and inferolateral hypokinesis. The ejection fraction was 35%. Successful percutaneous intervention and stent placement were performed on the lesion in his left anterior descending artery on the following day. The patient was phlebotomized until his resultant hematocrit was 45%. Hematological workup for malignancy was negative. Total cholesterol was 219 mg/dl, low-density lipoprotein (LDL) cholesterol was 154 mg/dl, and high-density lipoprotein (HDL) 50 mg/dl. Standard medical therapy for acute myocardial infarction was initiated following the intervention and included aspirin, clopidogrel, beta-blocker, statin, and angiotensin converting enzyme inhibitor.


Anabolic steroids, acute myocardial infarction and polycythemia: a case report and review of the literature.

Stergiopoulos K, Brennan JJ, Mathews R, Setaro JF, Kort S - Vasc Health Risk Manag (2008)

The patient’s electrocardiogram on presentation.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2663437&req=5

f1-vhrm-4-1475: The patient’s electrocardiogram on presentation.
Mentions: A 44-year-old male without prior cardiac history presented with one day of intermittent exertional, substernal chest pain culminating in rest angina. He described associated features of left shoulder pain, shortness of breath and diaphoresis. He was taking high-dose intramuscular testosterone for the previous six weeks, and intermittently for two years. In addition, he was taking sildenafil occasionally. He was a recreational weight-lifter. His cardiac risk factors included tobacco abuse and family history of early coronary artery disease. There was no family history of lipid disorder. His physical examination was remarkable for his muscular appearance and a blood pressure of 190/100. He was in mild distress with no signs of heart failure. His blood chemistry revealed a creatinine of 1.3 mg/dl and elevated liver enzymes (aspartate aminotranferease 86 units/L, and alanine aminotransferase 79 units/L). Hematologic studies noted an hemoglobin of 22 g/dl and hematocrit of 63%. His platelet count was normal with a mildly elevated white blood count. His creatinine kinase (CK), CK-MB, and troponin were within normal limits on presentation. An electrocardiogram revealed sinus bradycardia, left ventricular hypertrophy, an acute inferior injury pattern with ST-segment elevation, and anterolateral ischemia. Ventricular bigeminy was also noted (Figure 1). Emergent cardiac catheterization was then performed via the right femoral artery. Selective left coronary angiography revealed a diffusely diseased left anterior descending artery (LAD) with a 95% lesion after the takeoff of a small septal branch (Figure 2). The circumflex artery was free of significant disease. Selective right coronary angiography revealed a total occlusion at the mid-portion of the vessel with intracoronary thrombus (Figure 3). The patient underwent percutaneous transluminal coronary angioplasty (PTCA) and stent placement in the mid and distal right coronary artery vessel. The right coronary artery was notably a large, dominant vessel (Figure 4). The procedure was complicated by distal embolization, treated with intracoronary adenosine and glycoprotein IIb/IIIa inhibitor, which resulted in some angiographic improvement. Clopidogrel (300 mg loading dose and 75 mg thereafter) was initiated immediately. The patient’s peak CK and CK-MB were 8830 units/L and 1800 units/L, respectively. A transthoracic echocardiogram demonstrated that the patient’s left ventricular systolic function was moderately reduced with inferior and inferoseptal akinesis, and inferolateral hypokinesis. The ejection fraction was 35%. Successful percutaneous intervention and stent placement were performed on the lesion in his left anterior descending artery on the following day. The patient was phlebotomized until his resultant hematocrit was 45%. Hematological workup for malignancy was negative. Total cholesterol was 219 mg/dl, low-density lipoprotein (LDL) cholesterol was 154 mg/dl, and high-density lipoprotein (HDL) 50 mg/dl. Standard medical therapy for acute myocardial infarction was initiated following the intervention and included aspirin, clopidogrel, beta-blocker, statin, and angiotensin converting enzyme inhibitor.

Bottom Line: The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women.The patient underwent successful percutaneous intervention of the right coronary artery.We suggest that the chronic and recent "stacked" use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794-8167, USA. kathleen.stergiopoulos@stonybrook.edu

ABSTRACT
The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women. However, several cardiovascular complications including hypertension, cardiomyopathy, stroke, pulmonary embolism, fatal and nonfatal arrhythmias, and myocardial infarction have been reported with supraphysiologic doses of anabolic steroids. We report a case of an acute ST-segment elevation myocardial infarction in a patient with traditional cardiac risk factors using supraphysiologic doses of supplemental, intramuscular testosterone. In addition, this patient also had polycythemia, likely secondary to high-dose testosterone. The patient underwent successful percutaneous intervention of the right coronary artery. Phlebotomy was used to treat the polycythemia acutely. We suggest that the chronic and recent "stacked" use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors. Physicians and patients should be aware of the clinical consequences of anabolic steroid abuse.

Show MeSH
Related in: MedlinePlus