Author/Authors :
پورزند، هوراك نويسنده Atherosclerosis Prevention Research Center AND Department of Cardiovascular, School of Medicine, Imam Reza Poorzand, Hoorak , جعفرزاده اصفهاني، رضا نويسنده Sabzevar University of Medical Sciences, Sabzevar, Iran Jafarzadeh Esfehani, Reza , حسين زاده، پيمان نويسنده , , وجدان پرست، محمد نويسنده Resident of Cardiology, Imam Reza Hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran ,
Abstract :
BACKGROUND: Anabolic steroids have been widely used in recent years. It could adversely
affect the cardiovascular system. Non-traditional risk factors for coronary heart diseases (CHDs)
have raised great concern.
CASE REPORT: A young bodybuilder was presented with crushing retrosternal chest pain,
excessive diaphoresis, and vomiting. The symptoms began during wrestling. The patient did not
have a history of traditional cardiovascular risk factors. He was using large quantities of
nutritional and bodybuilding supplements with multiple intramuscular injections of
dexamethasone during past 6 months. The electrocardiography (ECG) revealed ST-segment
elevation in the precordial, I and aVL leads consistent with acute extensive myocardial
infarction (MI). Lipid profile, cardiac troponin, and creatine phosphokinase-MB (CPK-MB) was
abnormal. Transthoracic echocardiography (TTE) revealed mild left ventricular (LV)
enlargement and reduced global systolic dysfunction with regional wall akinesia. The patient
received thrombolytic therapy which was resulted in symptomatic relief and resolution in ST-T
changes. Significant smoke was seen in LV cavity without clot formation on the discharge day.
About 1 week later, large fresh clots were seen in the apex. He was admitted again, and the
burden of clots was reduced significantly after initiation of oral warfarin. Other laboratory tests
were as follows: High-sensitivity C-reactive protein (CRP): 25.9 mg/dl, homocysteine: 26.2
µmol/l. The patient was discharged with specific medication. Clots were disappeared after 6
weeks of warfarin therapy. Later, the patient was evaluated again, and there was not any
symptom and LV clots.
CONCLUSION: Hyperhomocysteinemia could be induced by steroid abuse and may cause
atherosclerotic and thrombotic effects in healthy athletes. We suggest clinicians to take a careful
history of young athletes presented with MI or thrombotic events and also pay special attention
to their homocysteine levels in their follow-ups.
