Anabolic steroid abuse and cardiac sudden death - A pathologic study

Context-Androgenic anabolic steroids (AAS) used for improving physical perf ormance have been considered responsible for acute myocardial infarction an d sudden cardiac death. Objective.-To establish the relationship between AAS and cardiac death. Design.-Case report. Patients.-Two young, healthy, male bodybuilders using AAS. Main Outcome Measures.-Pathologic cardiac findings associated with AAS inge stion. Results.-The autopsy revealed normal coronary arteries. In one case, we doc umented a typical infarct with a histologic age of 2 weeks. A segmentation of myocardial cells at the intercalated disc level was observed in the non- infarcted region. This segmentation was the only anomaly detected in the s econd case. No other pathologic findings in the heart or other organs were found. Urine in both subjects contained the metabolites of nortestosterone and stanozolol. Comment.-A myocardial infarct without vascular lesions is rare. To our know ledge, its association with AAS use, bodybuilding, or both lacks any eviden ce of a cause-effect relationship. The histologic findings in our 2 cases a nd in the few others reported in medical literature are nonspecific and do not prove the cardiac toxicity of AAS. A better understanding of AAS action on the neurogenic control of the cardiac function in relation to regional myocardial contraction and vascular regulation is required.