Anabolic steroid abuse and cardiac death.
OBJECTIVE
To examine the relationship between anabolic steroid abuse and cardiac death. We report the first two cases in Australia. They are the only reported cases in which the anabolic steroid oxymesterone has been detected. This compound has never been approved for use in Australia.


METHODS
Two footballers, aged 18 and 24, sustained fatal cardiac arrests while at training sessions. Both were considered fit and healthy.


RESULTS
Autopsy revealed features of a hypertrophic cardiomyopathy in the 18-year-old; the 24-year-old had findings of a myocarditis. In both cases the coronary arteries were normal and there was no evidence of coronary thrombosis. Urine in both subjects contained the anabolic steroid oxymesterone.


CONCLUSIONS
There are limited clinical uses for anabolic steroids but they are widely abused by athletes in attempts to alter lean body mass and strength. Acute non-fatal myocardial infarction was first reported in 1988 and fatal myocardial infarction in 1990. While a causal relationship is hard to prove, it is possible that the anabolic steroid contributed to the increase in cardiac size in the first subject and may have increased his responsiveness to catecholamines causing an arrhythmogenic event. In the second, the inflammatory changes could have provided the focus for an arrhythmia. It would appear that anabolic steroid abuse should be considered in any athlete presenting with an acute vascular event.
Kennedy
M C
MC
Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW.
Lawrence
C
C
D000293:Adolescent; D000328:Adult; D045930:Anabolic Agents; D002312:Cardiomyopathy, Hypertrophic / Q000139:chemically induced / Q000473:pathology; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000473:pathology; D004300:Doping in Sports; D005538:Football; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000139:chemically induced / Q000473:pathology; D019966:Substance-Related Disorders / Q000150:complications* / Q000473:pathology
D045930:Anabolic Agents