Myocardial ischemia associated with clenbuterol abuse: report of two cases.
BACKGROUND
Clenbuterol is an orally administered long-acting beta-2 adrenergic agonist closely related to albuterol that, in recent years, has become a substance of abuse in the bodybuilding and athletic community.


OBJECTIVE
We report two cases of acute myocardial ischemia associated with clenbuterol abuse in two healthy young male body builders.


METHODS
Two male bodybuilders, ages 18 and 22 years, presented to the Emergency Department with palpitations, nausea, vomiting, chest pain, diaphoresis, and tachycardia shortly after ingesting clenbuterol. Both patients experienced prolonged sinus tachycardia that, in one patient, was relatively resistant to both beta- and calcium channel blockade. Both patients were found to have elevated troponin levels, the first patient as high as 4.71 ng/mL (normal<0.04 ng/mL). Further investigation revealed normal coronary arteries at catheterization and normal cardiac magnetic resonance imaging in the first patient, and normal echocardiograms for both patients. The tachycardia gradually resolved and both patients recovered uneventfully. The etiology of cardiac ischemia in these patients is uncertain.


CONCLUSIONS
Emergency physicians should be aware of the clinical presentation of clenbuterol abuse and overdose, and the possibility of related cardiac ischemia and rhythm disturbances. Suggested treatment includes intravenous fluids, oxygen, aspirin, beta-blockers, and benzodiazepines, although efficacy remains unproven.
Department of Emergency Medicine, Newton-Wellesley Hospital, Newton, MA 02462, USA.
David S
DS
Huckins
Mark F
MF
Lemons
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D002637:Chest Pain / Q000139:chemically induced; D002976:Clenbuterol / Q000008:administration & dosage / Q000009:adverse effects*; D004300:Doping in Sports; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000139:chemically induced*; D009325:Nausea / Q000139:chemically induced; D013610:Tachycardia / Q000139:chemically induced; D014336:Troponin / Q000097:blood; D014839:Vomiting / Q000139:chemically induced; D014891:Weight Lifting; D055815:Young Adult
D000318:Adrenergic beta-Agonists; D014336:Troponin; D002976:Clenbuterol