# Non-ischemia Cardiomyopathy and Polycythemia Secondary to Anabolic-Androgenic Steroid Use

## TL;DR

A young man developed heart and blood disorders from using anabolic steroids, highlighting the risks of illicit drug use in athletes.

## Contribution

This case highlights the under-recognized link between anabolic steroid use and non-ischemic cardiomyopathy with polycythemia.

## Key findings

- AAS use was linked to dilated cardiomyopathy with reduced ejection fraction.
- Polycythemia occurred without evidence of polycythemia vera or ischemic heart disease.
- Steroid-induced cardiomyopathy and polycythemia can be misdiagnosed if drug use is not considered.

## Abstract

Athletes and bodybuilders use anabolic-androgenic steroids (AAS) to increase muscle mass and enhance performance. Its use is widespread among competitive athletes in order to enhance athletic performances. However, the use of AAS has been linked to many deleterious adverse effects, including cardiomyopathy and polycythemia. We present the case of a young man in his late 20s who presented with uncontrolled hypertension and elevated hemoglobin. He was found to have a reduced left ventricular ejection fraction of 20-25%. Further workup showed dilated cardiomyopathy and low normal erythropoietin (EPO) levels. Evaluation for polycythemia vera was negative, and there was no evidence of ischemic cardiomyopathy. The patient later admitted to using injected AAS for professional bodybuilding. The coexistence of both these conditions can be challenging to diagnose and treat. While primary and secondary polycythemia can lead to hyperviscosity and result in ischemic cardiomyopathy from coronary occlusion, anabolic steroids can directly result in cardiomyopathy and polycythemia. This case points to the importance of identifying cardiomyopathy and polycythemia from illicit drug use, which can often be missed, and the workups needed to identify the etiology.