Anabolic androgenic steroid induced myocardial toxicity: an evolving problem in an ageing population

Abstract

SUMMARY Widespread use of anabolic androgenic steroid (AAS) abuse is a rapidly increasing public health concern with an expanding demographic. Previous studies and reports have been exclusive to young individuals at low risk for traditional, non-AAS associated, cardiovascular disease. To-date, the impact of AAS use on older patients has not been well characterized. The patient herein presented documents a dramatic case of an older individual who developed decompensated heart failure secondary to illicit use of AAS, highlighting an evolving problem amongst a rapidly expanding demographic and illustrating that a.) AAS, used to alter appearance or augment performance, is no longer an issue confined to young adults; b.) Older individuals with aging myocardium may be particularly susceptible to AAS toxicity and may present with fulminate congestive heart failure; and that c.) AAS abstinence coupled with traditional heart failure pharmacotherapy may be an effective treatment for this condition.

Effects of Substance Abuse on the Cardiovascular System and Its Management

“…Prolonged use of ketamine is associated with decreased cognitive function and psychological health [ 35 ]. Ketamine also has a role in chronic pain management due to its ability to both inhibit opiate tolerance and resensitize to opiate analgesia [ 32 ]. Ketamine toxicity often manifests as respiratory depression and sedation, requiring supportive therapy.…”

“…Recent studies have shown a possible role for ketamine in the treatment of depression. Subanesthetic doses of ketamine produce marked and prolonged antidepressant activity [ 32 ]. Recreational use of ketamine saw a surge starting in the 1980s, with users seeking a sense of euphoria, increased social interaction, and hallucinations.…”

“…Higher doses of ketamine are associated with a dissociative state. Other adverse acute effects include nausea/vomiting, increased secretions, nystagmus, increased intracranial pressure, and increased risk of seizure [ 32 ]. Prolonged use of ketamine is associated with decreased cognitive function and psychological health [ 35 ].…”

“…Ketamine is a noncompetitive NMDA antagonist, which is primarily metabolized by the liver through the CYP450 pathway into norketamine [ 32 ]. Current indications for ketamine include induction and maintenance of general anesthesia as well as premedication.…”

“…Ketamine hydrochloride (Ketamine) is a phencyclidine derivative developed in the 1960s as an anesthetic alternative to PCP [ 32 ]. Ketamine is a noncompetitive NMDA antagonist, which is primarily metabolized by the liver through the CYP450 pathway into norketamine [ 32 ].…”