Toxic Cardiomyopathies: Alcohol, Amphetamines, and Anabolic Steroids

Abstract

Toxic cardiomyopathies include those caused by drug abuse, as well as chemotherapy agents. This review addresses cardiomyopathies induced by alcoholism, amphetamines, and anabolic steroids, focusing on their pathophysiology, clinical presentation, treatment, and prognosis. Alcoholic cardiomyopathy is frequent and predominates in males. It is dose-dependent, with a probable genetic predisposition. Women are susceptible at lower doses of alcohol intake. The disease ranges from a subclinical asymptomatic form to the typical form of dilated cardiomyopathy with systolic dysfunction and heart failure with reduced ejection fraction (HFrEF). Diagnosis is based on history and exclusion of other etiologies. Treatment is similar to other forms of heart failure, and prognosis depends on cessation of alcoholism. The use of amphetamines has increased, as has the incidence of secondary cardiomyopathy. The majority of patients are young and male. The pathophysiology is multifactorial. Diagnosis is based on history. During the acute phase, there is adrenergic hyperactivity. Treatment is similar to other etiologies of HFrEF. Not infrequently, patients progress to cardiogenic shock and require circulatory support and indication for heart transplantation. Cardiomyopathy secondary to use of anabolic steroids usually occurs in young men. Anabolic steroids have a direct or indirect impact on the cardiovascular system, through their risk factors. Presentation can range from asymptomatic to cardiogenic shock. It is imperative to discontinue anabolic steroid use and institute guidelines-based therapies, usually with reverse remodeling and favorable prognosis.