AAS and Cardiovascular/Pulmonary Function

[Michael Scally MD]

Singh B, Treece JM, Murtaza G, Bhatheja S, Lavine SJ, Paul TK. Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review. Case Rep Cardiol. https://www.hindawi.com/journals/cric/2016/6460386/

A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal.

 

[Dr JIM]

Interesting but how many times have I noted a considerably elevated BP in AAS users!

AD has a cause and in this instance, absent a path exam of the recected aorta, "asymptomatic" HTN seems the most likely culprit IMO.

This fella is lucky to be alive!

 

[hurricane]

Singh B, Treece JM, Murtaza G, Bhatheja S, Lavine SJ, Paul TK. Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review. Case Rep Cardiol. https://www.hindawi.com/journals/cric/2016/6460386/

A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal.

With my onset of heart conditions I also started to pass out either at the gym or at home. BP was also way down, and with an O2 saturation of 92 I thought they would of checked for a PE like I also had. I think AAS use brings on otherwise "sleeping" medical conditions to the forefront. I could be way off because I'm only going off myself and brothers cardiac issues after heavy lifting and AAS use. Life is also to short Doctor. I apologize for the mood I've been in on the site. I found out from my cardiac ep that I'm having many episodes of bradycardia and I'm having a pacemaker put in on Saturday. I take my faith in God seriously and with surgery coming up I'm looking for Him to keep me safe. I'm done with that other post. Politics and religion are two subjects that will always stir the pot. Enjoy your evening. And I apologize for my words.

 

[hurricane]

Singh B, Treece JM, Murtaza G, Bhatheja S, Lavine SJ, Paul TK. Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review. Case Rep Cardiol. https://www.hindawi.com/journals/cric/2016/6460386/

A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal.

The reason we know I'm in bradycardia is that I have an implanted linq recorder to analyze my abnormal heart rhythms.

 

[Dr JIM]

Actually a path was conducted and reveal Cystic Medial Degenerative changes which ARE
seen in certain forms of inherited Collagen Vascular Disorders and in HTN patients.

 

[Dr JIM]

Politics and religion are two subjects that will always stir the pot.

Add vials of AAS, a few "young youngsters", an unbridled and anonymous PED forum and it's a recipe for disaster IME!

 

[hurricane]

Add vials of AAS, a few "young youngsters", an unbridled and anonymous PED forum and it's a recipe for disaster IME!

Without a doubt Dr Jim. Not to mention me being scared shitless about Fridays upcoming procedure to put in a pacemaker. No excuses on my end. I believe in God and should of left that topic alone. Its like throwing gas on a fire.

 

[Dr JIM]

Consequently religious and political discourse topics are far to personal on an "evidence based" PED forum and are more likely to divide rather than unite Meso participants IMO.

 

[hurricane]

Consequently religious and political discourse topics are far to personal on an "evidence based" PED forum and are more likely to divide rather than unite Meso participants IMO.

Very true. That is exactly what it did. And now I'm ashamed of my actions. Glad you have the foresight to see that. I let my beliefs override my rational thought. Dr Jim a pacemaker isn't a big procedure. Is it?? I stop my xarelto Tuesday and just hope this week fly's by. My anxiety is already through the roof.

 

[Dr JIM]

Without a doubt Dr Jim. Not to mention me being scared shitless about Fridays upcoming procedure to put in a pacemaker. No excuses on my end. I believe in God and should of left that topic alone. Its like throwing gas on a fire.

Something's are better left unsaid IME

 

[hurricane]

Something's are better left unsaid IME

Very true and lesson learned. Some topics are better left unturned. Especially when nothing productive will come of it. Thanks for the wisdom.

 

[Dr JIM]

Without a doubt Dr Jim. Not to mention me being scared shitless about Fridays upcoming procedure to put in a pacemaker. No excuses on my end. I believe in God and should of left that topic alone. Its like throwing gas on a fire.

Pacemaker insertions are about as "routine" as any "cardiac surgery" there is fella.

I suspect your anxiety would be greatly diminished if you spent some time on the net (like Web MD) to obtain a better understanding of how simplified such a procedure has become for the large majority of patients.

A little Versed, a 1-2 cm skin incision
the formation of a pocket to "hold" the pacer itself, several MM pronged leads are then affixed onto the epicardial surface, capture is confirmed, skin closure.

Time required 20-30 min !

 

[Dr JIM]

You'll do fine

 

[hurricane]

You'll do fine

Thanks Dr Jim. I think because it was so sudden it threw me for a loop. My wife is freaking out. Don't know what to tell the kids. I see my cardiac ep tomorrow to go over things. The one thing I couldn't find is where the device goes. Meaning under the skin or under the pec muscle. Again I appreciate everything Dr Jim.

 

[Dr JIM]

They can be placed almost anywhere including in the belly BUT are typically placed underneath the sub-q fat layer below (or inferior to) the pectoral musculature.

There are reasons such as; the pacer type, need for periodic "interrogation", (this is accomplished thru the use of a hand held computer and enables the Cadio to check the pacers FUNCTION on a long term basis wo removing it) electrical interference ect that are not as much a concern as they once were BUT it's best you bounce those options off your Cardio.

Curious did they give you a SPECIFIC EKG diagnosis with respect to your BRADYCARDIA?
like SICK SINUS SYNDROME, a HEART BLOCK etc?

 

[Dr JIM]

If your wife is "freaking out" the source of her anxiety is likely YOU and unless the both of you can approach your kids in an calm and age appropriate manner, it's probably best to tell the kids; "DADS HAVING SURGERY" and leave it at that, IMO

 

[hurricane]

They can be placed almost anywhere including in the belly BUT are typically placed underneath the sub-q fat layer below (or inferior to) the pectoral musculature.

There are reasons such as; the pacer type, need for periodic "interrogation", (this is accomplished thru the use of a hand held computer and enables the Cadio to check the pacers FUNCTION on a long term basis wo removing it) electrical interference ect that are not as much a concern as they once were BUT it's best you bounce those options off your Cardio.

Curious did they give you a SPECIFIC EKG diagnosis with respect to your BRADYCARDIA?
like SICK SINUS SYNDROME, a HEART BLOCK etc?

Yes Dr Jim its my sinus node that doesn't do its natural pacing job.

 

[hurricane]

If your wife is "freaking out" the source of her anxiety is likely YOU and unless the both of you can approach your kids in an calm and age appropriate manner, it's probably best to tell the kids; "DADS HAVING SURGERY" and leave it at that, IMO

It probably is me. I know I'm being a baby but I'm just nervous. And I agree about the 2 kids. Not going to mention the heart.

 

[Dr JIM]

Yes Dr Jim its my sinus node that doesn't do its natural pacing job.

Since your anxiety is palpable I'd strongly suggest you check out the Web MD discussion on "Sick Sinus Syndrome" as its a relatively common cause of symptomatic bradycardia.

What is perhaps even more important, understanding one's condition and its treatment is the most effective means of allaying anxiety IME. (Exclusive
of a little pre-operative Valium or Versed . )

 

[hurricane]

Since your anxiety is palpable I'd strongly suggest you check out the Web MD discussion on "Sick Sinus Syndrome" as its a relatively common cause of symptomatic bradycardia.

What is perhaps even more important, understanding one's condition and its treatment is the most effective means of allaying anxiety IME. (Exclusive
of a little pre-operative Valium or Versed . )

Again your right on. I am prescribed anxiety meds on a prn need basis because of how bad my anxiety will be when I feel my heart racing, slowing down, or "fluttering" in my chest. Heart rhythm disturbances really have a dramatic saying in your quality of life if the anxiety always gets the best of you. Hopefully the pacemaker will give me some peace of mind that my heart isn't going to just stop.