CLINICAL CASE OF DEVELOPMENT OF MYOCARDIAL INFARCTION (NECROSIS), TYPE 2, INDUCED BY USING OF ANABOLIC STEROIDS AND BETA-ADRENERGIC STIMULATORS

Abstract

Risk factors and triggers of myocardial infarction in young people may be non-traditional cardiovascular, but also other causes such as spasm of coronary artery, drug abuse and other toxic substances (exogenous glucocorticoids, anabolic steroids, beta-adrenergic stimulators, etc.) associated with active promotion of bodybuilding and drugs that promote muscle build-up and fat burning.

The aim of the study – to increase the attention and motivation of doctors to timely diagnosis and adequate treatment of myocardial infarction (necrosis) in the context of receiving of high doses of anabolic steroids and beta-adrenergic stimulators.

Materials and Methods. The clinical case of the patient with myocardial infarction against the background of the use of anabolic steroids and β₂-agonists is analysed.

Results and Discussion. The peculiarity of clinical manifestations, diagnosis and treatment of this type of myocardial infarction (necrosis) is not only the presence of infarction-like electrocardiographic changes, but the onset of the disease is manifested by the atypical, "erased" syndrome of angina on the background of hyperdynamic syndrome (severe tachycardia and increased systolic blood pressure) and signs of activation of the sympathetic nervous system. Differential diagnostic criteria in such cases may be infarction-like elevation of the ST segment, but without reciprocal changes, absence of local zones of hypo- and akinesis according to the data of the echocardiogram, as well as a detailed explanation of the risk factors and possible triggers of necrotic changes in the myocardium. A "golden standard" for differential diagnosis in such cases is considered as contrast coronary angioventriculography.

Сonclusions. Uncontrolled use by young patients of anabolic steroids and beta-adrenostimulaion agents significantly increases their cardiovascular risk and may be a trigger for the development of zones of myocardial necrosis (type 2 MI). Treatment of myocardial infarction owing to overdose of β₂-agonists (in particular clenbutеrol) should include the intake of β-adrenoblockers in adequate doses, as well as detoxification and antihistamines therapy, which allow achieving a rapid clinical effect and prevent the development of life-threatening complications.