SHM Converge Scientific Abstract ePoster Gallery-The Heart Under Load: Severe Aortic Insufficiency and Root Aneurysm in a Weightlifter Using Anabolic Steroids

Pdf Summary

This case describes a 41-year-old male weightlifter with hypertension, hyperlipidemia, obstructive sleep apnea, and chronic anabolic steroid use who presented with acute chest pain and shortness of breath during lifting. Initial evaluation showed mild troponin elevation and markedly elevated BNP, but no ischemic ECG changes. Coronary angiography was normal. Further imaging revealed severe aortic insufficiency and a 4.9 cm aneurysm of the sinus of Valsalva with borderline ascending aortic dilation. During hospitalization, he developed acute hypoxemic respiratory failure from multifocal pneumonia and ARDS, requiring intubation and ICU care, but later stabilized. He subsequently underwent aortic valve repair and aortic root reconstruction.<br /><br />The report emphasizes that anabolic androgenic steroids are known to cause cardiovascular harm, including hypertension, dyslipidemia, thrombosis, and cardiomyopathy, but their association with aortic disease is less recognized. The authors propose that steroids may weaken connective tissue by altering collagen and elastin metabolism, increasing vascular stiffness and predisposing to aneurysm formation and valvular regurgitation. In this patient, the likely cause of aortic root injury was multifactorial: chronic hypertension, supraphysiologic steroid exposure, and repetitive hemodynamic stress from intense resistance training.<br /><br />Although inherited connective tissue disorders such as Marfan or Loeys-Dietz syndrome were considered, the lack of phenotypic features and the history of anabolic steroid use supported steroid-associated non-syndromic aortopathy. The case highlights that such patients may initially present like acute coronary syndrome, delaying diagnosis. Clinicians should consider aortic pathology in chest pain presentations among anabolic steroid users and pursue early multidisciplinary management, including cardiology, cardiothoracic surgery, and genetics.

Asset Subtitle

Carlos G. Martinez Bauza

Meta Tag

Author List Carlos G. Martinez Bauza, Nikhil Seth, Samuel A. Sara

Category Clinical Vignettes

Concept Severe Aortic Insufficiency

Concept Aortic Root Aneurysm

Concept Aseptic Abscess Syndrome

Concept Steroid-Associated Non-Syndromic Aortopathy

Concept Chest Pain

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Carlos G. Martinez Bauza

Track Adult

Keywords

anabolic steroid use

aortic aneurysm

sinus of Valsalva

aortic insufficiency

chest pain

weightlifter

hypertension

aortopathy

aortic root reconstruction

acute respiratory failure

Severe Aortic Insufficiency

Aortic Root Aneurysm

Aseptic Abscess Syndrome

Steroid-Associated Non-Syndromic Aortopathy

Chest Pain