Cardiomyopathy and heart failure secondary to anabolic-androgen steroid abuse

Bodybuilders often use anabolic-androgenic steroids to improve performance. We report a case of a 30-year-old male bodybuilder with anabolic-androgen steroid abuse while getting ready for a bodybuilding contest. He had New York Heart Association class IV heart failure, severe nonischemic dilated cardiomyopathy, new-onset atrial fibrillation, cardiogenic pulmonary edema, and acute respiratory distress requiring mechanical ventilation. After 6 months of heart failure guideline-directed medical therapy, cessation of anabolic steroids, and maintenance of sinus rhythm, his ejection fraction improved.