Did AAS Lower my Ejection Fraction, and is it Permanent?

[Deleted member 106824]

I started a thread a couple of weeks ago here ( http://www.professionalmuscle.com/forums/professional-muscle-forum/119373-chest-pain-ekg-issue.html ) regarding chest pain and a slightly abnormal EKG. Medic08 and others reassured me that the EKG was not really bad and my nurse was just wrong.

I went to a cardiologist and she confirmed with another EKG that things looked completely normal, so that was great to hear. However, I suggested we do an echocardiogram just to be safe.

I got this done on Monday and she called me today with the results.

Good news: No ventricular hypertrophy. To be honest this surprised me. 8 years of intensely working out and 2.5 years of gear, I expected mild hypertrophy

Bad news: Unexpectedly, she said that my ejection fraction is 50 (normal being 55-70). Also mentioned ventricle was slightly dilated but didn't seem concerned about this.

I was always under the impression that EF would be affected by an incident, like a heart attack drastically lowering it. But could AAS be slowly negatively impacting my cardiac tissue, lowering my EF?

I was never overly worried about liver enzymes and cholesterol because they were temporary changes, though I still took all precautions I could to improve them (milk thistle, liv52, NAC, cardio in the off season, fish oil, curcumin, etc), however here we are seeing a direct negative effect on my heart.

She said that an echo can give an error in the EF based on hydration, but that a higher hydration level would give a higher EF reading and I am always drinking a lot so if anything I feel like that means my real EF could be even lower.

We have a cardiac MRI scheduled but not until 11/26 as the earliest date. So as the title of the thread asks...
1. Do you think this is caused by my AAS use over the last 2.5 years. I am only 23 years old with no predispositions to heart issues.

2. Can I get my EF back up to a healthier number, or am I basically screwed for life now?


Thank you for the help

 

[Mini Truck]

Hey Pumped,

There is no disputing the fact that long term AAS use will
negatively effect heart health.

But from all the studies I've read, "long term" refers to 8-10+ years
of use. You were not on for 2.5 years non stop, correct?

But say you were.
Studies show that long term use can lower ones EF.
And although the norm is 55-70, at 50, it's just slightly below normal.
Plus your Dr didn't seem too concerned.

Studies also show that it is unclear if this can be reversed.
But I completely disagree with that.

Was your diastolic function reduced as well?

In summary, because you have some concerns, you may want to
reconsider your AAS use above Rx HRT.

You can still make gains and stay lean without gear.
Agreed, at a slower level, but sometimes it simply boils down to priorities.

Plus since you have no desire to compete, make health your
number one priority.

Don't allow this small negative to control your life.
Turning any negative into a positive is first a mental step when it comes
to these matters.

Peace,

-MT

I started a thread a couple of weeks ago here ( http://www.professionalmuscle.com/forums/professional-muscle-forum/119373-chest-pain-ekg-issue.html ) regarding chest pain and a slightly abnormal EKG. Medic08 and others reassured me that the EKG was not really bad and my nurse was just wrong.

I went to a cardiologist and she confirmed with another EKG that things looked completely normal, so that was great to hear. However, I suggested we do an echocardiogram just to be safe.

I got this done on Monday and she called me today with the results.

Good news: No ventricular hypertrophy. To be honest this surprised me. 8 years of intensely working out and 2.5 years of gear, I expected mild hypertrophy

Bad news: Unexpectedly, she said that my ejection fraction is 50 (normal being 55-70). Also mentioned ventricle was slightly dilated but didn't seem concerned about this.

I was always under the impression that EF would be affected by an incident, like a heart attack drastically lowering it. But could AAS be slowly negatively impacting my cardiac tissue, lowering my EF?

I was never overly worried about liver enzymes and cholesterol because they were temporary changes, though I still took all precautions I could to improve them (milk thistle, liv52, NAC, cardio in the off season, fish oil, curcumin, etc), however here we are seeing a direct negative effect on my heart.

She said that an echo can give an error in the EF based on hydration, but that a higher hydration level would give a higher EF reading and I am always drinking a lot so if anything I feel like that means my real EF could be even lower.

We have a cardiac MRI scheduled but not until 11/26 as the earliest date. So as the title of the thread asks...
1. Do you think this is caused by my AAS use over the last 2.5 years. I am only 23 years old with no predispositions to heart issues.

2. Can I get my EF back up to a healthier number, or am I basically screwed for life now?


Thank you for the help

 

[nothuman]

I was actually using google quite a bit on EF research the other night. It appears that it can be improved. Just be sure do all the right things and then get it re-tested.

 

[Stewie]

Any chance you may suspect that you have sleep apnea?

 

[Deleted member 106824]

Hey Pumped,

There is no disputing the fact that long term AAS use will
negatively effect heart health.

But from all the studies I've read, "long term" refers to 8-10+ years
of use. You were not on for 2.5 years non stop, correct?

But say you were.
Studies show that long term use can lower ones EF.
And although the norm is 55-70, at 50, it's just slightly below normal.
Plus your Dr didn't seem too concerned.

Studies also show that it is unclear if this can be reversed.
But I completely disagree with that.

Was your diastolic function reduced as well?

In summary, because you have some concerns, you may want to
reconsider your AAS use above Rx HRT.

You can still make gains and stay lean without gear.
Agreed, at a slower level, but sometimes it simply boils down to priorities.

Plus since you have no desire to compete, make health your
number one priority.

Don't allow this small negative to control your life.
Turning any negative into a positive is first a mental step when it comes
to these matters.

Peace,

-MT

Hey MT, thank you for chiming in.

Have their been 8-10 year long studies regarding that? I have never come across a long term AAS study as it would be deemed unethical.

Correct, I definitely was not on for the entire 2.5-3 years. I would say total time on was maybe 1/2-2/3 of that time from the beginning. Off time either being completely off or 100-150mg TRT.

I believe my doctor just didn't want to freak me out until we confirmed with a cardiac MRI. She was definitely surprised that it was only 50%.

I am not sure about the diastolic function. I believe it was normal but I'm going to pick up the full results next week. She said EF was 50%, no hypertrophy was seen (at least there's that), ventricle was mildly dilated (pretty much brushed over that), the rest was normal.

Thank you for helping to put things in perspective. I'm usually very logical in my decision making but this is my soft spot. I have put so much time and effort into this and while I may be able to make minor progress on just TRT I think it's safe to say that it will be the end of any dramatic progress. So it's a very hard jump for me to say "OK, this is it....time to accept reality that I have to be content with what I have" because for the last 8 years it's all been about progress, progress, progress at all costs....except health, which is why I need to step back. Because I'm not going to turn into one of those guys who says "who wants to live past 60 anyway". I want to be healthy and that does need to come first. Again it's just hard to accept.

I really wanted to finish when I was 26...allowing for this years bulk and cut and then 2 subsequent years just with injectables. Was hoping that would allow another 10lb or so of muscle and then at that point I'd be more mentally ready to come off. But if it's really affecting my heart so directly to already have my EF 5% below the lower limit than I can't justify doing more significant damage. It was one thing to have temporarily worse cholesterol or liver enzymes which wouldn't be a huge deal long term. If the cardiac MRI confirms a low EF, and we can't come up with another reason besides the AAS, then I may just do one final cutting cycle and end my AAS use besides TRT.....and focus on just being skinny lean lol

I know I tend to catastrophize when it comes to these health issues, but it does concern me.

I was actually using google quite a bit on EF research the other night. It appears that it can be improved. Just be sure do all the right things and then get it re-tested.

I will have to do my own research this weekend, but would you mind briefly explaining what you found appeared to increase EF?

I'm only 23 so this is obviously worrisome. I have the cardiac MRI on 11/26 to recheck but being on a cycle now I am wondering if it's only going to get worse. Or if it really is just worse than 50% and the echo had it arbitrarily higher due to excess hydration or something.

Any chance you may suspect that you have sleep apnea?

No I don't believe so. I wake up 2-3 times per night to go to the bathroom, but I'm only a little over 200-210lb at 6ft and don't have any breathing issues.





Again thanks for the input so far

 

[nothuman]

Ejection Fraction

IMPROVING YOUR EF
Depending on your EF number, your doctor may make recommendations to help you improve your EF. In some cases, medication may be prescribed. There are also other things you can do to improve how well your heart pumps.

Limit Salt – Limiting salt (sodium) to 2,000 mg a day is an important part of maintaining a healthy heart and treating heart failure. With a low EF, your kidneys get less blood than they should. This makes them unable to rid the body of excess water and salt. Eating too much salt can lead to even more fluid buildup. It also increases your blood pressure, which makes an already weakened heart work harder.
Manage Your Fluids – With a low EF, blood can back up in your lungs and force fluid into the breathing spaces. The fluid then builds up, making it difficult to breathe. Excess fluid can also cause weight gain and swelling. Your doctor will recommend the amount of fluids you should have daily, depending on your EF.
Exercise Regularly – Exercise can help strengthen your heart and improve how well it pumps blood to the rest of the body. All it takes is 30 minutes a day of activity, even if that activity is walking. Talk to your doctor about an exercise program that is right for you.

 

[Reno911]

Skip to the 2:00 mark in this link. Dr Sal provides some pretty good info. At 2:09 they talk about echo interpretation.

http://www.rxmuscle.com/radio//HeavyMuscle01-14-13.mp3

 

[nothuman]

Skip to the 2:00 mark in this link. Dr Sal provides some pretty good info. At 2:09 they talk about echo interpretation.

http://www.rxmuscle.com/radio//HeavyMuscle01-14-13.mp3

Holy crap! Whoever gave Palumbo the wrong info about his EF being 25% should be suspended! He must have been so terrified.

Thanks for that link

 

[lafbear2]

I the had to have emergency surgeries (12 of them in May and June) in the middle of a cycle. I nearly died...the actually told my family to come to the hospital because I was not going to survive. Of the many diagnostic findings, they told me that I had endocarditis, an enlarged heart, pulmonary hypertension, EF 40-45%.

Long story made short: after recovery and following up with cardiologist: everything has returned to normal...except for surgical incision scars. I think the 2 months of hyperbaric oxygen treatments helped with the heart (although this was ordered to help prevent amputating my arm.)

 

[Gizmo]

I the had to have emergency surgeries (12 of them in May and June) in the middle of a cycle. I nearly died...the actually told my family to come to the hospital because I was not going to survive. Of the many diagnostic findings, they told me that I had endocarditis, an enlarged heart, pulmonary hypertension, EF 40-45%.

Long story made short: after recovery and following up with cardiologist: everything has returned to normal...except for surgical incision scars. I think the 2 months of hyperbaric oxygen treatments helped with the heart (although this was ordered to help prevent amputating my arm.)

Wow that's scary stuff, care to elaborate what was thought caused it? AAS use? Were you a heavy user? Glad you're still with us.

 

[nothuman]

I the had to have emergency surgeries (12 of them in May and June) in the middle of a cycle. I nearly died...the actually told my family to come to the hospital because I was not going to survive. Of the many diagnostic findings, they told me that I had endocarditis, an enlarged heart, pulmonary hypertension, EF 40-45%.



Long story made short: after recovery and following up with cardiologist: everything has returned to normal...except for surgical incision scars. I think the 2 months of hyperbaric oxygen treatments helped with the heart (although this was ordered to help prevent amputating my arm.)

Unreal. I can't imagine what you went through. Amazing you were given another chance.

 

[Mini Truck]

Pumped,

There are several studies available on the internet regarding this topic.

Please know that I am not on a pedestal casting judgement, because I am not.

And I am very aware of how difficult it may be to reevaluate what you
are up against.

The one thing I can guarantee is that the longer you wait to make a decision,
the more difficult it will be for you, or any of us for that matter.

If you proceed with your plan to continue to use until you're 26, the decision
will be that much more difficult.

And will those extra 4 years create more issues? Maybe not but probably so.

I am in no way trying to sway your decision.
The challenge every one of us face is that we compare ourselves with the
.00005%(?) of the population who have developed incredible physiques.
We idolize them to a certain degree.

Our vision and goals will probably never get us to that level.

But that's only a negative if you interpret it as such.

Train hard, eat healthy, and do the best with what you've got.
Training and life in general will be much more fun.
You will always look good.
The problem is we surround ourselves with athletes who operate with little
disregard to their health.

Step out of the "circle" and look at it from that perspective.

Here's one study I ran across:


Anabolic Steroids May Weaken the Heart

Study Shows Long-Term Use May Have an Impact on Heart Pumping Function

By Salynn Boyles
WebMD Health News

Reviewed by Elizabeth Klodas, MD, FACC


WebMD News Archive

April 27, 2010 -- Long-term use of anabolic steroids appears to weaken the heart, and it is not clear if this weakening is reversible, researchers say.

In a small but alarming new study, middle-aged weight lifters who took steroids for roughly a decade showed evidence of impaired heart pumping function that was not seen in weight lifters who did not take steroids.

The finding suggests that many years of anabolic steroid use weakens the heart more than has been previously recognized, says cardiologist and study researcher Aaron L. Baggish, MD, of Harvard Medical School and Massachusetts General Hospital.

It may also have important public health implications because the use of steroids to improve sports performance is no longer the exclusive domain of a small group of elite athletes.

Steroids use is now common in fighting sports, such as boxing and mixed martial arts, in addition to weight lifting, Baggish says.

Anabolic steroids are synthetically produced drugs that mimic the naturally occurring male sex hormone testosterone, which builds muscle.

"Steroid use in the general public wasn't really an issue until the late 1980s or even the mid-1990s," Baggish tells WebMD. "Even now, when we hear about steroids it's because a professional baseball player or cyclist has taken them. But the vast majority of steroid use is now happening among casual athletes who work 9-to-5 jobs."

Impact of Steroids on the Heart

In an effort to better understand the impact of long-term anabolic steroid use on the heart, Baggish and colleagues performed heart function testing on 12 weight lifters who took steroids and seven who did not take the drugs.

The average age of the study participants was 40, and the steroid users had taken the drug for an average of nine years. The two groups were similar with respect to duration of weight lifting, total physical activity level, and weight, but the steroid users had more muscle mass than nonusers.

Doppler echocardiography ultrasound was used to examine blood flow through the heart.

In most of the steroid users, the heart's main pumping chamber, known as the left ventricle, showed evidence of weakness during contraction.

A healthy left ventricle pumps 55% to 70% of the blood that fills the heart. This measurement is known as ejection fraction.

Ten of the 12 steroid users had ejection fractions of less than 55%, which has been linked to an increased risk for heart failure and sudden cardiac arrest.

Only one of the seven weightlifters with no history of steroid use had a low ejection fraction.

The steroid users also showed evidence of impaired diastolic function, which is the ability of the left ventricle to relax and fill with blood following contraction.

Left ventricle relaxation was reduced by almost half among steroid users compared to nonusers.

-MT

 

[QuietStorm]

No I don't believe so. I wake up 2-3 times per night to go to the bathroom, but I'm only a little over 200-210lb at 6ft and don't have any breathing issues.





Again thanks for the input so far

That waking up 2-3 times a night may just very well be you waking up because you have breathing issues...and oh while Im up, let me go pee. I know only because I've been there.
I strongly urge you to have a sleep apnea test done. Weight and fat are not the only factors in developing this problem. It is a very serious condition, so please do yourself the favor of having a test done.

Storm

 

[Deleted member 106824]

Ejection Fraction

IMPROVING YOUR EF
Depending on your EF number, your doctor may make recommendations to help you improve your EF. In some cases, medication may be prescribed. There are also other things you can do to improve how well your heart pumps.

Limit Salt – Limiting salt (sodium) to 2,000 mg a day is an important part of maintaining a healthy heart and treating heart failure. With a low EF, your kidneys get less blood than they should. This makes them unable to rid the body of excess water and salt. Eating too much salt can lead to even more fluid buildup. It also increases your blood pressure, which makes an already weakened heart work harder.
Manage Your Fluids – With a low EF, blood can back up in your lungs and force fluid into the breathing spaces. The fluid then builds up, making it difficult to breathe. Excess fluid can also cause weight gain and swelling. Your doctor will recommend the amount of fluids you should have daily, depending on your EF.
Exercise Regularly – Exercise can help strengthen your heart and improve how well it pumps blood to the rest of the body. All it takes is 30 minutes a day of activity, even if that activity is walking. Talk to your doctor about an exercise program that is right for you.

This is one of those things where I'm not sure it would change anything since it's talking about something indirect. What I mean is, for example, lower salt to lower blood pressure to help your heart. My salt intake is high, but my BP is 110/70 on average....so would lowering my salt intake really even do anything in that case?

Obviously already exercising regularly, though maybe even more cardio would help? Right now I usually workout ~4-5 hours per week and do cardio for an hour or so.

I the had to have emergency surgeries (12 of them in May and June) in the middle of a cycle. I nearly died...the actually told my family to come to the hospital because I was not going to survive. Of the many diagnostic findings, they told me that I had endocarditis, an enlarged heart, pulmonary hypertension, EF 40-45%.

Long story made short: after recovery and following up with cardiologist: everything has returned to normal...except for surgical incision scars. I think the 2 months of hyperbaric oxygen treatments helped with the heart (although this was ordered to help prevent amputating my arm.)

That's intense. What was the cause of all of that, I don't think endocarditis would have to do with AAS use?

What is your EF now? Did you have to do anything specific to get it back up? Are you off gear for good now?

 

[Deleted member 106824]

That waking up 2-3 times a night may just very well be you waking up because you have breathing issues...and oh while Im up, let me go pee. I know only because I've been there.
I strongly urge you to have a sleep apnea test done. Weight and fat are not the only factors in developing this problem. It is a very serious condition, so please do yourself the favor of having a test done.

Storm

Thanks. You know I have thought before about this because I already have to go to the bathroom all of the time anyway and there have been some times when I've woken up and not really had to go (at least not enough where it seems like it should have kept me from sleeping).

Do you (or stewie) know how this relates to my EF/heart issues?

I will look into the sleep apnea test. Are there any other factors that would indicate I might have it? No one in my family does

 

[Deleted member 106824]

MT thanks for posting that.

I definitely don't look at it as you casting judgment. I really appreciate your input.

You know, I researched steroids very in depth for about 2 years before beginning and continued to do so while taking them. But I guess, maybe subconsciously, I just glanced over or ignored some of the studies because so many people say steroids are fine, won't lead to long term issues if you're safe about them, etc.. and I guess I figured as long as I took the necessary precautions I'd be safe.

I will say I don't think the decision to come off would be any harder after 2 more years than it would now because that's what I was mentally prepared for. For me if I know what's coming it's much easier to be ready for it and have all that time to think about it versus just suddenly having to stop.

Having said that, that study pretty clearly shows reduced cardiac function with long term use and I just can't justify that. I have seen a number of studies showing no increased mortality rates among professional athletes who were highly suspected of long term AAS use BUT I think the fact that there was no difference between them and the general public almost indicates the AAS did cause issues because otherwise we would expect well trained fit athletes to have a significantly longer life span.

So while I really wanted to continue for the rest of my time in school, I would just feel so crappy about it knowing what I was doing to my body. I have quite a bit of gear right now....I think I will do one final cutting cycle in the spring and then that will be it for me and I'll just have to accept what I can get with TRT. More and more I've had health scares come up (even if admittedly maybe overblown in my mind) and it doesn't seem worth it.

I just hope when all is said and done and I come off everything besides TRT that I can get everything...liver function, heart function, etc......completely back to normal. Given I'll be 24 at the time I would hope my recovery abilities would help with that but the heart issue is obviously the most worrisome for me.

 

[ketsugo3]

Pumped- as long as you go to the docs and rule out anything. It's very common for athletes to have abnormal EKG . Our muscles get bigger as our heart walls are also muscle so they grow too. I've had several opinions as it can be scary but I was told that all my arterial walls grew symmetrically so my heart is big and strong . If you recall some famous athletes I can recall Len Bias of the Boston celtics collapses died- he apparently had only one side grow so the other had to over work . Doing cardio is now important for health for me not just controlling fat. My doc called it runners heart as many marathon runners develop enlarged hearts. So not so much the aas as to the fact that we work out hard . Between my martial arts daily for almost 50 years and my weight training 5-6 days week for 32 years my heart grew . Yes aas makes our bodies fire and take in more nutrients so all muscles including our organs grow . I've always tried to be modest with my cycles , my doses. Honest to god I want to bodybuild to be healthier and look and feel younger . Never have I allowed my passion to grow overtake my patience and discipline to train smart. When ever I post anywhere past 20 years of forums even when I sound like an asshole I'm really trying to help people see. Always think of health , even when doing cycles we have safety measures in place - like using certain dosages over certain times . People that go on endless cycles , staying on the same compound using huge dosages don't realize they are playing with health. We can use aas to be healthier . Our diets can support ultra health . The whole hysteria that aas or hgh will kill you is not fair really . I'm 50 I'm the healthiest I've and biggest and strongest ever. I've lifted weights since age 12 , karate,judo , various martial arts since age 5. Plus I'm veteran of the armed forces toured 3x . I've broken my spine,my neck ripped every tendon at least 2 times . It's bodybuilding that helped me come through. Of course I was totally natural until I was in my 30s, twenty plus cycles since and I don't bridge but I don't cycle aas without hgh. To me if I could only use 2 compounds testosterone and HGH would be it.


LICSW/MSW/cscs/ USArmyVet

 

[Deleted member 106824]

Pumped- as long as you go to the docs and rule out anything. It's very common for athletes to have abnormal EKG . Our muscles get bigger as our heart walls are also muscle so they grow too. I've had several opinions as it can be scary but I was told that all my arterial walls grew symmetrically so my heart is big and strong . If you recall some famous athletes I can recall Len Bias of the Boston celtics collapses died- he apparently had only one side grow so the other had to over work . Doing cardio is now important for health for me not just controlling fat. My doc called it runners heart as many marathon runners develop enlarged hearts. So not so much the aas as to the fact that we work out hard . Between my martial arts daily for almost 50 years and my weight training 5-6 days week for 32 years my heart grew . Yes aas makes our bodies fire and take in more nutrients so all muscles including our organs grow . I've always tried to be modest with my cycles , my doses. Honest to god I want to bodybuild to be healthier and look and feel younger . Never have I allowed my passion to grow overtake my patience and discipline to train smart. When ever I post anywhere past 20 years of forums even when I sound like an asshole I'm really trying to help people see. Always think of health , even when doing cycles we have safety measures in place - like using certain dosages over certain times . People that go on endless cycles , staying on the same compound using huge dosages don't realize they are playing with health. We can use aas to be healthier . Our diets can support ultra health . The whole hysteria that aas or hgh will kill you is not fair really . I'm 50 I'm the healthiest I've and biggest and strongest ever. I've lifted weights since age 12 , karate,judo , various martial arts since age 5. Plus I'm veteran of the armed forces toured 3x . I've broken my spine,my neck ripped every tendon at least 2 times . It's bodybuilding that helped me come through. Of course I was totally natural until I was in my 30s, twenty plus cycles since and I don't bridge but I don't cycle aas without hgh. To me if I could only use 2 compounds testosterone and HGH would be it.


LICSW/MSW/cscs/ USArmyVet

Thanks for posting your experience. Have you had your ejection fraction measured recently? It seems my EKG results are actually fine, but my echo turned out poorly in the sense that my EF was lower than expected.


Crazy how my OCD for health pushed me to get these tests I never would have even thought to get otherwise and could have been doing harsher things for many more years had I not gotten the test.

 

[nothuman]

Thanks for posting your experience. Have you had your ejection fraction measured recently? It seems my EKG results are actually fine, but my echo turned out poorly in the sense that my EF was lower than expected.





Crazy how my OCD for health pushed me to get these tests I never would have even thought to get otherwise and could have been doing harsher things for many more years had I not gotten the test.

If I didn't become paranoid about my own health, I might be dead by now. Good job getting checked out so you can try to fix the problem before it gets worse. That's what I'm currently doing and I'm making sure I'm 100% before I lift weights again, let alone do another mild blast.

 

[Mini Truck]

NH,

It's scary to know how few people never get checked.
The "hey, I feel great" attitude is not the measure of health.

Or they do only after taking a break, letting their system clear, not
being honest with their doctor, and drawing conclusions after they get the
results.

It's nothing short of living in a lie.

You and Pumped are on the right track! Good job!!!!!!!

-MT

If I didn't become paranoid about my own health, I might be dead by now. Good job getting checked out so you can try to fix the problem before it gets worse. That's what I'm currently doing and I'm making sure I'm 100% before I lift weights again, let alone do another mild blast.