LVIDD = Left Ventricular Inter Dimension Diastole LV Mass = Left Ventricular Mass LV Mass Index = Left Ventricular Mass Per Unit Surface Area

It is possible that this subject has a cardiomyopathy, but there were no echocardiographic features of a hypertropic obstructive cardiomyopathy (HOCM) and his ejection fraction (Simpson's Rule) was normal. LV masses of this order. have been reported only in cases of severe valvular disease (Bennet and Evans, 1974), but our patient had no clinical or echocardiographic evidence of this. We think it probable therefore that anabolic steroids augment the effects of regular physical exercise on the myocardium. We do not know the physiological or pharmacological mechanisms behind this muscle hypertrophy, but we assume that myofibrillar hypertrophy and increased intra-cellular storage products are involved. It is possible that such changes only occur in individuals taking anabolic steroids while undergoing regular training. The long-term consequences of this degree of hypertrophy are rather worrying for two reasons. Firstly the increased muscle mass may jeopardise blood supply to the subendocardial layers in later life particularly if atherosclerosis supervenes. Secondly anabolic steroids may be implicated in the atherosclerotic process itself. We feel that the effects of anabolic steroids on left ventricular mass may be significant and represent a hitherto unrecognised danger to those athletes abusing these drugs, and hence merits further study