Background: Steroids are known to have various cardiac side effects, such as hypertension, left ventricular hypertrophy, myocardial infarction, and sudden cardiac death. They are also known to cause rare but potentially life-threatening cardiomyopathy. The mechanisms behind steroid-induced cardiomyopathy are multifactorial, potentially involving direct or indirect myocardial toxicity, such as tissue fibrosis, apoptosis, and alterations in cardiac remodeling pathways via the renin-angiotensin-aldosterone system. Cardiomyopathy is known to occur with anabolic steroid use, but the literature on glucocorticoid-induced cardiomyopathy is scant. We present a rare case of glucocorticoid-induced dilated cardiomyopathy(DCM) in a patient with a history of refractory asthma who was treated with oral prednisone for greater than 40 years.
Case Description: A 46-year-old male with a history of childhood asthma treated with oral prednisone since the age of eight months presented with worsening exertional dyspnea and volume overload. Transthoracic echocardiogram(TTE) was remarkable for dilated left ventricle(LV) with reduced LV ejection fraction(EF) of 25-30%, along with diffuse hypokinesis. Given the new onset of decompensated heart failure with reduced EF, the patient underwent cardiac catheterization, which ruled out ischemic cardiomyopathy. After an extensive negative workup (including endocrine, drug screen, and autoimmune panel), the patient was diagnosed to have glucocorticoid-induced non-ischemic DCM. The patient was advised to taper the current steroid dose and follow up with a pulmonologist for asthma management. The patient was started on guideline-directed medical therapy (GDMT) for DCM and discharged on a life vest. At the six-month follow-up, the patient remained asymptomatic, and his EF improved to 45%. Resolution of the patient's symptoms with discontinuation of steroids confirmed the diagnosis of steroid-induced DCM.
Discussion: Steroid cardiomyopathy due to the overuse of anabolic steroids containing testosterone has been well-reported in the literature, but DCM due to the overuse of glucocorticoids is extremely rare. This case highlights the rare presentation of reversible DCM due to the chronic use of glucocorticoids. The reversible nature of this condition underscores the need for vigilance regarding steroid-induced cardiomyopathy, emphasizing early diagnosis, cessation of steroid use, and initiation of GDMT for improved outcomes. With increasing amounts of chronic steroid use for various disorders and recreational use, it is important to add steroid-induced cardiomyopathy to our lists of differentials for newly diagnosed heart failure patients.