T Nation

Hypertrophic Cardiomyopathy (HCM)

Hey there,
Quick Background: 200 lbs, 21 y/o, 7% bf, on TRT prescribed by a doctor, have run one test blast @ 300 mg/week and one Primobolan blast/cruise @ 200 mg/week along with TRT (both cycles for 8 weeks). @theleangentleman on Instagram if you’d like to see my current physique. I eat extremely healthily (less than 12g sat fat/day, moderate carb, high protein, moderate fat). I used to compete in D1 track and XC but switched over to bodybuilding after a knee injury.

Anyways, I recently got referred to a cardiologist by my general practitioner because my blood pressure has always been slightly elevated when getting my physical (140/80). It always drops back down by the end of the physical to normal (120/80) I think it may just be nervousness. I decided to go and see the cardiologist just to be safe. I got an EKG and the doctor said that the voltage was a bit high. He suspects it could be enlargement of the walls of my heart. I am set to get an echocardiogram to rule out whether or not I have HCM in the next few weeks.

I am super concerned that I do have it, despite being very physically fit and healthy and young, I often get very winded when lifting in the gym. I get numbness of my fingers when I lay down or wake up from sleep (all indicators of poor blood flow). I go hard af in the gym (to failure on every set) and train for 3 to 4 hours a day. I’m super dedicated to bodybuilding and would be extremely upset if I did indeed have this condition. Apparently HCM is either caused by your genetics (I don’t have anyone in my family with it) or could be caused by lifting too much and elevating blood pressure to the point where it puts too much stress on the heart, which in turn, becomes more muscular to combat the added stress.

I was wondering if anyone had any familiarity with HCM and could let me know if I would still be able to continue bodybuilding with the condition. It has become my life and I’m very dedicated to turning pro. This would be devastating news for me and I hope one of you could chime in.
Thanks.

You know what also causes hypertrophic cardiomyopathy and predisposes you to sudden cardiac death? Anabolic steroids… as to what dose/duration will induce it is entirely genetic… and perhaps you’re cardiac enlargement is merely pathological as a result of you’re training… or perhaps it’s AAS mediated. You should’ve known about the cardiovascular risks entailed by AAS use before hopping on.

Do you have a familial history of HCM? If you do… then that’s why you’ve got it… probably

Can you still use gear with HCM? Well if you have the malignant type induced by genetics or gear (training induced morphological change is a bit of a grey area… but I guarantee you almost all on this forum who train vigorously will have some degree of LVH/increase in cardiac mass) then you can keep taking gear, compete… but chances are almost 100% that it’d kill you.

High blood pressure over time will induce malignant enlargement of the heart… if you’ve been running around with uncontrolled hypertension for prolonged periods of time then that may be the causing factor, and anabolic certainly won’t help

Should mention athletes heart will typically give off an abnormal ekg, and echocardiogram results can sometimes mirror/overlap with the results one would see from congenital cardiovascular disease. At which point you can tell the difference via stress testing. With athletic heart syndrome the heart may be significantly enlarged. Resting LVEF may even be low… but upon exertion LVEF with athletes heart should return to normal, arrhythmia during exercise should be minimal perhaps barring a few PVC’s… with HCM/DCM this won’t be the case, and brief bouts of vtach may be present during exercise, the heart may respond innnapropriately to exertion, austonomic dysfunction may be present regarding HR recovery post exercise (don’t be on cycle when you get this test as AAS blunt parasympathetic nervous system recovery, thus HR recovery rate will be impeded.)

Wow, thank you. You seem very knowledgeable on this subject and I hope you don’t mind me asking a couple questions on the matter. I was well aware that anabolics increase the size of the heart and cause such problems. However, the fact that I’ve only used low dosages and live such a healthy lifestyle, it really surprises me that I could have have HCM. I’m currently on just TRT dosages of test (144mg/week) and that puts me in the normal range/slightly above.

Here are my questions to you:

  1. I haven’t done any cardio since I quit track/XC (1 year ago), I’m just starting to get back into an hour of cardio per day b/c this really scared me. Does lots of weightlifting induce ‘athletes heart’ just as much as lots of cardio does?
  2. By your demeanor HCM seems worse than athletes heart, will a stress test entirely rule out one or the other?
  3. Is HCM and/or athletes heart reversible?
  4. It it okay to continue to body-build having either condition?
  5. I do not have a history of HCM in my family and I’m very precautious when it comes to what I put in my body (I have only taken extremely low dose cycles for short periods of time), you say it would possibly kill me to continue taking gear, but what is the main mechanism behind the gear causing heart hypertrophy (is it elevated BP, higher protein synthesis, etc.)? What if its not HCM and just athletes heart, then would continuing to take gear be RELATIVELY safe?
  6. I would have to continue TRT regardless, what would you reccomend to do if I indeed am diagnosed with HCM? Cut down on training intensity? Do more cardio instead?

Answers

  • does weightlifting induce cardiac hypertrophy similar to endurance exercise? Yes and no… cardiac adaptation in part from strength training tends to be in the form of concentric left ventricular hypertrophy… in which the hearts walls thicken, yet the internal diameter of the left ventricle remains unchanged, excessive concentric hy-ertrophy induced by say high blood pressure or AAS will cause the left ventricle to stiffen, impairing the capacity of the heart to pump blood adequately. Endurance training induced an eccentric left ventricular hypertrophy, in which the internal diameter of the left ventricle widens. I’m going to have to answer each question in a new post as my device is fucked, and if the message goes over a certain length I can no longer see what I’m typing
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  • androgen receptor binding… androgen exert hypertrophic stimuli/enhanced gene expression via AR binding. Cardiac myocytes contain androgen receptors, thus over time it’s plausible to assume ( rodent models back this up too) that cardiac cells will grow alongside skeletal muscle… when the cells grow large enough, apoptosis mechanisms will be activated as a protective mechanism, the dead cells are now replaced with fibrous, stiff tissue predisposing the user to arrhythmia.

  • increased sensitivity to catecholamine release and sympathetic nervous system up regulation leading to autonomic dysfunction. Increased sensitivity to say ephinephrine etc will predispose the user to arrhythmia during exercise, increased heart rate in response to exertion and blunted parasympathetic nervous system recovery = heart pumping need;Easley harder for a prolonged period post workout (tachyarrythmia induced cardiac enlargement)

  • secondary effects like high blood pressure

Oxidise stress/antioxidant profile imbalance leading to cardiac damage/arterial stiffening

  • shitty lipids… long term plaque buildup and coronary calcification…

I can’t see anything I’m typing right now so this is all I can put today

Yes, firstly LV cavity dimensions differ typically between athletes heart and cardiomyopathy, secondly LV filling is typically preserved in athletes heart… also in HCM/DCM asymmetric septal hypertrophy, abnormal e/a ratios and a LV diameter of greater than 16mm may be present, wherein with athletes heart a LV dimension of greater than 16mm would be exceptionally rare and reserved for say… a pro cyclist… for some, esp AAS users athletes heart and cardiomyopathy may overlap with one another… final;y, with athletes heart, much of the structural changes will reverse upon deconditioning (say don’t exercise for six months) whereas with cardiomyopathy they won’t… however AAS induced cardiomyopathy when treated does appear to be at least partially reversible, other forms of cardiomyopathy such as arrhythmia induced cardiomyopathy are also typically reversible following treatment of the causing factor.

With athletes heart, yes… whether athletes heart presents a significant risk is up to interpretation, it does appear to (potentially) increase the risk for afib later on in life… however many, many athletes have enlarged hearts (malignant/drug induced and pathological… sometimes both overlap), and although the rate of sudden death is higher than normal… it isn’t like they’re dropping dead like flies (although this is starting to happen amongst bodybuilders as drug abuse is getting more and more extreme.

Yes

Not usually, depends on the cause

Holy hell, I’m no help with HCM, but going to failure every set for 3-4 hours daily sounds highly excessive. Could this possibly be the cause? I don’t know a thing about HCM, but damn that’s a lot of training.

That’s exactly what I thought. Doesn’t sound reasonable at all. I don’t think you could abuse your body like that without TRT and I don’t think you should do it with either.

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Although I have never ran any “heavy” cycles, my understanding of training and recovery still tells me that even those on grams of gear do not benefit from maxing out every set and doing so for 3-4 hours daily. At some point you end up doing more harm than good. Recovery is key.

Then again, I don’t know as much about working out on AAS as I do without. Maybe he knows something I don’t. I just can’t help but wonder if that could be contributing to the issue?

I entirely agree. I’ve been going to the absolute extremes to build muscle and it works in the short term. However, it’s been an overall detriment to my health “mentally too”. I shall keep you all updated with the echo cardiogram results (I’m going tomorrow and being called back by doc on the first week of Jan.) and in the meantime I’m going to cut back to two hours MAX at the gym and a mandatory off day once/week. I feel like the lack of recovery has really been hindering my ability to build muscle. Thanks for all the feedback guys, this forum is the shit and you all are great.

I actually think you will find that you build more muscle if you tone it back a bit. Inevitably you are overtraining. I don’t know a ton about muscle hypertrophy specific to AAS, as I’ve only run a few cycles. But AAS or not, that sounds extremely counter productive to me. I can’t argue much, as you’ve got a great physique, I do however think you will probably find that you get bigger by easing back a bit on the amount of time and the amount you reach failure.

As you get older, I think you’ll notice it helps you even more. Sounds like your body has been pretty phenomenal at recovering so far.

I really hope you figure out what’s going on and that you’re able to continue pursuing your body building. Sounds like a tough position to be in, best of luck!!

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On AAS it’ll work if the dose is high enough… without it’s undoubtedly overtraining… or not, it’s a lot harder to overtrain than most realise

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The question is where you draw the line. I think mental side effects of training are normal but if you get depressed almost every day of the week, I think that is overtraining as well as if you got all the other physical sides. And most of overtraining depends on life stress generally. A hard working individual is a lot faster over trained than a guy who goes to school and trains in his spare time free of any worries.

Man take at least 2 off days per week until you’re feeling better. And get your workouts in a shorter time frame, cut the junk volume. No need for 2 hour workouts every day.

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This is what changed my mindset from going hard every day for as long as I could push myself. You’re obviously much more advanced and know what works for you but this is a good read anyway.

Excerpt from Stan Efferding
It’s never the training routine that’s limiting growth, it’s always the recovery phase, eating and sleeping. The vast majority of people who want to get bigger and stronger already train hard enough to grow, they just don’t eat and sleep enough to grow. They carry a notebook and want to show me every rep and set of every workout and routine they’ve done for the past three years, but there’s not one page with a record of their meals. I feel bad for them because I know they work hard in the gym and they rarely miss a workout, but the notebook just documents all the muscle they’ve broken down and has no record of what they’ve been doing to build it up. I know because I did it myself. When I started college nearly 30 years ago there was no Internet and few reliable resources to find information about getting big and strong. I started lifting two hours a day, six days a week, doing endless sets and reps of every exercise in Arnold Schwarzenegger’s Encyclopedia of Bodybuilding. I struggled to put on five pounds a year until I finally came across an experienced lifter who told me I was wasting my time with all that lifting and told me to go home and eat. By cutting my training back to an hour three days a week and hiking my calories up to over 5,000 a day, I was able to put on 20 pounds in less than a year!

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This.

I literally have to fight myself to do less work, but it has helped me significantly in regard to putting on size. Look at guys like Dorian Yates who often do one exercise per muscle group and absolutely annihilate it in one complete set.

There’s definitely many ways to get the same results though. Certain things work better for some than others.

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Still haven’t heard back from the doc. Will update soon. However, are there any anecdotal ways to use anabolics in a way that reduces the tendency for the heart to form these unhealthy adaptations? Depending on what I hear from the doctor, I plan to continue to use anabolics - I’m just looking for the safest way possible. I only plan on ever using testosterone and primobolan because they have been proven to be the safest two anabolic steroids. However, do any of you have knowledge on how to use these compounds in the safest manner? I suspect lower dose cycles for longer periods of time (e.g. 400 primo and 200 test for 16 weeks) are a lot safer on the heart and body than higher dose cycles (e.g. 800 primo and 200 test for 8 weeks). Is there any evidence for this? What have been your experiences/awareness on this?

Hey there,
Quick Background: 200 lbs, 21 y/o, 7% bf, on TRT prescribed by a doctor (144mg/week), have run one test blast @ 300 mg/week for 8 weeks and one Primobolan blast/cruise @ 200 mg/week alongside TRT (for 6 weeks to see how I react to the compound). @theleangentleman on Instagram if you’d like to see my current physique. I eat extremely healthily (less than 12g sat fat/day, moderate carb, high protein, moderate fat, 4500 calories/day ‘lean bulk’). I used to compete in D1 track and XC but switched over to bodybuilding after a knee injury.

Anyways, I recently got my blood test results back:
WBC 5.9x10^3/u (3.4-10.8)
RBC 4.89x10^6/u (4.14-5.80)
Hemoglobin 15.5 g/dL (13.0-17.7)
Hematocrit 45.2% (37.5-51.0)
MCV 92 fL (79-97)
MCH 31.7 pg (26.6-33.0)
MCHC 34.3 g/dL (31.5-35.7)
RDW 13.8 % (12.3-15.4)
Platelets 143 L x10E3/u (150-450)
Neutrophils 70 % Not Estab.
Lymphs 19 % Not Estab.
Monocytes 9 % Not Estab.
Eos 2 % Not Estab.
Basos 0 % Not Estab.
Neutrophils (Absolute) 4.1x10^3/u (1.4-7.0)
L Lymphs (Absolute) 1.1 x10^3/u (0.7-3.1)
L Monocytes(Absolute) 0.5x10^3/u (0.1-0.9)
L Eos (Absolute) 0.1x10^3/u (0.0-0.4)
L Baso (Absolute) 0.0x10^3/u (0.0-0.2)
L Immature Granulocytes 0 % Not Estab.
Immature Grans (Abs) 0.0x10E3/u (0.0-0.1)
Glucose 86 mg/dL (65-99)
BUN 24 H mg/dL (6-20)
Creatinine 0.92 mg/dL (0.76-1.27)
BUN/Creatinine Ratio 26 H (9-20)
Sodium 137 mmol/L (134-144)
Potassium 4.5 mmol/L (3.5-5.2)
Chloride 99 mmol/L (96-106)
Carbon Dioxide, Total 25 mmol/L (20-29)
Calcium 9.4 mg/dL (8.7-10.2)
Protein, Total 6.4 g/dL (6.0-8.5)
Albumin 4.6 g/dL (3.5-5.5)
Globulin, Total 1.8 g/dL (1.5-4.5)
A/G Ratio 2.6 H (1.2-2.2)
Bilirubin, Total 0.6 mg/dL (0.0-1.2)
Alkaline Phosphatase 117 IU/L (39-117)
AST (SGOT) 55 H IU/L (0-40)
ALT (SGPT) 57 H IU/L (0-44)
Cholesterol, Total 159 mg/dL 100-199
Triglycerides 46 mg/dL (0-149)
HDL Cholesterol 35 L mg/dL (>39)
VLDL Cholesterol Cal 9 mg/dL (5-40)
LDL Cholesterol Calc 115 H mg/dL (0-99)
Chol/HDL Ratio 4.5 ratio (0.0-5.0)
Testosterone, Serum 791ng/dL (264-916)
Free Testosterone(Direct) 41.1 H pg/mL (9.3-26.5)
DHEA-Sulfate 227.8 ug/dL (164.3-530.5)
TSH 3.090 uIU/mL (0.450-4.500)
Prostate Specific Ag, Serum 0.6ng/mL (0.0-4.0)

This test was taken 4 weeks after ending my 6 week Primobolan blast/cruise and being back on TRT. Anyways, I have a few questions for some people more experienced than me.
I’m hoping someone could clarify these questions:

  1. Is there anything seriously wrong with my bloodwork? How do I interpret the flagged results? I know Primobolan was likely still affecting my bloodwork to a degree, does it seem to have caused any harm to my kidneys?

If you saw my last post: Hypertrophic Cardiomyopathy (HCM). To sum it up:
I am super concerned that I have HCM or LVM, despite being very physically fit and healthy and young, I often get very winded when lifting in the gym. I get numbness of my fingers when I lay down or wake up from sleep (all indicators of poor blood flow). I go hard af in the gym (to failure on every set) and train for 3 to 4 hours a day. I’m super dedicated to bodybuilding and would be extremely upset if I did indeed have this condition. Apparently HCM is either caused by your genetics (I don’t have anyone in my family with it) or could be caused by lifting too much and elevating blood pressure to the point where it puts too much stress on the heart, which in turn, becomes more muscular to combat the added stress. Since this post I have entirely restructured my training routine. (30 mins cardio every morning, 2.5 hours tops in the gym). …Back to the point:

  1. If I were to blast again, how long should I wait? What is the absolute safest/healthiest dosing to go about the dosing if my goal is to add more lean tissue while trying to minimize the possibility of worsening/developing HCM or LVM (only using test and primo). Anecdotally, would lower doses run over a longer time be healthier than simply blasting moderate doses for shorter periods of time? I understand the best thing to do is avoid adding anabolics to TRT altogether. But I’ve also learned that there are ways to minimize risk.

Thanks a lot if you made it this far.