Performance-Enhancing Drug-Associated Myocarditis in a Young Athlete: From Cardiogenic Shock to Clearance.

BACKGROUND

Current guidelines on activity restriction in myocarditis carry significant implications for athletes.

CASE SUMMARY: We present a case of fulminant myocarditis in a 21-year-old athlete after performance-enhancing drug use. He presented with chest pain and dyspnea with ST-segment elevations on electrocardiogram. Coronary angiography was normal, and cardiac magnetic resonance confirmed myocarditis. His course was complicated by cardiogenic shock requiring inotropic support but improved with diuresis and high-dose corticosteroids. A shared decision-making approach guided a stepwise return-to-exercise strategy based on symptoms, biomarkers, cardiac magnetic resonance, and exercise stress testing. The patient gradually resumed training and returned to unrestricted exercise 3 months after presentation.

DISCUSSION: This case demonstrates the value of individualized, shared decision-making for management of myocarditis in athletes.

TAKE-HOME MESSAGES: Individualized, guideline-informed return-to-exercise strategies help balance safety with athlete goals after myocarditis. Screening for performance-enhancing drug exposure is essential because these agents may represent an underrecognized contributor to myocarditis.