Many athletes may indicate that they are not taking medications and fail to recognize that herbal preparations and dietary supplements may contain prohibited sub¬stances that are cardiovascular stimulants. Substances commonly used by athletes include ephedra alkaloids (e.g., Ma Hung or ephedrine) and guarana (caffeine). Adverse effects include arrhythmias and catecholamine cardiomyopathy.
Anabolic steroids containing androstenedione or andro-stenediol may cause left ventricular hypertrophy. These two compounds are precursors to testosterone and estrogen. Cases of sudden death have been reported in athletes using anabolic steroids. A catecholamine cardio-myopathy may be a dangerous complication. Dickerman et al. reported that 100% of athletes using anabolic steroids had a left ventricle wall thickness greater than 11 mm. These substances may cause hypertension and dyslipidemia.
Creatine has been shown to enhance muscle growth and increase strength without the side effects of the anabolic steroids. This agent increases muscle mass in active athletes who engage in intense isometric training, but not in those are who trained aerobically. No major side effects have been observed. Weight gain may occur during the first two weeks of therapy.

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