Clenbuterol-induced myocardial infarction in a young bodybuilder

A professional bodybuilder in his 20s presented to the cardiology emergency with acute, retrosternal chest pain and diaphoresis lasting 3 hours. He reported using clenbuterol, a sympathomimetic drug known for its anabolic and lipolytic effects, at escalating doses up to 180 µg daily. ECG revealed normal sinus rhythm with ST-segment elevation in the anterior leads with raised serum troponin levels. Coronary angiography identified a grade IV thrombus in the proximal left anterior descending artery with thrombolysis in myocardial infarction 3 flow and normal flow in the remaining vessels. The patient was treated medically with anticoagulation, antiplatelets and statins and discharged on dual antiplatelet therapy, statins and guideline-directed medical therapy. This case highlights the importance of considering clenbuterol-induced vasospasm and thrombosis as a precipitating factor for acute coronary syndrome in young patients without traditional risk factors.