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Other side-effects can include alterations in the structure of the heart , such as enlargement and thickening of the left ventricle , which impairs its contraction and relaxation .  Possible effects of these alterations in the heart are hypertension, cardiac arrhythmias , congestive heart failure , heart attacks , and sudden cardiac death .  These changes are also seen in non-drug-using athletes , but steroid use may accelerate this process.   However, both the connection between changes in the structure of the left ventricle and decreased cardiac function, as well as the connection to steroid use have been disputed.  
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