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Thursday, November 08, 2007

cause of elite marathoner death not revealed by autopsy

It was a perfect weather day in New York for an Olympic marathon trial. At 5 1/2 miles into the race, world class runner Ryan Shay collapsed and died.

The preliminary autopsy findings did not reveal a cause.

According to a very good web site on sudden death in athletes which is actually entitled "Sudden Death In Athletes",The top three causes are Hypertrophic Cardiomyopathy (HCM)-26%, Commotio Cordis 20% and Congenital coronary artery abnormalities 14%. He was not struck in the chest and Anomalous coronary artery would have been noted on a gross autopsy but according to Dr. Douglas Zipes, a spokesman for the American College of Cardiology, differentiation between HCM and a very hypertrophied "runner's heart" can be difficult. At 5 miles into the race on a cool day there would be no reason to consider hyponatremia in an elite seasoned distance runner. I assume a cranial exam was done and no cerebral aneurysm was detected. So what is the answer? In some well publicized cases of athlete's death the answer was never made clear.

Two well known cases of sudden death during an athletic event,both leading to legal complications and controversy, were the deaths of Celtic basketball player,Reggie Lewis, and college basketball player Hank Gathers in Los Angeles. Apparently neither HCM nor anomalous coronary artery were the cause in either death which were surrounded with charges and counter-charges regarding how early symptoms were handled in these very "valuable"athletes.

In Italy, where the cardiology community is quite involved in screening athletes for potentially lethal cardiac conditions,an entity uncommon in the U.S. is said to be much more common namely, arrhythmogenic right ventricular cardiomyopathy (ARVC), a good discussion of which can be found here. The most common EKG finding is inverted right sided t waves, but this is also commonly seen with the benign incomplete RBBB pattern.A notch on the downstroke of the right precordial QRS complex is sometimes the tip off. In Italy, routine EKGs are recommended but that is not the consensus in the U.S. The Italian cardiologists have offered evidence that their evaluation which include EKGs have saved lives.

Shay's father has talked to the press and indicated his son had a history of "enlarged heart" as early as age 14 but he had been evaluated in the past and more recently and was given the OK to compete .

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