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Monday, November 05, 2007

Ryan Shay Autopsy Results Inconclusive

6 March 2008: News report on Ryan Shay autopsy: Why the delay? And results are imminent

More detailed posts and insights on Ryan Shay and sudden death during exericse:

As all of us still try to accept the tragic death of Ryan Shay during the USA Men's Olympic Marathon Trials, the cause of death has not yet been determined by the medical examiner's office. An autopsy was performed on Sunday but was not conclusive.

Ruling out a heart attack

Although inconclusive, one thing we can say is that Shay's death was apparently not due to any kind of coronary artery disease that would result in a heart attack---that is, the arteries supplying blood to the heart become clogged and the heart does not receive sufficient blood and oxygen. Instead the lack of any significant finding at this point suggest that the cause of death was cardiac arrest, which is when the heart stops pumping due to electrical imbalances. All the available evidence to date suggest this and includes that fact that Shay collapsed suddenly and also that he is below the age of 35.

In our post on Saturday night, we discussed how circulatory problems, like coronary artery disease, are responsible for most sudden deaths in older athletes, whereas younger runners usually experience electrical problems leading to sudden death. The two main reasons for these electrical failures are Hypertrophic Cardiomyopathy (an enlarged heart) or abnormalities in the coronary circulation. Ryan Shay was apparently diagnosed with an enlarged heart, but we also did point out that all athletes have larger than normal hearts, so even that is not a telling indication of the cause.

Adrenal Fatigue Sydrome?

According to a recent article on Runner's World Shay was told in 2006 that he had "Adrenal Fatigue Syndrome," the main consequence of which appears to be a fall in cortisol production. While possible Shay really had this, it appears unlikely to feature in the cause of his death, although it might warrant a post in The Science of Sport in the future.

In the mean time we must wait for the histology results to come back from the ME's office in New York. They will examine the tissue microscopically to check for any signs of pathology that might be responsible for his untimely passing.

Friends and fans of Shay should visit the LetsRun.com official remembrance thread in their discussion forum. Barely 24 h after his death there are over 16 pages of remembrances and tributes, which indicates clearly that he will be missed by everyone in the US running community.


DrWinn said...

He had an enlarged heart as a teenager, so I suspect it was not a 'totally' benign condition - kinda supported by his sudden death. I think the real take home lesson here is that defibrilators should be present at all athletic events. Also, screening ECGs in sports physicals should be mandatory (and paid for by insurance) to identify those individuals with long QT syndrome and WPW. In Italy, where screening ECGS are required, sudden cardiac death in young atheletes is 10 times lower than the U.S.

Ross Tucker and Jonathan Dugas said...

Hi Dr Winn

Thanks for the comments. Agreed on some points, though I just have to point out that they did have defibrilators at the event, and he was apparently treated very soon after collapsing - quite what this treatment involved, I don't know.

As for the mandatory screening - that is something we did cover in previous posts on this topic, first after a spate of sudden deaths in the sport of soccer, and then after this latest event - you'll be able to find these by doing a search on the site. And while I acknowledge that the screening has helped in Italy, there are also studies that have shown this to have a pretty low cost-benefit ratio. And while I don't wish to assign financial value to life, the evidence suggests that these screenings are probably not that effective because they still fail to pick up on very many possible conditions.

More than this though, there is a massive ethical question - what do you, as a clinician, tell an athlete who has been diagnosed with MVP, for example, not to train, when the actual incidence of mortality in this population is so low? For things like WPW, there's more reason to do this but it does raise a host of ethical questions.

Thanks for the comments!

Anonymous said...

When are the histology results expected?

And what is the protocol on autopsies? Are they always performed when cause of death is unclear? Are the results always publicly released?

Recently, Mike Janelle, a 40 yr old US pro endurance cyclist, died in his sleep. Given the state of pro cycling, one can't help but wonder whether EPO use contributed to his untimely passing. I wonder if there will be an autopsy and public release of the results.

Amanda said...

I am a nurse, a long distance runner, and recently diagnosed with an enlarged heart. The cardiologists refer to it as a normal deviant. Hearing about Ryan Shay though freaked me out. I am in the middle of training for a marathon and wish to know how to play it safe. I am curious to know how medical officials clear someone for running.
In the course of my medical studies I have learned how hydration issues can irritate the heart and cause electrical imbalances. In addition to pathology tissue samples taken from Ryan Shay, will there be any studies looking at his blood and electrolyte status?

Ross Tucker and Jonathan Dugas said...

Hi Amanda, and thanks for your question.

We have all been waiting anxiously for more results from Ryan Shay's autopsy. The medical examiner's office said it would be a week t odo the tissue samples, and sine then no one has heard a peep from them!

I suspect many, including his family, are waiting to hear the final results, and one can only guess why the ME's office is taking so long with this one. However it would appear to unrelated to hydration since 1) his collapse occurred after only 5.5 miles, and 2) I would argue that even after a marathon as long as a person had ad libitum access to fluids any dehydration they have is not clinically significant.

Your enlarged heart is likely the result of your exercise training. A family history of sudden death of cardiac myopathy would be an important sign, that is, if you have a family history then you are at higher risk.

As I am not a medical doctor I cannot advise you on the medical implications. However the evidence shows that the risk of sudden death during exercise is relatively low.

If you are really concerned about it, seeking a second or third opinion might help you feel better about your situation.

Kind Regards,

Anonymous said...

i have a question relating to but may not be, i am a 30 year old male and was diagnosed with atrial fibrilation, does this mean that my heart is degenerative, and is it a symptom of an enlarged heart because i also was diagnosed with that too...oh i am also a runner, i have really stopped running with any consistancy because of this and would like to get back to it because i use to be about a 4:10 miler but i am afraid of what the strain would do to my heart. thanx and wish all the best

Anonymous said...

It seems odd to me that, after articles and blogs saying "we anxiously await the final autopsy results" there were never any more postings anywhere about results. I was at Central Park that day, and the first few miles of the race were not run very hard -- the pack was at slower than 5:00 pace at the 3 miles mark. I think a runner at the level of Ryan Shay must have literally done *hundreds* of runs up to 5-6 miles long that hard during his life (between 10k races and splits in longer races at that pace, tempo runs and speed workouts) ... the chances of dying from some random anomaly (electrical signal disturbance, etc...) at that point in the olympic trial seem so slim. Whatever the cause of death, it is a tragedy, and Ryan's family and friends have my sympathy. But I'm wondering if there were findings that were not made public in deference to the family and them memory of the runner? If, for example, some performance enhancing drug were found -- and I am *not* suggesting this is the case, just using it as an example -- would that have been made public in a case like this? Or, if there were more discovered about a congenital problem (I'm also *not* suggesting this was the cause), would that have been made public?

Ross Tucker and Jonathan Dugas said...

Hey anonymous

Thanks for the thoughts. I've been trawling through the various websites and blogs and chat rooms in the last few weeks hoping to find those autopsy results myself, but nothing. There is a lot of speculation, and the occasional frustration that they're not available yet.

I don't know the reasons and it would be remiss to speculate on the reasons. I do know that it can take a while - we have had cases here in South Africa where there is such a back-log on the autopsies that it can take years. That's SA though, I imagine it's unusual in the USA to take this long.

There are a couple of other possible reasons though, so I wouldn't leap to the banned substances theory by default. I still believe the electrical disturbance in the heart is the likely explanation - it's happened four other times this year (most recently, to a soccer player in Scotland), and while I acknowledge the improbable odds of it happening, the thing is that it DOES happen, and I think it happened here.

But we need to wait on this autopsy, and I'm not sure when that will come, if ever.


Jeff said...

Hello Ross and Jonathan.

I Did a Google search for Ryan Shay Autopsy and came across your blog.

It was most interesting to find the latest post (Jan 3) which basically echoed what was on my mind - followed by your very thoughtful and respectful post in reply....

Hopefully some more information will be forthcoming soon - about this terrible tragedy.....

When it does, I suspect you'll post it here.......

Jeff Dinkin

Ross Tucker and Jonathan Dugas said...

Hi Jeff, and thanks for visiting us here at The Science of Sport.

We are staying tuned for the final results from the autopsy, but to date nothing has been released. Unfortunately his case is probably tied up in normal big-city red tape and bureaucracy.

We hope to see you in some the discussions of our future posts. You can receive all of the posts via email by subscribing on the front page.

Kind Regards,

Anonymous said...

First of all, an enlarged heart (aka "athlete's heart") is NOT normal. It is a response to intense training which, let's face it, is not something the human body was really designed to do. So, some elite (and here I mean high school who compete at national levels as well as collegiate and professional) athletes do develop athlete's heart and no one thinks too much about it because it's perceived as normal when, in reality, it is a potentially lethal reaction to something that the body really isn't designed to do. In addition, hypertrophic cardiomyopathy (HCM), which is potentially very deadly in athletes, can mimic athlete's heart. (HCM, by the way, is genetic and affects 1 out of 500 of the general population.) Of course, there are other heart conditions given as diagnoses which, also, are really HCM. In any case, knowledge, even by cardiologists, regarding HCM and, specifically, HCM in athletes (much less elite athletes) is not widespread, and there is also definitely the fear that one may be curtailing or completely eliminating competition for an athlete when the perceived risk of death is low. From my new education on HCM, if Ryan's heart wall is over 1.5, the death was almost certainly caused by HCM. [Although the fact that his resting heart rate has been reported to be as low as 28(!) leads me to believe that, although HCM could have been a contributing factor, he may have been one of those "lucky" individuals to be hit with at least one other heart condition, most likely genetic, and oftentimes (but not always) undetectable without genetic screening.] For more info on HCM, you can visit www.4hcm.org and for more info in sudden cardiac death, you can visit www.sads.org. [I'm a spokesperson for neither; just a sad parent looking for answers.]

I'm definitely looking forward to the final autopsy results, although if it wasn't HCM (or if it were in addition to HCM), only genetic tests could give us an answer.

honeyrose said...

Any update on Ryan Shay's histology and toxicology results or reason for the delay?

Ross Tucker and Jonathan Dugas said...

Hi Honeyrose,

Thanks for visiting us here at the Science of Sport.

Unfortunately we have heard no news whatsoever on the results from Ryan Shay's autopsy. We have been glued to the net and waiting for any news to come out, but the medical examiner's office in New York still has not released the final results from the toxicology.

It seems all we can do is stay tuned and keep watching the news sites for a press release.

Thanks again for visiting!

Kind Regards,

Jeff said...

I assume you'll most likely post a new blog entry when the results finally do come out, but if possible, would you please post something in this comment section once you do?

Particularly since I (and others) have subscribed to the E-mail alerts that notify me (us) of comments added to this thread.

This is a great blog, but I'm personally just too busy to keep checking the blog manually for an update. This would be a huge help...


Ross Tucker and Jonathan Dugas said...

Hi Jeff

Sure, we'll do that. You can also subscribe to the new posts we do, in addition to subscribing to comments from this post only - so if you want to get posts as they go up, you can go that way.

But we'll try to get some answers on this - no word even on why there has been such a delay, but we'll try to get some answers soon, and post here as well.


The Sports Scientists said...

Hi Jeff,

As Ross said, as soon as we hear any news we will definitely do a post as it will be an important chapter in the story of Ryan Shay's untimely death.

Definitely subscribe---it will save you having to check back all the time. The best thing about the Feedburner service, besides that it is free, is that you only receive something when we post. . .so, no post, no email from us. It is a great way to keep up to date with The Science of Sport without visiting everyday.

Thanks for the support!

Kind Regards,

Jeff D said...

Hi guys,

I had this bookmarked and thought I would check back here to see if there was anything new about Ryan Shay, but it would seem not.

Isn't this highly unusual and suspicious?

I can't believe how much time has elapsed with nothing new to report.

Makes one wonder what they are hiding.....

Ginny said...

I am very interested in this case. My daughter died from complications after a heart transplant at 26yrs. She had been diagnosed from the age of 5 with a hypertrophic cardiomyopathy. Strange thing is my madien name is Shay. Curious isn't it ? Hers was a birth defect. No cmv or other infections.

OmegaGX said...

any news on the autopsy report?