Collapse of 48 year old male

[GYPZE]

Avid Long distance runner for 6 years.
slightly enlarged heart (congenital)
Presently possible use of fat burners and performance enhancers.
Was on lasix and something else for high blood pressure.
I just Recently found out he had taken fen-phen about 6 years ago
for more than 6 months.

There was no direct cause of death on the autopsy.
Blood work came back with nothing found.
A specialist was called in.
Patient had mentioned chest pain, fatigue and leg pain while
running about 8 mos. prior to collapse on April 25th, 2003.
Enzymes were checked then- all within normal limits.
EKG ????? or Echo ????

I am an x-wife and best friend. Can VT/VF be found from the
autopsy??   How can I get details from the pathologist
that performed the autopsy or from the specialist that has
been called in.    And Could there be any other causes
of the collapse....  And would all this be painful?? Or what happens?? to the Patient??
This is very important to me... I loved him very much??
Thank You!!!
GYPZE

[CCF-M.D.-RCJ]

GYPZE,

Thanks for the post.  I'm very sorry for your loss.

Ventricular rhythm disturbances, like VT or VF, cannot be detected on autopsy.  A poor analogy would be that you could not find a short circuit in a computer if the computer had no power source.

The most common cause of VT/VF in the United States is coronary artery disease, which can be detected on autopsy.  If significant coronary artery disease is detected at autopsy, and the person collapsed and died suddenly, then a diagnosis of Sudden Cardiac Death can be rendered -- this was the presumptive diagnosis when Daryl Kyle (the young St Louis Cardinals pitcher) died last year.

However, other causes for VT/VF exist.  A short list of causes could include dilated cardiomyopathy, congenital heart disease, congenital Long QT syndrome, drug-induced long QT syndrome, and other less common causes.

Sudden Cardiac Death is not thought to be painful, as evidenced by discussions with survivors.

Contacting your doctor or the doctor for the deceased may facilitate a discussion with the pathologist and/or specialist who performed the autopsy.  I would recommend a face-to-face conversation, not over-the-phone.

Hope that helps.

[GYPZE]

Thank You for your help and support!!

[HealThySelf]

Sorry about your loss.  I'm been told that I am at high risk of sudden cardiac death, because of my advanced coronary artery disease. I have come to terms with it over the last couple of years, although I don't place my risk as high as the cardiologist did.  I would say it's fast and relatively painless -- probably just go unconscious and don't wake up.

I would be suspect of the Furosemide (Lasik).  I don't think that it's a very good idea to draw the water out of every cell in your body and then go long distance running.

I do very strenous all day hiking to the tune of at least 10,000' of elevation and 35 miles each week.  I try to put 2 or 3 bottles of water in during the day.  Your cells need a lot of H20 to burn when they are working.  Of course water in the cells effects conductivity in the heart muscle also.  I definitely would stay away from any diuretic drug.

Unfortunately diuretics have come back into fashion for BP control.  That may be okay for Grandma sitting in her rocking chair or Joe Blow sitting in his recliner in front of the TV, but they could be deadly for active people like your friend.

Best Wishes

[HealThySelf]

Try putting Diuretics + Sudden Death into your internet search engine.

I came up with a lot of hits.

The main problem with diuretics seems to be the depletion of magnesium and potassium which can cause life threatening arrythmias and sudden death.

That drug in a physically active person with hypertrophic cardiomyopathy might have been a deadly.

According to one article that I read:

"Adrenalin released during intense physical or athletic activity often acts as a trigger for sudden cardiac death when these predisposing conditions are present."

Unfortunately a recent study stated that the older diuretic drugs were just as effective against BP as the newer ace inhibitors and calcium channel blockers.  

Of course they are off patent so they are cheap and the insurance companies like that.  The problem is that sometimes doctors are just interested in one endpoint such as BP control and don't look at the big picture.

Best Wishes





  

[HealThySelf]

One last note.  Lasik documentation has a warning not to use if taking seratonin-reuptake inhibitors the risk being SCD.

That would include most of today's anti-depressent drugs.

[GYPZE]

Thank You for the input!!!!
I will look into what you have suggested.

I hope you are not putting your life at risk
unnecessarily..... for the people that love you.
I know that may be selfish of me but I would give
anything to turn the clock back....  To have
Terry back in my life.

The Best to you!!!!
Gypze

[HealThySelf]

Yes, physical exersion with a diseased heart can be deadly.  Of course no exersion with coronary artery disease is ultimately deadly also.

Unfortunately for many people, like your ex-husband, the first time they experience an arrythmia it's fatal.  

I would suspect the combination of diuretics and hard physical exercise.  Those two things work against each other.  If he was on an anti-depressent the risk would be even greater.

Even seemingly innocuous drugs can be dangerous under certain circumstances.  I think both beta-blockers and diuretics are drugs seen by doctors as a very safe, effective, and cheap way to control BP, but I don't think either class is a good first choice.  

Good luck to you, and may you find happiness in life.

[GYPZE]

I think you are right about what happened.
The final diagnosis was Heart Attack... something with
Ishemic.  I do know what that means.  I didn't request
a copy of the autopsy... decided to try to just accept
it.  The end result is the same.
Thank You for the Well Wishes!!!!
Many Blessings to you too!!!  
I have come to accept that he was happiest running,
And did not have to go through a lot!!
So, I am proud that he loved it so much and found a place
to express himself.
Best Wishes!!
Gypze

[HealThySelf]

I have watched people die over a period of time with such things as liver cancer and kidney failure.  It's long and angonizing for the patient and family and usually takes place in hospital rooms.

Wednesday I hiked up about 3,000' to an extremely beautiful place here in the North Cascades.  On the way back down, I took a swim in this high mountain lake.  It's hard to describe how beautiful it is with the mountains all around and a perfectly blue sky.  I only saw 4 people up close and 3 from a distance all day -- not like how most of us live in the 21st century.  

I try to do this stuff at least every other day in the summer.  I have been told that I am at high risk of sudden death because of my un-bypassed coronary artery disease, but I can't think of a better way to go.  Much better than dying from a big fat liver over a period of weeks in a hospital bed.  

I think that it's important to enjoy your last day on earth and you don't know when that is going to be, so you really have to enjoy every day as much as possible.

Also, much of the joy in life comes from using your body.  My heart has some limitation, but It still gets me there and I ask it to do something every day.

Best Regards