Sudden death of 21 year old male

A family member of mine recently died very suddenly. He wasn't suffering from any sypmtoms, didn't usually drink or do drugs. The night he died he drank a few beers and took some oxymorphone. We thought for weeks he died of an accidental overdose. However, when the results of the autopsy came back it said he died of natural causes due to an enlarged heart. The doctor said his heart was twice the size of an average heart. He was 21 years old and very active. He was not overweight & worked as a roofer outside all day.

I would really appreciate if this could be explained to me in greater detail. Could the oxymorphone have cause his heart to swell?

[grendslori]

I certainly wouldn't think the drug would have caused this to happen. There are many people who die suddenly from Cardiomyopathies, which is what your family member died from. It is probably more realistic to say he was having symptoms, but keeping how he felt to himself. He may have been in denial of a problem; young people think they will live forever! He died from the same disease that basketball players on the courts die from. Do you know if he had Dilated Cardiomyopathy (where the heart walls are too thin) or Hypertrophic Cardiomyopathy (where the heart walls are too thick)? If he had the latter (HCM) then the family should all be tested for this disease because in many families there is a genetic factor.  

[erijon]

An 'enlarged heart' is the term used to describe a heart with an excessively thickened muscular wall or, alternatively, an over-stretched heart with dilated chambers. Both conditions impair the efficiency of the heart's pumping action and can be associated with 'heart failure'.

A thickened cardiac muscle nearly always results from prolonged and uncontrolled high blood pressure. Occasionally it's due to a tight exit valve (the aortic valve), and very rarely it is caused by an inherited disease of heart muscle.

An over-stretched heart is the result of cardiac muscle damage of any sort, most often due to coronary heart disease (blockage of  the arteries supplying blood to the heart itself), but it can also be the result of abnormal valves and, more rarely, the toxic effects of alcohol or infection on the cardiac muscle (cardiomyopathy).

Most drug related sudden cardiac deaths are due to an arrhythmia caused by the drugs, not en enlarged heart.

So sorry for your loss, I hope this helps,

Jon

[Jlcole1]

Thank you both so much for your input.

I talked to another family member today abou symptoms he may have been suffering && when looking back she remembered him complaining about having swollen feet. I'm not sure what other symptoms he had.

He was born with a murmur and the doctor said this would disappear as he got older. They didn't have health insurance so there was really no way of him knowing what what happening.

[kenkeith]

Jon is correct. "An 'enlarged heart'' is the term used to describe a heart with an excessively thickened muscular wall or, alternatively, an over-stretched heart with dilated chambers".  Thickened walls are almost always rigid, less flexible, also the enlarged walls crowd out available space for the filling phase (diastolic).  The result is usually diastolic failure (a loss of capacity to adequately distribute blood) and eventually if not treated successfully will cause congested heart failure.  Swollen feet could be an indication of rightside heart failure consistant diastolic dysfunction.

A dilated heart is not a risk because walls are "thin*  as previously stated..  A dilated left ventricle almost always results from an overworked heart (high resistance to blood flow caused by included vessels, loss of cardiac output due to valves, etc. The left ventricle increases in diameter to compensate...a dilated LV increases contractions when compensating (EF may be higher than normal at that phase) invoking Frank/Starling law of physics.  When over stretched (over compensation) there is a loss contractility (decrease of EF) and heart failure.  As an anology, if a handspring is stretched it will recoil stronger, but if over stretched it will become flaccid.  AN Enlarged Heart can/will cause a fatal arrhythmia...distort impulse pathways??.

QUOTE: "An enlarged heart may cause no symptoms. If symptoms are present, they can include:
shortness of breath
arrhythmia (Read about "Arrhythmia")
SWELLING or edema.(fluid in lung tissues)"

A murmur could/would indicate heart valve defect that could have stressed the heart to the degree that it enlarged and that condition could cause a rapid decrease in cardiac output, and/or heart arrest arrhythmia.