Official Ryan Shay Autopsy Results Are Here

Thanks Alan. From that same link here's the entry on hypertrophic cardiomyopathy http://www.clevelandclinic.org/heartcenter/pub/guide/disease/hcm/default.htm

Runningart2004 wrote:

About 1 in every 50,000 marathoners die during the race due to similar cirumstances . . .

If you are correct, about 8 people would die during U.S. marathons each year just from this ailment, to say nothing of other heart conditions, heat stroke, hyperhydration, etc. 403,000 runners finished U.S. marathons in 2007. (See

) Are saying that 8 of those 403,000 people died in 2007 during their races due to "similar circumstances"? That can't be right. Is what you meant? If so, what is your basis for saying it?

Don't know if this sheds light regarding fibrosis, i'm not a doctor, but i seemed to remember ryan discussing in a mensracing interview complications he was having with tooth issues -- which led to infection. Perhaps a doctor can shed light. Did this have a role on his fibrosis?

I wasn't sure whether to post or not, i really want to be sensitive to the Shay family. I am so sorry for their loss. I hope they seek comfort in knowing that he truly is immortal in the eyes of so many people. Whether we live one more day or 90 more years, all we could do is aspire to achieve what he achieved. He accomplished what anyone strives for during an entire lifetime -- to leave their mark on others forever. He did it in 28 years. One could look at that fact simply: he accomplished his work in 28 years, while the normal person is given from 70-90 years and often comes up short. Pretty darn impressive for Ryan. I suppose nothing other than that really matters -- he is immortal.

As an ex-runner who prides himself on being healthy, I suppose I grappled with the autopsy to understand why, and to convince myself that as a runner, who idenifies with Ryan on some level, we are invincible. Mr. Shay said it best -- indeed we are not invincible.

http://www.mensracing.com/athletes/interviews/ryanshay03.html

This is what I was wondering too. Hope our medical brothers & sisters can shed some light on this.

First off, I hope that I am not being disrespectful. Seeing that Case Shay is on here, I am abashed even to join the discussion. I lost a dear brother to a sudden cardiac event (fibrillation caused by myxomatous degeneration of the mitral valve--easier to diagnose). Knowing that, I hope you will accept my comments and my deepest sympathy.

Never having had a personal history of heart disease (at least that I know of), and not being a physician, it seems to me that the only tools that would have found this are ones usually reserved for those with heart disease and older people--specifically a cardiac catheterization/angiogram, or open-heart surgery (usually not your first option).

Should Ryan have had a cardiac cath? Ryan might have gotten it past the insurance company, if he had insurance, because his heart was already so big. Apparently no physician thought it was necessary. He was a young man, and crazy fit.

Relating this back to the rest of us, I don\'t believe that most of us could get this test paid for. I may be wrong on that; most of us non-elites think elites get tested weekly for everything, but I\'ve learned from this site that this is not so. I\'d bet not even the Italian athletes are required to get an angiogram.

Now, assuming that Ryan had had a cardiac cath and that he learned of the scarring, would he have been medically advised to quit competition? One has no idea. I guess it would depend on how much scarring and where, and on the docs\' opinions. The docs might not have advised him to quit.

I figure some troll may say, \"Oh, he wouldn\'t quit anyway.\" Ummm...bullshit. From all accounts, this man was way too loving to do that to his family.

All right, I\'m almost done. How should this addition to our limited knowledge change our behavior--specifically whether and how hard we run? We still don\'t know. All we can do is get all the information we can, try to do right, possibly go to war with our respective health insurance carriers, and leave the rest in God\'s hands.

God bless the Shay family.

M. Sullivan (Kentucky)

Ok, here's the deal on cardiac caths:

Cardiac catheterization is a procedure that is done to evaluate the blood vessels of the heart (and occasionally the vessels leading to and from the heart)

As such, they are useful in identifying problems with those vesssels - narrowing usually due to cholesterol deposits.

Ryan Shay had "fibrotic" tissue in his heart. Fibrosis is a fancy medical term for scar tissue, but the key is that the fibrosis was not in the blood vessels. It was found in the actual working part of the heart - presumably the atria and the ventricles. Shay's problem had absolutely nothing to do with the blood vessels of the heart (the coronary arteries and their branches) or the vessels leading to or from the heart.

The only test that can identify fibrotic tissue of the heart is a biopsy - where they stick a hollow needle into the heart and extract tissue - or an autopsy. Heart biopsies are extremely dangerous, and basically used as a test of last resort when a patient is on the verge of death.

From all media reports, Ryan and his family were aware that there was something abnormal with his heart, dating back at least until the time he was 14 years old. From the same media accounts, it appears Ryan was followed by cardiologists ( = heart doctors) over the years.

What killed Shay was a spontaneous abnormal electrical rhythm (i.e. an arrhythmia). These abnormal rhythms were presumably caused by the enlargement of the heart over the years.

Think of it this way - in a very simplified model:

Running throughout the heart there are many wires that conduct electrical charges. These charges are synchronized so that the entire heart beats in unison. When the heart gets bigger than it should, some of those wires stretch and bend. Thus, some electrical charges are conducted normally, some take longer due to the stretching. Some might even begin to "fire" on their own, conducting electricity out of seeminly nowhere.

When that happens, it's just a matter of time before they pass through the entire heart, and make it impossible for the heart to beat normally, and thus pump blood normally.

The only "cure" at that point is defibrillation ( = shocking with the paddles) and sometimes that is not enough to reset the rhythm.

There are very few tests to a spontaneous abnormal rhythm. An electrocardiogram (EKG) can measure the electrical impulses of the heart, but unless there is a problem right then and there, it won't show up. Longer term electrical monitoring (called a Holter or event monitor) can be used, but again, unless an event happens when the person is wearing the monitor, you won't find the problem.

Finding a spontaneous abnormal rhythm is akin to standing a random street corner waiting for an accident to happen. The law of statistics tell you that is possible, but you can stand there for a day, a week, a month, or a year and not see an accident. And the day you leave there could be a 5 car pile up. It's completely random, hit or miss, and at this time there is no good way to predict it.

Hope this helps.

Well, yeah, that helps a lot. Sorry. I didn't know where the fibrosis was. Thanks.

I don't really think that we disagree much in the end result, though. I agree with you (even though you are perhaps an MD and I am definitely not) that the chances of a spontaneous arrhythmia are microscopic. You could have put a Holter monitor on Ryan for a month but it wouldn't have meant a thing. My point was that even if you could easily ID fibrotic tissue, and you could get the cath paid for, so what? The doc might still tell you it's OK to run. They don't know, and we don't know. That's what is making it so hard for this family and the running community at large.

On the other hand, life is like that.

Peace out