It’s Not Natural, and Definitely Not Normal, to Die From Cardiac Arrest: The Death of Caballo Blanco

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It’s Not Natural, and Definitely Not Normal, to Die From Cardiac Arrest:
The Death of Caballo Blanco
By Sock Doc, Dr. Steve Gangemi

It’s interesting to read a report, in this case an autopsy report, which reads that the individual died of heart disease that was “natural” when that person was only 58 years old and supposedly in excellent health. I’m referring to the sudden and to some extent, unexplained death of Micah True, also known as Caballo Blanco – the man made well known throughout the world from the huge success of Christopher McDougall’s book Born To Run. He was found dead during a training run on March 27, 2012.

The medical examiner performing the autopsy has deemed True’s death a result of “unclassified cardiomyopathy which resulted in a cardiac dysrhythmia during exertion.” Basically this means that he died because his heart muscle was deteriorating slowly over time and eventually this created the electrical activity of his heart to beat abnormally most likely leading to inefficient pumping of the heart and finally cardiac arrest. Normal? Definitely not. Common? Perhaps very much so.

The examiner further states, “The manner of death is natural.” Sure this is officially classified as “natural” on the death report since he wasn’t shot or had a boulder fall on his head, but dying this way is far from natural. A heart doesn’t “naturally” fail in such a manner, especially at 58 years of age. Though the most common reason for cardiomyopathies is ischemia (lack of oxygen supply to the heart), the medical examiner notes that there was no evidence of ischemia or inflammation of the heart. It’s all a bit strange.

So since there was apparently no ischemia or other cause for True’s heart disease, this could very well leave one to speculate that his condition, and death, was one which resulted from hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy (HCM) is a thickening of the heart muscle and the most common leading cause of sudden cardiac arrest and heart problems in athletes. Those with HCM often have a severe thickening of the left ventricle of the heart, and True’s autopsy does clearly state this. This condition, known as left ventricular hypertrophy (LVH) can eventually result in cardiomegaly – an enlarged, inefficient heart. The medical examiner does note in his review of the cardiovascular system that True’s “heart is enlarged” and further notes “mild to moderate arteriosclerosis”, though he makes no relationship of either condition to his LVH and further back to his HCM – his “cause of death.”

Ultimately True died in the same matter many fit but unhealthy athletes have died in the past, and unfortunately many more will succumb to the same fate in the future. In 2007 during the Olympic marathon trials, 28 year old long distance athlete Ryan Shay collapsed and died from a heart attack. He, like True, also had cardiac hypertrophy, and subsequently cardiomegaly. And like Caballo Blanco, his final autopsy notes that he too died of “natural causes.”

I can assure you one thing – dying from a heart attack due to prolonged, chronic structural changes in your heart is far from normal and further from what “natural” really is. A thickening and scarring of cardiac tissue is the result of the body’s inability to keep up with prolonged and excessive stress demands – essentially it’s in constant repair mode, and losing. Shay had this process occurring in his heart (fibrosis) and True in his arteries (arteriosclerosis). These “osis” conditions are due to free radical damage, inflammation (even temporary, but frequent), and hormonal and metabolic problems that occur from training too hard, lack of rest, improper diet, and other lifestyle factors.

In Part V of the Sock Doc Training Principles I go into further detail how and why highly conditioned athletes are dying from chronic endurance training and steps you should be actively taking now so you too don’t all of a sudden die from a “natural cause” such as a heart attack, cardiac arrest, or any other disease or disorder in which your body can no longer keep up with the demands you place on it.

http://naturalrunningcenter.com/2012/05/10/autopsy-report-micah-trues-death-due-cardiomyopathy/

http://sock-doc.com/2012/05/micah-true-death/
 
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A thickening and scarring of cardiac tissue is the result of the body’s inability to keep up with prolonged and excessive stress demands....... True in his arteries (arteriosclerosis). These “osis” conditions are due to free radical damage, inflammation (even temporary, but frequent), and hormonal and metabolic problems that occur from training too hard, lack of rest, improper diet, and other lifestyle factors.
http://sock-doc.com/2012/05/micah-true-death/

TJ, it sounds to me like the Sock Doc is attributing True's atherosclerotic coronary artery condition to lifestyle factors.
I don't question that the enlarged heart (cardiomyopathy) MAY have been directly related to running, and inflamation of course IS currently thought of to be the major culprit in the etiology of CAD, but I believe within the next ten years researchers will prove that coronary artery disease in athletes that don't smoke, have normal lipid profiles, are not diabetic, and are not overweight is due to genetics and that only a miracle med or gene splicing will prevent it.
It's always nice to believe that we are in charge of our own health, but the secret to preventing coronary artery disease has still not been unlocked.
 
At 46 I am still a life novice. If I came with an operating manual, my parents lost it somewhere along the way. Having said this, I feel that Soc Doc has a good point. Physical conditioning is a process of damage and repair. For whatever reason many parts of our bodies either cannot tell us what they need or we cannot hear them. Regardless, I agree that death at such a young age is neither natural nor acceptable.

Soc Doc, is there some mechanism for athletes to reasonably find out the actual health of their hearts? I know several pretty hard core ultra runners and wonder if they are also at such risk as Caballo Blanco.

Longboard, you may indeed be right that the true base culprit is genetics (or perhaps environmental??). If so, knowing that this hazard exists could cause some to recalibrate their training with the right medical/health advice.
 
Soc Doc, is there some mechanism for athletes to reasonably find out the actual health of their hearts?

Longboard, you may indeed be right that the true base culprit is genetics (or perhaps environmental??). If so, knowing that this hazard exists could cause some to recalibrate their training with the right medical/health advice.


Coronary artery disease kills more Americans than all other forms of heart disease, cancer, and infectious diseases combined.
Until around ten years ago the classic first sign of the condition was sudden death from heart attack.
Sure docs used blood pressure, resting pulse rate, cholesterol numbers, the presence of diseases like diabetes and family history as general indicators, but there was really no way to know the true condition of the coronary arteries unless they injected dye into them and viewed the heart with a flouroscope like device.
Ultrasound could show how the heart was working at rest as well as under stress, and a "stress test" could show how well blood was being supplied to the heart muscle, but if you passed these tests it still did'nt really tell you whether you were indeed suffering from the condition or not.
These imaging techniques did however warn of enlarged hearts, thickening of walls, and congenital as well as aquired defects, etc.
Around a dozen years ago with the development of a high a speed CAT scan of the coronary arteries the degree of calcification could be directly measured, so even the active person with no signs of the disease that passed the nuclear stress test and doppler echo tests could be warned well in advance that they were suffering from the condition even if it was not clinically significant.
Then came three dimensional imaging of the coronary arteries themselves, which also told the patient nothing of actual function, but could clearly show blockages without resorting to the invasive arteriogram, AKA cardiac cathaterization procedure, which although considered the gold standard is still only done when there is evidence of the disease.
So why know?
A highly trained athlete with no signs of disease may one day be running uphill in very cold temps and suddenly find themself in the midst of a heart attack.
Had an imaging study shown the presence of coronary artery disease, they may well have been advised to keep up the training, but to be careful under certain conditions, in this case cold temperatures causing arterial spasm and a decrease in efficiency of the cardiovascular system.
I know a guy who is a non smoker, regular exerciser, normal weight and lean non diabetic who volunteered for the calcium scan of the coronary arteries only to find that he was in the 5'th percentile of assumed blockage for his age! This walking heart attack waiting to happen was shocked, but then again not so much. His father had been a health and fitness junkie and had suffered a heart attack at age seventy followed by triple bypass surgery.
Knowledge is power, I strongly recommend calcium scoring and nuclear stress testing for all adult athletes, and ultrasound imaging for every teen athlete.
 
Dr. G. made a couple of edits to the article, so I updated it above. Don't know which ones.
 
People love to use genetics as an excuse for so many things it's out of hand. Sure genetics have a role in EVERYTHING but it's how you turn on and turn off genes >> Gene Expression. Diet, lifestyle, exercise, etc...all have an impact on your genetics. And yeah there are genetic disorders but we're not going to discuss that here. Genetics as a reason for CAD? Come on. These are overtrained, under-rested, stressed out athletes eating poorly for the most part. Sure maybe they wouldn't have died the way they did if they had better genes but there's so much more that can be done preventively. The "secret to preventing coronary artery disease" is never going to be found, because there is not just one "secret" just like there is and never will be a "cure" for cancer.
 
Dr. G. made a couple of edits to the article, so I updated it above. Don't know which ones.
The edits were because I realized that the use of the word "natural" per the death report and natural in regards to health were confusing a bit.
 
I agree with all of the Sock Doc's stuff except the line

.....and True in his arteries (arteriosclerosis). These “osis” conditions are due to free radical damage, inflammation (even temporary, but frequent), and hormonal and metabolic problems that occur from training too hard, lack of rest, improper diet, and other lifestyle factors.....

I find it hard to believe that the arteriosclerosis had anything to do with training to hard, lack of rest, etc.
But even the coroner's findings did not indicate that the presence of coronary arteriosclerosis had anything to do with Micah's death, which was attributed to cardiomyopathy.
 
I agree with all of the Sock Doc's stuff except the line

.....and True in his arteries (arteriosclerosis). These “osis” conditions are due to free radical damage, inflammation (even temporary, but frequent), and hormonal and metabolic problems that occur from training too hard, lack of rest, improper diet, and other lifestyle factors.....

I find it hard to believe that the arteriosclerosis had anything to do with training to hard, lack of rest, etc.
But even the coroner's findings did not indicate that the presence of coronary arteriosclerosis had anything to do with Micah's death, which was attributed to cardiomyopathy.

Rather than say you disagree you should offer your own opinion or back it up with well, something. And I never say that arteriosclerosis had anything to do with his death, though I note that these conditions are very much related to one another. It's much like an injury in a way - you can say you have Achilles tendonitis, shin splints, and a bad back. Treating them individually will only get you so far. But understanding the connection - as great or small as that may be - is the way to really figure out a problem.
 
I'll try to be more clear.
In my opinion The Sock Doc included an opinion of his that is not necessarily backed up by science.

arteriosclerosis....due to...... training too hard, lack of rest,.

That is the only part that I was taking issue with. In the larger quote posted in my prior response I did'nt edit out as much of his statement, but he clearly implicated that arteriosclerosis can be caused by training to hard.
I believe it is up to him to cite the evidence for that, not me.
 
I'll try to be more clear.
In my opinion The Sock Doc included an opinion of his that is not necessarily backed up by science.

arteriosclerosis....due to...... training too hard, lack of rest,.

That is the only part that I was taking issue with. In the larger quote posted in my prior response I did'nt edit out as much of his statement, but he clearly implicated that arteriosclerosis can be caused by training to hard.
I believe it is up to him to cite the evidence for that, not me.
Seriously? You're kidding right? I mean I get it that you're the guy who always goes against most of what I have said on posts but this too?

Science (not my opinion): Training too hard / too much of any stress increases tissue oxidation (free radical damage). Over oxidation is linked to increased blood vessel permeability, inflammation, and arteriosclerosis...and a whole lot of other problems. Just do a pubmed search...
 
There's way too much on pubmed for me to find an article linking overtraining to coronary artery disease, but I would appreciate if you had any links to such a study that you would post them here.
 
It's overtraining to oxidation not directly (but indirectly) to CAD. Too much stress = oxidation of cells. Then that to CAD. But come on, let's get real here. No study, even a group of them, is going to convince you of anything different than what you already believe. People find studies to support their beliefs and other studies to dispute what they don't agree with. I could find you all the studies in the world and you're going to find something wrong with them. The fact that you can't pubmed search "arteriosclerosis" and "oxidation" tells me that. And overtraining and oxidation, well that too.

That being said, I'm out.
 
Always in search of new info, I was hoping the doc (now officialy off duty) would provide a link or two detailing this concept of over training leading to CAD theory. My search has found nothing.
 
The Science of Sport covers a bit about sudden cardiac death in athletes. Here's a link about Ryan Shay that seems pretty good:
http://www.sportsscientists.com/2007/11/sudden-death-in-marathon-tragic-case.html

And this one:
http://www.sportsscientists.com/2007/11/sudden-death-during-exercise-what-does.html

These guys hit pubmed for fun, and they say that sudden cardiac death is much less common in athletes than in general population. It just makes the news when an athlete goes this way. It sounds like, if the same person was a non-athlete, they would have died walking up the stairs rather than in a marathon.
 
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I can assure you one thing – dying from a heart attack due to prolonged, chronic structural changes in your heart is far from normal and further from what “natural” really is. A thickening and scarring of cardiac tissue is the result of the body’s inability to keep up with prolonged and excessive stress demands – essentially it’s in constant repair mode, and losing. Shay had this process occurring in his heart (fibrosis) and True in his arteries (arteriosclerosis). These “osis” conditions are due to free radical damage, inflammation (even temporary, but frequent), and hormonal and metabolic problems that occur from training too hard, lack of rest, improper diet, and other lifestyle factors.

In Part V of the Sock Doc Training Principles I go into further detail how and why highly conditioned athletes are dying from chronic endurance training and steps you should be actively taking now so you too don’t all of a sudden die from a “natural cause” such as a heart attack, cardiac arrest, or any other disease or disorder in which your body can no longer keep up with the demands you place on it.

http://sock-doc.com/2012/05/micah-true-death/

im thinking part V will go into detail about the stuff i highlighted in blue and red. looking forward to continuing to read.

Also hope Dr. G comes back for the questions above.
 
im thinking part V will go into detail about the stuff i highlighted in blue and red. looking forward to continuing to read.

Also hope Dr. G comes back for the questions above.


So, the Science of Sport post says that for some of the sudden cardiac deaths of athletes for which information is available, the family reports retrospectively that the person said he or she wasn't feeling so great. There was some dizziness or chest discomfort, but none of it was alarming, and nothing alarming enough to make them decide not to run. My uncle (not an athlete) died of a sudden cardiac event when he was in his late 30s - and that's what happened to him as well. He died at home after attending a wedding. He said he didn't feel quite right that whole day, but he didn't feel bad enough to skip the wedding, and he even had a good time there. He danced a bit. Then Whammo.

So I do wonder if it's preventable - and I also wonder if skipping the race would even be a good thing. I wish I could find it on my hard drive right now, but there's a paper out about sudden cardiac events at marathons. Apparently, they are survivable for a portion of the population if a defibrillator is used. They sometimes have those at marathons. I don't have one at my house. So what if I felt a bit dizzy, but not alarmingly dizzy? Should I race? Or stay home? Maybe if I stayed home, I'd flop over weeding my garden (no defibrillator) and croak. But if I ran the race, I'd have a chance of running near a defibrillator.... Who knows?
 
It seems to me that Micah wouldn't care (didn't know him personaly offcourse).But I got the impression that he lived his live the way he wanted and isn't that the essence of what life should be.Only a 100years ago it would've been a good average to become almost 60 years old.Aren't we expecting a bit too much,I mean,all of us wanting to become 80?!Sure it's tragic if someone dies,we want to know why...we expect the medical world to have an answer to everything.Shouldn't we just enjoy the hell out of it and do as we please?run/bike/whatever,as much as we want and the let chips fall as they may...?8Worrying about what might happen won't prevent it,you better have a blast at life and see where it takes us:).