I was sorry to hear this story. A high school student in Colorado Springs, CO died suddenly on the football field. There was no apparent cause. Autopsy revealed that the boy had an enlarged heart:
A preliminary autopsy conducted by the El Paso County Coroner on Saturday said Vialpando died as a result of a cardiac condition.
"They told us he had an enlarged heart," said J.R. Vialpando. "They don't know if the heart attack caused the heart to enlarge, or if the heart was already enlarged and caused the heart attack. They're going to do more tests."
No drugs were present in Vialpando's system, the coroner's report said.
Angela and J.R. both said their nephew had no history of heart trouble.
"He had no medical history, other than broken fingers or things like that," Angela said. "He was a healthy kid."
Hogan and Harrison football coach Shawn Mitchell also said they knew of no medical problems concerning Vialpando. All players are required to have a physical prior to competing each season on file at the school.
I wanted to talk about this story because from time to time you read about young kids dying for no apparent reason, usually when they are participating in some kind of sporting activity. When you have gone through medical education, you always shake your head when you hear this because there are basically two causes of sudden death in young people when there are no preceding symptoms. The sad part is that you can usually tell by looking at the person which one was the cause.
There are two primary causes that I can think of for sudden death in young people involved in sporting events. (I am not talking about traumatic injury here or drug use; I am just talking about kids who were fine one moment and gone the next.)
The two are hypertrophic cardiomyopathy and Marfan's aortic dissection.
Hypertrophic cardiomyopathy is a disorder where the walls of the heart become enlarged and the muscle fibers are in disarray. We think that the cause is probably genetic. These people will be totally fine until they stress themselves physically because under normal circumstances the enlarged walls of the heart still function relatively well. However, when they are physically exerting what can happen is that the walls obstruct the outlet of the ventricles, preventing blood from leaving a contracting heart. This can sometimes result in cardiac arrest or death.
Here is a diagram illustrating what I mean:
The unfortunate part about this disease is that, particularly in severe forms, the first presentation can be a fatal one. It is really difficult to diagnose without already knowing that something is wrong and administering the right test. Thus, the stereotypical presentation is a normal kid who is playing a football game or a track meet. They are working hard, and then they suddenly collapse and don't wake up.
The other one I mentioned, Marfan's, is an inherited connective tissue disorder resulting from a mutation in a protein called fibrillin-1. It has a diverse set of presentation like lax joints and long bones. People with Marfan's are generally tall and very gangly -- it was speculated that Lincoln had Marfan's. Unfortunately, the connective tissue issues are widespread, and these patients also have a tendency to valvular abnormalities in the heart and a very serious condition called aortic dissection where the aorta starts to come apart.
The stereotypical presentation of one of these patients is a really tall, thin basketball player. They are playing hard in a game when they fall down with the worst stomach ache of their life. They have dissected and are bleeding into their abdomen -- a big-time medical emergency.
So which one do I think this guy had? My suspicion is hypertrophic cardiomyopathy. The autopsy showed an enlarged heart. Plus it says that he was 6-1 and about 210 -- not tall enough and too big to be a Marfan's patient.
It is all really sad, but I thought I would share because it helps the shock when you understand the causes better.
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