I just received a grim e-mail to end an otherwise unremarkable day. The subject line read, "Ryan Shay Autopsy Released." 

Shay's death while running in the Men's Olympic Marathon Trials in New York City last November was beyond tragic.

A Michigan native, Shay was a 28-year-old elite athlete, a newlywed, and had a life full of living left to do.

His autopsy revealed no surprises, other than an enlarged heart can kill anyone regardless of age and fitness level. I suppose that shouldn't be surprising, but it still is.

Runner's World reported that a brief summary released by The New York City medical examiner's office said that Shay died from from an irregular heartbeat due to an enlarged heart. There was no mention of the toxicology report, however according to the story, Joe Shay, Ryan's dad, said he was told no drugs were found in Ryan's system. His heart had old scar tissue from an undetermined cause. Could have been childhood pneumonia, could have been a prior heart attack, could be the result of overtraining, could be something, well, undetermined.

Undetermined. Turns out that's not a terribbly useful word.

What we are left with is the question of how and whether athletes and the medical community should move forward more pro-actively to diagnose this condition. Although Shay is thought to be the first elite athlete to die during a marathon competition, several hundred american athletes under the age of 30 succumb to sudden cardiac death every year. And yet current studies show the risk of sudden cardiac death in high school athletes stands at 1 in 300,000 among females and 1 in 100,000 among males. This begs the question, when does screening make sense?

Cardiologists who are aware of sudden death in young athletes believe that the cost of screening the athletes for potential problems would cost far more than anyone would be willing to spend, and further argue that a positive heart screening (meaning there is some sign of enlargement) should not dictate that a young athlete be kept out of sports. Not much clarity there.
Everything I've read on the subject suggests that a consistent fitness routine is the best way to ward off cardivascular damage that could lead to sudden cardiac arrest. Bottom line: If you only exercise a couple days a week, try to extend it to 30 minutes a day and don't sprint for the line at your next 5k or cycling race unless you have trained for a sprint finish.

Happy Spring and thanks for reading.