Sudden Unexpected Death- Usually There Are No Warning Signs

Dr. Beth Sullivan | July 3rd, 2019

The news of the unexpected passing of the Los Angeles Angels’ starting pitcher Tyler Skaggs rocked the sports world late Monday afternoon. An autopsy was to be performed today, but it may take some time before a cause of death is officially determined. As of the time the notification was made it was made clear that foul play and suicide did not appear to be the reason for his unexpected passing.

In an otherwise healthy young adult, sudden death is very hard to understand for those left behind. In this article, I will review the five most common causes of sudden unexpected natural death in young adults. I suspect that one of these may be determined to be the cause of Skaggs passing. I am not presuming to try to determine a cause of death, but rather educate our readers going forward.

The five most common reasons usually identified for the sudden unexpected death in a healthy young adult include:

Hypertrophic Cardiomyopathy (HCM) is an inherited condition where the walls of the heart muscle thicken. The thickened muscle can lead to disruptions in the heart’s electrical system, leading to fast and/or irregular heartbeats (arrhythmias), which can lead to sudden cardiac death. Hypertrophic cardiomyopathy, although not usually fatal, is still the most common cause of heart-related sudden death in people under the age of 30. In athletes, It’s the most common identifiable cause of sudden death. HCM often goes undetected and is often only identified after the sudden death of a person suffering from this condition. Jason Collier a center for the Atlanta Hawks was identified as suffering from an enlarged abnormal heart by the coroner who did his autopsy when he died at age 28.
Long QT Syndrome (LQTS) is an inherited disorder in the heart’s electrical system which can result in sudden episodes of irregular heartbeats which if they go undetected and untreated can result in sudden death. LQTS can also be caused by certain medications and is usually screened for with an EKG before the medications are prescribed. LQTS is more common in women and is screened for by asking about a family history of cardiac death before age 50, or a personal history of a sudden loss of consciousness. Dana Vollmer was an Olympic swimmer who won a gold medal in the 100-meter Butterfly at the after opting to have a defibrillator implanted to treat her cardiac arrhythmia.
Myocarditis is a disease that causes inflammation of the heart muscle. This inflammation enlarges and weakens the heart creating scar tissue. The changes in the heart brought on by this condition forces it to work harder to circulate blood and oxygen throughout the body. In an athlete who depends on proper oxygenation for optimal performance, this condition can be seriously debilitating and is the third most common cause of Sudden Unexpected Death in young adults. Myocarditis can affect anyone, including young adults, children, and infants. In fact, it most often affects otherwise healthy, young, athletic types with the high-risk population being those from puberty through their early 30’s. Males are affected twice as often as females. Myocarditis can be caused by bacterial or viral infections that lodge in the heart. In addition, some snake and spider venoms can cause sudden onset myocarditis. In 1993, Boston Celtic Reggie Lewis collapsed during the playoffs and was diagnosed as having myocarditis. He was treated and allowed to return to practice but died suddenly after playing in an offseason practice game.
Intracranial Emergencies not related to Blunt Force Trauma is a fancy way to say a stroke. While most people assume strokes only occur in older patients ten to fifteen percent of all strokes occur in patients under age 40. In the younger population, a hemorrhagic stroke or ruptured aneurysm is more common than an embolic or bloodless stroke. There are usually no warning signs and an aneurysm can rupture causing massive debilitating effects or sudden death. Aneurysms are not routinely screened for unless there is a reason such as severe unrelenting headaches or unexplained loss of consciousness or seizures. When Danny Farquhar was a relief pitcher for the Chicago White Sox he collapsed in the dugout during a game due to a ruptured brain aneurysm. He underwent extensive surgery to repair the problem and has been trying to resume his pitching career. However, this is not going well and was recently released by the New York Yankees after appearing in two games for a minor league team in their system.
Anaphalytic Compromise this is the exposure of a severely allergic person to a known or unknown allergen that results in respiratory insufficiency and if left untreated can result in sudden death. Most people who have such a severe allergy are prescribed epinephrine in a self-injecting pen it that can be used to treat an unexpected exposure to a known allergen. However, in the case of an unknown allergen, exposure can lead to sudden death. Zhaire Smith is a point guard who plays for the Philadelphia 76ers who also has a severe nut allergy. In August 2018, he ate chicken at the team’s facility and went home. He was found by his mother and rushed to the emergency room due to a severe allergic reaction due to the nuts that were in the chicken he ate earlier in the evening.

Our condolences go out to the Skaggs’ family, his Angels’ teammates and fans of the Angels. It was reported yesterday that the final autopsy results would not be available until October. I hope the information in this article will help you to understand some of the possible causes for his untimely tragic death and may help open a dialogue with your physician if you have experienced any unexplained symptoms before it is too late.

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