Doctors: Ark. marathon runner died of rare mix of heart condition, electrolyte abnormalities

Updated: April 7, 2008, 6:43 PM ET
Associated Press

LITTLE ROCK, Ark. -- The Wisconsin man who collapsed and died last month after finishing the Little Rock Marathon had a heart condition that would have been undetected in a routine physical exam and was not by itself fatal.

Dr. Stephen J. Erickson, a pathologist with the state crime laboratory, said Monday that Adam Nickel had narrow heart arteries that tended to restrict the flow of blood that caused his death when combined when combined with the electrolyte abnormalities that can result from running long distances.

Nickel, 27, a graduate student at the University of Wisconsin in Madison, collapsed after finishing the 26.2-mile race in 3:02:26 on March 2. He was an experienced long-distance runner and had no known medical problems.

"This was like a lightning bolt out of the blue, very bad luck that he had this unseen silent abnormality in his heart muscle," said Erickson, one of two doctors who conducted the autopsy. "This is a very, very rare kind of event."

Dr. Charles Kokes, chief medical examiner, said if Nickel hadn't been a runner, the heart condition, known as multifocal small coronary artery fibromuscular dysplasia, might not have caused problems for him for some time. Instead, Nickel went from an irregular heartbeat to death without experiencing symptoms that would have caused him to faint, slow down or stop.

"He just went from running a marathon to essentially dead within a matter of seconds," Kokes said.

The electrolyte abnormalities, including elevated potassium levels, can cause abnormal heart rhythms, but experienced runners normally recover, Kokes said. Neither Erickson nor Kokes knew what caused the abnormalities, which could have been caused by dehydration usually seen in runners no matter how much water they drink during a race.

"There's no way we can pinpoint how these electrolyte abnormalities came to pass," Kokes said. "These are things that happen to most people every time that they do run a marathon."

The autopsy also showed a breakdown of muscle tissue, called rhabdomyolysis, but the doctors also did not know if that was a cause or effect of Nickel's death.

"This is an instance where several different adverse things came together at just the wrong time to cause a serious, indeed fatal, problem," Kokes said.

Copyright 2008 by The Associated Press

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