Posted by: Joe English | April 9, 2008

Follow-up: Cause found in death of Little Rock Marathon runner

In an article in the Appleton Post Crescent today, we learned an explanation for the death of Adam Nickle in the Little Rock Marathon earlier this year. There had been speculation in the press that Nickle may have died of a rare potassium toxicity called hyperkalemia — a speculation that I found somewhat unlikely. The findings of the medical examiner on the case now confirm that Nickle died of a rare heart condition instead.

In an article I posted at the time, I discussed the four most likely causes of death in marathon runners. The most common of these among younger men are undetected heart conditions, like the one that looks to have killed Nickle. If you’re interested in reading more about the subject, click here to go to the article.

Here is the story from the Post-Crescent:

“LITTLE ROCK — A Kaukauna native who died last month upon finishing the Little Rock Marathon had a heart condition that would have been undetected in a routine physical exam, a doctor said Monday.

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

But an autopsy showed Nickel had “multifocal small coronary artery fibromuscular dysplasia,” or microscopically small heart arteries that tended to restrict the flow of blood, said Dr. Stephen J. Erickson, a pathologist with the state Crime Laboratory.

In addition, Nickel’s narrow arteries were located near nodes that regulate electrical pulses in the heart and, combined with electrolyte abnormalities seen in long-distance runners upon completing a race, caused Nickel’s sudden death, Erickson said.

“This was like a lightning bolt out of the blue.”

Dr. Charles Kokes, chief medical examiner, said if Nickel hadn’t been a runner, the small arteries in his heart might not have caused problems for him for some time. Instead, Nickel went from an irregular heart beat 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 due to dehydration usually seen in runners no matter how much water they drink during a race.

Nickel graduated from Kaukauna High School in 1999 and from Lawrence University in Appleton in 2003.”

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