We learned recently of the death of Micah True, an ultra-runner, at the age of 58. Bringing back memories of the equally untimely death of runner-athor, Jim Fixx, True also died while he was out for a long run….and also died from seemingly unrecognized heart disease.
In adult life he took the name Micah (from the Old Testament prophet) True (the name of a mongrel pet), but he was born Michael Hickman and in his early adulthood enjoyed a career as a prize-fighter. True turned his attention to ultra-distance running in adulthood and found considerable success. Some have described his lifestyle as nomadic, splitting his time between Boulder, Colorado, and Mexico and Central America. He became interested in and involved with the Tarahumara people (aka Raramuri) of Mexico’s Copper Canyon region and learned from their natural approach to running. True was a central character in the 2009 bestselling book by Christopher McDougal, Born to Run: A Hidden Tribe, Superathletes, and the Greatest RAce the World Has Never Seen. In 2003 True founded the Copper Canyon Ultra Marathon to benefit the Tarahumara and served as the event’s race director as recently as this spring.
On March 27, 2012, True went for a planned 12-mile run in the Gila National Forest, familiar southwest New Mexican territory for the runner. He never finished the run. Several days later his body was found alongside a stream, with some abrasions on his arms and legs. Some speculated that he had gone to the stream to wash up after stumbling along the trail.
Chemical tests during an autopsy suggest that True was mildly dehydrated and had caffeine in his system. The most striking autopsy finding was dilated cardiomyopathy….enlargement of the left ventricle (the pumping chamber of the heart) along with thickening (hypertrophy) of its walls. No specific cause for the cardiomopathy was evident and the coroner speculated that the immediate cause of death was a fatal arrhythmia. Quoting from the autopsy report:
[t]he decedent did not have a regular physician and no medical records particularly electrocardiograms or blood pressure readings were available for review
[t]he best determination is that of unclassified cardiomyopathy which resulted in a cardiac dysrhythmia during exertion.
Cardiomyopathy refers to a situation where the heart muscle is weakened. There are a variety of causes. The condition can be inherited. The typical example is hypertrophic cardiomyopathy (HCM), a condition that predisposes an individual to sudden cardiac death (SCD) because of fatal arrhythmias. There are also acquired forms, due in adulthood primarily to coronary artery disease (CAD) or valvular heart disease. But none of these appeared to be the case for True. And occasionally a cause cannot be identified and we call the situation idiopathic (meaning, simply, without identifiable cause). In the absence of any other identifiable cause of death, the coroner is probably correct, though, in attributing True’s death to a sudden, fatal arrhythmia.
If there is a lesson here for athletes, it’s this: even in seemingly healthy, fit athletes, there is the very real possibility of unsuspected–and potentially serious–unrecognized heart disease. Take nothing for granted. Most athletes would be well-served by medical screening for heart problems and by taking any warning signs seriously.
Chagas disease (chronic) was ruled out then?
Lawrence L. Creswell, M.D. says
Very good question.
We know that True spent a great deal of time in locations (Mexico, Central America, S. America) where the parasite, T. cruzi, the causative organism for Chagas disease is endemic. And we also know that Chagas disease in its chronic form may manifest with dilated cardiomyopathy.
The autopsy report–at least the report offered online–does not give any specific information that suggests Chagas disease, but it’s not clear what efforts were made to evaluate for that possibility.
Thinking about the macroscopic findings (visible to the naked eye) that might favor Chagas disease, there can be an aneurysm of the left ventricle, at its apex, without the fibrosis typical of previoius myocardial infarction (MI). At a microscopic level, there might be molecular studies or immunohistochemical studies that could identify the parasite, particularly within the heart’s conduction (electrical tissue) system. These would be very special studies and might require assistance from authorities such as the CDC.
In the end, I would say that Chagas disease IS a possibility here even though the autopsy report didn’t establish that diagnosis.
I had corresponded with you a while ago about developing atrial fib while training for my first ultramarathon (52 yo male from Oregon) and your correspondence was extremely helpful and encouraging. My EP, who I will actually see for the first time Friday, advised against doing the ulta (a 50K near Sheridan, Wyoming) and presumably against doing a regular marathon for that matter (I only actually asked about the ultra) so I decided to cancel the 50K but I went ahead and signed up for a nice, easy, flat road marathon last Sunday in Vancouver, Washington.
I was quite nervous about it because I had no idea how it would go. Would I die? Would I DNF? Would I have to walk the whole thing? Although it was my sixteenth marathon it felt, in many ways, like my first. I went slow, avoided “racing,” walked up the few hills, and finished a nice slow but complete marathon. I suffered like an animal, like I always do, but had absolutely no heart issues as far as I could ascertain. It was basically the same unremarkable, back of the pack marathon that I have ran for my past several races – maybe fifteen minutes slower because I was so cautious. I am absolutely delighted that I finished and had no issues except for crying like a little kid at the finish line.
At this point I am starting to think that I may have been in atrial fib for quite some time and probably have ran marathons in a fib in the past.
At mile 21.5 I thought, “Crap, I should’ve put a Holter monitor on!” (we have two at my office). Oh well, maybe next time. That would have been helpful info for the EP.
Anyway – thanks for your terrific article on a fib, your helpful advice, your encouragement, and your kind words.
I am still considering writing an endurance athlete/ atrial fib blog, BTW.
Lawrence L. Creswell, M.D. says
Glad the race went well. I’ll bet that you’ll find a comfort zone that allows you to continue to participate.
Any updates on cause of death?
Lawrence L. Creswell, M.D. says
Haven’t seen any further information reported on cause of death.