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 thinning 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
and
[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.
