What May Have Caused the Tragic Death of the Angels’ Tyler Skaggs, the Danger of Media Speculation

Tyler Skaggs

What May Have Caused the Tragic Death of the Angels’ Tyler Skaggs, the Danger of Media Speculation, and a Cautionary Tale for Young Athletes:

In an all-too-familiar and tragic story, another young athlete has died under mysterious circumstances, leaving fans devastated, and uninformed media and gossip types to speculate on the cause of his untimely demise.

This time, the unfortunate victim was Los Angeles Angels pitcher Tyler Skaggs, who perished at the tender age of 27. Skaggs was found unresponsive in a Texas hotel room. Police said there were no signs of foul play.

Why Are Young Athletes Dropping Dead Without Warning?

Ever since we saw promising athletes like Len Bias cut down from “heart attacks” at ages where the very idea of a heart attack seemed inconceivable, we ask ourselves why and how such a thing could happen.

Nowadays, Don’t Immediately Think “Drugs”

In the Len Bias case years ago, it was a cocaine overdose that caused the young basketball star to die of sudden cardiac arrest. And, to be sure, some athletes, seduced by eight-figure contracts and all the trappings that go with them, have succumbed to the temptations of dangerous drugs like cocaine, but today’s generation is much healthier than the previous ones, and—it would appear—and more educated than previous generations: and therefore, considerably less likely to risk their very life just to get high, especially before going out on the court/gridiron/field.

In Tyler Skaggs’s case, it was soon made public that Skaggs had undergone several surgeries in the past, so speculation quickly arose that he had somehow become addicted to painkillers, and thus overdosed on drugs, but police stated that no drugs or signs of overdose were found at the scene, although an autopsy will be performed.

This type of speculation, of course, is all too common, nowadays, with any sports star or rock star. After all, if someone dies young, they must have OD’d on drugs, right? Well, not necessarily. There are other reasons.

The Problem Isn’t Usually That Athletes Are  Just “Working Out Too Hard/Overdoing It”

Another thing that some people say is that athletes just “work out too hard.” They overdo it when training, and their coaches must have pushed them too much, especially if we’re talking about high school or college kids. Maybe that is what happened, but that is an oversimplification, and doesn’t help solve any problems.

One Soluble Problem Is That Athletes Are Not Getting Properly Screened. Only Cardiologists—Not GPs— Have the Training and Experience to Catch Problems Including Rare Genetic Mutations That May Cause Sudden Cardiac Death. Because of the Hype and Public Outcry, the American College of Cardiology (ACC) Has Been Investigating and Providing Recommendations.

Some athletes may have rare inherited conditions that may predispose them to sudden cardiac death (SCD). These are not easily diagnosed by general practitioners with an EKG, and certainly not with a history and physical. To identify these conditions, a cardiologist is needed. Yet teams don’t recognize this, or are unwilling to make the investment, and then find out the hard way when a teenage kid or twenty-something keels over on the court without any warning. The literally heartrending tragedy repeats itself time and again. We can, and must, do better.

So What Could Have Been Responsible For Tyler Skaggs’s Sudden Cardiac Death?

I decided to do a little medical detective work, and started with a hunch: that Mr. Skaggs was very likely not a chubby type of baseball player like Fernando Valenzuela or the Great Bambino, Babe Ruth.

Sure enough, I clicked on a picture of him and his stats, and he was lean and lanky, at 6’4” and 225 pounds. Just as I’d predicted. A prime candidate for just this kind of sudden cardiac death, just by virtue of having what we call a “Marfanoid phenotype.”  People with Marfan’s syndrome have a genetic condition characterized by having a tall and thin build, with unusually long fingers, arms and legs. They are often double-jointed, have flat feet, and may have scoliosis, back pain, and a sunken chest. They are often nearsighted. They may have crowded teeth. These qualities are, of course, extremely common among young athletes. One common problem among these individuals, which often goes undiagnosed, is is that they are MVPs: and by this, I don’t mean that they are “most valuable players”—I mean they have mitral valve prolapse: a leaky and regurgitating heart valve, which can be very serious. But even without MVP, Marfan’s patients may develop loss of left ventricular function, and this is a classic cause of cardiomyopathy: literally, diseased heart muscle. This is a common cause of sudden cardiac death in Marfan’s patients, and, I believe, could very well have led to Tyler Skaggs’s death.  

Do I know that Tyler Skaggs had Marfan’s syndrome, per se? No, I don’t. Remember, this is also only speculation on my part, as well, and I don’t know what the actual cause of death was. For one thing,  I said “Marfanoid phenotype” because there is a whole family of rare Marfan-like connective tissue syndromes, such as Ehlers-Danlos syndrome. There is even something called the “MASS phenotype” that refers to Mitral valve prolapse, Aortic root diameter, Skin stretch marks and Skeletal features (including scoliosis, chest wall deformities and hypermobility). MASS is not as serious as Marfan’s.

However, given the fact that Skaggs had a lean/lanky body type and a history of surgeries involving what seemed like hyperrotation and hyperextension of his joints, it felt to me like hypermobility and loose joints could have been going on. These syndromes, unfortunately, are associated with fragile tissues and heart conditions. Again, I was just doing basic medical detective work.

You should know, though, there are many tall, lanky individuals with hyperflexible joints who don't have any cardiovascular disease. One possible cause of the sort of sudden death that befell young Mr. Skaggs is arteriovenous (AV) malformation of the intracranial blood vessels. In this situation, a bunch of arteries and veins in your brain gets tangled together so that the blood in your arteries gets rerouted away from normal brain tissue and diverted into the tangled veins. These vessels can get dilated, weaken, rupture, and bleed, causing a stroke (intracranial hemorrhage).  Another possibility that must always be considered in sudden cardiac death is electrical abnormalities, namely, arrhythmias.

These are almost exclusively ventricular tachyarrythmias. And, whereas you would expect to see left ventricular hypertrophy in most cases of sudden cardiac death (SCD), studies of SCD among young athletes have shown it’s the right side of the heart that’s to blame: It turns out that as many as 5% of SCD in young athletes may be due to a condition called ARVC (Arrhythmogenic Right Ventricular Cardiomyopathy).

Finally, in about 1/5 of hearts afflicted by SCD, the structure of the heart may appear totally normal on autopsy.  In those cases, the culprit may turn out to be  very rare arrhythmias, such as Brugada syndrome, torsade de pointes tachycardia, and long QT syndrome.

It is entirely possible that other factors may have been involved, and it will be interesting to see the autopsy, but you have my two cents for now.

Testing IS Available. Check Yourself Before You Wreck Yourself. Seriously.

So, what can you do? If you are an athlete, whether you’re tall, skinny, double-jointed, or whatever, if you’re concerned, or even if you’re not. If you get fatigued easily on exertion, or even if you don’t, you never know: Get checked out before it’s too late. You may have a rare mutation. Family members of high school, college, and pro athletes: Please get your kids and loved ones checked!

Dr. B, the Heart Doc

Author
Arash Bereliani, M.D., M.S., F.A.C.C. Beverly Hills Institute For Cardiology & Preventive Medicine

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