The Death of an All-Star

By Christine Gorman

There's no way of knowing whether the death of Darryl Kile, the All-Star pitcher for the St. Louis Cardinals who died at age 33 from an apparent heart attack in his hotel room two weeks ago, could have been avoided. Detecting heart disease, particularly in the young, isn't that easy. But there are some lessons here that we can all learn from.

Preliminary autopsy results show that Kile had 80% to 90% blockages in two coronary arteries--a pretty common finding in people who die suddenly of heart disease. But that doesn't mean the fatty deposits or plaques clogging his arteries had been there--or had been that large--for long. "Small plaques that burst can be just as deadly as large ones," says Dr. Rose Marie Robertson, past president of the American Heart Association and a professor of medicine at Vanderbilt University in Nashville, Tenn. "You could have a 30% narrowing yesterday that becomes 90% to 100% with a plaque rupture today."

The St. Louis baseball club hasn't released many details about Kile's medical history other than to say he passed a routine physical during spring training. (It apparently was unaware that the ballplayer's father had died from a stroke after suffering a heart attack at age 44.) Kile's examination probably included an electrocardiogram (ECG), which gives doctors an indirect reading on how well the heart muscle is working by monitoring its electrical activity.

Unfortunately, an ECG by itself won't necessarily pick up any signs of blockages in the coronary arteries unless there has already been some damage to the cardiac muscle. Hidden cases of heart disease can sometimes be spotted by performing an ECG while the subject is exercising on a treadmill--the so-called stress test. The greater the demand placed on the heart, the more likely a problem will turn up. Using ultrasound or radioactive dyes during a stress test may provide more clues--by showing how well the arteries are supplying blood to various parts of the heart. But here again, small blockages may not trigger any symptoms. Even the gold standard for detecting fatty deposits, an invasive procedure called angiography, can't tell you which plaques are likely to burst--though doctors are starting to experiment with new imaging techniques that may do the trick.

The night before he died, Kile told his brother he was tired and his right shoulder hurt. Unexplained pain that lasts more than five minutes in either arm or anywhere in the chest, jaw, neck or back can be a sign of a life-threatening heart problem. Was it just Kile's pitching arm acting up or a hint that something most serious was wrong? We will never know.

More than 3,000 Americans ages 15 to 34 died suddenly of heart disease in 1998, an increase of 10% over the previous decade. Nobody knows why the numbers are up, but part of it may be that the young--especially young athletes in their prime--don't expect to have heart attacks and aren't attuned to the warning signs. Whether or not you have a family history of heart disease, it's never too early to find out what your risks may be.

For more info, visit www.nhlbi.nih.gov or americanheart.org