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46-Year-Old Sergeant Suffers Fatal Cardiac Event at Station –

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Executive Summary

On August 2, 2020, a 46-year-old male career Sergeant (SGT) suffered a sudden cardiac arrest while 

taking a meal break during his police shift as part of his public safety job. Another officer found him 

pulseless and non-responsive on the kitchen floor at approximately 2300 hours, called dispatch, and 

initiated cardiopulmonary resuscitation (CPR). Other officers assisted with resuscitation efforts until 

paramedics arrived and provided advanced cardiac life support. The ambulance arrived at the 

emergency department (ED) at 2332 hours. At 2348 resuscitation efforts were deemed unsuccessful 

and the SGT was pronounced dead. 

The Medical Examiner’s report listed hypertensive and arteriosclerotic heart disease as the underlying 

causes of death. Pulmonary hypertension and obesity were listed as contributing factors. The autopsy 

report noted an enlarged heart (weight of 658 grams), ventricular wall hypertrophy, and significant 

coronary artery atherosclerosis (50%–70%) in the three main coronary arteries. There was no evidence 

of acute thrombus or of myocardial scarring. The SGT had cardiac risk factors including a medical 

history of obstructive hypertrophic cardiomyopathy, hypertension, and elevated lipid levels along with 

being a prior smoker. National Institute for Occupational Safety and Health (NIOSH) investigators 

concluded that the SGT suffered a sudden cardiac arrest due to arrhythmias resulting from his 

underlying cardiac disease. 

The SGT’s public safety job required him to work split shifts as both a firefighter and a police officer. 

On the day he died, he was on a 24-hour shift which required him to work the first 8 hours as a 

firefighter and the second 8 hours as a police officer. The SGT suffered his cardiac arrest 7 hours after 

completing the portion of his shift worked as a firefighter. Since his death occurred within 24 hours of 

his last actions as a firefighter, it is considered to be a firefighter line of duty death.

Key Recommendations

NIOSH investigators offer the following recommendations to prevent similar fatal events, and to 

address general health and safety issues among firefighters at this and other fire departments across the 

country. 

Key Recommendation 1: Ensure that all firefighters receive an annual medical evaluation consistent 

with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational 

Medical Program for Fire Departments

F2021-02 • June 1, 2021
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Key Recommendation 2: Ensure firefighters are cleared for duty by a physician knowledgeable about 

the physical demands of firefighting, the personal protective equipment used by firefighters, and the 

various components of NFPA 1582 

Key Recommendation 3: Phase in a mandatory comprehensive wellness and fitness program for 

firefighters. 

The National Institute for Occupational Safety and Health (NIOSH) initiated the Fire Fighter Fatality Investigation and Prevention Program to examine 

deaths of fire fighters in the line of duty so that fire departments, fire fighters, fire service organizations, safety experts and researchers could learn from these 

incidents. The primary goal of these investigations is for NIOSH to make recommendations to prevent similar occurrences. These NIOSH investigations 

are intended to reduce or prevent future fire fighter deaths and are completely separate from the rulemaking, enforcement and inspection activities of any 

other federal or state agency. Under its program, NIOSH investigators interview persons with knowledge of the incident and review available records to 

develop a description of the conditions and circumstances leading to the deaths in order to provide a context for the agency’s recommendations. The NIOSH 

summary of these conditions and circumstances in its reports is not intended as a legal statement of facts. This summary, as well as the conclusions and 

recommendations made by NIOSH, should not be used for the purpose of litigation or the adjudication of any claim.

For further information, visit the program Web site at www.cdc.gov/niosh/fire or call toll free 1-800-CDC-INFO (1-800-232-4636).
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46-Year-Old Sergeant Suffers Fatal Cardiac Event at Station –

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Introduction

On August 2, 2020, a 46-year-old male career public safety officer who was working a split shift 

(8 hours firefighter, 8 hours police officer, 8 hours firefighter) suffered sudden cardiac death while 

preparing a light meal toward the end of his police officer tour. The U.S. Fire Administration notified 

the National Institute for Occupational Safety and Health (NIOSH) of this fatality on August 8, 2020. 

NIOSH contacted the affected public safety department on September 15, 2020 to gather initial 

information. In June of 2021, a contractor for the NIOSH Firefighter Fatality Investigation and 

Prevention Program (the NIOSH investigator) conducted a series of phone calls and reviewed records 

of the incident. 

During the investigation, the NIOSH investigator interviewed the following people:

• Union President and Departmental Point of Contact

• Medical Examiner

The NIOSH investigator reviewed the following documents:

• Incident reports for calls on preceding shift days

• Police report

• Emergency medical service (ambulance) report

• Hospital emergency department (ED) records

• Death certificate

• Autopsy report

Fire Department

This career public safety department has 1 station with 24 uniformed members who are cross-trained in 

fire, police, and first response. The department serves a population of approximately 5,000. 

The FD requires preplacement medical evaluations for applicants. The evaluations are performed by a 

clinic that provides medical evaluations on a contract basis. Components of the medical evaluation 

include the following:

• Complete medical history
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• Physical examination (height, weight, blood pressure, pulse, and respiratory rate)

• Complete blood count

• Urinalysis

• Urine drug screen

• Audiogram

• Vision test

• Respirator use questionnaire

• Spirometry

• Resting electrocardiogram (EKG)

• Chest X-ray

The department does not require annual medical evaluations for members. Members are required to 

provide medical clearance from a personal physician or the occupational clinic that contracts with the 

City after a serious injury. The department may require medical clearance if a safety officer misses 

more than three shift days. Respiratory fit test testing is performed annually by specially trained 

members of the department.

The department does not offer a comprehensive wellness/fitness program as recommended by the 

International Association of Firefighters//International Association of Fire Chiefs Wellness Fitness 

Initiative [IAFF and IAFC 2018]. The department maintains a workout space that includes aerobic and 

strength training equipment and encourages safety officers to use the facilities. One of the safety 

officers had formal training in fitness and nutrition and is available to assist other safety officers. 

There is an employee health program that provides programming for wellness and offers discounts to 

local gyms. 

Investigation

On August 2, 2020, a public safety officer (SGT) began his 24-hour shift. His shift was divided into 

three eight-hour segments; he was scheduled to work as a firefighter from 0800–1600 hours, a police 

officer from 1600–2400 hours, and a firefighter from 2400–0800. During the first four hours of his first 

8-hour firefighting shift, the SGT served as Shift Commander. He spent his time in the office doing 

office work and reports. At approximately 1200 hours he had a conversation with the oncoming 

Lieutenant about shift operations and the lieutenant later reported that there was nothing out of the 

ordinary about the SGTs appearance or behavior. Just after 1300 hours, the SGT and another 

firefighter were dispatched in an engine to assist with removing a tree that was blocking the roadway. 

Another firefighter operated the chainsaw and the SGT and a third member of the department cleared 

the tree from the roadway. They cleared the call at 1322 hours and returned to the station and put the 

engine back in service. 

At approximately 1500 hours, the SGT began to clean up and change for duty as a police officer. At 

1554 hours, just minutes before his police patrol was to begin, the department received a 911 hang-up, 

and the SGT went to the address to determine if there was an emergency. He found no emergency and 
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continued to patrol the city. At 1715 hours the SGT returned to the station to have dinner with his shift. 

Nothing out of the ordinary was noted. At 1814, the SGT and another officer were dispatched to assist 

an elderly man who had fallen and could not get back into his wheelchair. Throughout the rest of the 

evening, the SGT patrolled the city in his departmental vehicle, responded to a call for a citizen assist, 

and assisted another officer on two traffic stops. At 2240 hours he returned to the station. 

At 2301 hours, another officer entered the kitchen and found the SGT pulseless and unresponsive on 

the floor of the kitchen. There was a bowl of soup and glass of water sitting on the counter suggesting 

the SGT had returned for a light meal. The officer that found the SGT radioed dispatch that there was 

an officer down and requested medical assistance. The officer initiated cardiopulmonary resuscitation 

(CPR) and called dispatch to request an ambulance. The shift commander was notified by dispatch and 

went to the kitchen to assist with CPR. Other officers were notified by dispatch and returned to the 

station to assist with care. An automated external defibrillator (AED) was attached to the SGT, but no 

shock was advised or administered at this time.

An Advanced Life Support (ALS) ambulance arrived on scene at 2310 hours and initiated advanced 

cardiac life support protocols. The SGT remained unresponsive, and his heart was in asystole. An 

intravenous line was established, and epinephrine was administered. The airway was secured with a 

Combitube® (a double lumen airway device useful with blind insertion that some emergency medical 

technicians (EMTs) are certified to use. One tube blocks the esophagus ensuring an open airway via the 

second tube in the trachea). The heart rhythm changed to ventricular fibrillation and the SGT was 

manually defibrillated four times before arrival at the ED. The SGT received multiple rounds of 

epinephrine and a single dose of amiodarone. 

The ambulance arrived at the ED at 2332 hours with the SGT still in ventricular fibrillation. The SGT 

remained unresponsive, and his pupils were fixed and dilated. He received additional rounds of 

epinephrine and other cardiac medications. A bedside ultrasound was performed that revealed that 

there was no heart movement. At 2348 hours the SGT was pronounced dead. 

Medical Findings

The SGT was hired by this FD in June 2005. He had been diagnosed in 2006 with obstructive 

hypertrophic cardiomyopathy (an enlargement of the heart that interfered with blood flow from the left 

ventricle into the aorta), hypertension, and hyperlipidemia, and saw his physician regularly. It is 

unclear if this had been disclosed to the department. As part of his ongoing medical care, in June of 

2020, his physician ordered a resting echocardiogram (ECG), an exercise stress test, and a 24-hour 

ECG (also known as a Holter monitor evaluation). The ECG showed severe septal hypertrophy 

(1.7 centimeters [cm]) and moderate ventricular wall hypertrophy (1.3 cm) but with normal ejection 

fraction and no wall motion abnormalities. The SGT performed an exercise stress test using the Bruce 

protocol. He exercised for 10 minutes (estimated 10.2 metabolic equivalents [METs]) before reaching 

volitional fatigue (when the protocol was ended). The ECG at rest showed a deep T-wave inversion 

(consistent with hypertrophic cardiomyopathy). The 24-hour Holter monitor showed some premature 

atrial and ventricular contractions but were not considered to be clinically significant. The SGT was a 

former smoker. Records indicate that he worked with his physician to try to control his blood pressure 

and hyperlipidemia through diet and exercise and was compliant with his medication. He was 5’7” and 

weighed 230 pounds (lbs.) giving him a BMI of 36. 
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The medical examiner’s report identified (1) hypertensive and atherosclerotic cardiovascular disease 

which was evidenced by cardiomegaly, concentric left ventricular hypertrophy, moderate 

arteriolonephrosclerosis (atherosclerosis in the kidneys), severe coronary atherosclerosis, aortic 

atherosclerosis, and myocardial bridging (a coronary artery that “tunnels” under heart muscle ); 

(2) pulmonary hypertension (atherosclerosis in pulmonary arteries, right ventricular hypertrophy), and 

(3) obesity as factors contributing to the SGT’s death. The heart weighed 658 grams. The left 

ventricular wall thickness was 2.5 cm, the septal thickness was 1.8 cm, and the right ventricular wall 

thickness was 0.5 cm. They myocardium was red-brown and firm with no evidence of prior myocardial 

injury. The coronary arteries had significant atherosclerotic plaque leading to 50% narrowing of the left 

anterior descending artery, 45% narrowing of the left circumflex artery, and 70% narrowing of the right 

coronary artery. There was no evidence of an intracoronary thrombus. The medical examiner did not 

conclude that the SGT had hypertrophic cardiomyopathy but, in an interview, she indicated that 

nothing she found in the autopsy was inconsistent with that diagnosis. 

Discussion 

Hypertrophic Cardiomyopathy and Sudden Cardiac Events

Hypertrophic cardiomyopathies affect approximately 1/500 people and are characterized by 

enlargement of some structures of the heart that is unexplained by other factors such as hypertension or 

aortic stenosis [Cooper et al. 2017]. Hypertrophic cardiomyopathies increase the risk of fatal 

arrhythmias and sudden cardiac death. 

Hypertensive Heart Disease

Interactions between genetic factors and hemodynamic factors cause hypertensive heart disease in 

individuals with arterial hypertension [Diamond and Phillips 2005]. Hypertensive heart disease 

includes anatomical and functional changes to the heart and vessels as a consequence of long-standing 

hypertension. Left ventricular hypertrophy (LVH), due to myocyte enlargement with or without 

fibrosis, is a reflection of hypertensive end-organ damage. This can lead to increased ventricular mass, 

abnormal perfusion, congestive heart failure, and arrhythmias [Prisant 2005]. Increased heart mass is a 

predisposition to fatal arrhythmias [Kahan and Bergfeldt 2005; Tavora et al. 2012]. 

Myocardial Bridging

At autopsy, the SGT had evidence of myocardial bridging in the LAD (left anterior descending) 

coronary artery. Myocardial bridging is a congenital anomaly in which a portion of a coronary artery 

(usually the LAD) tunnels under the myocardium, creating a “bridge” of heart muscle overlying the 

coronary artery [Lee and Chen 2015]. Myocardial bridging is relatively common, having been reported 

in 40% to 80% of autopsy cases [Mohlenkamp et al. 2002]. Compression of the coronary artery occurs 

during systole (as the heart muscle contracts) and sometimes extends into diastole (relaxation). 

Myocardial bridging has been associated with coronary artery spasm, ischemia, and sudden cardiac 

death [Alegria et al. 2005; Lee and Chen 2015]. Autopsy and intravascular ultrasound studies have 

shown that the proximal segment of the “tunneled” coronary artery is prone to developing 

atherosclerosis, likely due to altered blood flow patterns in this area [Corban et al. 2014]. Myocardial 

bridging is more common in individuals with hypertrophic cardiomyopathy with a prevalence as high 

as 30% [Alegria et al. 2005; Basso et al. 2009]. 
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Occupational Medical Standards for Structural Firefighters

Nearly half of all firefighter duty-related deaths are caused by sudden cardiac death. Firefighting 

results in multiple cardiovascular changes, including high heart rates and blood pressure that could 

lead to plaque rupture or arrhythmogenic changes (due to ischemia) in individuals with underlying 

cardiovascular disease [Smith et al. 2016]. Research relying on autopsy data found that approximately 

80% of firefighters who suffered duty-related sudden cardiac deaths had atherosclerosis and/or 

cardiomegaly [Smith et al. 2018]. The high percentage of atherosclerosis and enlarged heart size was 

also found among young firefighters (< 45 yrs.) who had died due to duty-related sudden cardiac 

events [Yang et al. 2013]. To reduce the risk of sudden cardiac events or other incapacitating 

conditions among firefighters, the NFPA developed 1582, Standard on Comprehensive Occupational 

Medical Program for Fire Departments [NFPA 2018]. Guidance in the 1582 Standard recommends 

annual risk assessment of all firefighters ≥ 40 years old with a “Heart Risk Calculator” that takes into 

account age, sex, blood pressure, smoking status, etc., to estimate 10-year risk of sudden cardiac events 

or stroke [ACC/AHA 2018; NFPA 2018]. The SGT did not have an occupational medical evaluation, 

but NFPA 1582 indicates that obstructive hypertrophic cardiomyopathy can compromise the member’s 

ability to safely perform as part of a team where sudden incapacitation could result in mission failure. 

The SGT was compliant with medication to help relax the heart and help it function efficiently. 

However, he did not achieve the 12 METs recommended (minimum cardiorespiratory fitness) to ensure 

that individuals with cardiac disease can safely perform firefighting activity. 

NIOSH offers the following recommendations to help reduce the risk of sudden cardiac events among 

firefighters at this and other fire departments across the country.

Recommendations

Recommendation #1: Ensure that all firefighters receive an annual medical evaluation consistent 

with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire 

Departments. 

Discussion: Guidance regarding the content and frequency of these medical evaluations can be found 

in NFPA 1582 [NFPA 2018]. These evaluations are performed to determine a firefighter’s medical 

ability to perform duties without presenting a significant risk to the safety and health of himself/herself 

or others. This medical evaluation should be consistent with the requirements of NFPA 1582. In this 

case the SGT did not have a medical evaluation consistent with this standard and it is unclear if he 

would have been cleared for duty if that standard was applied. 

Recommendation #2: Ensure firefighters are cleared for duty by a physician knowledgeable about 

the physical demands of firefighting, the personal protective equipment used by firefighters, and the 

various components of NFPA 1582. 

Discussion: According to NFPA 1582, the department should require that physicians are familiar with 

the physical demands of firefighting and the risks that firefighters encounter and should guide, direct, 

and advise members with regard to their health, fitness, and suitability for duty [NFPA 2018]. The 

physician should review job descriptions and essential job tasks required for all positions to understand 

the physiological and psychological demands of firefighting and the environmental conditions under 

which firefighters perform, as well as the personal protective equipment they must wear during various 
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types of emergency operations. The SGT was being treated for his cardiovascular conditions, but it is 

unclear if the physician was familiar with the physical demands of firefighting. 

Recommendation #3: Phase in a mandatory comprehensive wellness and fitness program for 

firefighters. 

Discussion: Guidance for fire department wellness/fitness programs to reduce risk factors for 

cardiovascular disease and improve cardiovascular capacity is found in NFPA 1583, Standard on 

Health-Related Fitness Programs for Firefighters [NFPA 2015], the IAFF/IAFC Fire Service Joint 

Labor Management Wellness/Fitness Initiative (WFI) [IAFF and IAFC 2018], and Firefighter Fitness: 

A Health and Wellness Guide [Schneider 2010]. Worksite health promotion programs have been 

shown to be cost effective by increasing productivity, reducing absenteeism, and reducing the number 

of work-related injuries and lost workdays [Aldana 2001; Stein et al. 2000]. Health promotion 

programs for firefighters have been shown to reduce coronary heart disease risk factors and improve 

fitness levels, with mandatory programs showing the most benefit [Blevins et al. 2006; Dempsey et al. 

2002; Womack et al. 2005]. The department has exercise equipment available to personnel but does 

not have a formal wellness/fitness program. NIOSH recommends that all firefighters have access to a 

well-structured health and wellness program such as the IAFF/IAFC WFI. 

References

ACC/AHA [2018]. Atherosclerotic cardiovascular disease (ASCVD) risk estimator. Washington, D.C.: 

American College of Cardiology/American Heart Association.

Aldana SG [2001]. Financial impact of health promotion programs: a comprehensive review of the 

literature. Am J Health Promot 15(5):296–320. 

Alegria JR, Herrmann J, Holmes DR Jr, Lerman A, Rihal CS [2005]. Myocardial bridging. Eur Heart J 

26(12):1159–1168. 

Basso C, Thiene G, Mackey-Bojack S, Frigo AC, Corrado D, Maron BJ [2009]. Myocardial bridging, a

frequent component of the hypertrophic cardiomyopathy phenotype, lacks systematic association with 

sudden cardiac death. Eur Heart J 30(13):1627–1634. 

Blevins JS, Bounds R, Armstrong E, Coast JR [2006]. Health and fitness programming for firefighters: 

does it produce results? Med Sci Sports Exerc 38(5):S454. 

Cooper RM, Raphael CE, Liebregts M, Anavekar NS, Veselka J [2017]. New Developments in 

Hypertrophic Cardiomyopathy. Can J Cardiol 33(10):1254–1265. 

Corban MT, Hung OY, Eshterhardi P, Rasoul-Arzrumly E, McDaniel M, Mekonnen G, Timmins LH, 

Lutz J, Guyton RA, Samady H [2014]. Myocardial bridging: contemporary understanding of 

pathophysiology with implications for diagnostic and therapeutic strategies. J Am Coll Cardiol 

63(22):2346–2355. 

Dempsey WL, Stevens SR, Snell CR [2002]. Changes in physical performance and medical measures 

following a mandatory firefighter wellness program. Med Sci Sports Exerc 34(5):S258.

Diamond JA, Phillips RA [2005]. Hypertensive heart disease. Hypertens Res 28(3):191–202. 

IAFF and IAFC [2018]. The fire service joint labor management wellness-fitness initiative. 

Washington, DC: International Association of Firefighters, International Association of Fire Chiefs. 
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Kahan T, Bergfeldt L [2005]. Left ventricular hypertrophy in hypertension: its arrhythmogenic 

potential. Heart 91(2):250–256. 

Lee MS, Chen C [2015]. Myocardial bridging: an up-to-date review. J Invasive Cardiol 27(11):521–

528. 

Mohlenkamp S, Hort W, Junbo G, Erbel R [2002]. Update on myocardial bridging. Circulation 

106:2616–2622. 

Myerburg RJ, Castellanos A [2008]. Cardiovascular collapse, cardiac arrest, and sudden cardiac death.

In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. 

Harrison’s principles of internal medicine. 17th ed. New York: McGraw-Hill.

NFPA [2015]. NFPA 1583. Standard on health-related fitness programs for fire fighters. Quincy, MA: 

National Fire Protection Association. 

NFPA [2018]. NFPA 1582. Standard on comprehensive occupational medical program for fire 

departments. Quincy, MA: National Fire Protection Association. 

Prisant LM [2005]. Hypertensive heart disease. J Clin Hypertens 7(4):231–238. 

Schneider EL [2010]. Firefighter fitness: a health and wellness guide. New York: Nova Science 

Publishers, https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1524-6175.2005.04119.x. 

Smith DL, DeBlois JP, Kales SN, Horn GP [2016]. Cardiovascular strain of firefighting and the risk of 

sudden cardiac events. Exerc Sport Sci Rev 44(3):90–97. 

Smith DL, Haller JM, Korre M, Fehling PC, Sampani K, Porto LGG, Christophi CA, Kales SN [2018]. 

Pathoanatomic findings associated with duty-related cardiac death in US firefighters: a case-control 

study. J Am Heart Assoc 7(18):e009446. 

Stein AD, Shakour SK, Zuidema RA [2000]. Financial incentives, participation in employer sponsored 

health promotion, and changes in employee health and productivity: HealthPlus health quotient 

program. J Occup Environ Med 42(12):1148–1155. 

Tavora F, Zhang Y, Zhang M, Li L, Ripple M, Fowler D, Burke A [2012]. Cardiomegaly is a common 

arrhythmogenic substrate in adult sudden cardiac deaths, and is associated with obesity. Pathology 

44(3):187–191. 

Womack JW, Humbarger CD, Green JS, Crouse SF [2005]. Coronary artery disease risk factors in 

firefighters: effectiveness of a one-year voluntary health and wellness program. Med Sci Sports Exerc 

37(5):S385. 

Yang J, Teehan D, Farioli A, Baur DM, Smith D, Kales SN [2013]. Sudden cardiac death among 

firefighters ≤45 years of age in the United States. Am J Cardiol 112(12):1962–1967. 

Investigator Information

This incident was investigated by the NIOSH Firefighter Fatality Investigation and Prevention 

Program, Cardiac and Medical Line-of-Duty Deaths (LODD) Investigations Team, located in 

Cincinnati, Ohio. Denise L. Smith, Ph.D., led the investigation and authored the report. Dr. Smith is 

Professor of Health and Human Physiological Sciences and Director of the First Responder Health and 

Safety Laboratory at Skidmore College, where she holds the Tisch Family Distinguished 
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Professorship. She is also a member of the NFPA Technical Committee on Occupational Safety and 

Health. Dr. Smith was working as a contractor with the NIOSH Firefighter Fatality Investigation and 

Prevention Program, Cardiac and Medical LODD Investigations Team, during this investigation. 

Judith Eisenberg, MD, MS, provided medical consultation and contributed to the report. Dr. Eisenberg 

is Lead for the Cardiac and Medical LODD Investigations Team in Cincinnati. 

Disclaimer

Mention of any company or product does not constitute endorsement by the National Institute for 

Occupational Safety and Health (NIOSH). In addition, citations to Web sites external to NIOSH do not 

constitute NIOSH endorsement of the sponsoring organizations or their programs or products. 

Furthermore, NIOSH is not responsible for the content of these Web sites. 
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Appendix A 

Autopsy Findings

Structural

• Cardiomegaly (heart weighed 658 grams) 

• Left ventricular hypertrophy (left ventricular thickness of 2.5 cm)

• Interventricular septum thickness (1.8 cm)

• Right ventricular thickness (0.5 cm) 

• No evidence of previous injury/scarring 

Coronary arteries 

• Significant atherosclerotic narrowing of coronary arteries

o Left anterior descending (50%) 

o Left circumflex (45%)

o Right coronary artery (70%)

• No evidence of intracoronary thrombus 

• Myocardial bridging of inferior portion of left anterior descending artery 

• No evidence of a pulmonary embolus (blood clot in the lung arteries) 

Blood analysis 

• Negative for drugs of abuse 

Author’s Discussion:

Predicted normal heart weight 399 grams (ranges between 302 and 526 grams as a function of sex and 

body weight), according to research in Silver and Silver [2001].

Left ventricular thickness of 2.5 cm is very high on the basis of postmortem studies by Kitzman et al. 

[1988] (normal range 1.07 cm–1.39 cm, average 1.23 cm).

References

Kitzman DW, Scholz DG, Hagen PT, Ilstrup DM, Edwards WD [1988]. Age-related changes in 

normal human hearts during the first 10 decades of life. Part II (Maturity): a quantitative anatomic 

study of 765 specimens from subjects 20 to 99 years old. Mayo Clin Proc 63(2):137–146. 

Silver MM, Silver MD [2001]. Examination of the heart and of cardiovascular specimens in surgical 

pathology. In: Silver MD, Gotlieb AI, Schoen FJ, eds. Cardiovascular pathology. 3rd ed. Philadelphia, 

PA: Churchill Livingstone.