Heart failure at 30 years old????
One explanation.....STERIODS!
Take this as a lesson boys. That shit will fuck up your life, if it doesn't kill you!
What follows is an extremely long post that probably belongs under 'Health and Wellness.'
Chronic use exogenous anabolic steroid use has demonstrated a mild degree of left ventricular hypertrophy (LVH) in weightlifters, though not to a pathologic degree, so I doubt this alone is the culprit ('Heart', April, 2004)
However, both cocaine and speed are notorious for inducing hypertrophic cardiomyopathy ('enlarged heart muscle disease'), as both are 'dopaminergic' (enhance the neurotransmitter/hormone dopamine). Dopamine is a pressor -- it raises systemic blood pressure -- and an inotrope -- it increases heart rate and contractility or 'ejection fraction'. So what you have is a heart that is beating more vigorously against a higher-pressure system. The heart muscle responds by getting bigger, at the expense of the capacity of the left ventricle to hold blood. So eventually the left ventricle can't accept enough blood to perfuse the system properly (left sided heart failure).
Also, the left ventricle receives oxygenated blood from the lungs, which itself receives blood from the right side of the heart (pulmonary circulation). The right pulmonary circuit is much lower pressure than the left, and the heart muscle (myocardium) around the right ventricle is significantly less thick than the left. Therefore, it is far less susceptible to hypertrophic insult: its ejection fraction remains relatively stable. Thus, the diminished left ventricle continues to receive the same amount of blood from the lungs. However, it can't accept it all, the system backs up, leading to pulmonary hypertension (high blood pressure in the lungs) edema (extravagation vascular fluid from the pulmonary veins into the lung parenchyma, i.e. a 'soggy' lung) and congestive heart failure. Eventually, the back up to the right heart is translated into the systemic venous circulation, leading to an enlarged liver, portal hypertension, acites (extravagation of vascular fluid into the gut) and pedal (foot) edema. This is called 'right heart failure’
The other possibility is that muscular hypertrophic left ventricle can over time become a floppy one (‘dilated cardiomyopathy’). Regardless of how big a heart gets, it only gets 5% of the blood flow. Moreover, heart muscle (myocardium) is the most aerobic tissue in our body: even in a resting state, myocardium will extract 60-70% of the oxygen from the blood (as opposed to 5-30% for other tissue). Therefore, myocardium is extremely sensitive to low-oxygen states ('hypoxia'). And when heart muscle -- or any muscle -- grows, it isn't making more cells. Rather the individual cells are just getting bigger. So what you have are bigger cells that are further away from the blood flow/oxygen source. They are more prone to experience hypoxia, and will eventually die. These dead cells are replaced by scar tissue (fibroblasts), which, unlike myocardium, have a very limited ability to contract. Moreover, scars are not incorporated into the heart's conduction system, which makes healthy heart muscle contract in a sequential, organized manner.
This situation is, in effect, a heart attack by degrees. Over time, what was once a big, muscular heart becomes a big, floppy heart: a very large left ventricle with greatly diminished relatively uncoordinated contractility (or low ejection fraction.). Small ejection fraction mean that blood sits around in the left ventricle, and when blood sits around under any conditions, it clots. Clots thrown from a floppy left ventricle often go to the brain, where they clog up arteries and cause mini strokes ('multi-infarct dementia'). This process takes place over many years; decades, even.
However, I don't think any of the above is what happened to Mr. Sager. For one thing, this guy doesn't look like he's been abusing meth or coke. What we have instead is a guy with positive family history of arrhythmias/possible 'conduction disorders'. In this setting, a slightly more muscular left ventricle secondary to steroid use (or for that matter just lifting a lot -- below) could 'unmask' what would otherwise be congenital benign pathology. Incidentally, this is a condition that can be ameliorated to a great extent by rigorous cardiovascular exercise (45 minutes, 4-5x/week), which 'fine tunes' the heart's conduction system, and tones heart muscle to beat more efficiently. However, very few bodybuilders engage in intensive cardiovascular training for fear that it will decrease their muscle mass.
Also, it is entirely possible that this gentleman had extremely high testosterone levels without the use of exogenous steroids. He has, so far as I can tell, nearly no body fat. Fat tissue converts testosterone into estrogen through an enzyme called aromatase. Of course, testosterone is considered a major player in the development of atherosclerotic plaques. Coronary arteries are especially susceptible to occlusion simply because they are so small. Estrogen, conversely, is protective against plaque formation. Again, a rigorous cardio exercise routine will help protect against plaque formation.
And having next to no body fat suggests still another possibility: this may have been a 'hungry heart' -- though not in the sense that The Boss meant. The principle metabolic fuel of heart muscle -- or any muscle working aerobically -- is fatty acid, i.e. broken down fat. If you don't have fat, your heart doesn't have fuel.
Moreover, the fat that fuels the heart comes mainly from the gut: fat cells in the gut are exquisitely sensitive to adrenalin, and will release their fatty acids under prolonged 'adrenergic tone', such as long distance running or other time intensive aerobic activity. So while much has been rightly been made of the pathology associated with 'truncal obesity' or 'apple' body habitus, you definitely need to have some fat there. Homo Sapiens is genetically programmed to be a long distance runner, not a couch potato.
A gut with no internal fat suggests yet another substance of abuse: 'hoodia' supplements. As I understand it, hoodia is a cortisol antagonist. Cortisol is a 'stress' steroid hormone that acts synergistically with insulin to enhance the uptake of carbohydrate by fat cells in the gut to improve fat stores. Again, the system is in place because Homo Sapiens is a long distance runner and always need to have a full tank.
Incidentally, cortisol also keeps our immune system in check. By antagonizing its activity, it is entirely possible to 'unmask' autoimmune diseases like Rheumatoid arthritis, Inflammatory Bowel Diseases, and Lupus (SLE).
The last thing that I would like to suggest it that this might have been a pulmonary embolus, like that perfectly healthy reporter in Iraq had a few years back. He formed a clot in his leg; it traveled to the right side of his heart, clogged up his pulmonary circulation, and killed him. Common things are common, as we say.