From a doctor on reddit:
[–]anesthetica 948 points 13 hours ago
Let me hijack the top comment to clear up some of the confusion in this subreddit. Like /u/KoalumVonMoger said below, this article is just some journalist with no medical background trying to decipher the autopsy report. Without the proper training, you can google every single word in the report and still not understand what they truly mean. I read the full autospy report and here's what I think (source: am doctor).
"The mid anterior lower neck had a tracheostomy and a tracheostomy tube. The mid left upper abdomen had a PEG tube. The medial aspect of the right arm had an IV catheter. An indwelling catheter was protruding from the urethra. The right wrist had hospital ID and DNR bracelets. A rectal tube was in place."
A tracheostomy tube and a PEG tube means he was in the hospital/ICU and bedridden for a long time on the ventilator; this basically means that a lot of the autopsy findings could be (and is very likely to be) from lying in the same bed without moving for 18 days.
"The lung appeared moderately-markedly congested with scattered areas of consolidations associated with greenish purulent exudates in the cut surfaces."
The "bronchopneumonia with bilateral purulent pleural effusions"is likely due to him being intubated for such a long time in the ICU. Anytime you have a breathing tube down your throat, you're prone to developing nasty pneumonia after 3-4 days. He was intubated for 18. It probably contributed to his death but likely developed after he was already in the hospital, as is true for most of the other significant findings on the autopsy.
The 3160 gm liver had a smooth serosal surface and that was yellowish-tan and greasy in texture from (mild) fatty change with no gross fibrosis, cirrhosis, necrosis, or neoplasm. The gallbladder was unremarkable.
With only "mild" fatty change and no gross fibrosis/cirrhosis, this tells me that the liver was probably fine prior to admission, although it is quite large. Probably no significant liver changes despite the "ascites" documented in the report, which could have been a result of being in the hospital and having a shit ton of fluids being given to you through an IV. I've taken care of a lot of patients in the ICU. They almost always get swollen from our IV fluids/medications if they stay long enough.
"Brain: edema, necrosis, ischemic changes"
These are microscopic findings. This shit happens to everyone who dies. See context below:
"No abnormality was noted in the reflected scalp, calvarium, dura, meninges or the base of the skull. The gyri were flattened with no obvious herniation. The cerebral vascular system was unremarkable. The circle of Willis and other basal vasculature appeared intact and normally formed. The 1500 gm soft friable dusky decomposing/necrotic appearing brain was free of gross neoplastic masses. The ventricles were compressed. The thalamus, the hypothalamus, the basal ganglia, the midbrain, the pons, the medulla and the cerebellum were normally situated and were atraumatic."
This tells me at least structurally that the brain was fine.
"The 670 gm heart had a normal configuration and an unremarkable epicardial surface. The coronary arteries were normally developed and had mild atherosclerotic disease. The myocardial cut surfaces had no fibrosis, infarctions or focal lesions. The chambers were not dilated. The atrial and the ventricular septae were intact. The heart was enlarged with the myocardium of the left ventricle and the right ventricle hypertrophied. The papillary muscles and chordae tendineae were thickened. The endocardium and heart valves were not fibrosed. The aorta had mild atherosclerosis. The major arteries and great veins showed normal distribution."
This is the juicy part.
His heart was huge at 670 grams (normal heart weight for males: about 330 grams +/- 60).
"Mild atherosclerotic disease" happens to nearly every male if you live long enough.
"No fibrosis, infarctions, or focal lesions" means probably not a heart attack.
The heart "was enlarged with the myocardium of the left ventricle and right ventricle hypertrophied. The papillary muscles and chordae tendineae were thickened." This means that the heart was fucking huge. Both the left and right ventricles were big, meaning it probably wasn't the heart valves or the lungs causing his heart to grow. This means either his genetics suck and gave him a big heart, or it was the drugs.
My suspicion is, like very many of you said below, that his heart was huge, and he developed an abnormal heart rhythm (arrhythmia) that caused a cardiac arrest. When your heart is that big, the intrinsic electrical activity is altered and puts you at risk for developing arrhythmias. Cocaine and other drugs can increase this risk. That being said, the pathologist is correct. Without a toxicology report in the setting of known drug use as well as a prolonged hospital stay, you really can't comment on the cause of death.
