All of us have “enlarged hearts” from intense strength training.I am no coroner but my guess would be added impact from recreational drugs to mask the psychic pain of life choices.
Obviously PEDs enlarges the heart further. Left Ventricular Hypertrophy, which I've had, when it gets to a certain point can cause electrical problems, and the heart failure when the heart doesn't pump effectively. Steroids do it but it gets worse when GH is added in and GH is cheap now so many megadose. Of course rec drugs like stims add to the risk.
Heart attacks also happen to squaky clean fellas, so maybe it was congenital...
