The family of a 24-year-old woman who died after collapsing just two miles from the finish line of the New York City Marathon has revealed the medical condition they say caused her death.
Rachel Apa was participating in the marathon on Sunday, November 1, when she collapsed near mile 24 in Central Park, close to East 85th Street, at approximately 1:30pm.
Her sudden death has devastated her loved ones, particularly as her family described her as being in excellent health before the race.
Rachel's father, Steve Apa, was following her progress through the marathon's tracking application from his home in Lewisberry, Pennsylvania, when he noticed she had stopped moving.
Speaking to The New York Times, he described the tragedy as almost impossible to comprehend, given his daughter's age and physical fitness.
Her family has now identified the condition they believe was responsible, prompting renewed discussion about a potentially life-threatening medical emergency that can affect otherwise healthy people.
What caused Rachel Apa's death?
According to her family, Rachel died from rhabdomyolysis, a serious condition involving the rapid breakdown of skeletal muscle tissue.
Commonly referred to as 'rhabdo', the condition can occur following extreme physical exertion, injuries and several other medical circumstances.
When muscle cells break down, they release substances into the bloodstream, including myoglobin, a protein that can damage the kidneys.
In severe cases, rhabdomyolysis can lead to acute kidney injury, dangerous electrolyte imbalances, abnormal heart rhythms and other life-threatening complications.
Although Rachel's family has attributed her death to the condition, the reporting does not establish whether a final medical examiner's determination has been publicly released.
What is rhabdomyolysis?
According to the Cleveland Clinic, rhabdomyolysis occurs when damaged muscle tissue breaks down and releases its contents into the blood.
The condition can develop after severe physical exertion, particularly when someone pushes their body beyond what it is accustomed to handling.
However, exercise is only one possible trigger.
Rhabdomyolysis can also result from crush injuries, prolonged immobility, heat-related illness, certain medications, infections and underlying medical conditions.
Although it is relatively uncommon, the condition can affect people of different ages and fitness levels.
The Cleveland Clinic estimates that approximately 26,000 cases occur annually in the United States.
Most people who exercise, including those who run marathons, will never develop the condition. However, understanding the warning signs can help people recognise when muscle-related symptoms may require urgent attention.
What are the early warning signs of rhabdomyolysis?
Symptoms can vary considerably depending on the severity of muscle damage and the underlying cause.
Some people develop obvious symptoms, while others experience only mild discomfort or have few noticeable warning signs.
Medical professionals identify several potential symptoms:
Symptoms may begin within hours of the triggering event or become apparent over the following days.
Importantly, not everyone experiences the commonly described combination of muscle pain, weakness and dark urine.
Someone can have rhabdomyolysis without developing every symptom.
Anyone who develops severe or unusual muscle pain, weakness, swelling or dark urine following exertion should seek urgent medical assessment rather than assuming it is normal post-exercise soreness.
Why can marathon runners be at risk?
Endurance events place significant demands on the body's muscles, cardiovascular system and ability to regulate temperature.
During prolonged strenuous activity, muscle tissue can become damaged, particularly when the intensity exceeds what a person has trained to tolerate.
Most exercise-related muscle damage is minor and forms part of the body's normal recovery process.
However, unusually severe muscle injury can sometimes trigger rhabdomyolysis.
According to the Cleveland Clinic, endurance athletes, marathon runners and people participating in intense exercise programmes may face an increased risk under certain circumstances.
Factors such as excessive exertion, heat exposure, dehydration and insufficient recovery may contribute.
Nevertheless, being a marathon runner does not mean someone is likely to develop rhabdomyolysis, and the condition remains uncommon compared with the number of people who participate in endurance events.
Can rhabdomyolysis affect healthy young adults?
Yes. Although certain medical conditions and circumstances increase the risk, rhabdomyolysis can occur in people who are young, active and otherwise healthy.
People participating in demanding fitness activities, including high-intensity interval training, strenuous cycling sessions and endurance competitions, can develop exercise-related muscle damage.
Military personnel undergoing intensive physical training are another group in whom exertional rhabdomyolysis has been documented.
People working in physically demanding environments, particularly during extreme heat, may also be vulnerable.
However, physical activity is not the only cause, and the condition can also affect people who are not particularly active.
How do doctors diagnose the condition?
Doctors typically begin by reviewing a patient's symptoms, recent physical activity, medical history and any medications they may be taking.
Blood tests are particularly important.
One key measurement is creatine kinase, commonly abbreviated as CK, an enzyme that enters the bloodstream when muscle tissue is damaged.
Significantly elevated CK levels can help doctors identify rhabdomyolysis.
Additional blood tests may assess kidney function and electrolyte levels, while urine testing can help identify evidence of muscle breakdown.
These investigations allow healthcare professionals to determine the severity of the condition and identify potentially dangerous complications.
Can rhabdomyolysis be treated?
Rhabdomyolysis can be treated, and many patients recover, particularly when the condition is recognised early.
Treatment depends on the severity of muscle damage and whether complications have developed.
Patients may receive intravenous fluids to support circulation and kidney function, alongside careful monitoring of electrolytes and urine output.
Doctors will also address the underlying cause and treat any complications.
In severe cases involving significant kidney injury, dialysis may be necessary.
Recovery times vary, and some patients experience muscle weakness or fatigue for several weeks.
Although many people recover successfully, severe cases can become life-threatening, particularly when dangerous electrolyte disturbances or organ damage occur.
How can people reduce their risk?
While rhabdomyolysis cannot always be prevented, medical professionals recommend several precautions when undertaking strenuous physical activity.
Hydration is important, but drinking water alone cannot guarantee prevention, and excessive water consumption during endurance events can cause separate medical complications.
Training, pacing, appropriate fluid intake and recognising warning signs all play a role in reducing risk.
Family left devastated by Rachel's death
Rachel's death has left her family grieving the sudden loss of a young woman they believed was in excellent physical condition.
Her father described the circumstances as unfathomable, particularly because she was only 24 years old.
The tragedy has also drawn attention to the fact that serious medical emergencies can sometimes develop during strenuous exercise, even in people without obvious pre-existing health problems.
For medical professionals, the central message is not that people should avoid exercise or endurance sports, but that unusually severe symptoms should never be ignored.
While rhabdomyolysis is uncommon, early recognition and appropriate treatment can be crucial in preventing serious complications.
