A 24-year-old woman who collapsed just two miles from the finish line of the New York City Marathon has died, with her father identifying a potentially life-threatening muscle condition as the cause.
Rachel Apa, from Lewisberry, Pennsylvania, was taking part in her first marathon when she suffered a medical emergency near mile 24 of the 26.2-mile course.
The former college athlete had reportedly spent months preparing for the event and was running to raise money for the Parkinson's Foundation in memory of her grandfather.
Despite receiving emergency medical attention and being transported to hospital, Rachel died later that evening.
Her father, Steve Apa, has since spoken about the devastating loss, explaining that his daughter had appeared to be in excellent health before the race.
He also revealed the medical condition he says was responsible for her death, prompting questions about its warning signs and how it can affect otherwise healthy people.
What happened to Rachel Apa during the New York City Marathon?
Rachel was participating in the marathon on Sunday, November 1, 2026, having trained for months to complete the race.
A former Division I field hockey player at Bucknell University, she was an experienced athlete who enjoyed physical activity.
Her participation carried personal significance because she was running in honour of her grandfather, who died from Parkinson's disease in 2022.
According to her father, Rachel had been exchanging text messages with him throughout the event.
At approximately mile 18, she sent a message reading "Ow".
A mile later, she followed it with another message saying "Ow ow".
Steve continued encouraging his daughter, sending her a message reading "final stretch" as she reached mile 23.
But shortly afterwards, Rachel collapsed in Central Park, with approximately two miles remaining.
Bystanders rushed to assist her, with reports indicating that two doctors helped administer CPR before event medical personnel arrived.
Medical staff also used a defibrillator as part of the emergency response.
Rachel was transported to Mount Sinai Medical Center, where doctors reportedly spent more than six hours attempting to save her life.
Her father said she was pronounced dead at approximately 9:40pm.
What condition did Rachel Apa's father say caused her death?
Steve Apa told The New York Times that his daughter had died from rhabdomyolysis, a serious medical condition involving the rapid breakdown of skeletal muscle tissue.
Often shortened to "rhabdo", the condition occurs when damaged muscle cells release their contents into the bloodstream.
These substances include myoglobin, a protein normally found inside muscle cells that helps store oxygen.
When substantial amounts of myoglobin enter the circulation, they can damage the kidneys and contribute to acute kidney injury.
Muscle breakdown can also release electrolytes, including potassium, into the bloodstream.
Dangerously elevated potassium levels can interfere with the electrical activity of the heart, potentially causing life-threatening heart rhythm disturbances.
In severe cases, rhabdomyolysis can lead to kidney failure, dangerous electrolyte imbalances and other complications.
Although Rachel's father identified the condition, detailed medical findings establishing the precise sequence of events leading to her death have not been publicly provided in the supplied reporting.
What are the warning signs of rhabdomyolysis?
According to the US Centers for Disease Control and Prevention and Cleveland Clinic, rhabdomyolysis can cause several symptoms that may initially resemble ordinary muscle soreness or exhaustion.
However, some symptoms can indicate that muscle damage is more serious than the normal discomfort associated with physical activity.
Potential warning signs include:
Not everyone with rhabdomyolysis experiences all of these symptoms.
Some people may not develop the classic combination of muscle pain, weakness and dark urine, making the condition difficult to recognise without medical testing.
The CDC advises that anyone who develops symptoms suggestive of rhabdomyolysis should seek medical attention immediately.
Can healthy people develop rhabdomyolysis?
Yes. Although rhabdomyolysis is relatively uncommon, it can affect people who are otherwise young, healthy and physically active.
One possible trigger is excessive or unusually intense physical exertion.
During demanding activity, muscle tissue can become damaged, particularly when the exercise is prolonged or exceeds what the body is accustomed to.
Heat stress, dehydration and inadequate recovery may increase the risk in some circumstances.
However, rhabdomyolysis is not limited to endurance athletes.
Other possible causes include:
The condition can develop through different mechanisms, and not every case is caused by exercise.
Why can rhabdomyolysis become life-threatening?
The danger comes from the effects of severe muscle breakdown on the body's organs and internal chemistry.
When muscle cells are extensively damaged, they release proteins and electrolytes into the bloodstream.
Myoglobin can contribute to kidney injury, while elevated potassium can cause dangerous changes in heart rhythm.
Other complications can include abnormalities in blood chemistry, reduced blood pressure and, in severe cases, multiple organ dysfunction.
Without prompt treatment, these complications can become life-threatening.
However, many people recover successfully when the condition is recognised and treated early.
How do doctors diagnose rhabdomyolysis?
Doctors generally diagnose rhabdomyolysis using a combination of symptoms, medical history and blood tests.
One of the most important tests measures creatine kinase, often abbreviated as CK.
This enzyme is released into the bloodstream when muscle cells are damaged.
Significantly elevated CK levels can indicate substantial muscle injury.
Doctors may also check kidney function, potassium and other electrolyte levels, alongside urine tests where appropriate.
The results help determine the severity of the condition and whether complications are developing.
Can rhabdomyolysis be treated?
Rhabdomyolysis requires prompt medical assessment, particularly when symptoms are severe or accompanied by dark urine, reduced urination or marked weakness.
Treatment often involves intravenous fluids to maintain circulation and help protect kidney function.
Doctors also monitor blood chemistry and kidney function closely.
If dangerous electrolyte imbalances develop, additional treatment may be required to stabilise the heart and other organs.
In particularly severe cases, patients may require intensive care or temporary dialysis if their kidneys cannot adequately perform their normal functions.
The outcome depends on the extent of muscle damage, the presence of complications and how quickly treatment begins.
What did Rachel Apa's family say following her death?
Rachel's father described the loss of his daughter as almost impossible to comprehend.
Speaking to The New York Times, Steve Apa said: "It's unfathomable."
He described Rachel as being in "perfect health, perfect shape" before the marathon.
His comments reflected the family's shock that someone so young and apparently fit could suffer a fatal medical emergency.
Rachel had been running in memory of her grandfather, making the event especially meaningful to her family.
Her death has also prompted an outpouring of sympathy from the wider running community.
What did New York City Marathon organisers say?
New York Road Runners, the organisation responsible for the marathon, confirmed Rachel's death and expressed condolences to her loved ones.
In a statement provided to ABC News, the organisation said it was deeply saddened by her passing following Sunday's race.
It extended its sympathies to her family, friends and the running community.
Organisers also confirmed that Rachel received emergency assistance after collapsing, including CPR and treatment from event medical staff.
When should someone seek emergency medical help?
Medical professionals advise people not to ignore severe or unusual symptoms following strenuous exercise.
Muscle soreness after physical activity is common, but extreme pain, pronounced weakness, swelling or dark urine can indicate a more serious problem.
Anyone experiencing these symptoms should stop exercising and seek urgent medical assessment.
In the United States, call 911 for a medical emergency. In the United Kingdom, call 999 in an emergency or contact NHS 111 for urgent advice when the situation is not immediately life-threatening.
Rachel Apa's death has highlighted the importance of recognising that serious medical emergencies can occur even among experienced athletes.
While rhabdomyolysis is often treatable, early recognition and medical intervention are essential to reducing the risk of severe complications.
