A 24-year-old running the NYC marathon collapsed 2 miles from the finish line and died

Caitlin Ochs/Reuters

A 24-year-old woman from Lewisberry, Pennsylvania, collapsed during the New York City Marathon on Sunday and later died at a hospital, New York police say. Rachel Apa was just a couple miles short of the finish.

Deaths during marathons are extremely rare, experts say, even as more people run these grueling 26.2-mile races.

The city medical examiner’s office said Tuesday that it is still investigating Apa’s death. Her father, Steve Apa, told the New York Times that the cause was rhabdomyolysis, also known as rhabdo , a rare condition in which skeletal muscle breaks down and dies quickly, poisoning the body. It can damage the kidneys, cause life-threatening heart problems or trigger total organ failure.

When Apa collapsed, a bystander performed CPR and race staff used a defibrillator. Paramedics took Apa to the hospital, but were unable to save her.

Dr. Doug Farrell, a nephrologist at Mount Sinai who was not involved in the case, said rhabdo is rare, but he has seen cases at the New York City Marathon before.

In a study published in April, Farrell documented a dramatic increase in rhabdo cases at the 2022 New York City Marathon. Doctors treated 24 marathoners for rhabdo that year, compared with the three or four they usually see in the race.

The difference appeared to be high heat and humidity, Farrell said.

In 2022, the heat index reached more than 76 degrees, making it the hottest New York City Marathon since the race moved to November in 1986. Marathon day also was much hotter than the two weeks before, so runners were not as acclimated to the temperature, Farrell said.

Temperatures on Sunday were milder, hovering in the mid-60s.

Heat can hurt or slow marathoners because it makes sweating less effective.

“When you run, your muscles generate a lot of heat. Your body’s main job is to get rid of it,” Farrell said. Some marathoners’ core body temperatures can exceed 104 degrees, he said. In hot, humid conditions, sweat doesn’t evaporate and cool the body. Heat also causes faster muscle breakdown. Dehydration can compound the problem.

Rhabdo symptoms can blend in with the normal discomfort of a long race, he said.

Early symptoms can include exhaustion, weakness, nausea, vomiting and muscle aches. Marathoners whom Farrell has seen with rhabdo often sought care after they passed out or became delirious during a race.

Dr. Jonathan Kim, founding director of Emory Sports Cardiology, said deaths during marathons are extremely rare, and deaths from rhabdo “would be really, really rare.”

Kim, who did not work on Apa’s case, co-authored two large studies of 23 years of death data from US half- and full marathons.

“This death is extremely tragic,” he said. “A young woman dying running a marathon is not common.”

Kim said the most common cause of sudden cardiac arrest in a marathon is myocardial infarction, “your colloquial heart attack,” not rhabdo.

For younger runners, the second most common cause of death from cardiac arrest is “unexplained,” he said, “even after an exhaustive cardiac workup.”

Milder cases of rhabdo often occur among distance runners because muscle breaks down during exercise. If someone played a football game and then had their blood checked for muscle enzymes, Kim said, a test would spot them, but these cases typically go undetected.

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Clusters of cases have emerged among college football players in Iowa in 2011 and swimmers in South Carolina in 2007 . In 2024 , nine members of Tufts University’s men’s lacrosse team were hospitalized.

More serious cases can also strike athletes who practice in heat or who did not train enough for a long-distance run, but most are treated with IV fluids and recover, Kim said.

“When you think of common causes of sudden cardiac arrest in young athletes, certainly rhabdo is not on the list of common causes,” Kim said.

Kim has watched interest in running marathons grow since he began studying marathon death data. Sunday’s race broke the world record for the largest marathon in history, with 61,146 finishers.

Nearly 30 million people ran in races from 2010 to 2023, yet runners’ chance of dying from sudden cardiac arrest fell by half, and the survival rate for people who go into cardiac arrest while running is close to 70%, he said.

“The only thing that rivals 70% would be your casinos, your airports, your high schools that have AEDs,” he said. “Compared to your standard out-of-hospital sudden cardiac arrest survival rate, that is like 10%.”

Kim urged anyone training for a marathon to watch for signs of heart problems, including chest tightness, lightheadedness, shortness of breath and a racing heart.

Tim Blackmore/Emily Palmer

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Kim advised runners to talk with their doctor before signing up for a marathon, especially if they have cardiac risk factors such as a family history of heart attack, a history of smoking or high cholesterol.

“You just need to make sure your traditional risk factors are addressed and discussed,” Kim said.

Apa’s health history, training regimen and family medical history remain unclear.

This was Apa’s first marathon. She played Division I field hockey for Bucknell University, where she graduated in 2024.

Apa said she ran the New York Marathon to raise money for Parkinson’s disease in honor of her grandfather, who died from it in 2022. On her marathon fundraising page , she wrote that he “taught me to stay active, push my limits, and embrace challenges, shaping my love for sports and movement.”

The Associated Press contributed to this report.

Caitlin Ochs/路透社

据纽约警方称，一名来自宾夕法尼亚州刘易斯伯里的24岁女子瑞秋·阿帕（Rachel Apa）周日在纽约马拉松比赛中晕倒，后在医院去世。当时她距离终点仅几英里。

专家表示，马拉松比赛中死亡事件极其罕见，尽管越来越多的人参加这种艰苦的 26.2 英里（42 公里）的比赛。

纽约市法医办公室周二表示，仍在调查阿帕的死因。她的父亲史蒂夫·阿帕告诉《纽约时报》，死因是横纹肌溶解症，也称横纹肌溶解症，这是一种罕见疾病，患者骨骼肌会迅速分解死亡，导致中毒。横纹肌溶解症会损害肾脏，引发危及生命的心脏问题，甚至导致器官衰竭。

阿帕倒地后，一名旁观者立即对她进行了心肺复苏，赛事工作人员也使用了除颤器。医护人员将阿帕送往医院，但最终未能挽救她的生命。

西奈山医院的肾脏病专家道格·法雷尔博士（他并未参与此病例）表示，横纹肌溶解症虽然罕见，但他以前在纽约马拉松比赛中见过此类病例。

法雷尔在四月份发表的一项研究中记录了2022年纽约马拉松比赛中横纹肌溶解症病例的急剧增加。那一年，医生们治疗了24名患有横纹肌溶解症的马拉松运动员，而他们通常在比赛中只会遇到三到四例。

法雷尔说，区别似乎在于高温高湿。

2022年，体感温度超过76华氏度，成为自1986年纽约马拉松移至11月举行以来最热的一届。法雷尔说，马拉松当天的气温也比前两周高得多，因此跑者们还没有完全适应高温。

周日气温较为温和，徘徊在60多华氏度（约16-21摄氏度）。

高温会降低出汗的效率，从而伤害或减缓马拉松运动员的速度。

“跑步时，肌肉会产生大量热量。身体的主要任务就是排出这些热量，”法雷尔说。他表示，一些马拉松运动员的核心体温甚至会超过40摄氏度。在炎热潮湿的环境下，汗液无法蒸发降温。高温还会加速肌肉分解。脱水会使问题更加严重。

他说，横纹肌溶解症的症状可能与长跑带来的正常不适感混淆。

早期症状包括疲惫、虚弱、恶心、呕吐和肌肉酸痛。法雷尔医生接诊的患有横纹肌溶解症的马拉松运动员，通常是在比赛中昏厥或出现谵妄后才寻求治疗。

埃默里运动心脏病学创始主任乔纳森·金博士表示，马拉松比赛中死亡的情况极其罕见，而横纹肌溶解症导致的死亡“更是极其罕见”。

金（Kim）虽然没有参与阿帕（Apa）的案件，但他与人合著了两份大型研究报告，分析了美国半程马拉松和全程马拉松 23 年的死亡数据。

“这起死亡事件极其悲惨，”他说。“年轻女性在马拉松比赛中丧生并不常见。”

金表示，马拉松比赛中最常见的心脏骤停原因是心肌梗塞（“俗称心脏病发作”），而不是横纹肌溶解症。

他说，对于年轻的跑步者来说，心脏骤停导致的第二大常见死亡原因是“无法解释的”，即使经过详尽的心脏检查也是如此。

横纹肌溶解症的轻症病例常见于长跑运动员，因为运动过程中肌肉会发生分解。金医生说，如果有人踢完足球后进行血液肌肉酶检测，就能发现横纹肌溶解症，但这类病例通常难以被发现。

CNN新闻中心记者萨拉·西德纳完成了纽约马拉松

2011年爱荷华州大学橄榄球运动员中出现聚集性病例，2007年南卡罗来纳州大学游泳运动员中出现聚集性病例。2024年，塔夫茨大学男子长曲棍球队的9名成员住院治疗。

金说，在高温下训练或长跑训练不足的运动员也可能出现更严重的病例，但大多数患者通过静脉输液治疗后即可康复。

“当你想到年轻运动员猝死的常见原因时，横纹肌溶解症肯定不在常见原因之列，”金说。

自从金开始研究马拉松死亡数据以来，他一直关注着人们对马拉松的兴趣日益增长。周日的比赛打破了历史上规模最大的马拉松世界纪录，共有61146名选手完赛。

他说，从 2010 年到 2023 年，近 3000 万人参加了跑步比赛，但跑步者死于突发心脏骤停的几率下降了一半，跑步时心脏骤停者的存活率接近 70%。

他说：“唯一能与70%的存活率相媲美的，大概只有赌场、机场和配备AED的高中了。相比之下，院外心脏骤停的平均存活率只有10%左右。”

金敦促所有参加马拉松训练的人注意心脏问题的迹象，包括胸闷、头晕、呼吸急促和心跳加速。

蒂姆·布莱克摩尔/艾米丽·帕尔默

“跑者的冷静”帮助两位无家可归的纽约马拉松新手稳住了阵脚。

金建议跑步者在报名参加马拉松比赛前咨询医生，尤其是有心脏病风险因素的人，例如有心脏病家族史、吸烟史或高胆固醇。

“你只需要确保你的传统风险因素得到解决和讨论，”金说。

阿帕的健康史、训练计划和家族病史仍然不清楚。

这是阿帕第一次参加马拉松比赛。她曾代表巴克内尔大学参加一级联赛曲棍球比赛，并于2024年毕业。

阿帕表示，她参加纽约马拉松是为了给帕金森病研究筹款，以纪念她于2022年因帕金森病去世的祖父。她在马拉松筹款页面上写道，祖父“教会我保持活力，挑战极限，拥抱挑战，塑造了我对运动的热爱。”

美联社对本报道亦有贡献。