The Death of Stephen Gately

What can reliably be concluded about the cause of death of Stephen Gately? Sudden death does occur in apparently fit 33 year old men, but the list of diseases which can do this is short.

Conditions which might cause sudden death in a young man without previous diagnosis include:

- aortic coarctation;

- hypertrophic cardiomyopathy;

- aortic valve stenosis;

- coronary thrombosis;

- pulmonary embolism;

- subarachnoid haemorrhage.

All these would be identified with confidence at necropsy.

Some infections can rarely cause acute death - death within hours of onset. Two might be listed:

- meningococcal septicaemia;

- influenzal pneumonia.

These have a notoriety in this respect, but of course other infections might just do it.

A patient would feel ill, and raise alarm, probably even if sedated.

The authorities have reported that Stephen Gately was found in a kneeling position by a sofa, his head on a pillow. He had vomited, but had not inhaled vomit. At necropsy he had pulmonary oedema.

Pulmonary oedema is fluid accumulation in the tissues and alveoli of the lungs. It can be rapidly fatal if untreated. An erect posture relieves the severe breathing difficulties of pulmonary oedema, so his position when found is consistent.

Pulmonary oedema is not the same as fluid obstructing airflow in the trachea and bronchi, as would be found if vomit were inhaled, or in drowning.

The fluid in pulmonary oedema comes from the blood, not from outside.

I can imagine him asleep on the sofa, awakening in severe respiratory distress, weakened and confused by lack of oxygen, and managing to struggle to a kneeling position before final collapse and death.

The problem is that pulmonary oedema is not a complete diagnosis. In Britain a death certificate citing pulmonary oedema alone would be returned by the registrar. Pulmonary oedema is due to a primary condition, most commonly affecting the left ventricle of the heart and causing it to fail.

The first four conditions listed above could do this, but none is mentioned by the authorities. Perhaps more information will be released eventually.

Speculation is always dangerous, especially where there is celebrity and controversy. However I can think of one further cause of sudden death from pulmonary oedema, and that is the drug Ecstacy, MDMA.

Acute heart failure and pulmonary oedema are recognised complications of high doses of MDMA. This cause of death might not be evident at necropsy.

I understand samples are in the toxicology laboratory, so this hypothesis will be tested.

In the meantime we can only reflect again on the fragility of life, especially when acutely challenged, and mourn the death of a man in his prime.