The 16-year-old Citrus High School student who died during football practice in September had heart disease, which caused his death.

That was the conclusion of the medical examiner’s office for District 5 and 24 hours after examining the body of Antonio Hicks who was pronounced dead after paramedics rushed him to hospital from the Inverness school.

Associate Medical Examiner Dr. Shanedelle Norford identified hypertrophic cardiomyopathy as the cause of the teenager’s death. Norford also cited ventricular hypertrophy in her Dec. 29, 2021, autopsy report.

Hypertrophic cardiomyopathy is a disease in which the heart muscle becomes abnormally thick. The thickened heart muscle can make it harder for the heart to pump blood and cause an abnormal heart beat and cardiac arrest. Ventricular hypertrophy is when the wall of one of the two heart’s main pumping chambers thickens.

Norton also cited myocyte disarray in her findings.

That’s when heart muscle cells don’t align themselves in parallel but in circles around connective tissue in the heart. It’s often seen in cases of hypertrophic cardiomyopathy, according to the medical literature.

Norford also cited that pulmonary edema was seen, which means water in the lungs. That was most likely caused by attempts to resuscitate Hicks, Dr. Ralph Abadier, a cardiologist at Comprehensive Cardiology, Cardiovascular & Vein Disease Diagnosis & Treatment in Inverness, told the Chronicle.

Norford also reported that Hicks was 6 feet tall and weighed 288 pounds, with a body mass index of 38, which made Hicks morbidly obese.

Abadier reviewed the medical examiner’s report for the Chronicle and said the enlarged heart most likely caused an abnormal heart rhythm, which likely resulted in the boy’s death.

The heart disease and symptoms typically manifest themselves in patients during their teens and 20s, he said.

Asked by the Chronicle if Hicks could have avoided the symptoms of the heart problem had he not participated in sports, Abadier replied, “It would have shown itself anyway” and that his death could have occurred on the athletic field as well as off during normal activities.

Abadier said that dehydration and an absence of electrolytes could have “exacerbated” the boy’s heart problem during football practice, but noted that nothing in the medical examiner’s report suggested that Hicks was dehydrated or lacked electrolytes.

While its unknown if Hicks had symptoms of the disease, such as shortness of breath or dizziness, it could have been attributed to his excess weight.

Hypertrophic cardiomyopathy effects between 1 in 200 to 1 in 500 people, according to Expose HCM, a Bristol Myers Squibb website.

Mortality rates among people with the disease is at least four time higher than the general population for ages 20 years to 29 years and at least three times higher for those 50 years old to 69, according to the Centers for Disease Control and Prevention.

It’s estimated that about 85 percent of those with hypertrophic cardiomyopathy are undiagnosed, according to Expose HCM.

Cardiac arrest is sometimes seen in athletes.

For example, one notable death from the disease was Reginald Lewis, a basketball player for the Boston Celtics who died in 1993.

On July 27, 1993, during an off-season practice session Lewis suffered sudden cardiac arrest. He was 27 years old.

His death was attributed to hypertrophic cardiomyopathy, according to Time magazine and USA Today.

As for the Citrus County School District, it is remaining mostly quiet.

District spokeswoman Lindsay Blair said the district’s report on the death is not available for public view per statute FSS 768.28 16 B, C, D.

In addition, the school district would neither confirm, nor deny the completion of its internal inquiry.