On August 19, late Kent State football player Jason Bitsko got ready for bed to rest his body before 9 a.m. football practice. 

He sent a few goodnight texts and went to sleep around 11 p.m. The next morning, he never woke up.

Bitsko, a 21-year-old junior, was found dead in his off-campus apartment August 20. His roommates found him unresponsive in his bedroom after he didn’t show up to practice that morning.

That same week of Bitsko’s death, Portage County Coroner Dr. Dean Deperro ruled out head trauma and drugs for cause of death.At the time, Deperro said he was “pretty certain” Bitsko’s death was of natural causes. The final cause of death could not be determined or released until blood and toxicology reports were completed and analyzed. 

“We had a cause of death within the first 24 hours that needed to be confirmed,” Deperro said. “Mr. Bitsko was found to have a significantly enlarged heart, twice the size literally that we would have expected from somebody of his size, and that in it of itself is sufficient cause of death. But frankly I felt that for Mr. Bitsko’s case, it was important to dig as deep as we needed to rule out anything else that might have contributed to it. That’s why initially the toxicology screens came up negative.”

Deperro and his staff examined the case to find the root cause of Bitsko’s death, leaving no stone unturned. Eventually Deperro attributed his cause of death to an enlarged heart – medically known as cardiomegaly – which put him at risk for abnormal heartbeat, or cardiac arrhythmia.

“Once the heart becomes enlarged as it has, then other problems that can follow that, including an irregular heartbeat that can eventually cause death,” Deperro said. “There are a myriad of reasons why a heart can become enlarged, and that is why we took our time and wanted to be as thorough as possible.”

An entire football season, full semester and even part of winter break passed until Deperro finally verified Bitsko’s cause of death just before Christmas on Dec 23. 

“Every time you dig a little deeper to get this information, it takes a little longer to get back, and ultimately it took as long as it did because we had to wait for microscopic evaluations of slides that we’ve done of his heart,” Deperro said. “(Bitsko) really didn’t have anything other than a cardiomegaly to say a cause of death.”

There would finally be some closure for family and friends, but Bitsko’s unexpected death still raises so many questions, with one such wonder standing at the forefront.

How could a perfectly healthy 21-year-old athlete die so suddenly without warning? An enlarged heart caused Bitsko’s death, but what prompted his heart to become enlarged in the first place?

Unfortunately for future cases similar to this one, the central question still stumps even those in the medical world.

True cause of death remains unknown

In Bitsko’s case, the fact of the matter is that Deperro doesn’t know why Bitsko had cardiomegaly. When he and his staff carefully examined his medical history, there were no warning signs that Bitsko was predisposed to any sort of heart condition.

“My investigators had done a complete search of his best medical history, what Kent State University had on Mr. Bitsko with him being an athlete and spoke with the family, and prior to (his death), he did not have this problem,” Deperro said.

According to the investigation, Bitsko showed no apparent symptoms of heart problems up until his death.

“The only thing we knew…was that the day before, he had commented that he had a rough practice, but I believe that was just in reference to him being tired and kind of like he might have been coming down with something,” he said. “But we looked for viruses and infections of that nature when we did the autopsy and follow up, and in our investigation, we found none of that.” 

Trent Stratton, Kent State director of sports medicine, said a person with an enlarged heart would experience certain symptoms like profuse sweating or chest pain stemming from irregular heartbeat, but only if provoked by strenuous physical activity.

“They could certainly have symptoms that hopefully pull them from the activity and either investigate it or allow those symptoms to subside instead of keep pushing them,” Stratton said. “Then it would be too late. 

However, none of these symptoms manifested themselves in Bitsko’s case, making detection nearly impossible.

“You can have high blood pressure at a very young age, and no one’s quite sure how long your blood pressure has to be high and how high it has to be before you start developing an enlarged heart…and we will never know in Mr. Bitsko’s case exactly what happened,” Deperro said.

Bitsko’s size a health risk?

There was some speculation that Bitsko’s large size contributed to his enlarged heart and made him more susceptible to the condition.

An offensive lineman standing at 6-foot-3, 280-plus pounds, Bitsko was larger than the average male.

“Someone that’s a larger individual is typically going to have a larger heart, and then if they have quite a bit of muscle mass…maybe there’s some theory that would suggest that that’s enlarged because it’s a muscle and it’s doing extra work to keep up with the rest of the body,” Stratton said.

Because Stratton was not involved with the preparation, investigation and experimentation behind the coroner’s reports, he couldn’t say with any certainty that there was any correlation between Bitsko’s size and the size of his heart.

Deperro further confirmed Stratton’s uncertainty, saying there’s no definite correlation.

“There are a lot of bigger people out there who don’t have enlarged hearts, so as to say that all linemen need to be concerned about this is, no I don’t think that would be an adverse statement,” Deperro said.

Kent State’s physical and screening protocol

Like all Kent State student-athletes, Bitsko was required to go through various screenings and physicals before the university allowed him to play for the Flashes.

Stratton explained how the process works when a student-athlete comes to Kent State and must be screened before being cleared to compete. 

Every student-athlete sees their own physician prior to coming to campus to ensure that they have a physical done before coming to school, giving Kent State a clear indication of the athlete’s medical history.

Prior to coming to Kent State, Pam Bitsko, Jason’s mother, said she had her son screened with an echocardiogram before coming to Kent State once she found out his grandfather had hypertrophic cardiomyopathy (HCM), or disease of the myocardium (muscle of the heart).

“I did have Jason and his older brother screened with an echocardiogram at the time just to make sure he was OK,” Pam said. “After his screening, I got a letter from the cardiologist clearing him.”

Once the athletes come to Kent State, they see its doctors who review all of that information and then give them a full clearance. If there’s any further testing the doctors deem necessary, or if family history raises any red flags, then they have it done.

However, Kent State does not do an EKG, or an echocardiogram, on every student-athlete.

Stratton said student-athletes fill out health appraisals, which is essentially a health history that “will hopefully throw some red flags as far as a family history or if they’ve had any episodes in the past.”

“We have had student-athletes come in and maybe have heart murmurs as a kid, maybe they’ve had episodes of fainting or passing out due to exercise,” Stratton said. “Those all get referred to a cardiologist, and then we get a full clearance from the cardiologist before they’re allowed to go again.”

Stratton said he could not disclose whether or not there were any red flags in Bitsko’s medical history that would have stood out to him or any of Kent State’s doctors in charge of conducting his physicals, although Deperro already made it clear that Bitsko’s medical history was clean.

“We checked his records — and again the university does a good job screening their athletes — and we didn’t see anything in that regard,” Deperro said. “I’m sure they would have forced him into treatment had they seen anything. Everything seemed to be in order, and there was no suggestion of anything that would (stand out).” 

Is prevention an option?

Due to the condition being so undetectable, Stratton said there is really no way of preventing an enlarged heart, as the condition is virtually undetectable without prior symptoms.

Even EKGs, although more efficient than a basic school physical, don’t guarantee anything.

“I think in some of the research I have done in previous cases, and kids that have had a full workup, whether its an echocardiogram or a stress test, and they have been fine and then end up having issues, so whether there’s a delay in the time that they’ve had the testing versus when they have the issue, but I don’t foresee that there’s anything now that would help us,” Stratton said.

“It is something that obviously has some awareness, and it would certainly be nice if there was a foolproof way to detect something like this,” Stratton said. “Even a routine X-ray won’t necessarily catch anything with an enlarged heart.”

Would EKG testing help?

Ideally, all student-athletes would be checked via an EKG, but realistically and economically, performing an echocardiogram on every student-athlete that attends Kent State might not be practical or plausible, asthe average EKG test can cost anywhere between $1,000-$3,000, according to data collected from hospitals by nerdwallet.com. 

“An echocardiogram can help screen for some of that, but again you start looking at the incidents versus the benefit of doing an echocardiogram on every athlete that comes through, but it depends on…how much precaution you want to have,” Deperro said. “It’s going to require society to decide where they want to draw that line with participation in sports.”

Would the benefit of doing an EKG on all student-athletes entering Kent State athletic programs outweigh the exorbitant cost? Like most of the questions still surrounding Bitsko’s case, the answer remains ambiguous.

“What we can do to ensure health in our society may not be what is palpable to the economics of our society,” Deperro said. “I have no first-hand knowledge of what the university requires and if it’s uniform across all of its programs, and if you’re looking at college-endorsed athletics…and going to have people of any age participating in physical activity, and that’s where I think the question gets to be a difficult question to answer.” 

Still searching for answers

Pam said she received only a tiny bit of closure after her son’s cause of death was finally revealed.

The feeling of closure was only a tiny sense because she still has so many questions which need to be answered.

“I was a little discouraged with what (the coroner came up with) because I feel like there had to be a reason why he had an enlarged heart,” Pam said. “Those are the pieces that I’m trying to put together because obviously there could be some hereditary issues within the family of why this happened to him and could this happen to anymore of my children. I know it has to go back to some undetected heart issue. I’m not done investigating yet.”

Pam has further taken it upon herself to research her son’s condition and get her other children, Ryan and Kaitlin, checked for heart conditions.

Pam said she believes universities could do more to prevent this from happening in the future, starting with simple background checks of family medical histories.

Even though institutions can’t afford to test every student-athlete with an EKG, Pam said they could have athletes fill out paper-and-pencil questionnaires about family medical history to get a better idea of what to look for. 

“HCM is the leading cause of death for college athletes, and I feel (they should start) with a paper-and-pencil questionnaire, asking if HCM is in your family,” Pam said. “If it’s a yes and you’re aware of that, I would like to see universities start requiring yearly echocardiograms. I feel that if I would have known this from the past cardiologist I dealt with, could that have helped keep Jason alive now.” 

Although Pam acknowledged she would never know the answer to her question, she said if something had been detected, Jason would have never played college football.

Contact Richie Mulhall at [email protected].