Due to the several potential causes of death and the impossibility of conducting a toxicology report, the 46-year-old bodybuilder Rich Piana’s cause of death was classified as “unknown” in an autopsy report received by Men’s Health two and a half months after his untimely demise.
His claimed history of drug use, “severe” heart problems, and the absence of specimens from the hospital, all of which could have contributed to his demise, were listed as reasons why the autopsy could not identify a cause of death.
Men’s Health received confirmation from the Florida District Six Medical Examiner’s Office that no toxicology investigation was conducted to ascertain whether Piana’s system contained any medicines that would have led to his demise.
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William Pellan, Director of Investigations for the District Six Medical Examiner’s Office, said to Men’s Health, “We did not do toxicology analysis due to the admission specimens being discarded well before his (Piana’s) date of death.” The capacity to identify what was in a person’s system at the time of the incident is made possible by those specimens.

Pellan continued by stating that even though they are required in situations like Piana’s for running toxicology reports, hospitals frequently throw away specimens after three days. In this specific case, the hospital was contacted by the police agency and our office, who asked for the samples to be kept, he stated.
Piana unexpectedly passed out while receiving a haircut in early August and was sent to the hospital. He spent over two weeks in a medically induced coma before passing away in the hospital.
Given that Piana was upfront about using anabolic steroids and insulin, it has been hypothesized that drug use played a role in the beloved bodybuilder’s passing. Police reportedly discovered 20 bottles of steroids in his residence, according to TMZ.
Pellan stated that it was impossible to rule out drugs as a cause of death, even though the autopsy report could not make any connections between Piana’s death and drug use. “Due to the lack of available admission specimens, drug involvement could not be ruled out,” he said. “The findings do not indicate that drugs played a role in his death. The findings indicate an enlarged heart.”
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Piana’s autopsy revealed “coronary atherosclerosis,” or hardening of the arteries, in addition to cardiomegaly, or an enlarged heart. Without a toxicology report to rule out drug use, it is hard to rule out heart disease as the cause of Piana’s death despite these “severe” indicators of heart illness.
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