how did rich piana die

Rich Piana died after collapsing at his home and spending two weeks in a medically induced coma. He was 46 years old. The autopsy revealed "significant heart disease" including an enlarged heart and coronary artery hardening, with his heart and liver weighing over twice the average for an adult male. No definitive cause of death was determined because toxicology tests were not conducted—hospital specimens needed for these tests were discarded before the examiners could analyze them. There was speculation around his long-term anabolic steroid and hormone use contributing to his death, but the autopsy report was ultimately inconclusive, and no direct link was established. The cause of death was ruled "unknown" due to multiple contributing factors including heart disease and the inability to conduct toxicology, leaving the exact cause undetermined.