Rich Piana didn't like going to the doctor and had unexplained vomiting and shortness of breath in the days before his heart attack according to his girlfriend:
“They said he had no chance of a meaningful recovery and he was in a vegetative state,” Jansen told PEOPLE exclusively. “I said, ‘It’s a good thing it’s not up to me, because I love him so much I’m too selfish to make that decision [to take him off life support].’ He was breathing on his own for nearly a week, and then he just let go.”
"She said she had suspected that something was wrong with Piana, who has a history of steroid use, a few days prior to his heart attack, when the couple was visiting Los Angeles and Piana had two episodes of vomiting and difficultly breathing. She pushed him to go to the hospital, but Piana kept refusing.
"He hates going to the doctor, he hates going to the hospital; so he was just like, ‘No I’m fine,’ ” Jansen says. “He was the kind of guy who wouldn’t tell you he wasn’t feeling well. He was just real stubborn. He didn’t want to show that he was in pain or hurt."
Source: http://people.com/bodies/rich-pianas-girlfriend-denies-he-took-drugs/