T“I am the heart muscle.”
For Louai Razzouk, MD, MPH, interventional cardiologist and associate director of quality at NYU Langone’s Cardiac Catheterization Laboratory, this isn’t just a catchy phrase — it’s his guiding mission. “The sooner we can open an artery, the less damage there is to the heart and the lower the risk of heart failure or arrhythmia. The national target time to open an artery is 90 minutes. At NYU Langone, we can open blocked arteries in an average of 60 minutes or less.”
That so-called “quick door-to-balloon” time made a big difference for Ken Rich, 56, of Brooklyn. He woke up one morning in August feeling nauseous and in a cold sweat. Antacids didn’t help, so his wife drove him to the emergency department at NYU Langone Health Cobble Hill’s Joseph S. and Diane H. Steinberg Ambulatory Care Center.
After an extensive examination, the unbelievable became reality: Rich had suffered a heart attack.
“I thought, ‘How could this be?'” says Rich, a fish eater who follows a heart-healthy Mediterranean diet. “I had recently been on a family vacation in the Black Hills of South Dakota, where I’d chopped firewood, gone hiking and swam in the 24-acre Iron Creek Lake with my 12-year-old son, Roscoe. On paper, I was doing all the right things.”
Rich was taken by ambulance to the Ronald O. Perelman Emergency Center in Manhattan, located at NYU Langone’s Tisch Hospital and home to one of the most advanced catheterization labs in the country. Tisch Hospital is the recipient of the American Heart Association’s highest award, the Mission: Lifeline Gold Award, which recognizes a high-quality system of care for patients with heart attacks (also known as myocardial infarctions). Not only is the hospital equipped with all the latest equipment to open blocked arteries, but it is also staffed by an elite team of experienced interventional cardiologists, all of whom are affiliated with NYU Langone Heart Hospital. Further testing confirmed that not only had Rich suffered a heart attack, but that it was a “widow maker,” the most severe type.
“Widowmaker heart attacks, which are common in young men, occur when the left anterior descending artery (LAD), the main artery that carries blood to the left ventricle of the heart, becomes blocked,” says Dr. Razook. “The LAD artery provides approximately 50 percent of the heart muscle’s blood supply, making this type of heart attack immediately life-threatening.”
Life-saving procedure restores blood flow
A coronary angiogram, an x-ray of the coronary arteries, the blood vessels of the heart, confirmed that Rich’s LAD artery was 100 percent blocked at its origin. That level of blockage can occur when plaque, a waxy substance made of fat, cholesterol, calcium and other substances that builds up on artery walls, ruptures and completely cuts off blood flow to the rest of the heart, Dr. Razook said. Rich’s ejection fraction, or the amount of blood the heart pumps with each beat, told him his heart was in trouble. His ejection fraction was 30 percent; normal is 55 percent.
To restore blood flow to Rich’s LAD, Dr. Razook and his team performed a mechanical thrombectomy with continuous aspiration, given the large amount of clots present, followed by intracoronary imaging to right-size the stent. This procedure, which can only be performed in advanced catheterization labs like Tisch Hospital’s, involves aspirating the clot through a tiny catheter (tube) inserted into a blood vessel in the leg and then placed inside the heart. After the blockage was removed, a stent was inserted to keep Rich’s LAD open.
Within an hour, Rich was treated and blood flow to his heart was fully restored. Soon, with the help of medication, his ejection fraction returned to normal. “The cardiology team at NYU Langone was amazing, including the nurses,” says Rich.
Exercise is medicine
Just three days later, Rich was back home and in his music studio. Yet his swim across Iron Creek Lake the week before seemed like a lifetime ago. “After my heart attack, even walking up the subway stairs made me nervous. I didn’t know what was safe for my heart,” he says.
To safely recover, Rich underwent 36 one-hour sessions at the Joan and Joel Smilow Cardiac Prevention and Rehabilitation Center at NYU Langone. The medically supervised exercise program is designed to improve outcomes for people who have survived a heart attack, congestive heart failure, heart transplant, left ventricular assist device (LVAD) therapy, valve replacement surgery, open-heart surgery, angioplasty and stent placement.
Preventive Care for Heart Health
With advanced coronary artery disease, Rich needs to undergo regular checkups and take medications to reduce his risk of heart disease. “Our focus for patients who have had a severe heart attack is to use medications to strengthen the heart and reduce the risk of future heart attacks,” says cardiologist Gregory Katz, MD, of NYU Langone. Rich now sees Dr. Katz for regular follow-up care. “Optimizing his cholesterol and blood pressure and putting him on the right blood thinners should prevent a second heart attack,” Dr. Katz says.
“I am so grateful that I was in New York when my heart attack happened and had access to the best medical care in the world,” says Rich. Rich’s heart has made a full recovery and he can expect to live a normal lifespan and continue to enjoy an active lifestyle.
“Many of my patients who have had heart attacks have run marathons or climbed mountains,” Dr. Razzuk says. Rich’s goals are similarly ambitious. “Roscoe and I are looking forward to doing the 40-mile Five Boro Bike Tour this spring,” he says.
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