Time is 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 saying—it’s his guiding mission. “The faster we can open an artery, the less damage there is to the heart and the lower the risk of heart failure and arrhythmias. The national target for opening an artery is 90 minutes. At NYU Langone, we can open the blocked artery in an average of 60 minutes or less.”

This swift door-to-balloon time, as it is called, made all the difference for Ken Rich, 56, of Brooklyn. On an August morning, he woke up nauseated and in a cold sweat. When an antacid didn’t stop his symptoms, his wife drove him to NYU Langone Health—Cobble Hill Emergency Department at the Joseph S. and Diane H. Steinberg Ambulatory Care Center.

After extensive testing, the unbelievable became the reality: Rich was having a heart attack.

“‘How could this be happening?’ I thought,” says Rich, a pescatarian who followed a heart-healthy Mediterranean diet. “I had recently chopped wood, gone hiking, and swum across the 24-acre Iron Creek Lake with my 12-year-old son, Roscoe, while on a family vacation in South Dakota’s Black Hills. On paper, I was doing all the right things.”

Rich was rushed to Manhattan by ambulance to the Ronald O. Perelman Center for Emergency Services, which is within NYU Langone’s Tisch Hospital and home to one of the most advanced catheterization laboratories in the country. Tisch Hospital has received the Mission: Lifeline Gold Award, the highest award from the American Heart Association, which recognizes quality systems of care for patients with a heart attack, also known as myocardial infarction. The hospital is not only equipped with all the latest tools for opening blocked arteries but also staffed by an elite team of experienced interventional cardiologists, who are all part of NYU Langone Heart. Further testing confirmed Rich not only was having a heart attack, it was one of the most serious types, a “widow-maker.”

“A widow-maker heart attack, which is more common in men at a younger age, occurs when there’s a blockage in the left anterior descending (LAD) artery, a major artery that carries blood to the left ventricle, the left chamber of the heart,” Dr. Razzouk says. “This type of heart attack is immediately life-threatening because the LAD artery supplies about 50 percent of the heart muscle’s blood supply.”

Lifesaving Procedure Restores Blood Flow

A coronary angiogram, an X-ray of the heart’s blood vessels, the coronary arteries, confirmed that Rich’s LAD artery was 100 percent blocked, right at the origin. This degree of blockage can occur when plaque, the waxy substance made of fat, cholesterol, calcium, and other substances that can build up on arterial walls, ruptures to completely prevent blood flow to the rest of the heart, Dr. Razzouk says. Rich’s ejection fraction, the amount of blood the heart pumps each time it beats, confirmed his heart was in trouble. His ejection fraction was 30 percent; 55 percent is normal.

To restore blood flow in Rich’s LAD artery, Dr. Razzouk and his team performed a continuous suction mechanical thrombectomy, given the large amount of blood clot, followed by intracoronary imaging to size the stent appropriately. The procedure, which is only available at advanced catheterization laboratories like the one at Tisch Hospital, involves suctioning out the clot through a tiny catheter (tube) placed in the heart after it is inserted into a blood vessel in the leg. After the blockage was removed, a stent was placed in the Rich’s LAD artery to keep it open.

In under an hour, Rich’s treatment was complete and blood flow to his heart was fully restored. Soon, with the help of medications, his ejection fraction was back to normal. “The cardiology team at NYU Langone was just incredible, including the nurses,” Rich says.

Exercise Is Medicine

Just three days later, Rich was back home and in his music studio. Still, swimming across Iron Creek Lake the week before seemed like a lifetime ago. “After my heart attack, I was nervous just going up subway stairs. I didn’t know what was safe for my heart to do,” he says.

To safely get back on his feet, Rich attended 36 one-hour sessions at NYU Langone’s Joan and Joel Smilow Cardiac Prevention and Rehabilitation Center. The medically monitored exercise program is designed to help improve outcomes in people who have experienced a heart attack, congestive heart failure, heart transplant, left ventricular assist device (LVAD) therapy, valve replacement, open heart surgery, angioplasty, and stent implantation.

Preventive Care for Heart Health

With established coronary artery disease, Rich will require regular checkups and medication to control his heart disease risk. “When someone has a big heart attack, the two major things we focus on are using medication to help the heart get stronger and reduce the risk of a future heart attack,” says Gregory Katz, MD, an NYU Langone cardiologist. Rich now sees Dr. Katz for regular follow-up care. “If we optimize his cholesterol and blood pressure and get him on the right constellation of blood thinner medications, we should be able to prevent a second heart attack,” Dr. Katz says.

“I’m so grateful to have access to the best healthcare in the world and being in New York City when my heart attack happened,” Rich says. Because Rich’s heart fully recovered, he can expect a normal life expectancy and continue to enjoy an active lifestyle.

“Many of my patients after a heart attack have run marathons and climbed mountains,” Dr. Razzouk says. Rich’s goals are equally as ambitious. “Roscoe and I are looking forward to riding in the 40-mile Five Boro Bike Tour this spring,” he says.

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