Chain of Survival
July 29, 2024
Runner Survives Heart Attack at Cleveland Marathon Thanks to Well Planned, Quality Event Medicine
On Sunday, May 19, 2024, during mile 23 of the Cleveland Marathon, 66-year-old John Zack experienced severe tightness in the left side of his chest. After seven months of intense training, Zack was determined to cross the finish line. When he did, his wife immediately knew something was seriously wrong. From this point on, everything needed to go right for Zack to survive – and it did, thanks to the “chain of survival” set in place by University Hospitals.
“I’d run seven marathons. After this, I was planning to only run shorter distance races, but this one nearly became my last,” said Zack. He was making his best pace ever until mile 23 when the chest pain started. He then slowed to a fast walk for the last 3.2 miles. His wife, Rosella Baker, watching his race progress through an app, could tell he had slowed. She was worried and when she saw him at the finish line, her fears were confirmed. She headed with him toward the medical tent and on the way, someone met them with a wheelchair.
“John wouldn’t be here without the care, professionalism and urgency of everybody who touched him,” said Baker. “It was just so efficient and communication was spot on. They didn’t miss a beat at any step.”
Medical Tent & Transport
At the medical tent set up near the finish line, Zack was treated by Jeffrey Luk, MD, an emergency medicine and emergency medical services (EMS) physician at University Hospitals, who specializes in prehospital and disaster medicine and serves as medical director for the Cleveland Marathon.
“Mr. Zack was alert and talking. He explained he was having chest pain,” said Dr. Luk. “Not all heart attack patients go unconscious. Some have what may seem to be milder or atypical symptoms. We treat all complaints of chest pain seriously.”
Dr. Luk performed an EKG on site and confirmed it was indeed a heart attack.
“We told him he needed to go to the emergency department right away but he really didn’t want to go. We spoke to his wife, and she was able to convince him,” said Dr. Luk. “We administered preliminary medications and activated our cath lab team at University Hospitals Cleveland Medical Center to prepare for his arrival.”
Zack was cared for and transported to UH Cleveland Medical Center in a UH EMS-I Specialty Care Ambulance staffed by paramedic Gavin Lucietta and EMT Kira Mudryk.
Emergency Department
Once he arrived at UH Cleveland Medical Center’s emergency department, Zack immediately saw Ryan Marino, MD, an emergency medicine physician with UH who had already received information that Zack was on his way with a concerning EKG and chest pain while running the marathon.
Zack’s EKG was repeated and confirmed again he was having a heart attack. Dr. Marino and his team made sure Zack was stable and administered medications to prevent worsening of the heart attack before he was sent to have his cardiac intervention.
“My part of his care was extremely brief,” said Dr. Marino. “But I tried to explain what was going on and prepare him for the next steps, while moving things along for him and the rest of the team. We try to minimize the time that these patients spend in the emergency department waiting to have blockages opened. Despite the many separate moving pieces that are involved, everyone worked together to get Mr. Zack to the next step as quickly and efficiently as possible.”
Cath Lab
Zack received his cardiac intervention in the cardiac catheterization laboratory (cath lab) with Tarek Hammad, MD, interventional cardiologist with University Hospitals Harrington Heart & Vascular Institute.
Dr. Hammad and his team were charged with finding the blockage and addressing it. They discovered that Zack’s main artery, often called the widow-maker, was 100 percent blocked. Dr. Hammad and his team first opened the blockage with a balloon. They then used novel imaging technology called optical coherence tomography (OCT). Employing a high-resolution camera, they measured the exact size of Zack’s blocked vessel to identify the precise stent to place.
“As soon as we opened the blockage with the balloon his chest pain was gone,” said Dr. Hammad. “Mr. Zack left the cath lab with no chest pain and stable vitals.”
The Journey Continues
Zack’s heart attack and cardiac intervention happened on a Sunday.
“The ICU nurses had me up and walking on Monday,” said Zack, who was then discharged on Tuesday.
A month later, Zack said he felt “good.” He’s working on his running goals and doing cardiac rehab for three months. For the time being, he’s avoiding running and strenuous exercise. And now, the 2024 Cleveland Marathon won’t be his last. He sees Bradley Lander, MD, sports cardiologist with UH Harrington Heart & Vascular Institute, for continuing care. They set a goal for another marathon in a year’s time.
“We put so much care and planning into our event medicine program for the public and patients like Mr. Zack,” said Dr. Luk. “From prehospital, to mass gathering medicine, to sports medicine and emergency medicine – everything is connected by the qualified providers we put in place. Mr. Zack’s outstanding outcome is evidence of this quality care and expertise.”