Duane Ackerman

Duane Ackerman had been lifting weights and doing sit ups for an hour at LA Fitness in Orlando on Thursday evening, Jan. 28, 2016, when it was time to get in his cardio workout on the treadmill.

He started with walking, gradually increasing to a jog, and finally upping the setting to “sprint.” He had followed this same routine five times a week for years. But this time, seconds after he started sprinting, Duane was knocked off the treadmill onto the floor. It was as if someone had punched him in the chest.​

He sat on the floor and looked around, dazed. His legs felt weak, his fingers were numb and his chest hurt. What happened?

I can’t be having a heart attack, Duane thought. I’m in great health.

For a 54-year-old guy who mostly sat at a desk working on transit ads for a living, Duane was in great shape. Since college, Duane had gone to the gym five days a week to lift weights and run. He had regularly played basketball until he decided to hang up his sneakers at age 50. He had never been overweight, wasn’t on any medications, and had no family history of heart disease.

I can’t be having a heart attack.

He got up off the floor, gathered his things and started walking to the front door. When he got there, he still didn’t feel right. He sat down to gather his thoughts.

Was it stress? Anxiety?

After a brief rest, he got up and walked through the light rain to his car. Once in his car, he still didn’t feel better. He didn’t feel so bad that he thought he should call his wife, but still – things weren’t quite right. He knew Hunters Creek Emergency Room (ER) was five miles away – kidney stones had prompted a visit there the year before.

Thankfully there were very few cars on the road to the ER, allowing him to reach the front doors in minutes. Little did he know at the time that even a short delay from a traffic jam could have killed him.

When he arrived at the ER, his arms were stiff and tight and his chest was pounding.

Not good.

He walked in, holding his chest. He didn’t stop at the front desk. He didn’t have time. He needed to see someone immediately. He just kept walking, and a security guard began to follow him.

Hospital staff sat him down. They ran a few tests.

Then they told Duane he was having a massive heart attack.

No Prank Call

A nurse called Duane’s wife, Rubiela, to tell her about Duane’s condition. As the nurse told her that her husband was having a major heart attack, Rubiela hung up the phone.

Prank call, she thought. My husband can’t be having a heart attack.

For years, Rubiela had relied on her robust husband to help take care of a family that included a daughter and stepson, who are both adults now. In recent years, when Rubiela had been diagnosed with Parkinson’s disease, she had depended on him all the more.

Duane couldn’t be having a heart attack.

When the nurse immediately called back, Rubiela realized it was no prank.

Meanwhile, Duane was rushed by ambulance to Osceola Regional Medical Center, where they had the equipment and experts to treat his heart. On the ride there, Duane never lost consciousness – and never stopped praying.

Once at the hospital, Duane was rushed to what he called “a black room with a bright light” – the cardiac catheterization laboratory or “cath lab.”

As he lay on the table, Duane felt a cut in his groin. That’s not where my heart is, he thought.

“It was one of the largest MIs [myocardial infarctions] I have seen,” said Khurram Moin, MD, FACC, the interventional cardiologist who treated Duane that day (and past chief of cardiology at Osceola Regional Medical Center).

Duane’s left anterior descending (LAD) artery (the artery running in front of the heart) was completely blocked, and the LAD was an extremely large artery and probably supplied more than 60-percent of his heart muscle. His blood pressure was dropping and his heart was having trouble beating on its own. He was in cardiogenic shock, a condition in which the heart suddenly cannot pump enough blood to the body’s vital organs and they begin to shut down. The National Heart, Lung and Blood Institute estimate that half of the people in cardiogenic shock do not survive.[1] Duane’s heart would need support if he were to survive the heart attack, Dr. Moin decided.

Dr. Moin threaded a balloon-tipped catheter through Duane’s femoral artery to the site of a blockage. He inflated the balloon, pushing the blockage out of the way and then tried to place a tiny wire-mesh stent to prop open the artery. Duane overheard his doctors talk about how they were having trouble finding large enough stents to prop open his arteries. You’d better find something bigger – you don’t have much time, Duane heard.

“His arteries were so large, it was difficult finding a large enough stent,” Dr. Moin said.The typical cardiac artery stent is 3.5 millimeters in diameter. For Duane, Dr. Moin had to insert a stent usually used for large renal arteries that measured more than 7 millimeters in diameter. His large arteries were likely an effect of his years of lifting weights, jogging and basketball.

Support for Duane’s heart came in the form of a tiny heart pump called Impella 2.5, a small mechanical cardiovascular support system made by Boston-based Abiomed, Inc. Consisting of a tiny pump inside a catheter, the Impella device has an electric motor that can pump up to 2.5 liters of blood per minute. Dr. Moin inserted the small intravenous device like a catheter through the femoral artery of Duane’s groin to his heart’s main pumping chamber. There it could pump the blood out of Duane’s heart cavity (left ventricle) to the rest of his body.

The Impella would support Duane’s heart and allow it to rest and recover after the heart attack.

[1] National Heart, Lung and Blood Institute – What Is Cardiogenic Shock?

Prayers Answered

Duane was barely conscious, lying flat on his back for the first three days.

About 60 to 70 friends and relatives, many of them from the Holy Cross Catholic Church in Orlando where Duane and his family worshipped, filled the hospital waiting room as Duane recovered in critical care. Together, they prayed for Duane’s life.

He had survived the heart attack, but he faced yet another life-or-death hurdle. When Dr. Moin removed the Impella, a temporary heart assistance device, would Duane’s heart be able to take over pumping on its own?

​The answer, fortunately, was yes. The fact that he was in such good physical shape probably saved his life, Duane said.

But Duane’s heart remained very weak.

For a man who had played sports and worked out his whole life, Duane found it difficult to comprehend that he was having trouble even walking.“ Just sitting up was a big deal,” he said.

After about a week in the hospital, Duane went home. Within a few weeks he started to do what he had done all of his adult life: exercise. He began by walking up and down Snead Street (named for the pro golfer Sam Snead) near his home in Orlando. For a guy who used to run marathons, he was surprised at how tired the short walks made him.

Within a week of leaving the hospital, he was back at his computer again, working part-time for Direct Media USA. A week later, he was back full-time.“ They didn’t want me to return to work so soon, but I knew I had a lot of work that needed to be done,” said Duane, who worked out of his home the first three weeks before returning to his office in downtown Orlando.

Through cardiac rehabilitation, in which his heart is carefully monitored during exercise, he began to rebuild his fitness, little by little. He took 36 rehab classes – three per week over 12 weeks.

But his heart didn’t return to its former strength as doctors had hoped.

One measure of the strength of Duane’s heart is its ejection fraction as shown by a test called an echocardiogram. For a normal heart, the ejection fraction is about 60 to 65 percent. Duane’s ejection fraction was barely half of that, meaning that Duane’s left ventricle was pumping out only one-half the blood that a normal heart pumps with each beat. His doctors had hoped Duane’s ejection fraction would recover to at least 40 percent, but by August it had not – it was still at about 35 percent.

Duane’s doctors decided he needed back up in case his heart started to beat chaotically or too fast. They placed an implantable cardiac defibrillator (ICD) under his skin. Connected by a wire to his heart, the battery-powered device would deliver an electric shock to restore a normal heartbeat if Duane’s heart starts beating erratically.

As a result, Duane is careful not to allow his heartbeat to get too high: he doesn’t want to strain his heart or be shocked by his ICD.

Celebrating Life

Duane is back at the gym five days a week doing weight training and walking on the treadmill. He wears a heart monitor to make sure his heart rate doesn’t go over 130 beats per minute, but when it does, he just sits down and rests.​

“I’ve made a lot of progress,” Duane said.

Dr. Moin agrees: Duane is “doing fine – he’s very active.”

Duane had one issue in which his chest muscle was twitching every four to five minutes near to where his ICD was placed. When he called his doctor’s office, they were concerned enough to have him come in right away. It turns out that it wasn’t atrial fibrillation, an erratic heart beat that can lead to a heart attack, but just a reaction of his chest muscles to overuse.

There is hope that Duane’s heart could improve, Dr. Moin said. Damaged hearts can sometimes undergo “remodeling” – in other words, get better and stronger.

In September, nearly eight months after his procedure, Duane was back at the Osceola Medical Center’s cath lab.

“One nurse said, ‘I can’t believe you made it. You had such a big heart attack,” Duane said.

Duane has joined Abiomed’s advocacy program and recently described to some 800 Abiomed employees in Boston how the “doctors, the cath lab staff, and this amazing device, saved my life along with the help of our Lord.” He also credits the support of his friends and family.

“My new purpose in life is to spread the word about heart disease, how it can attack anyone at any time, and the innovative treatment that promotes heart recovery,” he said.

Duane celebrated one year of survival in a Heart Recovery Reunion ceremony at Osceola Regional Medical Center in Kissimmee on Feb. 2, 2017.


Impella® Protects the Heart During Cardiogenic Shock

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