Healthy 38-Year-Old Triathlete Survives “Widow-Maker” Heart Attack
When you picture a 38-year-old nonsmoking triathlete who eats healthily and has normal blood pressure, blood sugar, and cholesterol, you don’t imagine him collapsing during a race from a massive heart attack. But that’s what happened to Matias Escobar. His heart stopped pumping for a full 12 minutes. Fortunately, a series of Mount Sinai physicians stepped in—including one who treated him on the scene—and now he is back in training for the next triathlon.
Matias had just started the final leg of the New York City Triathlon in October 2023 when he had an acute ST-elevation myocardial infarction (STEMI), which blocks the main artery supplying oxygen to the heart. The most deadly type of heart attack, STEMI is nicknamed the widow maker. “You don’t get any warning symptoms with a STEMI,” explains Matias’s cardiologist, Serdar Farhan, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai. Timing is critical. Survival and the best outcomes require the blocked artery is opened within 90 minutes, preferably as early as possible.
Fortunately, a pulmonologist and critical care doctor, Christian M. Lo Cascio, MD, was watching the race with his wife and happened to see Matias collapse. Dr. Lo Cascio, Assistant Professor of Medicine and Thoracic Surgery at Icahn Mount Sinai, leaped over the barricade and sprinted over to Matias. Dr. Lo Cascio realized that if the man had simply tripped, or had a seizure or a stroke, there would have been some movement—but Matias was motionless. When Dr. Lo Cascio found no pulse, he started CPR. After about five minutes, Matias’s hand started moving a little. Dr. Lo Cascio continued with CPR until the ambulance arrived. Emergency Medical Services brought Matias to the Emergency Department at Mount Sinai West, where they did an electrocardiogram. Diagnosing a STEMI, they brought Matias to Cardiac Catheterization Laboratory at Mount Sinai Morningside.
Because of his otherwise excellent health, Matias is considered SMuRF-less (standard modifiable cardiovascular risk factors), which means he has no obvious risk factors for heart disease. But SMuRF-less people with STEMIs are surprisingly common; according to the National Center for Biotechnology Information, part of the National Institutes of Health (NIH), SMuRF-less patients represent 14 to 27 percent of STEMI cases. Mount Sinai is part of an NIH long-term study to identify any risk factors that might help predict possible problems.
In the Catheterization Laboratory, physicians administered advanced imaging tests, including an intravascular ultrasound, which confirmed that there was a clot in the left anterior descending artery. Dr. Farhan used an approach called percutaneous coronary intervention to open the clogged artery and place a metal stent coated with medication. The stent holds the artery open and remains there permanently. This minimally invasive procedure allows faster clinical recovery, lowers the risk of complications, and shortens hospital stays.
Meanwhile, Matias’s wife Keylla was waiting at the race finish line for Matias with their 20-month-old son, Vicente, on her hip. She had an idea when he would arrive, but when he didn’t, she thought perhaps she had missed him. Eventually, triathlon organizers told her he had “an accident,” which she took to mean he had been hit by a car. Finally, she tracked down her husband and spoke with Dr. Farhan, who explained that Matias had experienced a heart attack and was in a coma. “Something like this doesn’t just happen to the patient,” says Matias. “It happens to the people around him. It happened to my wife.”
Matias woke from the coma two days later, and the doctors removed the tube that had helped him breathe the following day. At this point, Keylla was at the bedside, and Matias’s brother was on the phone. “My wife and I speak Portuguese, and my brother speaks Spanish. So, when I woke up, I started speaking to her in Portuguese, to him in Spanish, and to the doctor in English. My brother said, ‘If he can do three languages, he’s going to be okay.’” And he was right. While Matias lost three weeks of his memory—a week prior to the event and two weeks after—he is otherwise functioning well physically and mentally.
Matias went for his first run a week and a half after he left the hospital. Then, two weeks later, he took a business trip to New Zealand and Australia. “My brother told me to get back to my life or I was going to get depressed.” A month after that trip, Matias started training again, taking it slow. “The moment I saw I could run, I didn’t feel insecure any more. I’ve met a lot of people who felt completely messed up after their heart attacks. They were worried all the time, they had panic attacks. But because I listened to my brother, I’m fine.” He also expressed profound gratitude to his medical team.
Dr. Farhan tried to determine if Matias had any risk factors they’d not known about. It turned out that he did have high cholesterol briefly when he was younger, but a few changes in his diet brought it back within normal range. “Sometimes if you have high cholesterol over a long period, it can cause some plaque build-up, even if it’s well-controlled later,” says Dr. Farhan.
Could Matias have done anything to avoid the heart attack? “He saw a cardiologist before the triathlon, and all his test results were within normal limits,” says Dr. Farhan. “If he had shown any risk factors, we might have done a scan to look for calcium spots on his arteries. But there was nothing to indicate he needed it. He was doing everything right as far as we knew.”
“Dr. Farhan is great,” Matias says. “He’s a straight shooter. But he also knows when to be supportive and compassionate.” And the rest of Mount Sinai—including Dr. Lo Cascio —was really helpful. “They’re all amazing; I’m really lucky,” Matias says.