Last September, Fielder Smith contracted COVID-19 for the second time and experienced mild symptoms. After the initial infection, he noticed that he felt really exhausted.
“The lack of energy seemed to linger,” he told TODAY.com. “For weeks afterwards, four or five hours were driving and I was completely exhausted.” Then a cough developed as he lay down. He went to an urgent care clinic, which diagnosed him with pneumonia and bronchitis. After taking medication for a few days, his condition did not improve, it got worse. He eventually ended up in the emergency room and later received a startling diagnosis: heart failure.
“It looks like he’s continued to be misdiagnosed, he’s young,” his wife Amy Mcilwain, 41, told TODAY.com. “Heart failure is not something they would think a 39-year-old would have.”
COVID, fatigue and cough
After having COVID-19 for the second time, Smith felt very tired and wondered if it had been COVID for a long time. Three weeks before landing in the cardiac intensive care unit, he underwent a physical examination with blood drawn and his results appeared normal. Then he started feeling “a bad cough” while at rest. An emergency doctor prescribed antibiotics and steroids. Instead of feeling better, however, Smith’s health deteriorated.
“Just a day or two after that, I got to the point where I couldn’t walk across the room without needing to sit down,” he says. “My (oxygen) saturation was around 71.”
A normal oxygen saturation level is 95 or higher according to the Centers for Disease Control and Prevention. The couple spoke with a neighbor who works in health care who advised Smith to go to the emergency room immediately.
“I thought it was a really nasty upper respiratory infection,” Smith says. “We didn’t even consider heart failure.”
Mcilwain had given birth just a week before, at the end of November, and thought her husband was not coping well with the lack of sleep.
“I was like, ‘You gotta get over this cold.’ I felt so bad afterwards because I didn’t realize it was heart failure,” she says. “I was like, ‘Hey nobody’s sleeping. Rest up, get over it.
Smith was admitted to the intensive care unit where doctors performed numerous tests to figure out what was wrong.
“Before they realized it was something that directly affected my heart, there were a lot of questions about my lifestyle, am I a smoker, am I an IV drug user,” he says . “It was, no and no.”
After three days of testing, doctors knew “it was a pretty serious heart condition” and he was transferred to a hospital equipped to perform heart transplants, if needed.
“It was becoming apparent that I was going to need heart surgery,” he says. “They also diagnosed a bicuspid aortic valve, a congenital condition that I didn’t know I had. So it was two things stacked on top of each other.
Doctors diagnosed him with endocarditis, a bacterial infection of the heart. In his case, it was in his aortic valve. But they couldn’t figure out where the infection came from or how long he had had it.
“His heart had widened. It was more than seven centimeters. So they said something had been affecting him for a while,” says Mcilwain. “It’s a question mark if he’s had endocarditis for a while; if he had something else affecting his heart that was causing it to run into overdrive.
They thought his age and health were helping his body “overcompensate”.
“But that caused this enlarged weakened heart that has now associated itself with this infected valve that needs to be replaced – it was just a recipe for disaster,” Mcilwain says. “We went on Tuesday night thinking it was pneumonia. By Thursday, they had diagnosed heart failure and the aortic valve was leaking.
Doctors were to perform open-heart surgery to give her a new aortic valve, clean out the infection and take a closer look at Smith’s heart. His ejection fraction, a measure of heart function, was in the 20s before surgery. According to the American Heart Association, a normal ejection fraction is between 50 and 70 percent, and less than 40 percent is considered heart failure. After the surgery, Smith experienced a setback.
“I felt pretty good and I was up and moving around and in good spirits,” he says. “I woke up and had been re-intubated. I had no idea what had happened. It turned out that it was ventricular fibrillation that led to cardiac arrest.
Mcilwain had returned home that day to care for her children because she believed he was “on the mend”. Upon her return, she was greeted by a member of the clergy.
“They had been performing CPR for over two and a half minutes and used the shock paddles to bring him back,” she says. “While I was there he was arrested again.”
Throughout the next day, he went into cardiac arrest and needed a jolt from an AED four times. His ejection fraction dropped to 10%.
“I witnessed it,” Mcilwain says. “We’re in the middle of a conversation and he just started to lose focus and pass out and the next thing I know the nurse comes in and starts giving CPR.”
A team of doctors looked at the medications he was taking and tried different combinations. They feared he was not strong enough to undergo another open-heart surgery. At one point he was so ill that they thought Smith wouldn’t survive.
“My liver was in shock and was shutting down and cascading into the kidneys and heart. They basically came and told me my body was shutting down and I was dying,” he says. “We had to make risky calls about how the treatment was going to go.”
The road to healing
To help, doctors put Smith on a new drug and took two more off him. Slowly he started to get better. However, it was possible that he still needed a heart transplant and was taken care of by the heart failure team.
“We had my kidneys and liver back in line,” he says. “They still told me that if you have another rhythmic episode, we basically call it for that heart and put you on the heart transplant list.”
At one point, doctors thought they could prevent another arrhythmia by “passing” them. They strapped Smith to a pacemaker and “made my heart race to 140 beats per minute.”
“Then he slowly tapered that off over the course of a few days and then took the meds off me one at a time to make sure I didn’t come back into one of these arrhythmic episodes,” he says. “It was a slow, steady progression to health.”
Mcilwain calls it a “Christmas miracle”.
“The meds started working…just around Christmas,” she says. “Children aren’t allowed in intensive care and he was allowed to see his son and daughter and they came and visited over Christmas which was huge because he had this newborn son that he hadn’t seen (for a month).”
Their friends and family stepped in to help them while Smith was so ill. Still, Mcilwain struggled.
“I was a mess, postpartum, my husband and partner and I watch him die, like literally going into cardiac arrest,” she says. “It was the hardest and most difficult thing of my life and I still have PTSD and those memories and I see that. I was broken.”
Smith returned home in January. While he experienced “a spike in white blood cells, which may be a sign of infection”, he is doing well. His ejection fraction is now at 49% compared to 27% at discharge.
“It’s something we didn’t even know was possible,” Mcilwain said. “We were hoping to get to the mid-1930s.”
He is still taking medication to prevent arrhythmia, an anticoagulant, a mechanical valve and an internal defibrillator to help him if he suffers from arrhythmia again. He began cardiac rehab to build up the strength and muscle mass he had lost in the hospital.
“I came out of there about 185 pounds, of which I’m 6’2, I’m a bigger guy. I haven’t weighed less than 200 pounds since college,” he says. “You have to work hard, but slowly.”
He and Mcilwain wanted to share his story to raise awareness and help others.
“A young, healthy person can suffer from heart failure. Like I said, it wasn’t even on anyone’s mind,” he says. “If you’re feeling low on energy, if you feel like you’re having a long COVID, it’s worth seeing your GP.”
This article originally appeared on TODAY.com