Last September, Fielder Smith contracted COVID-19 for the second time and experienced mild symptoms. After the initial infection, he noticed he felt really exhausted.
“The lack of energy seemed to hang around,” he tells TODAY.com. “For weeks afterward, four or five o’clock would roll around and I was absolutely drained.” Then a cough developed when he was lying down. He visited an urgent care clinic, which diagnosed him pneumonia and bronchitis. After taking medications for a few days, his condition didn’t improve — it worsened. He eventually ended up in the emergency room and later received a surprising diagnosis: heart failure.
“It feels like he kept getting misdiagnosed, he’s young,” wife Amy Mcilwain, 41, tells TODAY.com. “Heart failure is not something they would think a 39-year-old male would have.”
COVID, fatigue and coughing
After having COVID-19 for the second time, Smith felt tired a lot and wondered if it was long COVID. Three weeks before he landed in the cardiac intensive care unit, he underwent a physical with blood work and his results looked normal. Then he started experiencing “a nasty cough” when resting. An urgent care doctor prescribed antibiotics and steroids. Instead of feeling better, though, Smith’s health deteriorated.
“Just a day or two after that it got to the point where I couldn’t walk across the room without needing to sit down,” he says. “My (oxygen) saturation was about 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 an 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 prior, at the end of November, and thought her husband wasn’t coping well from lack of sleep.
“I was like, ‘You need to get over this cold.’ I felt so terrible afterwards because I didn’t realize it was heart failure,” she says. “I was like, ‘Hey no one’s sleeping. Get some rest, get over this.’”
Smith was admitted to the intensive care unit where doctors performed numerous tests to understand what was wrong.
“Before they figured out that it was something directly affecting 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 tests doctors knew “it was a fairly serious heart condition” and he was transferred to a hospital that was equipped to do heart transplants, if needed.
“It was becoming obvious I was going to need heart surgery,” he says. “They also diagnosed a bicuspid aortic valve, which is a congenital condition I never knew I had. So, it was a couple of things stacked on top of each other.”
Doctors diagnosed him with endocarditis, which is a bacterial infection in 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 it.
“His heart had become enlarged. It was over seven centimeters. So, they said that something’s been affecting it for a while,” Mcilwain says. “It’s a question mark whether he had endocarditis for a while; if he had something else affecting his heart that was causing it to work in overdrive.”
They thought that his age and his health helped his body “overcompensate.”
“But it’s caused this enlarged weakened heart that coupled now with this infected valve that needs to be replaced — it was just a recipe for disaster,” Mcilwain says. “We went in Tuesday night thinking it was pneumonia. By Thursday, they had diagnosed it as heart failure and the aortic valve was leaking.”
Doctors needed to perform open heart surgery to give him a new aortic valve, clean out the infection and take a closer look at Smith’s heart. His ejection fraction, a measurement of heart function, was in the high 20% before surgery. According to the American Heart Association, a normal ejection fraction is between 50 and 70% and lower than 40% is considered heart failure. Following surgery, Smith experienced a setback.
“I felt pretty good and was up and moving around and in good spirits,” he says. “I woke up and I had been re-intubated. I had no idea what happened. It turned out it was ventricle fibrillation that led to cardiac arrest.”
Mcilwain had gone home that day to care for her children because she thought he “was on the mend.” When she returned, she was greeted by a clergy person.
“They had been doing CPR for over two and a half minutes and used the shock paddles to bring him back,” she says. “While I was there, he went into arrest again.”
Throughout the next day, he went into cardiac arrest and needed a jolt from an AED four times. His ejection fraction plummeted to 10%.
“I witnessed it,” Mcilwain says. “We are in the middle of a conversation and he just started losing concentration and passed out and the next thing I know the nurse runs in and starts administering CPR.”
A team of doctors examined the medications he was taking and tried different combinations. They worried he wouldn’t be strong enough to undergo another open-heart surgery. At one point, he was so sick, they thought Smith wouldn’t survive.
“My liver had gone into shock and was shutting down and cascading to the kidneys and heart. They essentially came in and told me my body was shutting down and I was dying,” he says. “We had to make some dicey calls about how the treatment was going to go.”
The road to recovery
To help, doctors placed Smith on a new medication and took him off two others. Slowly he started getting better. Though, it was possible he could still need a heart transplant and was under the care of the heart failure team.
“We had gotten my kidneys and liver back online,” he says. “They still told me if you have another rhythmic episode, we’re basically calling it quits on this heart and putting you on the heart transplant list.”
At one point, doctors thought they could prevent another arrhythmia by “outpacing” them. They attached Smith to a pacemaker and “had my heart cranked up to 140 beat a minute.”
“Then it was slowly stepping that down over the course of a few days and then it was taking me off medications one at a time to make sure I wasn’t going back into any of these arrhythmic episodes,” he says. “It was a slow steady progression to being healthy.”
Mcilwain calls it a “Christmas miracle.”
“The medicines started to work … right around Christmas,” she says. “Kids aren’t allowed in the ICU and he was allowed to see his son and daughter and they came in and visited on Christmas, which was huge because he had this newborn son he hadn’t seen (in a month).”
Their friends and family stepped in to help them while Smith was so sick. Still, Mcilwain struggled.
“I was a mess, postpartum, my husband and partner and I’m watching him die, like literally go into cardiac arrest,” she says. “It was the hardest and most challenging thing of my life and I still have PTSD and those memories and seeing that. I was broken.”
Smith returned home in January. While he experienced “a spike in white blood cells, which can be a sign of infection,” he’s doing well. His ejection fraction is now at 49% from 27% at discharge.
“That’s something we didn’t even know was possible,” Mcilwain says. “We were hoping to get to the mid-30s.”
He still takes medications to prevent arrhythmia, a blood thinner, has a mechanical valve and an internal defibrillator to help if he experiences arrhythmia again. He started cardiac rehabilitation to build up the strength and muscle mass he lost while in the hospital.
“I walked out of there around 185 pounds, which I’m 6’2, I’m a bigger guy. I haven’t been under 200 pounds since junior high,” 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 end up in heart failure. Like I said, it wasn’t even on anybody’s mind,” he says. “If you’re feeling low energy, if you’re feeling like you have long COVID it’s worth seeing your GP.”