When a heart beats out of sync, it can be an anomaly or hint at bigger issues. Little did David Keith know, his irregular heart beat was a whisper of what was to come.

In December 2020, after hearing an irregular heart beat with his stethoscope, David’s primary care physician determined that he had atrial fibrillation (AFib). He began David on medication management and later referred him to J. Richard Daw, MD, FACC, of WakeMed Heart & Vascular.

Puzzling Symptoms Emerge

In 2021, before he had his first visit with Dr. Daw, David began to have concerning symptoms, including shortness of breath, swelling in his extremities, trouble sleeping when lying flat as well as low energy.

“Between my wife and I, we have five college degrees, and we made excuses for every one of those symptoms,” recalls David. “The shortness of breath I blamed on some orthopaedic problems that I have. The difficulty sleeping flat, I blamed on sinus congestion.”

One evening, in mid-April 2021, the couple was watching television when a WakeMed commercial aired explaining the symptoms of heart failure. To the couple’s shock, the symptoms aligned with what David had been experiencing. Alarmed, they decided to go to the hospital.

Multiple Complex Heart Conditions Revealed and Treated

David and his wife went to the WakeMed Cary Hospital Emergency Department. Upon initial assessment, he was immediately admitted and underwent a diagnostic heart catheterization. Within 36 hours, he was transferred to the WakeMed Raleigh Campus Heart Center where he went to the cardiac catheterization lab for an interventional procedure. He spent the next seven days in critical care with grave concerns of fluid retention.

The team determined that David had heart failure, mitral valve prolapse, blockages in three different coronary arteries (two of which were 100 percent and the third 70 percent blocked) as well as the previously diagnosed AFib. Over the course of 20 days, he was a patient in the cardiac intensive care unit (ICU).

He underwent seven different surgical procedures in that time, including a pacemaker installation with WakeMed cardiovascular surgeon Judson Williams, MD, MHS.

“Pacemakers send electrical signals to the heart to help it beat at a normal rate,” explains Dr. Williams. “They may also help the heart chambers beat in a more synchronized way to improve the efficiency of the heart’s pumping.”

Care with WakeMed Cardiac Rehab

Following his successful recovery, David was sent home, and a physical therapist made home visits to help him regain his strength. Once he was strong enough, David was referred to WakeMed Cardiac Rehabilitation in Cary.

“I was getting along very well,” shares David. “I had 36 sessions of rehab twice per week over 18 weeks. I had improved my ejection fraction and thought I was in great shape.”

Another Shocking Cardiac Diagnosis

Fast forward to 2023, while undergoing a routine echocardiogram with Dr. Daw, more concerning health discoveries emerged. Dr. Daw found that David had an aortic aneurysm. It was six centimeters — alarming since four centimeters presented actionable risks.

David was scheduled for aortic aneurysm repair, an aortic valve replacement and a triple bypass with Dr. Judson Williams. The surgeries were successful, but Dr. Williams noted challenges with inserting the catheter for surgery, so following successful surgeries, Dr. Williams referred David to WakeMed urologist Brandon Rubens, MD, for a biopsy of his prostate.

“Mr. Keith’s aneurysm had grown to above the threshold at which repair is indicated to prevent rupture of the aorta,” observes Dr. Williams, “and this is why he underwent the more extensive open heart surgery, and he recovered extremely well.”

This time, he was in the hospital for seven days. While hospitalized, occupational and physical therapists came by to work with him.

A Return to WakeMed Cardiac Rehab

Once again, after discharge following his surgeries, a physical therapist visited David in his home. He restarted WakeMed Cardiac Rehab in Cary. His insurance again approved 36 sessions, twice per week over 18 weeks. David also visited Dr. Rubens for his prostate biopsy.

“I spent a lot of time with the cardiac rehab staff, and I got to know them very well.”

David worked with a robust and energetic team, including exercise and fitness specialists Amy Birling, Alexis Hobson, Ashlyn Swafford Greg Hayes and Trey Rouse; nurses Kimberly Dail , Kristy Whitley, Heather Hughes, Brooke Listmann and Amanda Womack; and dietitian Diahnn Thompkins.

He received cardio and strengthening exercises. Since he has mild mobility issues, the team was careful to avoid machines that presented a safety issue, so he did not use a treadmill as part of his cardio workout.

“They went over and above to make sure I was safe. And, since I went through the program twice, I noticed program growth from 2021 to 2023. It was more structured. After the first eight sessions of exclusive cardio, I graduated to equipment with weights and resistance machines.”

David received instruction for his daily goals, including the resistance and speed expected in each session. He also received instruction in diet and medication management with printed materials for additional reading and reminders.

“I really enjoyed the program,” David glows. “I received a great education. Essentially, the program is threefold: education, motivation and safety.”

New Diagnosis, New Challenges to Overcome

In December 2023, David graduated from his second cardiac rehab stint. He also learned from Dr. Rubens that his biopsy results revealed an aggressive prostate cancer with a Gleason score of nine out of ten.

Dr. Rubens shares, “The Gleason score is a measure of how aggressive prostate cancer cells look when evaluated by the pathologist under the microscope.  The score is between six and 10 where 10 is the most aggressive form of prostate cancer. Treatment is typically recommended for anyone with a Gleason score of seven or higher.”

Soon after regaining his strength through WakeMed Cardiac Rehab, David went through another hospital system for prostate cancer treatment, which included hormone ablation therapy and radiation therapy.

“Dr. Williams had suggested I see a urologist. I put off going for some time because of all the heart surgeries. I’m grateful to Dr. Williams for urging me to see Dr. Rubens because I had no idea I had prostate cancer. I’m lucky the cancer had not metastasized, and my outcome is very hopeful.”

Plans for a Happy, Healthy Future

Once David completes prostate cancer treatment, he wants to get back in the gym. He misses the training, support and guidance he received while in WakeMed Cardiac Rehab and is committed to an active lifestyle. He also plans to start back traveling.

“My wife and I are retired, and we did a lot of traveling prior to all this, so we really want to get back to it. We’re going to start out 2024 with small trips, primarily to visit family because we haven’t seen some of our family for over a year. We also love riverboat cruises, and we have plans to enjoy those again. As well, we did a rocky mountaineer train trip a couple of years ago, which we loved. We hope to get back to these kind of big trips in the coming years.”

In the end, David credits his WakeMed Cardiac Rehab team for giving him back a worthwhile life.

“The cardiac rehab program resulted in two specific measurables gains for me. The first is that measurements taken at the beginning and the end of the program showed that I had significantly added muscle mass. And most importantly, the ejection fraction of my heart (measuring the amount of blood pumped out by the heart) increased from 20 percent to 55 percent. I’m so grateful for their care.”

About WakeMed Cardiac Rehab

WakeMed Cardiac Rehab offers a safe, monitored environment where you can gain the strength, confidence, camaraderie and nutritional know-how you need to live a heart-healthy life.

The WakeMed Cardiac Rehab specialists welcome patients who have or had:

• A recent heart attack
• Cardiac bypass surgery
• Angioplasty or stent placement
• Valve repair or replacement surgery
• A heart transplant
• Stable angina
• Heart failure

Patients with ventricular assist devices also benefit from our program.

About WakeMed Heart & Vascular

WakeMed Heart & Vascular physicians bring together expert cardiovascular, thoracic and vascular surgeons who are dedicated to delivering the highest level of cardiovascular care in Raleigh, Apex, Cary, Fuquay-Varina, Garner and Clayton, N.C. For decades, these physicians have chosen to bring their talent and expertise to WakeMed for its reputation for excellence in cardiovascular care and commitment to providing the most exceptional patient experience.

About WakeMed Urology