Life-giving cardiac rehab helps patient whose heart stopped for 8 minutes

The UCHealth Steadman Hawkins Clinic added a cardiac rehab program at a time when other cardiac rehab centers in Denver closed their doors.
Jan. 22, 2024
Bill Kelker at a cardiac rehab center in Denver, recovering from his heart attack.
Bill Kelker on a stationary bike during a cardiac rehabilitation session at UCHealth Steadman Hawkins Clinic Denver. Exercise physiologist Kendall Knetzger, behind the desk, and Joanne Deacon, RN, keep an eye on him and other participants as they exercise in ways precisely calibrated to boost heart function over 36 sessions. Photos by Cyrus McCrimmon for UCHealth.

Bill Kelker looks out over the snowy fairways of the Inverness Golf Club as the morning fog lifts. He is walking on a treadmill in a bright corner of UCHealth Steadman Hawkins Clinic Denver’s third floor. He does so in a highly prescribed and closely monitored fashion. For three minutes, he walks 9.1-degree incline at 3.4 miles per hour. Then, for two minutes, he will dial it back to 2.5 mph at a 2.5-degree incline. He will repeat this cycle four times, after which he will ride a stationary bike for 20 minutes and then do a bit of strength work.

Kelker, a youthful 68, is walking, riding and lifting for his life. Considering where he was just a few months ago, that’s understandable.

An EKG device in a blue fabric pouch he tied to himself like a tiny kitchen apron transmits his heart rate to a console over in the corner. There, Kendall Knetzger, a UCHealth exercise physiologist, and fellow exercise physiologist Linnea Magee monitor the heartbeats of Kelker, and five fellow exercisers partake in Steadman Hawkins’ newest service, launched in October: cardiac rehabilitation.

On Knetzger’s screen, Kelker’s heart rate appears along with a seismograph-like trace of his EKG data. It’s at about 110 beats per minute during the faster, steeper interval on the treadmill. That’s about 110 beats per minute more than it was for eight or so minutes on May 17, 2023.

The heart attack

Kelker had been to his local gym that Wednesday morning, lifting weights and doing a bit of cardio. Back at his Denver home, he had read through his emails – despite having an eye on a Sept. 1, 2023, retirement, he was still employed at a wholesale floor-covering business, and there was work to do. Then he hopped in the shower.

That’s all he remembers. Because, despite the hours a week in the gym and the long walks with wife, Jeanne, and the routine cardiac checkup three weeks before (nothing out of the ordinary, besides slightly high cholesterol), a chunk of arterial plaque broke loose and lodged in his heart’s left anterior descending artery.

Kelker’s 25th cardiac rehab session started with 20 minutes on a treadmill.
Kelker’s 25th session at a cardiac rehab center in Denver started with 20 minutes on a treadmill.

That particular blockage causes a heart attack known as a widow-maker, and it very nearly made Jeanne one. But she acted quickly. She heard the thump of her husband collapsing on the shower floor, found him unconscious, and immediately dialed 911. Paramedics got there fast. They detected no pulse, turned her husband over on the bathroom floor, pressed the defibrillator paddles to his chest, and zapped his heart back into action.

They rushed him to the nearest hospital. Kelker’s heart stopped twice more as doctors attempted to clear the artery. They would place two stents to restore blood flow. But Kelker was in a bad way, and things would get worse before they would get better.

For two-and-a-half weeks, Kelker lay intubated and unconscious in an ICU. He would spend roughly the same amount of time on an inpatient floor after that. His list of ensuing complications included cardiogenic shock, septic shock, pneumonia, metabolic encephalopathy, and acute kidney injury. He needed an Impella left-ventricle pump, a feeding tube into his stomach, and, to help him breathe after the ventilator tube was removed, a tracheostomy. He lost 24 pounds and had to learn how to swallow, talk, and walk again. But there was also good news: Somehow, Kelker’s brain had come through the long heart stoppage without damage.

He finally came home on June 23, 2023, 38 days after admission. Jeanne rented a bed for the main level because her husband couldn’t make it up the stairs. He was doing physical and occupational therapy, but his cardiologist also wanted him to do cardiac rehabilitation.

Why cardiac rehabilitation?

The UCHealth Steadman Hawkins cardiac rehab center opened on Oct. 11, 2023.
The UCHealth Steadman Hawkins cardiac rehab center opened on Oct. 11, 2023.

Cardiac rehabilitation delivers proven benefits for patients with heart failure and those recovering from heart attacks, as well as procedures ranging from valve replacements to heart transplants. Yet in metropolitan Denver, cardiac rehabilitation centers are closing their doors rather than opening them. Kelker was rebuffed from one program entirely and put on a two-month waiting list in another. Then, he got wind of the new Steadman Hawkins program. He was there on the program’s very first day.

Cardiac rehab specialists determine the participant’s heart function and then monitor it over 36 sessions (that’s what insurance typically covers). Each lasts 90 minutes, two to three times a week, and focuses on moderate exertion. How “moderate” plays out in practice will depend on each patient’s baseline capabilities, health status, estimated VO2 max, resting heart rate, estimated maximum heart rate, and other factors.

In Kelker’s case, that’s a heart rate of between about 105 and 120 beats per minute once he gets warmed up, Knetzger says. As the heart gets stronger, those heart rates will deliver more blood to the body, and that manifests in improved METS, a key cardiac rehab metric.

Kelker checks his heart rate on his watch as he rides the stationary bike. It’s also being monitored via the EKG device he and fellow UCHealth Steadman Hawkins patients wear during their cardiac rehab sessions.
Kelker checks his heart rate on his watch as he rides the stationary bike. It’s also being monitored via the EKG device he and fellow UCHealth Steadman Hawkins patients wear during their cardiac rehab sessions.

METS stands for metabolic equivalents. One MET is the energy it takes to sit quietly in a chair. Two METS is twice that, and so on. A study looking at the METS of various activities pegged cooking at 2.5 METS, playing basketball at 11.1 METS, and rowing fast at 19.1 METS. On his first day in cardiac rehab on Oct. 11, Kelker managed 3.6 METS – roughly the output of someone who is weeding, bowling, or fishing.

On his 25th visit two months later, that same moderate effort yields 7.9 METS, which could have him backpacking uphill with a 44-pound pack. That’s a roughly 120% improvement in heart function.

Building confidence at cardiac rehab center in Denver

Kelker has moved to a stationary bike. His heart rate is 134 beats per minute. A drop of sweat collects at the end of his nose.

Knetzger notes this. “What are your watts at?” she asks, referring to another measurement of energy output, this one displayed on the bike.

“Ninety-six to 103,” Kelker pants. “I’m maybe getting a little carried away.”

“Yeah, you are getting a little carried away, aren’t you,” Knetzger says.

“I’ve been scolded by Joanne,” Kelker admits. He eases up.

Joanne is Joanne Deacon, the UCHealth registered nurse who leads the cardiac rehab center’s four class sessions every Monday, Wednesday, and Thursday. She happens to be standing next to Knetzger. She explains that the team is fine with participants pushing it a bit, but they need to let the staff know because adaptations from exercise reduce the heart rate required for a given amount of power over time – and unsafe rhythms can also happen with these patients. (There’s always a cardiologist on call during cardiac rehab sessions.)

Kelker’s motivation is more than boosting his longevity for his sake and that of his wife Jeanne, son Jesse, and daughter Sydney, and for granddaughters Penelope, 3, and Lucy, 1. He wants to be as healthy as he can for as long as he can and knows that exercise is medicine.

The cardiac rehab session wraps up with about 15 minutes of strength and flexibility work.
The cardiac rehab session wraps up with about 15 minutes of strength and flexibility work.

He’s also doing a once-weekly physical therapy session with Steadman Hawkins physical therapist Matthew Lopez. Lopez emphasizes leg, core, and shoulder strength, as well as improving balance. Kelker is working out on his own based on what he has learned in cardiac rehab. While patients can self-pay and continue with a maintenance class after the 36th session – Kelker says he plans on doing so – the aim is to provide patients with a sense of how to best exercise for heart health so they can continue on their own in the years ahead.

“What this is all about for me is confidence – the confidence to know what to do, how long, and how hard,” Kelker says.

Despite his cardiologist’s assurances that the odds of another heart attack are low – and lower yet given the work Kelker is putting in – Kelker says he occasionally does feel anxiety about the possibility of another heart attack. But he soon subdues it.

“I keep telling myself, ‘That’s why I’m doing this,’” Kelker says.

About the author

Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of “A Beard Cut Short,” a biography of a remarkable professor; “The Laser That’s Changing the World,” a history of lidar; and “From Jars to the Stars,” a history of Ball Aerospace.