Alfonso Moretti was about to have surgery for a torn tendon in his calf muscle. At 45, and having been a personal trainer since his late teens, surgeries to repair injuries were nothing new. This would be his eighth.
But this time, during a routine exam before anesthesia would be administered, the doctor asked: "Do you realize you have AFib? It's actually quite bad."
AFib, or atrial fibrillation, is an irregular heart rhythm that increases the risk of stroke, heart failure and other heart-related complications.
Moretti said that was news to him. But the diagnosis did explain a lot.
Ever since he started lifting weights at 13, Moretti had struggled to catch his breath when exercising. He'd even passed out a handful of times when he really pushed himself. It happened often enough that he figured that's just the way it went.
Moretti had occasional medical checkups and, of course, had been prepped for surgery seven previous times. Nobody ever noticed a heart problem.
Among his many immediate concerns was how the diagnosis would affect his career.
He'd started training clients in New York City, then set his sights on Hollywood. In 2014, he moved to California. After months of no work and even having to sleep in his car for a few months, he'd finally realized his dream of becoming a celebrity trainer. His roster includes Matthew McConaughey, Camila Alves, LL Cool J and Erika Jayne. He also works with non-celebrities.
The diagnosis came in late 2019, a few months after he and his wife, Michelle Nielsen-Moretti, had opened a gym in Beverly Hills, where they live.
Doctors thought Moretti's condition would improve with medication and non-surgical procedures.
They put him on a cocktail of drugs that left him more tired than ever. Moretti was so exhausted that his wife would accompany him to his classes at the gym so she could demonstrate the workouts he put clients through.
During this time, Moretti had two procedures to improve his heart rhythm, an ablation and a cardioversion. Neither provided lasting results.
In spring 2020, with COVID-19 shutting down the gym, Moretti spent much of his time lying on the couch or sleeping. He didn't know if it was from the medication or a worsening heart.
He chased down as many consultations with specialists as he could.
Finally, one doctor told him, "You're never going to feel better until you fix your aortic valve."
Armed with that information, he returned to his primary cardiologist.
Initially, doctors said his condition wasn't serious enough to repair or replace the valve.
Meanwhile, Moretti stayed on the couch. He often felt dizzy, short of breath and exhausted. He battled depression. As the country opened back up, Moretti and his wife decided not to restart the gym.
"One of the things that made it so challenging was you'd look at me and you'd think I was fine," he said. "People just didn't get it."
Finally, Moretti had had enough.
"I can't live like this anymore," he told his doctor. "You have to do something."
After months of additional testing, doctors agreed it was time for Moretti to have valve replacement surgery.
This past February, doctors replaced his faulty valve with a new one made of animal tissue. The doctor later told him his valve had been worse than they'd thought. More than half his blood had been returning backward through the valve and into his heart instead of moving forward and out to his body.
Recovery from the open-heart surgery was grueling.
"It was shocking how painful it was," Moretti said. "Then when I was at home, I couldn't lift anything. I couldn't even pull myself up to sit. Michelle had to help me."
Soon turning 50, Moretti is figuring out a new approach to fitness, especially after a doctor told him that his years of hard-core weight training might have contributed to his heart problem.
"I want younger people to know that they don't need to bleed every time they hit the gym," he said. "I try to teach balance and recovery more than annihilation and focusing on lifting excessively heavy weights."
Avoiding the extreme end of training is one thing. The challenge now is finding a new sweet spot. He's scaling back on bodybuilding and lifting heavy weights, focusing instead of flexibility and overall fitness.
"Though without weightlifting, I have to relearn how to feel good about myself," he said.
Just like the days when Nielsen-Moretti acted out her husband's workout instructions, she continues to be a supportive partner.
"The gym has been his life for so long, so it's already been a big change," she said. "But he doesn't see what I see. I see that he looks great, and that he's doing amazingly well. I think he'll see that too."
Stories From the Heart chronicles the inspiring journeys of heart disease and stroke survivors, caregivers and advocates.