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George X

Age at interview: 78
Age at diagnosis: 63
Brief Outline: George has had AF for 15 years and has experienced two minor strokes. He is unable to take medication to control his blood pressure and had an allergic reaction to warfarin. He continues to have attacks of AF but takes aspirin to minimise stroke risk.
Background: George is a retired teacher. He is married with one adult child. Ethnic background/nationality: White British.

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After collapsing in town, George was taken to hospital with a suspected heart attack. Tests proved negative and he was released. A few months later, however, after he consulted his GP with ‘terrible pains and shortage of breath’, an ECG diagnosed AF. George continued to have AF attacks over the next few years but cardiologists were unable to regulate his heartbeat because of his unstable blood pressure. He describes his blood pressure as ‘going up and down like a yo-yo’. Medication, however, caused his blood pressure to fall to very low levels, leaving him on the point of collapse. 

George has a family history of heart disease. Having a major stroke and ending up in a wheelchair is a major concern. He admits that while AF can’t kill you, ‘it’s one of the worst complaints to give you a stroke’. He has had two minor strokes. The first he associates with the blood pressure drug lisinopril which he was taking at the time. Citing the patient information sheet, he says that ‘one of the side effects is a heart attack or a stroke’. 

George ‘swears to this day’ that the aspirin which he takes daily stopped him from having a full-blown stroke. An allergic reaction to warfarin – ‘I went as red as a beetroot and felt pretty bad’ – has meant that he is unable to take anti-coagulants to help minimise stroke risk. Although he has heard about new medications he is reluctant to raise this with his GP ‘because really she should be telling me’. 

George describes the care he received after his minor strokes as ‘absolutely marvellous’. However, he believes that the fact that he is unable to take medication for his AF has left medical professionals with ‘nothing else to offer him’ and an attitude of ‘let him get on with it’. He has lost faith in his local cardiology department and says he is still waiting for a Myoview stress test (to check for Coronary Artery Disease (CAD) or myocardial infarction (MI - heart attack)) which a consultant promised to arrange 4 years ago.  After waiting so long George feels it might be worthwhile getting another referral. He would like the opportunity to sit down and talk to a specialist about his condition, but feels 10 minute consultations are inadequate.    

George continues to get ‘some pretty bad attacks’ of AF which cause chest pain and breathlessness. He describes it as ‘an odd feeling – like struggling to get your breath into a big empty chamber’. Attacks can be brief, or last a couple of hours or, in some cases, all day. George enjoys walking for exercise but AF attacks can ‘stop me dead in my tracks’. He has found that sitting down at home afterwards with a coffee and a drop of whisky ‘seems to help a lot’.

One of George’s great loves is his garden and his prize-winning pelargoniums. However, an hour or two of strenuous activity in the garden can leave him ‘absolutely breathless’ and feeling depressed and short-tempered. 

Interview held 1/08/12
 
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George X experienced pain during an episode of AF.

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Phew, well, if you get a bad attack it is very, very bad. You start off by having difficulty in breathing and then you get a pain in the chest, which goes right the way down on my left side into my thumb, in fact. You can feel it all going down there and it comes up into the neck and sort of stops at the chin. That’s how it affects me. And then as you try to get your breath, it’s almost as though you’re, it’s an odd feeling. It’s almost as if you’re breathing into, struggling to get your breath into nothing. There’s nothing there and you’re, [heavy breathing] and it’s just like a big empty chamber. 
 
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George X experienced two TIAs/minor strokes; the first 8 years ago, the second 4 years ago. He described the symptoms of his first TIA.

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I had it, my first one in the June I think it was, June July time. That was eight years ago, June, that’s it and this doctor, lady that’s passed, absolutely brilliant. I had it on the Monday night, I’d been out for a little walk with [wife] because she can’t walk much and it was such a lovely day. No problems. Came back, sat in the settee, [wife] went and made a cup of tea about half past six, I was watching Central News. No pain or anything. I was then going to make a pot of tea. She said, “The kettle’s boiling if you’re going to make the tea.” She’s in that doorway, “Are you messing about? Are you messing me about?” And I can’t move, I’m paralysed all down my left side.” So the emergency chappy came out from [town] at eight o’clock that night and [laughs] by then I could talk again. My speech had come back.
 
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George X leads a healthy life which includes eating well and regular exercise.

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Well, yeah, I mean apparently I’m doing everything I should do. We don’t cook with salt. We don’t have any salt. The only time we do, we have lo-salt, which [wife] uses when she mashes potatoes. She doesn’t like it other than that. We have that Benecol low fat stuff. Fibrous food for breakfast. Well, not much else I can do I think, everything is sort of, I make sure everything is going okay, yeah. I’m not overweight. I walk from all over the place and I enjoy walking.
 
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George X felt that a ten minute appointment with his GP was insufficient.

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The stroke lady told me that I ought to really go back because there’s a lot going on and see the doctor but, you know, you get ten minutes and you find that ten minutes is nowhere near enough to tell the doctor what’s going on. They will book a double appointment but they’ve got to sanction it rather than you ring up the receptionist and say, “I want a double appointment with the doctor.” Because you just can’t get it. It doesn’t work like that so you either take the ten minutes, take your luck.
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