Age at interview: 78
Age at diagnosis: 64
Brief Outline: Raymond was diagnosed with AF 12 years ago and prescribed digoxin, bisoprolol, and warfarin. A pacemaker was fitted 4 years later after episodes of passing out. He has had no further problems. He eats a healthy diet and does not smoke or drink.
Background: Raymond is a retired electrical engineer. He is married with four children. Ethnic background/nationality: White British.

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After his retirement Raymond began going to the gym to keep fit. He knew something was wrong, however, when his heart rate registered 160-170 while walking on the treadmill. Afraid that his heart would eventually stop and ‘end up in a heart attack’, Raymond consulted his GP who diagnosed AF. Raymond has ‘not the vaguest idea’ what might have caused his AF. There is a family history of strokes but most of his relatives died in their eighties. 

Raymond was prescribed digoxin and bisoprolol to regulate his heart, a blood pressure tablet (ramipril), and warfarin to prevent blood clots and minimise his risk of stroke. He has regular INR (International Normalised Ratio) checks to monitor his warfarin levels and has his blood pressure checked on a regular basis. He believes that diet can affect his warfarin levels but doesn’t know ‘which bit of the diet causes this to go wrong’. He’s also concerned about the risk of internal bleeding with warfarin and feels he has ‘absolutely no control’ over it.

Looking back, Raymond wishes that someone had warned him that he might find his ‘heart stopping a wee bit’. He remembers episodes of feeling tired, falling asleep, and passing out for brief moments but thought little of it and didn’t mention it to his GP. He describes himself as an ‘innocent’ who just thought he needed to sort himself out and get a bit more fresh air. Four years after his diagnosis, however, while in hospital for overnight monitoring, his heart stopped beating for around 10 seconds and he was advised to have a pacemaker fitted. The operation was a success. Raymond recalls feeling a bit sore for a day or two after the operation but otherwise has been ‘totally normal’ since. He has his pacemaker checked every year and the only restriction to his life is that he can no longer go through scanners at the airport.

Raymond believes that exercise and a good diet are important in helping to prevent stroke. After his pacemaker was fitted he started to build up a programme of walking in his local area from 3 miles to 20 miles. Recent knee and spinal operations, however, have meant that at present he is unable to exercise. He eats a varied diet of fish, meat and chicken, fruit and vegetables. An ex-smoker, Raymond no longer drinks alcohol and gave up coffee years ago because it tended to trigger AF. 

Raymond is aware that AF can be a serious problem and, despite being on medication, there is a possibility that he might ‘still have a clot and still have a stroke’. But since having his pacemaker fitted he’s been able to ‘forget about AF’ and get on with enjoying his life. 

Interview held 14/03/12

On hearing that Tony Blair and Elton John had had AF, Raymond felt reassured.

Round about that time, two very famous people had it. Elton John and Blair, Tony Blair and from what I picked up from listening to what they were going, Blair never stopped. I don’t even think he stopped even to get to get the test done [laughs]. And it was so that was that was it seeing whether they had, I’d picked up both of them up over the over the years and that. They didn’t stop so I said, “I’m not going to stop either.”

I mean both Elton John still tours. Tony Blair still travels the world lecturing. He’s done the same as everybody else and he’s got a bit older and put a wee bit of, put a pound or two on in places I mean you see photographs of him but, you know, that’s the sort of thing, that’s the sort of thing that you shouldn’t do is allow the weight to go on.

Raymond, who went on to have a pacemaker fitted, spoke of passing out (syncope) when he had an episode of AF.

When I had an attack, I knew it was coming. I had not very long, just a second or two but I knew it was that was the beginning.

It was in [hospital] and I sort of felt it happen and I wakened up and I was sliding down the door post, I had my back against the door post and I was sliding down and ended up on, that was the end of it then. Can’t remember any more problems. Probably didn’t say anything to anyone about it because I was going home and I wouldn’t have been going.

Raymond, who had a pacemaker fitted after collapsing several times, was delighted with the result.

The heart had stopped for something like five seconds. It’d start up again on its own and then I found out it went as far as ten seconds, it wasn’t the only one. So I had a pacemaker fitted, end of end of subject. I’ve been totally normal since. Travelled, travelled to parts of Africa, where we went on safaris and did stupid things and we went out to Australia.

Raymond would have appreciated knowing that he might pass out or need a pacemaker so that he could adjust his lifestyle.

Yes, I’d like to have known I’d like to have known what I was liable to fall foul of like passing out, like needing a pacemaker, like anything else that maybe I mightn’t take but possibly, I could I could have taken. I mean I don’t know. I know well, I don’t know actually what I’m talking about because I don’t know if there is I don’t know if there is any. It may be that there isn’t sufficient but nobody said to me at any time, not even my own doctor, who I had, as I say, respect for very, very much, nobody said to me, “Be careful, you might find yourself, the heart stopping a wee bit.” Nobody ever said that to me and I had had I had had I had a monitor fitted for twenty four hours but I never had any problem during that particular twenty four hours. And I was just lucky enough in a way, I suppose that during the overnight they detected the problem and everything then was pushed into place. But if I’d have known then, if I’d have known then what I know now and for the months beforehand, I wouldn’t have been driving, definitely not driving.
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