Tim had his first heart attack ten years ago aged 43 followed by a cardiac arrest while in the ambulance. He had a second heart attack a month later, after which two stents were inserted but a year later one of them collapsed, causing another heart attack. Damage to his heart from the heart attacks has caused heart failure and he cannot do as much physical activity as he used to. He has also suffered damage to his brain from lack of oxygen during the cardiac arrest, resulting in short term memory loss. He doesn’t remember the term heart failure’ being used although it may have been.

Tim has other health problems. Two years before his first heart attack he was injured in a road traffic accident, leaving him with lasting back pain. More recently he has been diagnosed with an acoustic neuroma and a cholesteatoma, affecting his balance and causing facial pain. He is hoping to have an operation for this soon but is waiting for the anaesthetist to confirm he is prepared to give him a general anaesthetic. Tim is prepared to accept the risks associated with a general anaesthetic for someone with heart failure and four years ago had a general anaesthetic for an operation to remove parts of his thyroid gland because of suspected cancer; the tissue removed turned out to be benign.

Tim takes strong painkillers three times a day with meals. He takes bisoprolol, ramipril, aspirin and a statin for his heart condition. Although he was told clopidogrel is not recommended for long term treatment, because his third heart attack occurred after he stopped taking the drug, he is now taking it for life to try to prevent further attacks. He also takes omeprazole to counter the unwanted effects of some of the other drugs. One of the blood pressure medicines caused him erectile dysfunction but his doctors would not prescribe Viagra because it is risky in people with heart conditions; however, he obtained some elsewhere and found it effective. After a couple of years his erections returned so he has no further need for Viagra and has an active sex life. He resents taking so many medicines but accepts that they are keeping him alive. He relies on his wife to give him his pills at the right times since his memory cannot be trusted.

Tim has not seen a heart specialist for about eight years but every three months he is called to an appointment with his GP, who checks his blood pressure and takes blood samples to check his kidney and liver function as both are at risk from his medicines. Sometimes an ECG is also done. Whenever he has felt unwell or concerned about his heart he has phoned the GP and someone has come in about five minutes. He has occasionally called an ambulance, which has arrived in about 20 minutes, which he is very reassured by given that he lives in a very remote location. He always carries a copy of his last ECG printout so that medical staff can see what it was like before. He feels very satisfied with his care because it has kept him alive for ten years so far and his doctors treat him like a human being not a number.

Although he was told to stop smoking after his first heart attack because it would prevent future attacks, Tim took it up again after his second heart attack and continues to smoke today. He uses cannabis to relieve his constant pain. He finds this more effective than the prescribed painkilling medicines, which also tend to make him aggressive. He thinks it unfair that people with multiple sclerosis can have cannabis on prescription but he can’t. He and his wife eat a reasonably healthy diet and lost some weight through Slimming World. He cannot walk without pain or exert himself without becoming tired, so he manages his 8 acre garden with the help of tractors and machinery and has designed it to be as low maintenance as possible.

Tim believes in living as full a life as he can despite his health problems. He doesn’t think about his heart condition except when taking his medicines or attending a check-up. He takes every day as it comes, enjoys life, and doesn’t worry about what the future may hold.