Richard

Richard’s heart problems began 25 years ago in 1990 with a heart attack, which was followed by a quadruple coronary arterial bypass graft 9 months later. In 2006 he became breathless and tired and couldn’t keep warm. He was diagnosed with heart failure due to enlargement of the left ventricle, which was not pumping enough blood around his body. He had another operation to insert four stents in his coronary arteries and had a cardiac arrest caused by debris from the operation blocking one of the coronary arteries further down. Richard’s heart failure has improved slightly since that time due to taking medicines and trying to exercise as much as he can. However, the heart failure limits his activity; he is breathless and cannot walk far but still drives and has a blue badge for disabled parking. He uses a mobility scooter at a shopping centre and needs use of a wheelchair if visiting a museum. He pays people to do his housework and gardening.

Richard has been discharged by the hospital team but sees his GP approximately every three months for a check-up. He measures his own blood pressure just before going to the appointment and gives the reading to the doctor to save time in the consultation. Blood tests and ECGs are done periodically and Richard has asked the hospital laboratory to send copies of results to him as well as to his GP. The doses of Richard’s heart medicines have been experimented with by the GP to arrive at an optimum level for him, and his condition is currently stable. He takes aspirin, a statin, carvedilol, digoxin, prednisolone, ramipril and spirinolactone. He also takes a sleeping tablet. Some of the medicines he takes in the morning when he cleans his teeth; others when going to bed at night. Some of his heart medicines interacted with a medicine he had been taking for his prostate, so the latter was discontinued.

Richard is depressed through a combination of his heart condition preventing him from pursuing his hobbies, poor sleep, and grieving for his wife who died a few months ago; he had been her full-time carer. He sees his grown up children periodically but his social networks have been shrinking, particularly since his wife’s death. He declined an offer of anti-depressant medicine. He has lost weight through a combination of disrupted meals while busy caring for his wife, and more recently, reducing the amount of carbohydrates and trans and saturated fats in his diet.

Richard has read a great deal about heart failure and is involved with local and national heart charities. He is happy with the way his heart condition is managed.