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Richard

Age at interview: 70
Brief Outline: Richard was diagnosed with heart failure in 2006 after becoming breathless and tired. He had had a heart attack 16 years previously and has had two operations on his heart. His heart failure is currently well controlled with medicines and he is happy with the way it is managed but feels frustrated that his condition limits his activities.
Background: Richard is a retired university teacher. He is widowed and has grown-up children. Ethnic background: White English.

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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.
 

Richard was prescribed an anti-depressant but he chose not to take it.

Richard was prescribed an anti-depressant but he chose not to take it.

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My GP also prescribed for me tablets for somebody who is depressed. But I was very reluctant to take those. I didn’t want to become addicted to tablets for depression. And sometimes people say that tablets for depression can give you highs temporarily, and I didn’t want that high/low flicking, so I didn’t take the tablets for the depression and I agreed that with my GP. 
 

An ambulance had been called for Richard 3 or 4 times because of heart problems before his condition was stabilised.

An ambulance had been called for Richard 3 or 4 times because of heart problems before his condition was stabilised.

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Generally, I have not had any sudden changes of my symptoms in between seeing my GP  in the last two to three years.  There were times previously when I was not on the current regime that I am now on the tablets, and the patterns of tablets that I was taking were obviously not the optimum for me, and I had several emergency admissions to the local hospital—999 call, and I had got very low blood pressure or I had got something else, and GTN (glyceryl trinitrate) tablets had not cured it. And so, I might have high blood pressure and GTN tablets bring down the blood pressure. But I had still got major heart problems and the people I was with just phoned and got an ambulance. And there were three or four of those over several years, in the years from about 2003, 4, 5 through to about 2010. 

 

Richard had been advised that if three doses of glyceryl trinitrate spray didn’t stop his angina pain he should phone for an ambulance.

Richard had been advised that if three doses of glyceryl trinitrate spray didn’t stop his angina pain he should phone for an ambulance.

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Okay, so have your doctors ever given you any instructions about what you should do if you suddenly feel your heart symptoms are getting worse?

I’ve had instructions of that kind, yes. I carry GTN (glyceryl trinitrate) all the time. And I haven’t had any GTN for several years now. The instruction with GTN is  if you get chest pains such as angina then you take two squirts of GTN under your tongue, and then if that doesn’t cure it within five minutes, take two more squirts. If that doesn’t cure it within another five minutes, then at the ten-minute point take two more squirts, and then if it hasn’t cured it by quarter of an hour, phone for an ambulance and straight into hospital. 

What if it wasn’t pain that you were having, what if it was breathlessness or something? 

That’s for chest pain, for angina. 

What if you suddenly felt much more breathless than you do normally, what would you do?

For breathlessness, the basic statement is rest and lie down and get your breath back slowly.

Would you call for help at all?

I’ve never had to call for help for breathlessness, no. But obviously, if I was severely breathless then I suppose, you know, it’s ambulance and into hospital. 
 

As well as hiring a mobility scooter for shopping, when visiting a museum Richard borrows a wheelchair and needs someone to push it.

As well as hiring a mobility scooter for shopping, when visiting a museum Richard borrows a wheelchair and needs someone to push it.

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Another thing that’s changed as a result of me having heart failure is that because I can’t do a lot of things that I used to do, I have to rely more on other people. And I have to get help from other people on all sorts of things— carrying things around and help with perhaps managing my own finances. 

I also need to, you know, arrange that I can get a wheelchair if I am going out somewhere to visit somewhere such as a museum where you would need to go round walking, or even to go shopping in a major shopping centre. I can’t walk the distances around the shops. And therefore I would need a mobility scooter to do that. And I find all that frustrating. 

So do you use one of those shop mobility schemes?

Every time I go to the major shopping centre near here I have to hire a mobility scooter, yes. And I went to a museum yesterday and I had to have a wheelchair there and somebody to push it round all the day. 

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