Keith

Age at interview: 61

Age at diagnosis: 57

Brief Outline: Despite episodes of irregular heartbeat, Keith put off seeing his doctor. His AF was diagnosed by chance at a check-up after a knee operation. A minor stroke about a year later convinced him to give up smoking. He takes warfarin and sotalol.

Background: Keith is a head teacher. He is married with one adult child. Ethnic background/nationality: White British.

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Keith had been experiencing increasingly frequent attacks of irregular heartbeat after meals and while playing cricket. He describes it as a ‘curious feeling, like a butterfly fluttering around in your chest’. Yet, ‘a bit like an ostrich’ with its head in the sand, he did nothing about it and hoped it would go away. He describes it as ‘pure chance’ that he had an attack while his doctor was taking his pulse during a check-up after a knee operation. A couple of weeks later a consultant confirmed the diagnosis of AF. Keith was prescribed the beta-blocker, sotalol, but later had the initial dose halved after it made him feel ‘permanently tired’. 

On his doctor’s advice he also took half an aspirin a day to prevent blood clots. Although it was made clear that AF could increase the risk of stroke, Keith was ‘not in the slightest’ concerned, believing that it would not happen to him. A year and a half later, however, after driving back from holidays, Keith’s speech became slurred and he felt ‘slightly detached’ from his surroundings. He links his minor stroke (or TIA) to his AF and suspects he had ‘reaped the rewards’ for missing his regular dose of aspirin after running out three days before the end of his holiday. 

Keith recovered well from his stroke, returning to work after six weeks. He was prescribed warfarin which he continues to take alongside sotalol and simvastin, a statin designed to keep cholesterol levels low. Keith dislikes being on warfarin, which he describes as those ‘wretched things’. He has noticed that he bleeds and bruises more easily but wonders whether this might be ‘an age thing’ as well. He also has to attend regular blood tests every 2-3 weeks to regulate his INR levels, but describes this as an ‘amazingly efficient system’. 

With no heart disease in the family, Keith is unsure what might have caused his AF, though wonders if it could have been smoking or possibly stress. Having a minor stroke ‘did the trick’, however, in convincing him to give up smoking and reduce drinking. He now takes ‘a bit more care’ of his health and is currently trying to lose weight by cutting out fats and cutting down on carbohydrates.  

While AF has not made a significant difference to his life, Keith initially found it difficult to come to terms with the diagnosis, his subsequent TIA episode, and the need to take regular medication. As he says: ‘I don’t like to admit weakness anyway and I could see that as a form of weakness’. 

Keith feels very fortunate that his care has been ‘extremely efficient and caring’. He has been kept well informed throughout and given good advice by ‘high quality staff who knew what they were doing’. He believes that it is important for politicians and decision makers to listen to the patient’s voice because ‘this is who the service is for’. In retrospect, he describes his decision not to seek medical advice when he started to get palpitations as ‘foolish’. He advises others experiencing an irregular heartbeat to consult their doctor straight away.

Since taking sotalol, Keith has had only a couple of repeat AF attacks. Describing his heart as ‘fairly steady and static’, he continues to lead an active life, taking part in sport and enjoying his role as head teacher. Yet his experiences of AF and TIA have promoted Keith to try and achieve a better work-life balance. With this in mind, he is currently planning to retire in the next academic year. 

Interview held 30/07/12

Keith ignored his symptoms and hoped they would go away. It was not until his GP checked Keith’s pulse during a regular check-up that his AF was diagnosed.

The frequency of the attacks increased for some reason, I’m not sure when. I’d mainly have them after a meal, sitting down after a meal and I’d get this irregular heartbeat just for a matter of seconds. But the frequency increased and so did the length of the length of the attacks and I suppose this went on for over a year or so and a bit like an ostrich, I put my head in the sand and didn’t want to do anything about it. I just hoped it would go away really but it didn’t. I still didn’t do anything about it even though the attacks were becoming more frequent and should have done I suppose. But it just happened that I was going to a doctors, to my doctors for a check-up following an operation on my knee and I just happened to have an attack when the doctor was taking my pulse. And he sort of raised his eyebrows and said, “What’s going on here then and how long have you had this?” And then it was diagnosed, after a whole series of tests on the strength of my heart, which was perfectly healthy apparently, apart from the fact that I’d had atrial fibrillation and was it was prone to irregular heartbeat.

Keith saw it as a sign of weakness to reveal his condition.

No, I suppose again, a bit like the ostrich, I just stick my head in the sand and if you don’t look at it will go away but no, I didn’t tell anyone. I told my family, immediate family because there were drugs involved with keeping the heart on a regular plane as it were but I didn’t tell anybody else, no, no.

Was there a reason you didn’t or?

No, that’s quite a, that that’s a good question really. I don’t like to admit weakness anyway and I would see that as a form of weakness I suppose. Yes, I suppose that’s the truth of it really. I didn’t want to admit, I wouldn’t like to admit to other people that there’s a weakness there [laughs].

Keith had a TIA/minor stroke after driving back from Bath. His speech was slurred and he felt detached from his surroundings.

I’d driven back from near Bath and felt perfectly good. Went into to my house and we got back safely and I just turned to talk to my wife and couldn’t, I was slurring speech. I couldn’t speak clearly so I stood up and looked to my left and a window seemed to veer to the left and change colour [laughs]. But again, it was it was a strange feeling in that I felt detached from it, not any pain at all, just slightly detached from where I was and so I sat down at the other end of, I moved to the other end of the sofa and sat down and then gradually, very gradually, speech began to return bit by bit and by that time, the ambulance came and I was away. But when I got feedback from that it was it was it was, I was told that there’d been a blood clot and in in one of the vessels in my heart and that had pumped up to the brain and that’s what caused it and I’d been extremely lucky that the effects had been so slight.

After his TIA, Keith reluctantly accepted the need for warfarin rather than aspirin.

I had to go onto warfarin, well, following that I had six weeks, I couldn’t go to work for six weeks, which was very frustrating because my speech had come back by then and I felt good and I was advised to go out and get as much exercise as possible, which I tried to. Then of course, I was on blood thinners then, warfarin, aspirin wasn’t deemed strong enough so I went onto warfarin then. And I, and I really dislike that. I don’t know why. Again it’s more tablets really. Again it’s another admission that things aren’t fully a-okay but. 

Tell me what it’s meant for you being on warfarin.

It means I bruise more easily and I bleed more easily and I have to remember to take the wretched things. Again, it’s an admission of weakness I think, you know, there’s a there’s a, I’d much rather be without it.

Since his diagnosis, Keith’s care has been very positive.

All the way through and from my doctor instantly and then in the [name of hospital], when I went to see the consultant there, had all the tests, everything was crystal clear and explained absolutely perfectly. I was really you know, really delighted with that because I knew just where I was and what the. What the outcomes would be. 

Keith would like to see people better informed about AF symptoms so that they go to their GP for treatment or referral to a consultant.

I suppose then given my experience, one good thing would be to inform people a little better about AF because I’m an educated person. I knew about AF really and I still didn’t do anything about it, which in retrospect is foolish isn’t it. There’s no reason why I shouldn’t have gone to the doctors but I suppose one thing would be education of people that this is what happens, this is what you should do when you get an irregular heartbeat, go to the doctor and the doctor will be able to push you in the right direction either to a consultant or give suitable drugs or whatever help is needed.