Martin

Age at interview: 73

Age at diagnosis: 71

Brief Outline: Martin’s sister has AF so he was aware of the symptoms when he experienced them himself. He saw his GP and was later diagnosed with AF at the hospital. Martin takes aspirin and sotalol, and will shortly start taking ramipril for raised blood pressure.

Background: Martin is a retired university lecturer and lives with his wife. He has five grown up children. Ethnic background/nationality: White.

More about me...

Martin was walking home and realised that his heart was beating very fast. His sister has AF, so he was aware of the symptoms and suspected he might have AF too. Martin saw his GP and was sent for tests at his local hospital. He had an ECG, an echocardiogram, chest X-ray and blood tests. He was diagnosed with AF and put on aspirin to reduce his stroke risk. He felt ‘fed up’ when he was diagnosed. Martin decided he wanted to see a heart specialist, so asked his GP to refer him. Martin says that for his six appointments, he saw five different doctors, and some expressed slightly different opinions on treatment. Martin feels that this kind of inconsistency can undermine patients’ confidence in what doctors say, and that to some extent, the care received can depend on who you see. Martin was reluctant to take medication for his AF. He says he compromised and agreed to be prescribed sotalol as a ‘pill in the pocket’ medication, to take when he had an AF episode. However, this did not work for Martin, so he agreed to take 40mg of sotalol twice a day. This has reduced Martin’s AF episodes from 4-6 per month to once a month. He takes sotalol on an empty stomach as he believes this helps the absorption of it. A side effect of the sotalol is that Martin feels tired. When Martin has an AF episode, he feels weak, and sometimes needs to urinate frequently. He does not have any warning signs that he is going to have an episode, and can still function during it. Martin noticed that alcohol was a trigger, so has cut it out completely, along with caffeine. After overdoing some work in the garden once, Martin also had several episodes of AF. 

Martin has had a 24 hour Holter monitor (as he has a low heart rate of 40 beats per minute at night), plus a 24 hour blood pressure monitor. Martin’s blood pressure is a little high, so he has agreed to start taking ramipril for this. He has been told that if his AF symptoms get worse, he can try a higher dose of sotalol, or could consider an ablation. Martin takes aspirin and is not keen on taking warfarin, due to the dietary restrictions and blood testing required. He would consider an alternative that does not involve blood tests. Martin feels that arrhythmia specialists are very focussed on one area, and thinks they should take a broader, more holistic view of the patient. He has now been discharged by the cardiologist, but is able to contact the department if he needs to. Martin says he feels lucky as he is aware that his AF is not as severe as some other people’s. Having AF has made him more aware of his heart and the role it plays. He is happy with the care he has received and has felt that AF and possible treatments have been explained to him.

Martin wonders whether there could be a hereditary aspect to AF, as his parents both had heart problems and his sister has AF. He feels that patients should research their condition, so they can listen to advice and make an informed decision. Martin reads information about AF online, and finds the Atrial Fibrillation Association website useful. He advises family members of someone with AF not to panic or fuss over the person, but to be supportive. He advises medical professionals to treat the patient as a partner in their care, but that reassurance is also important.

Interview held 5.3.12

Martin, whose sister has AF, had ‘an inkling’ he might have it too when he had palpitations walking home.

Yes, I discovered I was having palpitations in June 2009. I’d been to a meeting of the [town] U3A (University of the Third Age) and I was walking home, which is over a mile, and I suddenly realised my heart rate was very, very fast. And I had an inkling it might be AF because my sister suffers from this. So I took myself to the GP the next day. He gave me a form to take to the local hospital, clinical measurement department, and he said, “When you next get these palpitations, go up there and get them to do an ECG.” Which I did. And a couple of days later I had this experience and I got on a bus, which takes me into the hospital grounds, and fortunately, I was still having the fibrillation when they did the ECG. So that is the only recording they’ve got on a twelve lead ECG of my condition. They sort of panicked at the time and whisked me round to A and E where I spent four hours linked up to another machine, but by the time I’d got in there, it had stopped. 

Martin found that he could get by with a smaller dose of sotalol if he took it on an empty stomach.

I’m meticulous about taking the sotalol too. And the other thing I wanted to tell you, I take it on an empty stomach. I took the view that if I take it, it says you can take it with food. I took the view that that would slow the absorption and might even prevent some absorption, because food sometimes combines with a drug and it doesn’t get absorbed, especially if you had a lot of bran or something. So I read on an American website that you should take it one hour before food, and I try to do that. And I think half an hour is long enough actually, and I’ve got better results with it. So I, these things you discover as you go along to make the most of the small dose.

Martin was interested in an alternative anticoagulant which did not need monitoring and had no side effects.

Well, if they were available I would certainly consider them, because if they are better than aspirin but there’s one, I can’t remember the name, it doesn’t matter, but it does you don’t need to monitor it. You just take and I think you take one tablet a day and it’s it is as effective as warfarin, without any of the side effects. I don’t know anything about how it works physiologically, but I know it’s extremely expensive. So if it was available, yes, I think most people would take that up because they wouldn’t have to go to hospital every fortnight and have a blood test and then be told, “Oh, alter your dose.

Martin felt it was important for people to learn about AF on the internet so that they could hold ‘meaningful conversations’ with their consultants.

You’ll find in the Atrial Fibrillation Association, the patients know a lot. They take a very close interest and I rather like the slogan, which has arisen recently, which says, ‘no decision about me without me.’ And that I think is I’m all for patient empowerment, and I think it’s up to us to actually look at the evidence. Fortunately, there’s lots on the web about it. You can teach yourself cardiology [laughs] and how to interpret a, if you’ve got the time and intelligence how to interpret the ECG. And I suppose the doctors have to accept this, that we are we don’t know as much as they do but we can hold a meaningful conversation with them and, you know. 

Martin praised his wife for letting him get on with his life.

My wife just, she’s an amazing woman and is very supportive but she she’s an ex-nurse, but she’s not a fussy sort and she is I think she is concerned. I think she is but she’s sort of doesn’t make a fuss, which is so helpful. You know, the last thing you want is someone fussing round you and, “Be careful and don’t do this.” And so I went down to the [holiday location] to do the landscaping, and she takes the view, “Well, you know, it’s what he wants to do. It’s up to him. He’s running his life.”