Consider causes and other issues

Dillon’s self management plan:

• Diet: Obesity and high blood pressure can increase the risk of AF therefore Dillon should be advised to follow a healthy diet. Recommendations should include 5 portions of fruit/ veg per day. Should try to keep red meat to 2-3 portions per week. Should be watching the amount of diary produce i.e. cheese, cream, butter full fat milk he has in his diet. Dillon should have no more than 6g salt/day and having an awareness of hidden salts especially in foods such as bread, breakfast cereals. Watch the amount of high fat foods such as biscuits, crisps, sweets, pastry
• Work: Dillon can carry on working in his usual job providing his symptoms are well controlled. When considering medical managment it is important to consider someone’s job. There are many professions which are not ameniable to taking anticoagulation and this can influence a person’s decision making.
• Driving: Dillon should be able to drive his car or motorcycle if his symptoms have been well controlled for 4 weeks. He should be advised never to drive with symptoms and discuss any change with GP. NOTE: DVLA states that driving can continue unless symptoms have caused or are likely to cause incapacity. There are different requirements if someone has an an ablation or a pacemaker inserted and you should refer to the DVLA website for further information. Dillon should also be made aware he needs to contact his insurers and inform them of his recent diagnosis.
• Alcohol:Alcohol can trigger AF. Some people have symptoms from just one or two drinks while others have no effects until heavy drinking is involved. It was mentioned Dillon noticed the irregular heartbeat after drinking, so the GP would need to clarify the amount of alcohol consumed for the AF as a start. Dillon should be advised to drink with the government recommendations which for a man is 21units per week with 2 free alcohol days. He should also be advised never to binge drink and have no more than 3-4 units/day.
• Activity:Most patients with AF taking appropriate (rate-rhythm) medication tolerate activity very well and should be encouraged to continue. This activity should include a warm up and any queries should be discussed with their GP or cardiology contact.However there are a few specific aspects of activity that should be highlighted regarding activity or exercise and AF. In patients with new or uncontrolled AF the advice should be no exercise at all (aerobic or otherwise). For weight training, this can be continued when stable as long as the person uses light weights and these are done as part of a circuit, with 10-15 reps per set, one set per muscle group, 8-10 different key muscle groups, 2-3 x per week. People should be advised not to weight lift competitively or lift maximum loads. This is due to the likelihood of breath holding and lack of venous return. In any activity the person it should be highlighted that the main thing in this group of people is to have no breath holding / valsalva manoeuvres to prevent blood pressure and the Resting Pressure Product (RPP) to increase, and advise to feet kept moving to maintain venous return.Activities and/or being active and meeting individual goals can be beneficial to discuss with people following a diagnosis of AF. Its important to consider any activity or exercise changes or restrictions and discuss these in order to support a good quality of life. The persons mental health should also be considered as anxiety and depressive symptoms are common following a diagnosis of AF and are associated with poorer quality of life. It may be helpful to perform a mental health screen and ask about stress, both at home and at work.