Atrial Fibrillation/Flutter

1. Background/Cultural Points:

   Atrial Fib/Flutter (AF) is common in Cambodia especially related to increased prevalence of thyroid disorders and rheumatic heart disease (RHD). Most common presenting complaints are palpitations and shortness of breath.

2. Diagnosis & Lab:

   1. EKG
   2. Labs to consider: H/H, Glucose, U/A, Creatinine, Na/K, CXR, TSH; Troponins available at MMC
   3. Consider Echocardiogram to rule out valvular disease (Calmette)

3. Management/Education/Treatment:

   1. Review with patient: 1) Will likely need medication life-long; 2) Treatment of underlying cause if treatable; 3) Treatment for rate-control and prevention of VTE.
   2. Lifestyle Points:
      1. Avoid caffeine products, tobacco, ETOH
      2. Dietary precautions if using warfarin (rare)
   3. Medications (consider, if no contraindications, and based on comorbidities):
      1. Antiplatelet: Aspirin (ASA) 325mg QD. Consider GI protection prophylaxis or at follow-up. Add Plavix 75mg QD (assuming not able to receive cath/CABG).
      2. Beta blocker: Atenolol/Metoprolol
      3. Plaque stability/cholesterol: Simvastatin
      4. Anti-anginals: Isosorbide mononitrate po
      5. ACEI: Lisinopril/Enalapril
   4. Referral:
      1. Jeremiah’s Hope or Visiting Cardiology Team List for CAD (stent, etc)

4. Follow-Up:

   1. Initial follow-up at 1 month, then q3-6 mos, then annually
   2. Monitor labs appropriately, based on medication chosen (ECG,,Cr/K, LFTs q3-12 mos).
   3. Monitor for metabolic syndrome, HTN