Medical Bytes Thailand Number 108 Is AF a Terminal Diagnosis?

The following is a guest opinion article from Doc Martyn. His opinions and advice are entirely his own and may not necessarily be those of The Pattaya News Company Limited. His contact information can be found at the end of the article.

  1. Atrial Fibrillation, AF, is the most common heart arrhythmia in the world, particularly in seniors. It usually results from an abnormality of the pacemaker that controls the beat of the heart. It causes an abnormal tachycardia, and rapid heart rate, described as irregularly irregular, see photo 1. The irregularity is in both the timing of the beat and the blood volume contained within each beat.

This arrhythmia increases the mortality rate fourfold.

A serious complication, and a significant cause of death, is stroke. This is caused by the pooling, and then clotting, of blood in the appendage, pocket, of the atria, see photo 2.

  1. Paul is 71 years old. His initial episode of AF occurred when he was 35. His Australian cardiologist at that time managed his arrhythmia. He advised Paul that he would probably die prematurely and that he was unlikely to survive past his 70th birthday.
  2. Paul emigrated to Thailand 19 years ago. He sought the opinion of a Thai cardiologist regarding his continued management. The cardiologist changed his management and medication: In addition to a cardiological review every 3 months, at a cost of THB6000 each visit, for the next 19 years, Paul was committed to taking up to 14 pills/day.

His treatment included Losartan 50mg daily, an ACE inhibitor for hypertension, Warfarin, varied dose according to his INR, a blood thinner, Reaptan 10/10, a combination drug to protect the heart, Chlorvasc 40mg, for cholesterol, Lorazepam 1.5mg to sleep.

  1. Despite this medication, Paul’s AF was unstable. If his AF failed to settle spontaneously within 24 hours, Paul would be admitted to the hospital for inpatient management. Over the last 5 years, Paul has increasingly required hospitalization.
  2. Before I moved to Pattaya Paul and I were friends. He was not a patient of mine.

On February 9, 2023, I visited him following his recent discharge from the hospital for an episode of prolonged AF. His recent birthday, 2 days previously, was his 70th birthday. During that day he reflected on the words of his Australian cardiologist. This may be his last.

During our talk, we spoke earnestly. His trepidation was palpable, he was not ready to die.

I reviewed his medication which was old fashioned and, now, outdated. He required an antiarrhythmic drug. I laughed and promised to keep him alive for at least another 10 years.

  1. Paul agreed to let me change his treatment, which I did. For the past year, Paul has been taking Apolets 75mg daily, aka Clopidogrel, a blood thinner, Tambocor 50mg twice/day, an antiarrhythmic, Chlovasc 40mg nocte, for cholesterol, and Lanzaar 10mg daily, an antihypertensive medication.
  2. Since this change in medication, over 12 months ago, and for the first time in over 15 years, Paul has not experienced any episodes of AF. Indeed, on four occasions over this past year, Paul has been seriously ill. On two occasions he suffered extensive cellulitis in his leg, see photo 3. Later he suffered viral pneumonia for 2 weeks and finally, he had a motorcycle accident which left him bed/chair bound for 6 weeks, see photos 4 and 5. Yet throughout these periods of significant ill health, his heart did not “miss a beat”.

In Paul’s case, the correct management has not only saved his life, it has saved him at least THB50,000/year in expensive investigations and medication. He is a happy man, as am I! Paul promised Payment in Kind, I chose Guinness.

  1. “AF is not a terminal diagnosis”.

Addendum: Over the past 6 years, as a retired medic living in Buriram I offered second opinions on any medical issue. I recently moved to Pattaya. As in this case, if you reside outside of Pattaya, telephone consultations are provided. For assistance; please contact me, Doc Martyn, on Facebook or call Dao on 095 414 8145.

Adam Judd
Mr. Adam Judd is the Co-owner of TPN Media since December 2017. He is originally from Washington D.C., America, but has also lived in Dallas, Sarasota, and Portsmouth. His background is in retail sales, HR, and operations management, and has written about news and Thailand for many years. He has lived in Pattaya for over nine years as a full-time resident, is well known locally and been visiting the country as a regular visitor for over a decade. His full contact information, including office contact information, can be found on our Contact Us page below. Stories please e-mail About Us: Contact Us: