Consult Letter IM

DIAGNOSES:

1. Persistent atrial fibrillation.

RECOMMENDATIONS:
She presents with persistent atrial fibrillation that has shown improvement in frequency and duration with the current amiodarone regimen. Episodes are now shorter and occur approximately every seven days. She denies significant side effects from the medication and has no issues with her current treatment plan. Calcifications in her carotid arteries were noted on a prior computed tomography scan, but no significant occlusive disease was identified.

1. Continue with the current amiodarone regimen.
2. Referral to an electrophysiologist has been made for consideration of an electrophysiology study with a view to ablation.

Dear Electrophysiologist,

I saw Margaret Turner on May 19, 2025, to review her persistent atrial fibrillation.

HISTORY OF PRESENTING ILLNESS:
Margaret Turner presents for follow-up regarding her persistent atrial fibrillation. She reports that the episodes have become shorter in duration, lasting approximately one minute, and occur roughly every seven days. She uses a cardio mobile device to monitor these episodes. She denies any issues with her current amiodarone regimen and has not experienced significant side effects. She also denies any sleeping problems related to her current medication but prefers not to escalate sleep aids beyond melatonin. She mentions a prior computed tomography scan of her head that revealed calcifications in her carotid arteries, though no significant occlusive disease was noted. She has a known intolerance to higher doses of beta blockers. Overall, she feels that her symptoms have improved with the current treatment plan.

REVIEW OF SYSTEMS
Cardiovascular: Denies chest pain, heart palpitations, and dizziness.
Respiratory: Denies shortness of breath, cough, and wheezing.

MEDICATIONS:
• Amiodarone 200 mg once daily.
• Premarin SR 0.625 mg once daily.
• Perindopril 2 mg once daily.
• Ferrous polysaccharide 150 mg by mouth on alternate days.
• Oxazepam 1 mg by mouth daily at bedtime when necessary.
• Xarelto 20 mg once daily.
• Omeprazole 40 mg once daily.
• Sertraline 50 mg once daily.
• Metoprolol 25 mg by mouth twice a day.

PHYSICAL EXAMINATION:
• Blood pressure: 142/58 mmHg.
• Heart rate: 66 beats per minute.
• General: She appears well, alert, and in no acute distress.
• Cardiovascular: Heart rate regular, S1S2 normal, no murmurs.
• Respiratory: Lungs clear to auscultation bilaterally, no wheezes or crackles.
• Chest examination is normal.
• Ejection fraction was 57% and left atrial size was normal.

ASSESSMENT:
I've made the recommendations as noted above.

Thanks once again for involving me in the care of this pleasant patient.

With regards,  
Transcribed with voice dictation software.  
David Bennett, MD, FRCPC  
Regional Medical Center