Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac failure, Cardiac telemetry normal, Chest pain, Condition aggravated, Constipation
Clinical narrative: Date of Admission  02/13/2022   Date of Discharge  02/18/2022   Reason for Hospitalization   pt discharged on 02/11, covid + 2/11 as well, increased SOB, couching, chest pain.  Hospital Course     Patient is a 71 yo male w/HFrEF, ICM, T2DM, COVID-19 (Dx 2/11/22)  who presented to ED on 2/13 with worsening shortness of breath found to be in HFrEF exacerbation and in hypertensive urgency after being discharged in order to attend his wife's funeral. Admitted to CICU for IV diuresis and BiPAP. Has diuresed well and was transferred to cardiology floor in stable condition. Continued on COVID-19 treatment and transitioned to oral diuretic which he tolerated well. Will discharge with 40mg Lasix BID, dexamethasone 6mg PO to finish out 10 day course and follow up with PCP, Cardiac rehab and follow up with cardiology heart and vascular clinic.  Discharge Diagnoses      1. Acute on chronic HFrEF exacerbation  - Admitted to CICU after needing BIPAP, IV diuresis and treatment for HTN urgency. He diuresed well and was able to be transferred to cardiology floor in stable condition where he was transitioned to oral diuretics.  - GDMT: Discharge with Lasix 40mg BID, Metoprolol succinate 50mg daily (decreased dose from prior d/t bradycardia), spironolactone 50mg daily (increased from prior), losartan 100mgqday  - Good candidate for Farxiga which was approved. Discharged with 10mg daily dapagliflozin  - Pt should continue to wear his BiPAP at night  - repeat echocardiogram in about 3 months. If EF continues to be reduced despite GDMT he will need ICD placement   2. HTN urgency/emergency  - Patient was hypertensive to 170s/100s on arrival to ED and was placed on nitro gtt which was able to be weaned off.  - Discharged patient with increased spiranolactone as above, losartan 100mg daily   3. Afib  - No events during hospital stay on telemetery. Continued on metoprolol succinate 100mg BID until he became mildly bradycardic. Decreased metoprolol succinated to 50mg BID with good rate control.  - Discharge with metoprolol succinate 50mg BID  - Continue home Apixaban daily 5mg BID   4. Diffuse Nonocclusive CAD s/p PCI RCA, mid LAD (11/2015)  - continue home ASA 81mg daily, atorvastatin 80mg daily   5. COVID -19 PNA  - Tested positive 2/11.  - Completed 5 day Remdesivir course 2/14-2/18.  - Will need to complete 10 day dexamethasone 6mg course on discharge (2/14-2/23)   6. Constipation  - Continued on doc-senna BID on discharge as patient had significant stool burden for several days and hard stools. Given suppository and enema this admission which resolved his constipationnon  Other Diagnoses   Ongoing  Atrial fibrillation  Coronary artery disease  Deafness  Essential hypertension  Heart failure with reduced ejection fraction  Insomnia  Lesion of Ulnar Nerve  Mixed hyperlipidemia  Morbid obesity  Pseudophakia  S/P complete repair of rotator cuff  Trigger finger of left hand  Type 2 diabetes mellitus  VUR - Vesicoureteric reflux  Historical  CAD - Coronary artery disease  Cataract  Laparoscopic cholecystectomy  NSTEMI (non-ST elevated myocardial infarction)  Operations and Procedures   none  Consultants  Medicine Cardiology   Pending Labs  none  Discharge Disposition  Home    Medications  New, Changed, or Refilled Medications  dapagliflozin (dapagliflozin 10 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 11 Refill(s)    dexAMETHAsone (dexAMETHAsone 6 mg, 1.5 Tablet(s), Oral, Daily, with food, 5 Tablet(s), 0 Refill(s)  Instructions:with food  furosemide (furosemide 40 mg) 40 mg, 1 Tablet(s), Oral, bid, 60 Tablet(s), 0 Refill(s)    metoprolol (metoprolol succin 50 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 0 Refill(s)    spironolactone (spironolacton 50 mg, 2 Tablet(s), Oral, Daily, 60 Tablet(s), 0 Refill(s)      Medications to be Continued  Misc. Medication (Dexcom G6 R See Instructions, Misc, Unscheduled, Use as directed, 1 Each, 1 Refill(s)  Instructions:Use as directed  Misc. Medication (Dexcom G6 S See Instructions, Misc, Unscheduled, Change Every 10 Days, 3 Each, 4 Refill(s)  Instructions:Change Every 10 Days  Misc. Medication (Dexcom G6 T See Instructions, Misc, Unscheduled, Change Every 3 Months, 1 Each, 3 Refill(s)  Instructions:Change Every 3 Months  apixaban (Eliquis 5 mg) 5 mg, Oral, bid, 60 Tablet(s), 11 Refill(s)    aspirin (aspirin 81 mg , chew 81 mg, 1 Tablet(s), Oral, Daily    atorvastatin (atorvastatin 80 80 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 11 Refill(s)    cyanocobalamin (Vitamin B-12 1,000 mcg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    docusate-senna (Senna Plus 50 1 Tablet(s), Oral, bid, PRN: Constipation, 60 Tablet(s), 2 Refill(s)    dulaglutide (Trulicity Pen 0. 0.75 mg, Subcutaneous, qWeek, 12 Each, 1 Refill(s)    finasteride (finasteride 5 mg 5 mg, 1 Tablet(s), Oral, Daily    insulin glargine (Lantus insu 45 units, Subcutaneous, At Bedtime    insulin lispro (HumaLOG insul 30 units, Subcutaneous, tid AC    losartan (losartan 100 mg) 100 mg, 1 Tablet(s), Oral, Daily, TAKE 1 TABLET BY MOUTH ONCE DAILY, 90 Tablet(s), 2 Refill(s)  Instructions:TAKE 1 TABLET BY MOUTH ONCE DAILY  metFORMIN (metFORMIN 1000 mg) 1,000 mg, 1 Tablet(s), Oral, bid, 180 Tablet(s), 3 Refill(s)    nitroglycerin (nitroglycerin 0.4 mg, 1 Tablet(s), Sublingual, As Indicated, PRN: Chest Pain, 50 Tablet(s), 0 Refill(s)    omega-3 polyunsaturated fatty 1,000 mg, 1 capsule(s), Oral, Daily, 0 Refill(s)    traZODone (traZODone 100 mg) 100 mg, 1 Tablet(s), Oral, At Bedtime, PRN: Insomnia, 30 Tablet(s), 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge       General: NAD Head: Normocephalic, Atraumatic Eyes: EOM intact, sclera clear Mouth: mucous membranes moist Neck: supple, no thyromegaly Respiratory: CTA b/l, no wheezes, rhonchi or rales, unlabored, symmetric chest rise Cardiovascular: RRR, no murmurs, rubs or gallops, normal S1/S2, +2/4 peripheral pulses bilaterally Abdomen: soft, nontender, nondistended, normoactive bowel sounds MSK: no gross deformities, normal ROM in all 4 extremities Neuro: alert and oriented, CN intact grossly, no focal neurologic deficits grossly, Psych: normal affect and mood, cooperative  Time Spent  > 35 minutes spent on discharge   Follow Up Appointments     Follow Up Appt Clinic Name/Phone: Provider Name: MD Within 14 Days, No tests, Reason for Exam hospital discharge, COVID   Follow Up Appt Medicine Cardiology, Clinic Name/Phone: Medicine Cardiology Clinic, Provider Name: FNP, Within 7 Days, No tests, Reason for Follow Up Clin hospital discharge, hf exac, Comments deaf    Appointment Type  When  With  Where  Contact Information  Status   RT1 02/25/2022 09:00 AM MD Confirmed  DC2 02/25/2022 01:40 PM FNP Vasc Cardiology   Heart and Vascular Clinic  Confirmed  RT1 04/11/2022 03:00 PM MD, Confirmed   Addendum by MD, on February 24, 2022 10:42:49 (Verified) I personally saw and evaluated the patient, independently performed the critical/key portions of the E/M service, and discussed the management with the resident/fellow on 2.18.22