Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Orthopnoea, Peripheral swelling, Prohormone brain natriuretic peptide increased, Renal impairment, SARS-CoV-2 test positive
Clinical narrative: Pfizer Dose 1 3/9/21 (EN6199) Pfizer Dose 2 3/31/21 (EN6207) Pfizer Dose 3 11/30/21 (FH8027) COVID Negative 2/1/22 COVID Positive 2/8/22  2/1/22: Patient is 75-year-old male with history of nonobstructive CAD and severe systolic dysfunction and EF 25%,  history of severe aortic stenosis s/p bioprosthetic valve replacement, history of permanent AFib on Coumadin, history of sustained V-tach s/p AICD, OSA on CPAP, CKD stage 3, history of hypertension, diabetes mellitus, presenting to the emergency depart with a complaint of worsening shortness of breath of 2 weeks duration.  Patient reports orthopnea and paroxysmal nocturnal dyspnea. Increased weight and lower extremity swelling.  Denies any fever or chills, no cough or sputum production, no chest pain or palpitations, no changes in his bowel movements or urinary habits.  Reports compliance with his medications and diuretics.  Compliance with diet.  His primary cardiologist Dr., was last time seen prior to Christmas time.  Apart from noted he denies any complaints.   In ED, EKG shows atrial fibrillation his heart rate was 118, he was placed on 2 L by nasal cannula but was with no hypoxia, reported shortness of breath, his potassium 5.1, glucose 199, BUN 39, creatinine 2.3 which seems to be at baseline, proBNP 11947, troponin 0.04, INR 4.3, he was given Lasix 80 mg IV x1, Dr. from Cardiology consulted and he recommended starting Lasix drip at 20 mL an hours.  2/12/22: 75-year-old male with history of nonobstructive CAD and severe systolic dysfunction and EF 25%,  history of severe aortic stenosis s/p bioprosthetic valve replacement, history of permanent AFib on Coumadin, history of sustained V-tach s/p AICD, OSA on CPAP, CKD stage 3, history of hypertension, diabetes mellitus, presenting to the emergency depart with a complaint of worsening shortness of breath of 2 weeks duration.  In ED, EKG shows atrial fibrillation his heart rate was 118, he was placed on 2 L by nasal cannula but was with no hypoxia, reported shortness of breath, his potassium 5.1, glucose 199, BUN 39, creatinine 2.3 which seems to be at baseline, proBNP 11947, troponin 0.04, INR 4.3, he was given Lasix 80 mg IV x1, Dr. from Cardiology consulted and he recommended starting Lasix drip at 20 mL an hours.  Subsequently the patient was managed with IV Bumex GTT that has been tapered down.  To oral Bumex dose. Electrolyte abnormalities were corrected  He is anticoagulated on Coumadin and INR which is therapeutic.  Both Cardiology and Nephrology assisted with management of patient's care during admission, patient will need longitudinal follow-up with PCP and possible referral to Nephrology as outpatient.  Renal function stabilized, Foley left in place for retention.  May need urology follow-up at some point  Incidentally tested positive for COVID 19 during discharge planning, patient is on 3 L, upper 90s not working hard to breathe.  X-ray without infiltrate, did not qualify for remdesivir/Actemra.  Suspect hypoxia mostly related to fluid overload/CHF supportive care for COVID-19 he was placed on dexamethasone will taper, vitamin-C, vitamin-D, zinc, 3 days of azithromycin.   Patient will need INR check in 3 days, BMP within 7 days ideally follow-up with PCP within 7 days of discharge. Follow-up with Cardiology for heart failure as discussed. All ED in RTC precautions provided to patient endorse understanding and initiate with plan as outlined.