Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram thorax abnormal, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment depression, Electrocardiogram T wave normal
Clinical narrative: Patient is a 53 y.o. male patient of DO with history of HTN, HLD, CAD s/p PCI, OA, fibromyalgia presented to Hospital with chest pain, SOB. Problem based management in the hospital is as follows:   Acute Hypoxic Respiratory Failure, resoled COVID-19 virus pneumonia Acute onset chest pain/shortness of breath early a.m. 9/30.  O2 sats initially 89% on room air with swift recovery with 4 to 6 L nasal cannula. VBG wnl. CXR with interstitial opacities, edema versus infiltrates.  CT PE with no PE, pulmonary edema with bilateral pleural effusions. COVID (+). Suspect AHRF multifactorial due to COVID, slight volume overload.  Continued scheduled breathing treatments, prn albuterol S/p 60mg solumedrol in ED, de-escalated Decadron, discharged on taper Received remdesivir x2 days Continue supplemental O2 to maintain sats >90%, now back on room air Blood and sputum cultures NTD Procal negative ID were following   Chest Pain, resolved CAD s/p PCI Chronic Angina Elevated Troponin  Elevated BNP Known coronary disease and chronic angina with previous left heart cath 7/12/2022 with DES x3 across chronically occluded circumflex artery/obtuse marginal branch.  Distally noted to have moderate right coronary disease, and patent stent previously placed in LAD, 30% proximal left main lesion.  Has since had an echo 3/23 which was normal. Repeat stress test 3/23 due to ongoing chest pain, that despite being abnormal showed no ischemia.  Last follow-up with Dr. 6/7/2023 with recommendation to continue current regimen, continue DAPT for now.  In ED, BNP 117, initial trop 85-- >202. ECG with ST depressions I, II, aVl, normal T  waves.  Imaging with noted pulmonary edema. States current symptoms feel more severe than chronic angina, does not have radiation similar to last time when he had an MI.  Given up-trending trop/non-specific ECG abnormalities, initiated on heparin drip, discontinued heparin drip at discharge Gentle IV lasix 20mg x1 Monitored on Tele Continued plavix, ranolazine, imdur HTN tx as below Cardiology consulted, appreciate recs, do not feel respiratory failure secondary to heart failure, no further inpatient work-up recommended.   Hypokalemia, resolved K 3.3 on admission, s/p 40mEq KCl  HTN BP on arrival 209/133-- >170/84. Suspect elevated trop as above related to acute illness and not indicative of hypertensive emergency from elevated BP.  Continued home meds   HLD Continued statin   T2DM Diabetic Neuropathy Gastroparesis Last A1c 1/20/23 was 8.2. Current home meds include: glipizide 10mgTID, 70/30 30u BID.  Lantus 20 units + SSI while admitted,  Discharged back on home meds   Fibromyalgia Continued prn tramadol   Depression Continued sertraline   RLS Continued requip   BPH Continued flomax   OSA Does not tolerate CPAP. Currently being evaluated for Inspire   After 2 days of hospital stay, patient was doing well so he was discharged in stable condition. Advised to f/u with PCP and cardiology. All questions and concerns were addressed before discharge.