Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: AST/ALT ratio abnormal, Acute respiratory failure, Alanine aminotransferase normal, Anion gap, Anticoagulant therapy
Clinical narrative: Date of Admission Admit Date: Jan-05-2023  Date of Discharge Date of discharge Jan-10-2023  Allergies No Known Allergies  Chief Complaint Shortness of breath  Final Diagnoses Pneumonia  Rapid atrial fibrillation  Acute exacerbation of chronic obstructive airways disease  Acute COVID-19  Procedure(s) Performed performed Jan-09-2023  Cardioversion  Performed by DO Jan-07-2023  Cardioversion  Performed by DO Lab Results Jan-10-2023 0445 Chemistry GLUCOSE  82BUN  24CREAT  0.7MDRD GFR  109NA  139K  4.3CL  100CALCIUM  8.8ALK PHOS  77CO2  28.5AST  28ALT  103AST/ALT  0.3TL PROT  6.0ALBUMIN  3.2TBILI  0.5DBILI  0.1OSMO  280.7ANION GP  14.8BUN/CRE  34.3CRP  3.30 Jan-10-2023 0445 Hematology WBC  12.4RBC  3.74HGB  12.5HCT  36.8MCV  98.4MCH  33.4MCHC  34.0RDW  13.2RDWSD  48.0PLT  185MPV  12.7AUTONEU%  77.5AUTOLYM%  6.1AUTOMON%  15.0AUTOEOS%  0.5AUTOBAS%  0.2AUTONEU#  9.6AUTOLYM#  0.8AUTOMON#  1.9AUTOBAS#  0.0AUTOEOS#  0.1SCAN DIF  YNRBC%  0.0NRBC  0.0HGB/HCT  2.9IG#  0.09IG%  0.7 Jan-10-2023 0445 Serology PROCALC  <0.05 Imaging Results Chest radiograph 1/8/23: "IMPRESSION: 1. Mild cardiac enlargement without evidence of heart failure. Resolution of previously described central pulmonary vascular congestion 2. Stable moderate bibasilar consolidations. 3. Stable small bilateral pleural effusions."  Chest radiograph 1/7/2022:: "IMPRESSION: 1. Mild cardiac enlargement with worsening central pulmonary vascular congestion consistent with CHF 2. Moderate bibasilar atelectasis and/or consolidations. Favor bibasilar pneumonia 3. Small bilateral pleural effusions not excluded."  Transthoracic Echo 01/06/23 "Conclusions Normal left ventricular systolic function with LVEF >60%. Restrictive physiology with markedly elevated left atrial pressure (Grade III diastolic dysfunction). Severe left atrial enlargement with LA index volumes greater than 48 cm2. Severe mitral regurgitation. Aortic cusps appear mildly calcified. Trileaflet aortic valve. Mild aortic regurgitation. There is mild to moderate tricuspid regurgitation. The estimated Peak RVSP is 43 mmHg."    Chest radiograph 01/05/2022: "IMPRESSION: Bilateral lung opacities. Consider infectious or inflammatory etiology. Electronically signed on Jan 5, 2023 3:27:04 AM by: MD   Functional Status* No Functional Impairments  Mental Status* Normal Cognition  Social History tobacco use Former Smoker, 2 Packs Per Day, 36 yrs, Ended Jan-01-2003, Smoking Cessation Not Applicable  alcohol use Liquor, Former, 3 Drinks Per Day  drug use No Known Use  marital status Married  general comment Lives at home with his wife  Health Concerns Pneumonia  Rapid atrial fibrillation  Acute exacerbation of chronic obstructive airways disease  Acute COVID-19  Former Smoker, 2 Packs Per Day, 36 yrs  Liquor, Former, 3 Drinks Per Day  Father Deceased @ 61 Myocardial infarction  Mother Deceased Old-age @ 95 Cerebrovascular accident; Heart disease  Brother Deceased Malignant tumor of pharynx  Sister Alive Malignant neoplasm of female breast  Vital Signs Jan-10-2023 0603 T 97.8 HR 88 RR 19 BP   150 / 73 O2Sat 96 Jan-10-2023 0412 T 97.7 HR 91 RR 20 BP       156  / 88 O2Sat 98 PHYSICAL EXAM CONSTITUTIONAL: Patient is well groomed 7 7-year-old male. He appears in no acute distress and resting comfortably in bed.  EYES: Pupils are equally round bilaterally with no ocular discharge, scleral icterus, or conjunctival injection noted.  CARDIOVASCULAR: Heart rate is irregularly irregular and rate is controlled in the 80's bmp while on telemetry. No murmurs appreciated on auscultation. No peripheral edema noted either. Radial pulses are 2+ bilaterally.  RESPIRATORY: Patient is wearing supplemental oxygen set at 4 L with SpO2 of 98%. There is no increased work of breathing or conversational dyspnea noted. Lung sounds are clear bilaterally and equal bilaterally. No wheezing noted on auscultation.  GASTROINTESTINAL: Abdomen is soft, nontender, and nondistended. Bowel sounds normoactive.  PSYCHIATRIC: Patient is awake and alert and oriented to person, place, and time. He is calm and cooperative. Mood and affect are also appropriate.  Consultations Dr Cardiology  Hospital Course Patient is a 77-year-old male with a past medical history significant for COPD on supplemental oxygen, chronic heart failure with reduced ejection fraction, atrial fibrillation, malignant tumor of the pharynx in 2012 status-post radiation/chemotherapy and PEG tube placement, and hypothyroidism. He presented to the emergency department on 01/05/2023 with complaints of worsening shortness of breath. He admitted for treatment and evaluation of COVID, COPD exacerbation, and atrial fibrillation. His total hospitalization was 6 days.   Patient was noted to be in Afib RVR on admission and on 1/7/23 patient was cardioverted an initially successfully converted back to sinus rhythm. Over the weekend patient was noted to have gone back into RVR and on 1/9/2023 patient was cardioverted again, but without successful conversion, unfortunately. Dr. also started the patient on diltiazem and midodrine with resultant rate c  Condition at Discharge Stable  Discharge Medications aspirin 81 mg capsule 81 MG PEG TUBE ONCE A DAY Breztri Aerosphere Inhalation Aerosol 160-9-4.8 MCG/ACT 2 PUF INHALATION TWICE DAILY Cefdinir Oral Capsule 300 MG 300 MG ORALLY TWICE DAILY (ePrescribed by RESIDENT on Jan-10-2023 1003) diltiaZEM HCL (IR) 60 MG PEG TUBE 3 TIMES A DAY (ePrescribed by RESIDENT on Jan-10-2023 1003) EMPAGLIFLOZIN 10 MG PEG TUBE ONCE A DAY (ePrescribed by RESIDENT on Jan-10-2023 1003) famotidine 20 mg tablet 20 MG PEG TUBE TWICE DAILY levothyroxine 112 mcg capsule 112 MCG PEG TUBE EVERY MORNING lisinopril 2.5 mg tablet 2.5 MG PEG TUBE ONCE A DAY metoprolol tartrate 25 mg tablet 25 MG PEG TUBE TWICE DAILY MIDODRINE HCL 5 MG PEG TUBE TWICE DAILY (ePrescribed by RESIDENT on Jan-10-2023 1003) Xarelto 15 mg tablet 15 MG PEG TUBE ONCE A DAY Discharge Disposition Discharge to home  Plan ASSESSMENT: -Sepsis (tachycardia, tachypnea) secondary to COVID-19 pneumonia, resolved -Atrial fibrillation with rapid ventricular rate, s/p Cardioversion x2. Currently rate controlled -Acute on chronic hypoxic respiratory failure, secondary to acute exacerbation of COPD -Acute exacerbation of COPD (dyspnea, increased productive cough) secondary to COVID pneumonia, improved -Acute COVID-19 pneumonia, improved -Oral candidiasis, improved -Hypoosmolar hyponatremia, moderate, Na 126 on admission, has chronic hyponatremia likely secondary to chronic alcohol abuse, resolved -Hyperkalemia, K 5.4 on admission, acute, resolved -Hypochloremia, Cl 89 on admission, acute on chronic, has chronic hypochloremia -Chronic obstructive pulmonary disease -History of throat malignancy treated with chemo and radiation in 2012 -Chronic dysphagia secondary to radiation, prior injury/airway intervention, PEG tube in situ -LVEF >60%, Grade III diastolic dysfunction, per echo 1/5/23 -Severe mitral regurgitation, per echo 1/5/23 -Chronic paroxysmal atrial fibrillation -Cardiomyopathy likely secondary to chronic alcohol abuse -Essential hypertension, chronic, unknown control -Hypercholesterolemia, chronic -Hypothyroidism, chronic, current control unknown -History of alcohol abuse -Chronic severe protein-calorie malnutrition with diffuse muscle and fat wasting -History of tobacco use, 80 pack year smoking history  Follow-up with: Primary Care Provider, within the next 7-10 days.  Cardiologist Dr on Tuesday 01/17/2023 at 11:15 am.  Pulmonologist: Dr  Primary Care Provider DO