Age: 66.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Alanine aminotransferase increased, Angiogram, Anion gap, Anticoagulant therapy, Arrhythmia
Clinical narrative: hospitalization Basic Information  Time Seen:  11/21/2022 15:35  Chief Complaint  Chest pain  History of Present Illness     Patient presents via private vehicle due to chest pressure and rapid heart rate x 1 hour PTA. Arrives in SVT. Patient denies prodrome or feeling sick prior to this episode beginning, denies CP or SOB prior to symptoms starting. Patient has a hx of liver transplant and is currently undergoing medication therapy for Hepatitis C, Epclusa. He was started on this medication at hospital where he could be monitored on tele for the initiation of the med. He had 2 episodes of SVT during that hospitalization. Released on 11/17.   Add'l medical hx includes: s/p liver transplant, Hep C, hx of SVT, HTN, CAD  Social hx:  non smoker  Review of Systems     Constitutional:  Negative, No weakness, No fatigue, No decreased activity.   Eye:  Negative.   Ear/Nose/Mouth/Throat:  Negative.   Respiratory:  Negative.   Cardiovascular:  chest pain, palpitations Gastrointestinal:  Negative.   Hematology/Lymphatics:  Negative.   Endocrine:  Negative.   Immunologic:  Negative.   Musculoskeletal:  Negative.   Integumentary:  Negative.   Neurologic:  Negative.   Psychiatric:  No anxiety, No depression.   All other systems are negative   Physical Exam/Objective  Vitals & Measurements last 24 hours  VITAL SIGNS  Temp C:       38 DegC  Heart Rate:       90 bpm  Resp Rate:       21 br/min  BP:       137 / 94 mmHg  SpO2 (%):       96 %  O2 Device:       Room air     Height CM: 165.1 cm  Weight KG: 72.8 kg  Ideal Body Weight: 61.5 kg     General:  Alert and oriented, anxious Eye:  Pupils are equal, round and reactive to light, Normal conjunctiva.   HENT:  Normocephalic, Neck:  Non-tender, No jugular venous distention, Cardiovascular:  tachy  rate, Normal rhythm, S1, S2.   Respiratory:  Lungs are clear to auscultation, Respirations are non-labored.   Gastrointestinal:  Soft, Non-tender, Non-distended, Normal bowel sounds, Integumentary:  Warm, Dry, Intact.   Neurologic:  Alert, Oriented, Normal sensory, Normal motor function, No focal defects, Psychiatric:  Cooperative, Appropriate mood & affect.    Medical Decision Making     EKG   Time completed: 1532  Rhythm: SVT  Interp: SVT interpreted by Dr.   rate: 172  QT/QTC: 286/483    Post adenosine  EKG   Time completed: 1541  Rhythm: NSR  Interp: NSR, normal intervals, no ST or T wave abnormalities; interpreted by Dr.  rate: 93  QT/QTC: 356/442    Patient arrived in SVT, P -174, BP stable  Vagal maneuvers tried and failed x 2  Adenosine 6 mg given fast IV push and patient successfully converted to NSR at that time.  Symptoms resolved after conversion.   Unfortunately patient is Covid 19 +. He is vaccinated and states he hasn't been exposed to anyone with Covid that he knows of unless he contracted it during his recent hospitalization.  He is vaccinated, but he is also immunosuppressed due to liver transplant status. He is currently asymptomatic, except for this run of SVT.   Labs are unremarkable, LFTS, PT/INR normal. Platelets are 90.  Patient has not had any additional runs of arrhythmia since his conversion.   1807 I spoke with Dr. from the liver transplant team at hospital. She requests patient have an obs admit at this facility tonight to be monitored on telemetry for any recurrence of SVT. She also requests a tacrolimus level be drawn which I have ordered. She state the liver transplant team physician will consult with our local hospitalist in the morning over the phone.  Hospitalist paged at this time.   1927 Admit to med surg with tele to Dr. Patient is full code.            Condition     stable  Assessment/Plan       1. SVT (supraventricular tachycardia)   I47.1    2. COVID-19   U07.1    3. Liver transplant status   Z94.4    4. Chronic hepatitis C   B18.2    5. Immunocompromised patient   D84.9    Orders:   acetaminophen, 1,000 mg, Orally, Tablet, ONCE, 11/21/22 18:00:00, 11/21/22 18:00:00  **Coronavirus SARS-CoV2 Rapid  **Rapid Influenza PCR  Auto Diff  BNP Pl QN  CBC w/Differential  Comp Metabolic Panel  COVID 19 PCR  Electrocardiogram  Electrocardiogram  FK506 Bld QN  Peripheral IV Insertion  PTINR  Rapid Influenza A/B Ql  Troponin-I High Sensitivity  XR Chest PA or AP     Follow Up  No qualifying data available   Chronic Problem List    Anemia  Anxiety  Chronic hepatitis C  Coronary artery disease  HCC (hepatocellular carcinoma)  Immunosuppression due to drug therapy  Impingement syndrome of right shoulder  Liver transplanted  Primary hypertension  Supraventricular tachycardia  Procedure/Surgical History  ?Complete resection of colon ?gall bladder ?liver cancer ?Liver Transplant ?Sebaceous cyst removal  Surgical History Internal  07/24/2022    Liver Transplant      02/25/2022    Angiogram      06/03/2021    Angiogram      05/06/2021    Angiogram      03/30/2021    Colonscpy Diagnostic/Screen      03/26/2021    EGD Diagnostic      03/20/2021    EGD Diagnostic      Medications  Home Medications (11) Active Epclusa 400 mg-100 mg oral tablet 1 Tablet, Orally, Daily flecainide 50 mg oral tablet 50 mg = 1 Tablet, Orally, Q12H hydroCODONE-acetaminophen 10 mg-325 mg oral tablet 1 Tablet, PRN, Orally, Q6H magnesium oxide 400 mg oral tablet 800 mg = 2 Tablet, Orally, BID methocarbamol 750 mg oral tablet 1,500 mg = 2 Tablet, PRN, Orally, TID metoPROLOL succinate 25 mg oral tablet, extended release 25 mg = 1 Tablet, Orally, Daily multivitamin Therapeutic oral tablet 1 Tablet, Orally, Daily mycophenolic acid 360 mg oral delayed release tablet 360 mg = 1 Tablet, Orally, BID omeprazole 20 mg oral delayed release capsule 20 mg = 1 Capsule, Orally, Daily sulfamethoxazole-trimethoprim SS 400 mg-80 mg oral tablet 1 Tablet, Orally, At Bedtime, Continue for 6 months after transplant (stop 1/24/23) tacrolimus 1 mg oral capsule 2 mg = 2 Capsule, Orally, BID, Z 94.4  Medication Administration   Given  adenosine, 6 mg, IV Push  metoPROLOL succinate, 25 mg, Orally  Sodium Chloride 0.9% - ED Bolus, 1000 mL, IVPB  Allergies   Bee Stings (SOB)  No Known Medication Allergies  Social History    Alcohol   Denies   Electronic Cigarette/Vaping   E-Cigarette Use Never.   Substance Abuse   Denies   Tobacco   Tobacco Use: Former smoker, quit more than 30 days ago.  Family History   Dementia: Mother.  Diabetes mellitus: Father.  Heart attack: Father.  Lab Results       Hemogram-Platelets-WBC Differential FS  LATEST RESULTS  HISTORICAL RESULTS          WBC  11/21/22 16:00  4.7  11/17/22  4.6          RBC  11/21/22 16:00  4.97  11/17/22  4.76          Hgb  11/21/22 16:00  14.6  11/17/22  13.9          Hct  11/21/22 16:00  43.6  11/17/22  40.6          MCV  11/21/22 16:00  88  11/17/22  85          MCH  11/21/22 16:00  29.3  11/17/22  29.1          MCHC  11/21/22 16:00  33.4  11/17/22  34.1          RDW  11/21/22 16:00  14.5  11/17/22  14.5          Platelet  11/21/22 16:00  90  Low  11/17/22  127  Low          MPV  11/21/22 16:00  9.7  11/17/22  10.0          Neutrophils %  11/21/22 16:00  78  11/17/22  63          Lymphocytes %  11/21/22 16:00  8  11/17/22  18          Monocytes %  11/21/22 16:00  13  11/17/22  11          Eosinophils %  11/21/22 16:00  0  11/17/22  6          Basophils %  11/21/22 16:00  1  11/17/22  2          Absolute Neutrophil  11/21/22 16:00  3.7  11/17/22  2.9          Absolute Lymphocyte  11/21/22 16:00  0.4  Low  11/17/22  0.8  Low          Absolute Monocyte  11/21/22 16:00  0.6  11/17/22  0.5          Absolute Eosinophil  11/21/22 16:00  0.0  11/17/22  0.3          Absolute Basophil  11/21/22 16:00  0.1  11/17/22  0.1           Routine Coagulation Studies FS  LATEST RESULTS  HISTORICAL RESULTS          PT  11/21/22 16:00  12.1  11/15/22  11.9          INR  11/21/22 16:00  1.06  11/15/22  1.06           Routine Chemistry Tests FS  LATEST RESULTS  HISTORICAL RESULTS          Sodium SerPl QN  11/21/22 16:00  130  Low  11/17/22  138          Potassium SerPl QN  11/21/22 16:00  4.5  11/17/22  4.5          Chloride SerPl QN  11/21/22 16:00  100  11/17/22  106          Carbon Dioxide SerPl QN  11/21/22 16:00  20  Low  11/17/22  23          Anion Gap  11/21/22 16:00  10  11/17/22  9          BUN SerPl QN  11/21/22 16:00  15  11/17/22  20          Creatinine SerPl QN  11/21/22 16:00  1.04  11/17/22  0.93          Estimated GFR (CKD-EPI, no race)  11/21/22 16:00  79  11/17/22  >90          Estimated CRCL (CG)  11/21/22 16:00  65  11/17/22  72          Glucose SerPl QN  11/21/22 16:00  89  11/17/22  83          Calcium Total SerPl QN  11/21/22 16:00  9.5  11/17/22  9.2          Alkaline Phos SerPl QN  11/21/22 16:00  84  11/17/22  77          ALT SerPl QN  11/21/22 16:00  47  11/17/22  89  High          AST SerPl QN  11/21/22 16:00  33  11/17/22  41  High          Bilirubin Total SerPl QN  11/21/22 16:00  0.8  11/17/22  0.5          Total Protein SerPl QN  11/21/22 16:00  7.1  11/17/22  6.2  Low          Albumin SerPl QN  11/21/22 16:00  4.5  11/17/22  3.8          Troponin-I High Sensitivity  11/21/22 16:00  18  07/25/22  54  High          BNP Pl QN  11/21/22 16:00  70  07/28/22  134  High           Molecular Diagnostic Tests  LATEST RESULTS  HISTORICAL RESULTS          COVID 19 Specimen Source  11/21/22 15:44  Nasopharyngeal  08/08/22  Nasopharyngeal          Coronavirus SARS-CoV2 Rapid  11/21/22 15:44  Detected Abnormal  07/31/22  Not Detected          Viral FS  LATEST RESULTS        Rapid Influenza Method  11/21/22 15:44  PCR - Liat        Rapid Influenza A PCR  11/21/22 15:44  Not Detected        Rapid Influenza B PCR  11/21/22 15:44  Not Detected      Diagnostic Results  XR Chest PA or AP    11/21/22 16:31:46  IMPRESSION:  1. No acute findings in the chest.   Thank you for consulting our team of subspecialty radiologists. Healthcare providers wishing to discuss  this case further can contact the Cardiothoracic.   Electronically Signed by:           Signature Line Electronically Signed on 11/21/22 19:28 ________________________________________________________   Electronically Signed on 11/21/22 19:28 ________________________________________________________