Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Hypertension, Ileus, Left atrial dilatation, Left ventricular dysfunction, Left ventricular hypertrophy
Clinical narrative: Admitted to hospital on 7/20.  Patient is a 80 y.o. male who presents to the emergency department with chief complaint of hypertension and gout.  History of present illness, patient states for about a month he has had increased fatigue more acutely since yesterday.  He states he was also having some associated dyspnea yesterday.  Denies any cough or pain in his chest.  He does endorse a history of dizziness with changing positions, however that is not new for him.  His wife believes he has become more unsteady with the increasing fatigue.  His wife is been checking his blood pressure and heart rate, he has noted to be hypertensive, and his heart rate has been low. in the 40s.  No syncope or near-syncope.  T The patient denies any nausea or diaphoresis.  He denies any headache.  He has not had any confusion or difficulty with his speech. He denies any orthopnea or PND.  He denies any injury or trauma or falls.  He denies any other modifying factors or associated signs or symptoms. Treated with amiodarone and steroids.  Cardiology progress note: Assessment/Plan    1. PVC/VT/SOB/fatigue --status post catheterization o The left ventricular systolic function is normal. o 2nd Diag lesion is 40% stenosed. o Prox RCA lesion is 30% stenosed. o Noncritical coronary artery disease o Preserved left ventricular systolic function o Idiopathic ventricular tachycardia questionable outflow tract for EP evaluation o Hypertension o Dyslipidemia o LVEF 55% with normal filling pressures   Right radial approach.  Five French tig catheter was used to cannulate the left main, RCA and obtain the LV g   Patient for transfer back to the room EP evaluation regarding the ventricular tachycardia for medical therapy No significant coronary disease or structural heart disease identified   -- cardiac MRI questionable sarcoid versus myocarditis -- pulmonary consult appreciated.  There is a very low suspicion for sarcoid. -- for now will assume this is myocarditis ?  Secondary to coronavirus vaccine.  Did receive Moderna vaccine -- on Medrol Dosepak but not tolerating and will decrease 4mg daily  --no further episodes of nonsustained V-tach.  Does not qualify for a LifeVest.  Explained to patient and wife as his episodes are brief and short will not cover life vest  Discharge summary Hospital Course 80-year-old male patient originally admitted to the hospital with nonsustained V-tach.  Refer to H&P.  He was seen by Cardiology and electrophysiology, there were concerns about myocarditis or sarcoidosis.  Sarcoidosis was ruled out by imaging.  Lyme antibodies were negative.  Patient diagnosed with myocarditis, completed steroids.   As for his nonsustained ventricular tachycardia improved with amiodarone.  Currently is on 200 mg daily.  Recommended by Cardiology ZIO patch which was given.   Seen by a doctor at 1st for ileus.  EGD as below.  No major improvement in a few days, family requested a 2nd opinion and now the patient is followed by another doctor.  Colonoscopy was done, no obstruction noted.  Ileus resolved.  Patient tolerating diet.   Patient did suffer from BPPV during his stay.  MRI negative for stroke.  Symptoms resolved.    Had acute on chronic renal failure stage 3 with RTA.  Seen by Nephrology.  Resumed on lisinopril.  Creatinine stable.  Blood pressure remains elevated, started on Norvasc 2 days ago, dose increased to 5 mg on discharge.  Also continued on metoprolol, started on hydralazine during his stay.  To check blood pressure twice daily and follow-up with PCP.  Can increase hydralazine and Norvasc dose if needed.   Stable for discharge, discussed with the patient's wife.  Home care ordered