Age: 73.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Troponin normal, White blood cell count normal
Clinical narrative: 2/4/22  74-year-old white female who presents to the emergency department with a chief complaint of "having all the symptoms of a heart attack".  The patient has a history of prior myocardial infarction and states she began having all the same symptoms tonight.  She complains of left-sided chest pressure that radiates to the left side of the neck and left shoulder region that began around 12:30 AM tonight while working as a cashier.  The pain is resolved at the time of my evaluation, lasting roughly an hour.  The pain was associated with shortness of breath, nausea, and diaphoresis.  She had no vomiting.  She felt lightheaded and near syncopal but did not lose consciousness.  She denies any exacerbating or relieving She denies any exacerbating or relieving factors, stating that her relief was spontaneous.  She denies any recent fever, sore throat, or runny nose.  She states she has a chronic cough.  She denies lower extremity pain and swelling.  She denies abdominal pain, diarrhea, and bloody stools. Review of Systems  Constitutional: Negative for chills and fever.  HENT: Negative for congestion, sore throat and sinus pressure.   Eyes: Negative for redness and itching.  Respiratory: Positive for cough (Chronic) and shortness of breath.   Cardiovascular: Positive for chest pain. Negative for leg swelling.  Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting.  Genitourinary: Negative for dysuria and hematuria.  Musculoskeletal: Negative for back pain.  Skin: Negative for rash.  Neurological: Positive for light-headedness. Negative for syncope and headaches.  Hematological: Negative for adenopathy.  Psychiatric/Behavioral: Negative for confusion.  All other systems reviewed and are negative.  Discharged Condition: stable    Hospital Course:  74-year-old female presented to emergency department with complaint of chest pain and shortness of breath that began while she was at work as a cashier at a convenience store.  She endorsed associated nausea, diaphoresis, and lightheadedness.  She has a history of myocardial infarction and was concerned symptoms were that of another MI.    Vital signs on presentation were unremarkable: Temp 97.7, pulse 88, BP 145/91, respiratory rate 20, SPO2 100%.  Laboratory studies were unremarkable.  Troponins were flat x4.  Covid testing is positive and CTA chest did reveal extensive bilateral groundglass opacities typical of COVID-19 virus infection.      Following presentation she required supplemental O2 to maintain oxygen saturation greater than 90%.  Respiratory status is stable on 2 L O2 BNC, SPO2 96%.  No increased work of breathing conversational dyspnea.  She was started on dexamethasone and vitamin supplementation.    Initial CRP was 0.4.  We suspect presenting chest pain and shortness of breath are related to COVID.    The patient was monitored with continuous telemetry following her admission and no arrhythmias were detected.  Fortunately the patient's respiratory status remained stable for her brief hospital course.  She was maintaining adequate oxygen saturations on 2 L O2.  She will be set up for supplemental O2 BNC, to be delivered to her room prior to her discharge today.  She will be followed on an ongoing basis by the hospital.  She already has a pulse oximeter at home and she will be provided with a BP cuff.