Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Iron deficiency, Left ventricular failure, Metabolic function test abnormal, Mineral supplementation, Mitral valve incompetence
Clinical narrative: Patient is a pleasant 76-year-old female who presented to the emergency department today from a residential facility for chief complaint of syncopal episode.  Patient was eating lunch at approximately 11 AM this morning when she began to feel lightheaded, and told others around her that she did not feel right.  She had a witnessed syncopal episode that lasted approximately 2 minutes and was reported to have urinary incontinence during which time she was incontinent.  Patient denies any postictal state, vision changes, or current headache.  Patient does report that she had a headache this morning, but has since resolved.  Patient just recently discharged from the hospital on 04/27 for weakness and anemia.  During that hospitalization she received 2 units PRBC, and was discharged to the residential facility for rehabilitation.  Patient reports that she had been feeling better up until today.  She denies any tobacco, alcohol or illicit drug use. She denies any chest pain, palpitations, shortness of breath, cough/sputum, fever/chills, abdominal pain, nausea/vomiting, diarrhea/constipation.   Work-up in the emergency department: CBC metabolic panel significant for mild hyperglycemia 225, chronic renal insufficiency noted, H&H 9.0 and 29.9.  Patient intentionally tested positive for COVID-19 and found to be hypoxic.  In the ED patient was given loading dose of Solu-Medrol prior to CT scan, and Benadryl 50 mg.  She was also given 500 mg Zithromax tablet.  This current time she is on 2 L nasal cannula with O2 saturation of 94 to 97%.  She is admitted under the hospitalist service for further work-up and continuation of care.  Patient was admitted to the medical surgical unit due to acute hypoxic respiratory failure secondary to COVID-19.  CT PE showed no evidence of acute pulmonary embolism or underlying pneumonia but patient does have advanced emphysema.  Patient was started on remdesivir, dexamethasone, and albuterol inhaler.  The following morning patient was feeling well and had no oxygen requirements.  She was agreeable to return to the residential facility where she is undergoing rehab.  Notably, patient is not ambulatory related to her history of CVA 3 years prior.  For this reason oxygen was only checked at rest, but patient remained mid to high 90s.  We did discuss the use of Paxlovid.  Patient declined stating that she felt fine.  Notably, patient actually presented to the emergency department due to a syncopal episode while sitting.  She states that this has happened before.  She had no precipitating symptoms.  She was not dehydrated. Echocardiogram 12/2022 reveals EF 61% with Mild MR. EKG shows SR with 1st degree AV block, unchanged from prior. There was no QT prolongation. Troponin negative. No further syncope or near syncope. I have asked her to follow up with cardiology event monitor. Patient was in agreement. Lastly, patient was started on iron for deficiency. She was feeling well and agreeable for return to the residential facility.    Discharge diagnosis Acute hypoxic respiratory failure, secondary to COVID-19 Syncopal episode Generalized weakness with frequent falls Anemia, likely of chronic disease, recently required transfusion Diastolic CHF, without acute exacerbation CAD Primary essential hypertension Mixed hyperlipidemia Diabetes mellitus type 2 with hyperglycemia History of CVA with residual left-sided deficit