Age: 41.0
Sex: F
Vaccine: COVID19
Symptoms: Bundle branch block right, C-reactive protein increased, COVID-19, Chest X-ray normal, Chest pain
Clinical narrative: Hospitalized (1.4.22 -1.6.21): COVID -19 positive (1.4.22); Fully vaccinated -pfizer x2 D/c Summary: Discharge Summary PA-C (Physician Assistant-Certified) ? ? General Medicine Cosigned by: MD, at 1/6/2022  3:39 PM Attestation signed by MD, at 1/6/2022  3:39 PM I have personally interviewed and examined the patient on 1/6/2022. Management was discussed with PA-C. I agree with the documented findings and plan of care in his note.   Brief exam:  Respiratory:  No acute distress Cardiovascular:  Regular rate and rhythm   Brief history and medical decision making:  Patient with no active complaints.  Respiratory status stable on room air.  No tachycardia with ambulation.  Patient felt comfortable with plans for discharge.  Patient was advised to closely follow up with PCP.         BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: MD Admission Date: 1/5/2022 Discharge Date: 1/6/2022    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 virus infection 01/05/2022 Yes   Resolved Hospital Problems No resolved problems to display.    Pre-Existing Active Problems   Diagnosis Date Noted POA ? Morbid obesity 07/30/2018 Unknown ? Adie's pupil 09/07/2011 Unknown ? PMDD (premenstrual dysphoric disorder) 09/07/2011 Unknown ? Headache 09/06/2011 Unknown     Discharge Disposition:  Home without services Active Issues Requiring Follow-up: COVID 19     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 virus infection [U07.1]   HOSPITAL COURSE: Pt is 41 y/o female with no significant past medical history who presented with chest pain and COVID-19. Pt had noted chest pain that had started night prior to admission and lasted 2-3 hours. Was described as burning in left chest, no aggravating or alleviating factors. Pain had woken her from sleep. In ED, pt was noted to be tachycardic. EKG showed RBBB, no previous echos on file. COVID was found to be positive. CXR unremarkable. Hstrop, d-dimer, unremarkable. With ongoing chest pain she was admitted for further evaluation.    While waiting in ED for transport pt did have echo completed which showed mild LVH LVEF of 65% and no pericardial effusion. CRP was found to very mildly elevated, ESR wnl. ProBNP normal. Pt felt better by morning of 1/6, only having few mild episodes of chest pain lasting < 5 minutes. She was able to ambulate without hypoxia or significant tachycardia. With low d-dimer felt low possibility of PE. With normal echo, probnp, trop, proBNP felt low likelihood of pericarditis. She was discharged home in stable condition.    CONSULTS / RECOMMENDATION:    Consult Orders (From admission, onward)   None     INPATIENT PROCEDURES:   BP 132/80  | Pulse 70  | Temp 36.7 °C (Oral)  | Resp 14  | Ht 1.651 m  | Wt 101 kg  | SpO2 97%  | BMI 37.05 kg/m²    Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: She is well-developed. She is obese.  HENT:     Head: Normocephalic and atraumatic.     Mouth/Throat:     Pharynx: No oropharyngeal exudate.  Eyes:     General: No scleral icterus.    Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Neck:     Trachea: No tracheal deviation.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: No murmur heard.    Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing or rales.  Chest:     Chest wall: No tenderness.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding or rebound.  Musculoskeletal:        General: No tenderness or deformity.     Cervical back: Neck supple.     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: She is alert. Mental status is at baseline.  Psychiatric:        Behavior: Behavior normal.   H&P: CHIEF COMPLAINT: COVID-19 virus infection     Assessment/Plan    ASSESSMENT / PLAN:   COVID-19 infection -vaccinated. No hypoxia or SOB -has mild cough and URTI symptoms -prn antitussives   Atypical chest pain -MSK vs pleuritic in setting of covid-19 infection -PRN tylenol, ibuprofen -lidocaine patch   Sinus tachycardia -likely 2/2 COVID-19 infection vs deconditioning vs dehydration. HR in 90s at rest, per ED note up to 130 with ambulation. -d-dimer neg in ED. Repeat pending. Low suspicion for PE -tele -Will give 1 L IVF   Morbid obesity   DVT prophylaxis with lovenox Full Code Dispo: observation. Possible DC tomorrow if she remains stable.   MD     70 minutes were spent on the unit/floor with the patient with over 50% spent counseling and coordination of care related to above.       Subjective    HISTORY OF PRESENT ILLNESS: Patient is a 41 y.o. female who is directly admitted today from ED with COVID-19 infection (she is vaccinated) and chest pain.    She presented to ED yesterday after developing acute onset L chest wall pain in the middle of the night around 2.30 am. She had been having mild cold like symptoms for a few days. In the ED she was hemodynamically stable although with mild sinus tachycardia at rest, 130s with ambulation. No hypoxia. COVID-19 +ve. EKG with RBBB. Trop x 3 neg. D-dimer neg ED notified cardiology who recommended she get an ECHO to rule out pericardial effusion due to concern for pericarditis prior to discharge. Patient could not get ECHO at ED apparently so she was planned for transfer to or tachycardia with ambulation.    Patient states she feels well otherwise. No change in chest wall pain. No SOB. Minimal cough. Denies fevers or chills. No chest pain with exertion. She has tenderness to palpation of L chest wall on my exam. BL 1/4. On 1/5 she did get the ECHO at another ED which was unremarkable and then she was still transferred to hospital due to concern f       Patient Active Problem List Diagnosis ? Headache ? Adie's pupil ? PMDD (premenstrual dysphoric disorder) ? Morbid obesity  ? COVID-19 virus infection OBJECTIVE: BP 153/85  | Pulse 93  | Temp 36.5 °C (Oral)  | Ht 1.651 m  | Wt 101 kg  | SpO2 97%  | BMI 37.05 kg/m²    Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is not ill-appearing.  HENT:     Head: Normocephalic and atraumatic.  Eyes:     Extraocular Movements: Extraocular movements intact.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal.  Abdominal:     General: There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:     Comments: L chest wall TTP  Skin:    General: Skin is warm.  Neurological:     Mental Status: She is oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.