Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Atrioventricular block, Blood thyroid stimulating hormone normal, Bradycardia, COVID-19, Echocardiogram abnormal
Clinical narrative: Admit date: 2/21/2024  Discharge date:  2/28/2024  Admitting Physician: MD   Attending Physician at the Time of Discharge: MD  Primary Care Physician: MD Reason for Admission: 79-year-old remarkable female who remains independent with a past medical history significant for longstanding history of multiple sclerosis, paroxysmal atrial fibrillation on apixaban, hypothyroidism, major depression, chronic low back pain, hypertension and hyperlipidemia who presented from home status post ground level fall remained on the floor for several hours prior to brother coming over to the house at which time EMS was called.  On presentation patient was noted to have rhabdomyolysis with acute on chronic kidney failure.  Patient complained of significant generalized weakness  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  Patient was given IV fluids and home losartan was held with improvement in renal function with resolution of rhabdomyolysis. Cardiology was consulted with concerns for arrhythmia with possible AV dissociation and possible syncope.  On further review the rhythm was felt to be atrial flutter with 3-1 block.  Cardiology recommended decreasing home beta-blocker dose from 50 to 25 mg daily.  They did not recommend any further interventions.  Patient had no further significant bradycardia.   Of note, TSH was within normal limits.  Patient developed a significant fever to 39.3 with mild tachycardia.  Patient was found to be COVID-19 positive and had a left lung infiltrate.  She was started on empiric doxycycline and ceftriaxone.  Respiratory viral PCR was performed which was positive for COVID-19 virus.  Infectious diseases recommended dexamethasone and remdesivir.  Patient completed a 5 day IV remdesivir protocol as well as five days of IV Ceftriaxone with respiratory status slowly improving with resolution of hypoxia with patient requiring up to 3 liters by NC with peripheral oxygen saturation of 84% prior to treatment.  Patient was discharged on additional 5 days of Decadron 6 mg daily to complete 10 days of treatment for her COVID 19 infection.    On separate note, neurology was consulted due to patient's history of multiple sclerosis and possible weakness related to fall to rule out MS flare.  She was found to have no evidence of MS flare, but did have evidence of a small punctate focus of diffusion restriction at the right periatrial white matter consistent with an acute to early subacute infarction.  Neurology recommended adding low dose Aspirin to patient's home apixaban.  Carotid ultrasound showed bilateral carotid atherosclerotic disease without stenosis.  Patient has known paroxysmal atrial fibrillation and was continued on home apixaban per neurology recommendations.  Echocardiogram showed preserved LVEF with no evidence of clot or thrombus.  It did show evidence of pulmonary hypertension.  Patient was noted to have an LDL 132 (previous LDL of 177 in June 2021) and was started on a high intensity Statin.   Patient was seen by therapies with recommendations for home care with PT and OT.   Patient was also noted to have severe vitamin-D deficiency and was started on replacement with 50000 units of cholecalciferol weekly.  Patient was continued on her home medications for multiple sclerosis.   Issues Requiring Follow Up: (Who, what, when, and how communicated?)  Follow-up history of multiple sclerosis and stroke with neurology; follow-up resolution of pneumonia and COVID 19 infection with PCP; follow-up CKD with nephrology; follow-up PAF with cardiology Discharged to Home