Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Dyspnoea exertional, Electrocardiogram abnormal, Enterovirus test negative, Fibrin D dimer
Clinical narrative: ED to Hosp-Admission Current   9/19/2021 - present (15 days) Hospital   MD  Last attending ? Treatment team COVID-19  Principal problem    Assessment and Plan   Patient is a 89 y.o. female with significant PMHx of paroxysmal atrial fibrillation, aortic stenosis status post TAVR, mitral valve stenosis, coronary artery disease status post PCI of the diagonal 6/2020, essential hypertension, chronic heart failure with preserved ejection fraction, chronic kidney disease stage III, history of TIAs presents to Hospital on 9/19/2021 with complaints of shortness of breath and cough.    Medical Problems             Hospital Problems          POA    * (Principal) COVID-19 Yes         Atrial fibrillation  Yes         Acute on chronic respiratory failure  Yes              COVID 19  Acute on chronic respiratory failure chronically on 2 L with exertion currently on 4 L at rest Mild intermittent asthma o D-dimer, procal, LDH, ferritin and CRP pending  o Patient follows with pulmonary outpatient, CT chest in September 2021 showed groundglass nodule o Pulmonary function test revealed mild obstructive airway disease patient was initiated on Breo and albuterol o Patient initiated on dexamethasone, end date 9/29 o Patient she did on remdesivir, and date 9/23 o Plasma ordered after consent was obtained   Atrial fibrillation with rapid ventricular response, now rate controlled Chronic paroxysmal atrial fibrillation CHA2DS2-VASc score of 5 o Currently on anticoagulation with Eliquis 2.5 mg twice daily   Mild hyponatremia, continue to monitor    Aortic stenosis status post TAVR 8/2020 Mitral valve stenosis   Coronary artery disease status post PCI of the diagonal 6/2020 o It appears that at some point patient's Plavix was discontinued, and has been resumed at this time.   Essential hypertension, continue home antihypertensives with hold parameters   Chronic heart failure with preserved ejection fraction, continue Lasix   Chronic kidney disease stage III, creatinine currently at baseline   History of TIAs, continue Plavix and statin   Vitamin D deficiency B12 deficiency o Continue supplementation   Nutrition: heart healthy  VTE prophylaxis: Eliquis Code Status: Full Code Disposition: pending clinical improvement   Patient is a 89 y.o. female with significant PMHx of paroxysmal atrial fibrillation, aortic stenosis status post TAVR, mitral valve stenosis, coronary artery disease status post PCI of the diagonal 6/2020, essential hypertension, chronic heart failure with preserved ejection fraction, chronic kidney disease stage III, history of TIAs presents to Hospital on 9/19/2021 with complaints of shortness of breath and cough.    Patient was discharged from the hospital last Wednesday 9/15 for symptomatic anemia.  the day after her discharge she was doing well. On 9/17 she started to have episodes of a non-productive coughing that started to get progressively worse. She started to become more short of breath even just moving would make her feel out of breath when normally she is able to walk from one side of the house to the other side without issues. She fevers, chills, headaches, arthalgias/myagias, loss of taste/smell, chest pain, abdominal pain. She has been having nausea but no vomiting. She has had loss of appetite. She is vaccinated.    In the Emergency Department, vital signs temperature 36.8, heart rate 138, respiratory rate 20, blood pressure 107/68, SPO2 92% on 4 L oxygen.  Lab work was remarkable for an H/H of 8.3/25.8, sodium 132, anion gap 12, BUN/creatinine of 34/1.67, glucose of 161, troponin of 0.11.  Respiratory viral panel was positive for COVID-19.  Initial EKG showed patient was in atrial fibrillation with rapid ventricular response.  She was given metoprolol 5 mg once and a 500 cc bolus of normal saline with improvement in her heart rate.  She was also given 1 dose of dexamethasone.   Hospitalist team was consulted for admission.