Age: 79.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Fibrin D dimer increased, Heart rate increased, Hypoxia, Lung infiltration, Peripheral artery aneurysm
Clinical narrative: Hospitalized 1/1/2022; COVID-19 positive 1/1/2022; fully vaccinated plus booster  BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider at Discharge: NP Admission Date: 1/1/2022 Discharge Date: 1/4/2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Typical atrial flutter  COVID-19 virus infection  Pneumonia due to COVID-19 virus  HOSPITAL COURSE: PATIENT is a 79-year-old male who presented for evaluation of shortness of breath. The patient has a history of afib/aflutter on eliquis s/p multiple cardioversions and ablations. His last ablation was in October 2021. He was scheduled for a cardioversion about 2 weeks ago but he converted on his own. This did not last long and on 12/29 he was seen in the cardiology office and started on amiodarone. Later that day he developed worsening symptoms and fever. He came to the ER on 1/1 with significant shortness of breath. In the ER the patient was found to be COVID positive. His labs showed an elevated BNP, indeterminate but down trending troponin, no leukocytosis. His heart rates were elevated in the 110-120s. The ER provider spoke with EP who recommended the addition of cardizem which was administered in ER. The patient had a CXR which showed left perihilar infiltrate and streaky atelectasis or infiltrate in the right lung base. He was not hypoxic and therefore was not started on dexamethasone. Due to his significant symptoms he was felt to be high risk and the hospitalist team was contacted to admit the patient for further observation.  The patient did end up requiring some supplemental oxygen during his stay but was able to be weaned to room air before discharge. Due to his hypoxia he was started on dexamethasone and remdesivir. His D dimer was elevated and he underwent CTA thorax which was negative for PE but showed possible fluid overload. He was started on IV laisx for diuresis with improvement in his symptoms. He had an echo which showed a reduced ejection fraction at 28%. He was evaluated by cardiology who felt that this was likely due to his acute illness as well as due to rapid rates and a flutter. The patient was started on cardizem as well as coreg with improvement in his heart rates. Cardiology recommended that the patient have a repeat EKG next week in the office to determine if cardioversion should happen next week. The patient was instructed to monitor his BP and heart rates at home and call the cardiology office for worsening symptoms or elevated heart rates for a more expedited cardioversion. He will also need a follow up limited echo in 2-3 months to evaluate his EF. Due to the patient's elevated D dimer he underwent bilateral upper and lower extremity dopplers which were negative for DVT however there was a finding of bilateral aneurysmal dilation of the distal femoral and popliteal arteries with significant atherosclerotic disease. A CT angiogram was completed for better evaluation and the patient was advised to follow up with his PCP for referral to vascular as an outpatient. At discharge the patient was given prescriptions for coreg, cardizem and decadron. He was feeling well and had no further shortness of breath. He verbalized understanding of follow up instructions and discharged home with his wife in stable condition.