Age: 77.0
Sex: F
Vaccine: COVID19
Symptoms: Anxiety disorder, Arteriosclerosis, Asthenia, Atelectasis, Bradycardia
Clinical narrative: Discharge Provider:  Primary Care Provider: Admission Date: 7/17/2022 Discharge Date: 7/19/22  PRESENTING PROBLEM: Essential hypertension  Generalized weakness  Elevated troponin  Dystonic drug reaction  Anxiety disorder, unspecified type Non-intractable vomiting with nausea, unspecified vomiting type COVID-19   HOSPITAL COURSE: Pt is a 78-year-old female with PMH significant for RA (prednisone, methotrexate, Plaquenil) and hypertension who presented to the hospital 7/17 due to worsening nausea and vomiting over the past 6 months. Patient has been having intermittent n/v over the past year but it has progressed to daily over the past six months. Symptoms are generally exertional and come on with ambulation or lifting heavy objects. Patient does not note an association with dizziness and her nausea. She also does not note any correlation with PO intake or constipation and nausea.  Previously PCP I requested a CT of abdomen which was mostly normal except for mildly enlarged gallbladder and a duodenal diverticulum. She was referred to GI and seen on 7/7 at which time she was prescribed zofran, advised to start Pepcid and and EGD and ECHO were ordered. In ER she was noted to be hypertensive, however labs were relatively unremarkable.  EKG showed bradycardia and nonspecific ST-T changes, troponins flat.  Chest x-ray was negative.  Patient had a reaction to IV Reglan in ER including dyskinesia and anxiety which resolved with Benadryl. CT abdomen/pelvis with IVC was negative.  She tested positive for COVID. Her only symptom included a runny nose that started on 07/15.    Patient was given supportive treatment with IV fluids, antiemetics and empiric PPI.  GI was consulted given her acute on chronic n/v and felt etiology remained unclear. They favored not pursuing EGD given her COVID symptoms and recommended keeping scheduled outpatient EGD on 8/9.  Diet was restarted.  Given her exertional nature of N/V, ECHO was done which showed LVEF 55% with mild mitral regurg. No major valvular disease and no WMA noted. Her nausea resolved while inpatient even with ambulation around her room. Discussed that this may be in part due to calcium being held while inpatient. Recommended monitoring symptoms and trying to correlate with whether calcium supp may be contributing. Also advised continuing zofran at home as this seems to be helping, and considering trying protonix rather than pepcid since symptoms improved while taking this. Also suggested following GERD diet and monitoring for improvement. Patient and daughter agreeable to trying these steps and following up for EGD on 8/9. If symptoms persistent and no findings on endoscopy, could consider further cardiac workup, possibly stress test.    She was noted to have pulmonary nodules in the right lung and hence noncontrast CT was done which showed mild bilateral atelectasis. Mild bilateral costophrenic granulomas were note and moderate calcified atherosclerosis of LAD.  She is a lifelong nonsmoker.   She was noted to have incidental COVID-19 infection, with symptoms of runny nose and dry cough that started on 07/15.  Provided no therapeutics as her only symptoms was nasal congestion