Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Alanine aminotransferase normal, Albumin globulin ratio decreased, Anion gap, Anticoagulant therapy
Clinical narrative: COVID+ 12/5/2022.  Vaccination status - moderna x3 BRIEF OVERVIEW: Discharge Provider:  Primary Care Provider:  Admission Date: 12/5/2022 Discharge Date: 12/7/2022    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 virus infection 12/05/2022 Yes ? Acute on chronic diastolic congestive heart failure (HCC) 12/16/2020 Yes ? CAD (coronary artery disease) 10/13/2022 Yes ? Paroxysmal atrial fibrillation (HCC) 05/13/2022 Yes ? Type 2 diabetes mellitus with diabetic polyneuropathy, without long-term current use of insulin (HCC) 11/15/2019 Yes ? COPD (chronic obstructive pulmonary disease) (HCC) 04/06/2015 Yes ? B12 deficiency 12/05/2022 Yes ? Hypothyroidism 12/16/2020 Yes ? Acute on chronic diastolic heart failure (HCC)   DETAILS OF HOSPITAL STAY:  Clinical Narrative:  The patient was admitted with COVID-19 lower respiratory tract infection/pneumonia.  As result she also suffered from a heart failure exacerbation which required diuresis.  She was also wheezing given her tobacco history was felt to have an exacerbation of chronic obstructive pulmonary disease.  She was treated for chronic obstructive pulmonary disease exacerbation and COVID-19 pneumonia with corticosteroids, per protocol.  She received remdesivir given her hypoxia on presentation.  She received gentle continue diuresis at suspect to her heart failure.  She did respond serially with these interventions.  She will be discharged home today and is in a stable & improved condition.  Please see the following problem-list oriented Hospital Course below:  COVID-19 virus infection Assessment & Plan Unclear contribution to current respiratory issue. However, will check inflammatory markers, give vitamins, start Remdesivir, give Solumedrol 40mg TID. Treat for CAP as well with Rocephin/azithromycin. Low threshhold to de-escalate antiviral/antimicrobial tx if makes continued improvement on diuresis.   12/5 - chest x-ray appearance consistent with alveolar infiltrates from viral pneumonia.  Remains on remdesivir.  Also being treated for a kidney acquired pneumonia.  She does, however, report improvement with the diuretic and repeat chest x-ray will be obtained in the a.m. Likely beneficial to stay somewhat on the dry side.  12/6 - improving.  Chronic obstructive pulmonary disease exacerbation improving as well.  Possibly home as early as tomorrow afternoon.  12/7 - treated for COVID-19 pneumonia given the degree of hypoxia on admission.  Pulmonary infiltrates.  Three days of remdesivir.  Improvement.  IV Decadron daily.  The patient does not want to complete a full 5 days of therapy and the literature supports stopping it after Day 3 for people that improve sufficiently/considerably.  This will be respected.  The patient will be discharged home today with continued corticosteroid dosing and concurrent therapy for possible bacterial superinfection.  * Acute on chronic diastolic congestive heart failure (HCC) Assessment & Plan Echo in Oct 2022 with EF 52%. Pulmonary congestion on CXR. Diurese with Lasix 40mg BID x3 doses; monitor response. Continue Toprol, Spironolactone, lisinopril.   12.5 - Lasix dosing decreased.  Replace potassium.  Recheck chest x-ray in a.m.  12/7 - doing well.  Responded to the Lasix dosing.  Acute on chronic diastolic congestive heart failure.  Exacerbation of.  Exacerbated by COVID-19 lower respiratory tract infection/pneumonia.  Improved.  CAD (coronary artery disease) Assessment & Plan NSTEMI in Oct 2022 with LHC showing severe 2V disease, unable to stent. Already infarcted. Continue Plavix. EF at that time 54%.   12/7 - continue with antiplatelet therapy, statin, and secondary prevention.  Paroxysmal atrial fibrillation (HCC) Assessment & Plan Controlled. Continued Eliquis, Toprol   Type 2 diabetes mellitus with diabetic polyneuropathy, without long-term current use of insulin (HCC) Assessment & Plan Recent A1c was 6.9, not on any hypoglycemics. Monitored. Stable.  COPD (chronic obstructive pulmonary disease) (HCC) Assessment & Plan This is in hx, but not on chronic inhalers. Give sch duonebs, Symbicort, mucinex.   12/5 - continue nebs and present treatment.  12/7 - chronic obstructive pulmonary disease exacerbation secondary to COVID-19 will restrict tract infection/pneumonia.  Improved nebulized therapies and concurrent corticosteroids.  Tobacco cessation discussed.  B12 deficiency Assessment & Plan  Replete. Continue at home. Follow CBC outpatient.