Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram head normal, Dizziness, Dyspnoea, Dyspnoea exertional, Electrocardiogram abnormal
Clinical narrative: The patient presents with Chest Pain  The patient is a 69 year old female, known to medical facility, with a past medical history as detailed below including No Known ASHD, Preserved LVEF, HTN, NIDDM, Hypothyroidism, and Family Hx CAD. She was seen in consultation per Dr. 12/10/15 due to a family history of CAD. Given she underwent Stress TTE 11/10/15, which was negative and her symptoms improved with protonix, it was felt to be related to GERD. She has since been lost to follow up.  She presented to  ED 1/23/22 secondary to chest pain and recent syncopal episode. Upon arrival, she was found to be afebrile with blood pressure 107/73, pulse 124, and SpO2 98%. Significant initial laboratory demonstrated COVID19+, troponin 14.6-- >14.5-- >14.5 and negative d-dimer. EKG demonstrated sinus tachycardia with no acute ST/T wave abnormalities and right axis deviation. CXR was negative for acute process. CT Head was negative for acute process. She was given full dose ASA and NTG and admitted for further workup. Cardiology was consulted on 1/24/22 to address her chest pain and syncope.  The patient reports a 2 month history of initially intermittent chest pain at both rest and with exertion which has become more constant over the last week.  She was recently hospitalized at Hospital 2 weeks ago at which time she underwent MPS which was reportedly negative.  Over the last week, she reports her chest pain has become more constant.  She describes central chest pressure and also a knife like twisting at times.  She reports it occasionally radiates to her left jaw.  The chest pain is worse with exertion and deep breathing at times. She has tried baking soda at home with some improvement.  Yesterday around 4:00 PM after getting up to walk to the bathroom, she became lightheaded with a tingling sensation in her head and subsequently slid down the wall.  She denies associated head injury, chest pain, or palpitations.  She feels that she did pass out for a few seconds. As such, she notified her son and the decision was made to proceed to the ER.  She describes a similar syncopal episode last week after getting up to walk into the kitchen.    She denies known cardiac history and has never undergone cardiac catheterization.  She reports a history of HTN and DM.  She is a nonsmoker.  She reports a strong family history of CAD in both parents and multiple siblings who reportedly had issues with a blockage "on the backside of their heart. "  She denies otherwise denies recent fever, chills, or known COVID exposure.  She does describe shortness of breath at both rest and with exertion over the last 2 days.  She denies cough, sore throat, or loss of taste/smell, She got her 2nd COVID vaccine 12/2021.  Presently, she is resting comfortably in bed and and reports resolution of her chest pain with NTG paste.  She denies chest pain or shortness of breath.  Telemetry is demonstrating NSR rate of 95 with blood pressure 164/95, and SpO2 100%/RA.  She is a widow and has 3 children.  PT IS INPATIENT AT THIS TIME.