Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Pain, Pain in extremity, SARS-CoV-2 test positive, Troponin increased
Clinical narrative: Date of Admission: 12/5/2023 Date of Discharge: 12/7/2023 Code Status: Full Code Advanced Healthcare Directive / available: NO. referral sent: NO.   Reason for Hospital Admission:  acute coronary syndrome   Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) HX OF NON ST ELEVATION MI   ? CAD W ANGINA, W HX OF CABG   ? AIDS (ACQUIRED IMMUNE DEFICIENCY SYNDROME)   ? HTN   ? HYPERLIPIDEMIA   ? DEPRESSION, UNSPECIFIED     Resolved Hospital Problems No resolved problems to display.     Issues to be Addressed in Follow-up: 1. How are patients symptoms at home? 2. Did patient stop using meth/cigarettes?    Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   11/27/2023  1:33 PM UNFRACTIONATED HEPARIN, ANTI FACTOR XA In process --       Hospital Course and Significant Findings:   Adapted from H&P. Please see those notes from 12/5/23 for further details    Pt is a 61 Y man w hx CABG 2014, CAD s/p 2 stents 6/2023, hyperlipidemia, HTN, AIDS (status confidential, on Biktarvy), depression/panic attack, HFrEF (EF 45% on TTE 6/2023), CKD3, thrombocytopenia, ureteral calculus, solitary kidney, unhealthy substance use behavior (Utox with methamphetamine 11/27/23), pulm nodules, ischemic CVA.  Occasional EtOH (last 1 week ago), daily cigars (last this AM).  Lives alone.   Admitted 11/26 - 11/28/23 with L arm pain, SOB, and cough.  Noted to have rising trop & COVID.  Managed medically.  Acute arm pain resolved.  States that at baseline he is short of breath with poor energy.   Presents with L anterior chest pain radiating to shoulder since 6 PM on 12/4/23.  Was at rest in bed.  Worsened overnight. Drove himself to ED.  Took ASA 325 mg @ home.   Patient transferred for cardiac cath: no intervention/stent placement (See below for details)   By problem list: #ACS (medically managed) underwent cardiac cath on 12/6/23 Cardiac cath 12/6/23: 1- LIMA-LAD patent with excellent result of previous stent.  2- Severe native coronary artery disease with some progression but overall similar appearance compared to previous study 06/2023. There are multiple lesions that could have served as substrate for his current presentation.  3- LVEDP ~15 mmHg.   Patient was medically managed with NSTEMI with ~48hrs of heparin gtt, coreg, lisinopril, plavix and asa along with isosorbide    Patient refused taking isosorbide while inpatient stating "that makes feel like crap"   Plan -coreg 25mg bid -lisinopril 5mg -plavix 75mg daily  -asa 81mg  -strongly advised drug cessation  Patient declined isosorbide   #hx of meth use Advised cessation of meth use   #AIDS Continue biktarvy and atovaquone    Advised compliance with medications     #GERD Continue ppi    #nicotine use Patient not ready to quit. Declines tobacco cessation clinic/patches    #covid  Positive 11/26/23 and again today.  CT low (20.20, 23.60, 22.10) so will admit to isolation.  Not hypoxic, less likely to progress this many days out   Patient had asymptomatic/mild disease of covid so per CDC 10 days of isolation is enough. Patient has reached that time period   Patient was NOT given RDV or dexamethasone     Active Hospital Problems   Diagnosis   ? (Principal) HX OF NON ST ELEVATION MI   ? CAD W ANGINA, W HX OF CABG   ? AIDS (ACQUIRED IMMUNE DEFICIENCY SYNDROME)   ? HTN   ? HYPERLIPIDEMIA   ? DEPRESSION, UNSPECIFIED         Complications: none   Operative Procedures:  Procedure(s) (LRB): CORONARY ANGIOGRAPHY (N/A) CARDIAC CATHETERIZATION LEFT HEART, RETROGRADE FROM ARTERY, PERCUTANEOUS (N/A)   Non-operative Procedures: None   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. CARDIOLOGY - INITIAL INPATIENT CONSULTATION. CARDIOLOGY - ONGOING INPATIENT CONSULTATION. CRITICAL CARE MEDICAL - INITIAL INPATIENT CONSULTATION. CRITICAL CARE MEDICAL - ONGOING INPATIENT CONSULTATION. CARDIOLOGY - INITIAL INPATIENT CONSULTATION. CARDIOLOGY - ONGOING INPATIENT CONSULTATION.   Smoker: Yes - Reason Medication or Counseling not ordered: Patient declined smoking cessation medications   Condition on Discharge: Stable   Events / Subjective:  Doing well no complains. Asking for ride back to clinic    Physical Exam: Vitals last 24hrs BP  Min: 121/70  Max: 163/97 Temp  Avg: 97.4 °F (36.3 °C)  Min: 97 °F (36.1 °C)  Max: 97.7 °F (36.5 °C) Pulse  Avg: 68  Min: 55  Max: 83 Resp  Avg: 17.6  Min: 16  Max: 19 SpO2  Avg: 96.5 %  Min: 95 %  Max: 98 % Weight: 12/05/23 : 72 kg (158 lb 11.7 oz)   General appearance -  alert, well appearing, and in no distress Mental Status -  Mental status normal. Chest - clear to auscultation, no wheezes, rales or rhonchi Heart - regular rate and rhythm Abdomen - soft, nontender, nondistended, no masses or organomegaly Extremities - no clubbing, cyanosis or edema   Discharge Disposition: Home   Speech recognition software was used in the preparation of this note, errors in transcription may be present. Please call/page if there are questions.   Note to patient: Medical notes like these available to patients in the interest of transparency. However, be advised this is a medical document. It is intended as peer to peer communication. It is written in medical language and may contain abbreviations or verbiage that are unfamiliar. It may appear blunt or direct. Medical documents are intended to carry relevant information, facts as evident, and the clinical opinion of the practitioner.       Note Details  File Time 12/7/2023 11:44 AM Author Type Physician Status Addendum Specialty Hospital Medicine  ED to Hosp-Admission (Discharged) on 12/5/2023  ED to Hosp-Admission (Discharged) on 12/5/2023   Revision History   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Linked Episodes  CORONARY ANGIOGRAPHY Noted 12/5/2023  Hospital Problem List   HX OF NON ST ELEVATION MI  CAD W ANGINA, W HX OF CABG  HYPERLIPIDEMIA  HTN  AIDS (ACQUIRED IMMUNE DEFICIENCY SYNDROME)  DEPRESSION, UNSPECIFIED Care Timeline  12/05   Admitted from ED 2028 12/07   Discharged 1314  Discharge   Home or Self Care.    Discharge Instructions (AVS) (Printed 12/7/2023) Medication Information  Unavailable: This encounter predates the concise medication summary feature. To view this encounter's medications you will need to open the encounter.