Age: 19.0
Sex: M
Vaccine: ANTH, FLUX, SMALL, ANTH, FLU3, SMALL
Symptoms: Palpitations, Pleurisy, Pulmonary valve incompetence, QRS axis abnormal, QRS axis normal
Clinical narrative: Facility was made aware of this 19 y/o male dx'd w/ "non-ischemic myocarditis" (per discharge summary-28NOV12). Dr. called on 19DEC12, reporting suspect SPV associated myocarditis & inquiring if facility needed to be made aware of this patient. Facility thanked Dr. & explained that, yes, the facility is responsible for eval & ongoing f/u of all patient's who meet diagnostic criteria for SPV associated myopericarditis & are assigned a ID. Facility contacted the patient & scheduled patient for eval by Dr. on 17JAN13. Per facility, patient recv'd primary SPV (LUE), as well as AVA #1 & Seasonal Influenza (IM) in his RUE on 21NOV12 for medical readiness preparation, as part of the Global Response Force (GRF). + HA at 48 hrs s/p immunizations. Detailed history was obtained from patient re adverse event following immunization (AEFI). Medical records of hosp (26-28th NOV 12) at hospital were obtained & reviewed & all pertinent notes since then. Patient was seen at ER (26NOV12, 0756 EST) for new onset exertional, substernal chest pain & pleuritic SOB, made worse with deep breathing, which began that morning (day # 5 s/p SPV), during PT run. Patient reports that about 1.75 miles into the run, he experienced the onset of sharp, squeezing pain in the center of his chest, accompanied by a sensation of cramping in his neck, sweating, dizziness & nausea - "I felt like I was going to pass out." He was immediately transported to ER. Initial EKG / ER (26NOV12, 1157 EST) "abnormal/unconfirmed dx" with "sinus tachycardia, V-rate of 99, a borderline right axis deviation, non-specific T-wave abnormalities- inferior leads, ST elevation" c/w diagnostic criteria for probable myocarditis, per Clinical Guidelines for Post-Smallpox Vaccine Associate Myopericarditis. Repeat EKG ER (26NOV12, 1208 EST) indicated "borderline T abnormalities, inferior leads, ST elevations. Positive troponin I cardiac of 0.037 ng/ml & elevated CK of 364 U/L, further support the diagnostic criteria for SPV Associated MYO, per algorithm. The patient was transferred to another hospital for continued workup. There, he underwent R radial cardiac catheterization which did not reveal any coronary blockage and, per report, did not indicate anomalous origins of the coronary arteries. TTE performed at hospital indicated an LVEF of 40-45% w/o regional wall motion abnormalities w/ no valvular or pericardial pathology. The patient was dx'd w/ nonischemic cardiomyopathy & d/c'd on enalapril 2.5 mg BID, since increased to 5 mg BID & COREG  3.125 mg PO BID, w/ orders to follow up w/ Dr. in the next 4-6 weeks. At Cardiology evaluation(s) w/ Dr. on 10 & 17 DEC 12, Dr. reported that the patient was doing well & denied recurrent chest discomfort, LE swelling, PND, orthopnea, lightheadedness or syncope. However, he did admit to occasional palpitations, which he experiences mostly just before sleep. These palpitations last several minutes & never wake him from his sleep. At initial eval on 17JAN13, the patient reported continued intermittent CP/pressure at hs- 2 days ago (15JAN13), he experienced CP/pressure of "5"/10 at hs, lasting 5-10 secs. He changed position & it went away. He continues to experience intermittent exertional CP & is currently walking at his own pace. His PMH is significant for HTN & a baseline creatinine of 1.3. Surgical Hx: PRK JUN 2012; denies hx of asthma, eczema, lupus or RA. SOC Hx: To TOB, ETOH or illicit drug use; Caffeine use: rare. FH is + for CVD: Mother died at 45 yrs. 'blood vessel heart burst'; Father, 2 Sis & 1 Bro in good health.