Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Chest pain, Dyspnoea, Echocardiogram normal, Ejection fraction, Nausea
Clinical narrative: Age: 60 y.o. Admit Date: 7/18/2022  9:33 AM Discharge Date:  7/19/2022 Admitting Physician:  Discharge Physician:    Discharge Diagnosis: Principal Problem:   Atypical chest pain Active Problems:   Morbid obesity with BMI of 45.0-49.9, adult   Coronary artery disease involving native coronary artery of native heart with angina pectoris   COVID-19     HPI: Patient is a 60 y.o. female who presents to ED with c/o CP that started as she was getting ready for work. Had sharp pain that radiated into L arm and neck. Associated with nausea and shortness of breath. Was initially severe but improved to dull ache. Other symptoms resolved. Has known h/o CAD on LHC in 2019 but did not need stent. Initial trop negative, admitted for further cardiac evaluation. COVID +, she was treated for a sinus infection 6 days ago, denies any current symptoms. Pt had NM stress test- which is negative - pt is stable for DC     Hospital Course:  Atypical chest pain Description of the Problem/Progression: New Plan: Admit. R/o MI with serial labs. Telemetry. Echo. Cardiology consulted. - no cardiac issue - pt is stable for DC from cardiac sten point stress test - negative    COVID-19- carrier- asymptomatioc  Description of the Problem/Progression: Likely incidental, ?contributing to symptoms Plan: Isolation. Not hypoxic and CXR clear, does not need treatment. Check COVID labs.    Coronary artery disease involving native coronary artery of native heart with angina pectoris Description of the Problem/Progression: chronic   Morbid obesity with BMI of 45.0-49.9, adult Description of the Problem/Progression: chronic    DC home -f/u with PCP as oitpatient    Physical Exam on the Date of Discharge: Constitutional:      Appearance: She is well-developed.  HENT:     Head: Normocephalic.  Eyes:     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Abdominal:     General: Bowel sounds are normal.     Palpations: Abdomen is soft.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Neck supple.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: She is alert and oriented to person, place, and time.         Consults:   CONSULT TO CARDIOLOGY   Significant Diagnostic Studies:      Conclusion The LV EF is calculated at 75% Fixed anteoapical defect Possible breast attenutaion Low risk Stress test     Disposition:  home   Discharge Condition:  good   Discharge Medications and Orders:   Current Discharge Medication List   CONTINUE these medications which have NOT CHANGED   Details busPIRone (BUSPAR) 5 mg tablet Take 1 Tablet by mouth Twice a day. Qty: 180 Tablet, Refills: 1   Associated Diagnoses: Anxiety and depression   Levothyroxine 125 mcg Cap Take 125 mcg by mouth Once Daily. THYROID Qty: 90 Capsule, Refills: 3   Associated Diagnoses: Hypothyroidism due to acquired atrophy of thyroid   buPROPion (WELLBUTRIN) 75 mg tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 1   Associated Diagnoses: Reactive depression   fluticasone propionate (FLONASE ALLERGY RELIEF) 50 mcg/Actuation nasal spray Spray 2 Sprays in nose Once Daily. Qty: 3 Each, Refills: 3   Associated Diagnoses: Seasonal allergies   levocetirizine (XYZAL) 5 mg tablet Take 5 mg by mouth Once Daily. Qty: 90 Tablet, Refills: 1   Associated Diagnoses: Seasonal allergies   semaglutide (OZEMPIC) 0.25 mg/0.2 mL (2 mg/1.5 mL) sub-Q injection Administer 0.4 mL (0.5 mg total) subcutaneously Every week Qty: 12 Each, Refills: 1   Associated Diagnoses: Insulin resistance; Class 3 severe obesity due to excess calories with serious comorbidity and body mass index (BMI) of 45.0 to 49.9 in adult   cyclobenzaprine (FLEXERIL) 10 mg tablet Take 1 Tablet by mouth At bedtime. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Degenerative disc disease, cervical; Cervical radicular pain   amitriptyline (ELAVIL) 50 mg tablet Take 1 Tablet by mouth At bedtime. Indications: 50 mg at bedtime Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Other insomnia; Intractable chronic migraine without aura and without status migrainosus; Neck pain   metoprolol (LOPRESSOR) 25 mg tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Essential hypertension   albuterol (VENTOLIN HFA) 90 mcg/Actuation inhaler Take 2 Puffs by inhalation Every 4 hours as needed. Qty: 3 Each, Refills: 1   Associated Diagnoses: Moderate persistent asthma with exacerbation   potassium chloride (KLOR-CON) 20 mEq tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 1   Associated Diagnoses: Hypokalemia   DULoxetine (CYMBALTA) 60 mg DR capsule Take 2 Caps by mouth Once Daily. DEPRESSION Qty: 180 Capsule, Refills: 3   Associated Diagnoses: Chronic pain syndrome; Reactive depression   torsemide (DEMADEX) 20 mg tablet Take 20 mg by mouth Daily as needed.   aspirin 81 mg chewable tablet Take 81 mg by mouth Daily.   valacyclovir HCl (VALTREX PO) Take  by mouth As needed.   LORATADINE (CLARITIN PO) 10 mg Daily.     STOP taking these medications     predniSONE (DELTASONE) 20 mg tablet Comments:  Reason for Stopping:        cefdinir (OMNICEF) 300 mg capsule Comments:  Reason for Stopping:        fluconazole (DIFLUCAN) 100 mg tablet Comments:  Reason for Stopping:        predniSONE (DELTASONE) 20 mg tablet Comments: