Age: 71.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Paracentesis, Pleural effusion, Portal hypertension, Procedural pain, Protein urine present
Clinical narrative: Provider summary "71 YO year old male with past medical history of CAD s/p RCA stent placement 5/2019, Dilated Cardiomyopathy, Hx of Cardiorenal syndrome, PHTN, IDA, T2DM, Alcohol abuse, Tobacco abuse, Insomnia, CKD3b, HLD, HTN, COPD presenting to Hospital with complaint of SOB, bilateral edema, abdominal distension. Patient started to have shortness of breath 2 weeks ago, both at rest and on exertion. Patient also c/o non-productive, cough, increase abdominal girth, bilateral leg edema.  Patient had extensive hx of CAD, dilated cardiomyopathy with LVEF 37% due severe alcohol abuse.  Patient haven't seen any cardiologist since his stenting procedure 2019. Patient was hospitalized 10/13-10/22/21 due to BRBPR with 4 U PRBC transfusion, colonoscopy revealed diverticulosis without active bleeding. He also did have a paracentesis and thoracentesis during this admission with fluid studies indicating portal hypertension and transudative. Lisinopril discontinued at that hospitalization. Patient has sick contact of his step son, who tested positive for COVID-19. Patient is vaccinated. Patient had a smoking history with 1 PPD for 50 years, quit 2016. Also had heavy drinking hx with 8-12 beers/day for 52 years. Patient stated he quit after cardiac stenting 2 years ago, and drink only 1 beer occasionally.    In ED, RR 22, BP 181/97, Saturation 86%, put on 2L NC saturation 96%. Hgb 9.1, BUN 32, Cr. 1.7, K 5.4 hemolysed, HCO3 19, Albumin 3.2, BNP 33536,  UA protein 300, 6 hyaline case, Troponin 103-- >101, COVID-19 positive. BCx pending. EKG ST depressions in 1, aVL seen on previous. CXR shows stable right side effusion and cardiomegaly. Patient performed 150 mL paracentesis, resulted transudative fluid. Patient was given Lasix 60 mg IV, ceftriaxone, patient will be admitted for further management.    Upon admission, patient was treated with IV lasix 80 mg BID, fluid restriction. Patient's fluid balance -2100 throughout stay. Patient's bilateral LE edema improved significantly. Patient was then switched back to oral Lasix 80 mg bid and add lisinopril for better renal protection. Patient continues to need 2L NC oxygen possibly multifactorial to pleural fluid and ascites and COVID-19. Patient underwent paracentesis 12/8, removed 3L clear ascites which tested transudate, cultures pending. Today 12/9, patient underwent thoracentesis, 1.3 L clear fluid removed, transudate, culture pending. Patient expressed chest pain during the procedure, procedure stopped immediately.  Post-procedure US shows 1L fluid remains in the chest, but no signs of pneumothorax. STAT CXR ordered interval decrease and moderate right pleural effusion. Atelectasis or infiltrate at the right lung base. No pneumothorax. Thoracentesis in previous thoracentesis noted to also have chest pain with exact 1.3L fluid removal which rises suspicion of trapped lung.  CT angio 10/13/21: Right hilar mass versus adenopathy, moderate pleural effusion. Pulmonology consulted on 10/21/21, recs Annually LDCT. CT thorax 10/21/21: Moderately sized partially loculated right pleural effusion has mildly diminished in volume.   Patient will be discharged home with 2L oxygen and referral to cardiothoracic surgery to discuss about the potential candidacy of VATS to break loculation and diaphragm patching. Also follow up with Cardiology to optimize CHF management for potential SGLT-2, AICD. Follow up with pulmonology regarding the loculated pleural space. Patient will follow up with PCP closely, patient notified with strict return policy.   "