Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Pulmonary valve incompetence, Tricuspid valve incompetence, Troponin normal, Ventricular hypertrophy, Ventricular tachycardia
Clinical narrative: ED to Hosp-Admission Discharged   8/12/2022 - 8/13/2022 (27 hours) HOSPITAL  MD  Last attending ? Treatment team Atypical chest pain  Principal problem   Discharge Summary RN (Registered Nurse)  Pt D/C per orders, new medication education provided by this nurse and verbalized understanding. PT left floor walking with no acute distress noted.    Discharge Summary MD (Physician) ? ? Hospitalist  Discharge Summary   Age: 70 y.o. Admit Date: 8/12/2022 11:18 AM Discharge Date: 08/13/22 Hospitalist Physician: DO   Discharge Diagnosis: Principal Problem:   Atypical chest pain Active Problems:   Type 2 diabetes mellitus without complication, with long-term current use of insulin   Hyperlipidemia associated with type 2 diabetes mellitus   NSVT (nonsustained ventricular tachycardia)   COVID-19   Essential hypertension     Consults:   IP CONSULT TO CARDIOLOGY     Subjective (08/13/22): Pt feeling better this AM. Anxious about stress test results. States he would like to be able to make his daughter's birthday dinner today. Denied CP/Palpiations/SOB/N/V/D   Hospital Course: (8/12/2022-08/13/22)  Patient admitted for atypical chest pain workup. Patient has history of palpitations/lightheadedness secondary to nonsustained ventricular tachycardia. Home medications including flecainide and atenolol 12.5 mg. Troponin is negative ×2. TTE showed left ventricular ejection fraction of 59% with normal ventricular wall motion. Normal left ventricular diastolic function was also noted. Patient underwent a cardiac stress test as well which show ejection fraction of 52% with no signs of ischemia. This was a normal study. Patient's home atenolol will be increased to 25 mg daily for his nonsustained ventricular tachycardia which thought to be contributing to his palpitations and symptoms. He is to follow-up with his primary care provider and cardiologist. He is now stable for discharge with close follow-up.       Physical Exam (08/13/22): General: Alert; NAD; pleasant HEENT: NCAT CVS: Regular rate; irregular rhythm; no pathological murmurs noted RESP: CTA b/l; No wheezes, rhonci, or rales ABD: Soft, Nontender, Nondistended SKIN: No jaundice EXT: No pitting edema MSK: No deformity NEURO: Alert; No focal deficits PSYCH: Cooperative; appropriate mood and affect          Diagnostic Studies:    Transthoracic Echocardiogram   Result Date: 8/13/2022 Aortic Valve The aortic valve has mild sclerosis. The aortic valve opens well. No aortic regurgitation is present. No aortic stenosis Atria The left atrial volume index is 'normal (16-34 ml/m2).'. Right atrial size is normal. The interatrial septum is intact with no evidence for an atrial septal defect. Diastology Spectral Doppler of the mitral valve shows a normal E/A wave ratio. A variety of Doppler measurements indicate normal left ventricular diastolic function. Great Vessels The aortic root is normal size. The aorta at the Sinuses of Valsalva is '3.2' cm in diameter. The ascending aorta is '3.4' cm in diameter, at the maximal visualized area. The inferior vena cava appeared normal (<2.1 cm) and decreased > 50% with respiration (RAP 0-5 mmHg). Estimated RAP of 3 mmHg. Left Ventricle The left ventricular end-diastolic dimension is 'normal for men (4.2-5.8cm).'. The relative wall thickness is >0.42 (increased). There is borderline concentric left ventricular hypertrophy. Left ventricular ejection fraction is '55%-60%' based on biplane method. Left ventricular ejection fraction derived by 3DE '59' %. The left ventricular wall motion is normal. Mitral Valve The mitral valve is grossly normal. There is no mitral valve stenosis. There is trace mitral regurgitation. Pericardium/Pleural There is no pericardial effusion. There is no pleural effusion. Procedure The exam was of adequate technical quality. Complete  2D MMode  echocardiogram. Complete spectral Doppler interrogation Color flow velocity mapping. Exam  was performed on 'EPIQ' Examination was completed  in the patients room. Pulmonic Valve The pulmonic valve is not well visualized. The pulmonic valve is not well seen, but is grossly normal. There is no pulmonic valvular stenosis. Trace pulmonic valvular regurgitation. Right Ventricle The right ventricle is normal size. The right ventricular systolic function is normal. The estimated global right ventricular systolic function based upon the tricuspid annular plane of systolic exursion (TAPSE) is 'normal >17mm.' The estimated global right ventricular systolic function based upon the TDE maximal myocardial systolic velocity S' is 'normal >10 cm/s.' Tricuspid Valve The tricuspid valve is grossly normal. There is no tricuspid stenosis. There is trace tricuspid regurgitation. MMode 2D Measurements & Calculations Doppler Measurements & Calculations   Z-Scores(Vital Signs) Classic Z-Scores(Vital Signs)   Z-Scores(Vital Signs) Other Measurements & Calculations Conclusion Left ventricular ejection fraction derived by 3DE '59' %. The left ventricular wall motion is normal. There is trace tricuspid regurgitation. Trace pulmonic valvular regurgitation. A variety of Doppler measurements indicate normal left ventricular diastolic function. There is trace mitral regurgitation.    Stress Test, Pharmacological,w/Myoview (Lexiscan 0.4 mg IV x 1)   Result Date: 8/13/2022 ECG SB, NSSTTWC Non-diagnostic Lexiscan stress test. Left Ventricle The LV EF is calculated at 52% Procedure The patient was given 0.4 mg  IV of Lexiscan per protocol. There are no significant ST segment changes throughout the injection or recovery period. The patient tolerated the procedure well lexiscan myoview 1 day Lexiscan Nuclear Stress Test Rest Injection Patient was injected with 9.99mCi of tetrofosmin IV at rest Risk Factors DM, HTN, HLD Stress Findings VENTRICULAR PREMATURE BEATS ISOLATED No ischemic ST changes during the stress test. Stress Injection An additional 29.99 mCi of tetrofosmin IV was injected at peak exercise Stress Supervision Provider:  APRN MMode 2D Measurements & Calculations Boston Z-Scores(Vital Signs) Other Measurements & Calculations Conclusion The LV EF is calculated at 52% normal study    XR Portable Chest   Result Date: 8/12/2022                         Medical Center  Radiology  PATIENT NAME:                       MR#:   PROCEDURE DATE:  08/12/2022                       ACCOUNT#:  ACCESSION #:  ROOM#:  ORDERING PHYS:  MD  Chest pain  Chest one-view  Findings:  Less than optimally inflated lungs without infiltrate or effusion. Cardiac size within normal.  IMPRESSION:  No acute cardiopulmonary finding.               THIS IS AN ELECTRONICALLY VERIFIED REPORT             8/12/2022 12:23 PM:  MD, MD:  08/12/2022:  08/12/2022 JOB #:  Radiology Page 1    of   1                                                          COPY         ED to Hosp-Admission Discharged   8/12/2022 - 8/13/2022 (27 hours) HOSPITAL  MD  Last attending ? Treatment team Atypical chest pain  Principal problem   Discharge Summary RN (Registered Nurse)  Pt D/C per orders, new medication education provided by this nurse and verbalized understanding. PT left floor walking with no acute distress noted.    Discharge Summary MD (Physician) ? ? Hospitalist  Discharge Summary   Patient ID: MRN:  Name:  Age: 70 y.o. Birthday:   Admit Date: 8/12/2022 11:18 AM Discharge Date: 08/13/22 Unit:  Hospitalist Physician: DO   Discharge Diagnosis: Principal Problem:   Atypical chest pain Active Problems:   Type 2 diabetes mellitus without complication, with long-term current use of insulin   Hyperlipidemia associated with type 2 diabetes mellitus   NSVT (nonsustained ventricular tachycardia)   COVID-19   Essential hypertension     Consults:   IP CONSULT TO CARDIOLOGY     Subjective (08/13/22): Pt feeling better this AM. Anxious about stress test results. States he would like to be able to make his daughter's birthday dinner today. Denied CP/Palpiations/SOB/N/V/D   Hospital Course: (8/12/2022-08/13/22)  Patient admitted for atypical chest pain workup. Patient has history of palpitations/lightheadedness secondary to nonsustained ventricular tachycardia. Home medications including flecainide and atenolol 12.5 mg. Troponin is negative ×2. TTE showed left ventricular ejection fraction of 59% with normal ventricular wall motion. Normal left ventricular diastolic function was also noted. Patient underwent a cardiac stress test as well which show ejection fraction of 52% with no signs of ischemia. This was a normal study. Patient's home atenolol will be increased to 25 mg daily for his nonsustained ventricular tachycardia which thought to be contributing to his palpitations and symptoms. He is to follow-up with his primary care provider and cardiologist. He is now stable for discharge with close follow-up.       Physical Exam (08/13/22): General: Alert; NAD; pleasant HEENT: NCAT CVS: Regular rate; irregular rhythm; no pathological murmurs noted RESP: CTA b/l; No wheezes, rhonci, or rales ABD: Soft, Nontender, Nondistended SKIN: No jaundice EXT: No pitting edema MSK: No deformity NEURO: Alert; No focal deficits PSYCH: Cooperative; appropriate mood and affect          Diagnostic Studies:    Transthoracic Echocardiogram   Result Date: 8/13/2022 Aortic Valve The aortic valve has mild sclerosis. The aortic valve opens well. No aortic regurgitation is present. No aortic stenosis Atria The left atrial volume index is 'normal (16-34 ml/m2).'. Right atrial size is normal. The interatrial septum is intact with no evidence for an atrial septal defect. Diastology Spectral Doppler of the mitral valve shows a normal E/A wave ratio. A variety of Doppler measurements indicate normal left ventricular diastolic function. Great Vessels The aortic root is normal size. The aorta at the Sinuses of Valsalva is '3.2' cm in diameter. The ascending aorta is '3.4' cm in diameter, at the maximal visualized area. The inferior vena cava appeared normal (<2.1 cm) and decreased > 50% with respiration (RAP 0-5 mmHg). Estimated RAP of 3 mmHg. Left Ventricle The left ventricular end-diastolic dimension is 'normal for men (4.2-5.8cm).'. The relative wall thickness is >0.42 (increased). There is borderline concentric left ventricular hypertrophy. Left ventricular ejection fraction is '55%-60%' based on biplane method. Left ventricular ejection fraction derived by 3DE '59' %. The left ventricular wall motion is normal. Mitral Valve The mitral valve is grossly normal. There is no mitral valve stenosis. There is trace mitral regurgitation. Pericardium/Pleural There is no pericardial effusion. There is no pleural effusion. Procedure The exam was of adequate technical quality. Complete  2D MMode  echocardiogram. Complete spectral Doppler interrogation Color flow velocity mapping. Exam  was performed on 'EPIQ' Examination was completed  in the patients room. Pulmonic Valve The pulmonic valve is not well visualized. The pulmonic valve is not well seen, but is grossly normal. There is no pulmonic valvular stenosis. Trace pulmonic valvular regurgitation. Right Ventricle The right ventricle is normal size. The right ventricular systolic function is normal. The estimated global right ventricular systolic function based upon the tricuspid annular plane of systolic exursion (TAPSE) is 'normal >17mm.' The estimated global right ventricular systolic function based upon the TDE maximal myocardial systolic velocity S' is 'normal >10 cm/s.' Tricuspid Valve The tricuspid valve is grossly normal. There is no tricuspid stenosis. There is trace tricuspid regurgitation. MMode 2D Measurements & Calculations Doppler Measurements & Calculations Z-Scores(Vital Signs) Classic Z-Scores(Vital Signs) Z-Scores(Vital Signs) Other Measurements & Calculations Conclusion Left ventricular ejection fraction derived by 3DE '59' %. The left ventricular wall motion is normal. There is trace tricuspid regurgitation. Trace pulmonic valvular regurgitation. A variety of Doppler measurements indicate normal left ventricular diastolic function. There is trace mitral regurgitation.    Stress Test, Pharmacological,w/Myoview (Lexiscan 0.4 mg IV x 1)   Result Date: 8/13/2022 ECG SB, NSSTTWC Non-diagnostic Lexiscan stress test. Left Ventricle The LV EF is calculated at 52% Procedure The patient was given 0.4 mg  IV of Lexiscan per protocol. There are no significant ST segment changes throughout the injection or recovery period. The patient tolerated the procedure well lexiscan myoview 1 day Lexiscan Nuclear Stress Test Rest Injection Patient was injected with 9.99mCi of tetrofosmin IV at rest Risk Factors DM, HTN, HLD Stress Findings VENTRICULAR PREMATURE BEATS ISOLATED No ischemic ST changes during the stress test. Stress Injection An additional 29.99 mCi of tetrofosmin IV was injected at peak exercise Stress Supervision Provider:  APRN MMode 2D Measurements & Calculations Boston Z-Scores(Vital Signs) Other Measurements & Calculations Conclusion The LV EF is calculated at 52% normal study    XR Portable Chest   Result Date: 8/12/2022                         Medical Center                                                                   Radiology  PATIENT NAME:                       MR#:  PROCEDURE DATE:  08/12/2022                       ACCOUNT#:  ACCESSION #:  ROOM#:  ORDERING PHYS:   MD  Chest pain  Chest one-view  Findings:  Less than optimally inflated lungs without infiltrate or effusion. Cardiac size within normal.  IMPRESSION:  No acute cardiopulmonary finding.               THIS IS AN ELECTRONICALLY VERIFIED REPORT             8/12/2022 12:23 PM:   MD, MD:  08/12/2022:  08/12/2022 JOB #:   Radiology Page 1    of   1                                                          COPY