Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Heart rate decreased, Lung opacity, Procalcitonin increased, SARS-CoV-2 test positive, Small airways disease
Clinical narrative: Discharge Provider: MD Primary Care Provider: PA Admission Date: 9/26/2022 Discharge Date: Sep 30, 2022  PRESENTING PROBLEM: Shortness of breath [R06.02] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 60 year old male with past medical history of AFib on Eliquis, heart failure preserved ejection fraction, history of severe aortic stenosis status post valve replacement, right bundle-branch block, non-insulin-dependent type 2 diabetes with neuropathy, anxiety/depression, physical deconditioning secondary to peri-prostatic hip fracture who presented to the hospital complaining shortness of breath for 1 week.   In the ER, patient was found new have low heart rate 42, need oxygen 4 L O2 initially.  White count 12.7.  Found to be COVID positive.  CT angiogram was performed rule out thrombotic disease.  CT came back negative for pulmonary embolism but showed showed multifocal patchy central lobular nodules with surrounding ill-defined ground-glass throughout the lungs, most suggestive of small airway infection, a few larger solid nodules at the right lung apex, short-term posttreatment noncontrast CT chest is recommended to ensure expected improvement.  EKG with QTC greater than 500 milliseconds and right bundle blanch block.  He was admitted to the hospital for acute hypoxic respiratory failure secondary to COVID pneumonia.   After admission, patient was started on dexamethasone and remdesivir.  He complained about shortness of breath preceding COVID diagnosis.  Did consult pulmonology who recommended continue with current care of steroids and remdesivir.  Pulmonology also recommend checking sputum culture and procalcitonin level.  Procalcitonin level came back elevated 0.3 and sputum culture came back showing Gram-positive cocci in chains/pairs.  Was started on antibiotics for pneumonia.  MRSA screen collected and ID consulted.  Sputum culture finalized as normal flora.  MRSA screen came back negative.  Id recommended stopping antibiotics.    In terms of low heart rate, heart medications Cardizem and beta-blocker were held and Cardiology was consulted.  Initially Hospital consult but patient follows with provider for his history of aortic valve replacement and therefore was admission cardiology was consulted as patient continues to want to follow with provider after discharge.  Heart rate did improve after holding of his heart medications.  Echo was performed showing normal ejection fraction, no wall motion abnormalities. Losartan 100 mg daily was added for BP control.  Also, added amoldipine 5 mg daily and lopressor 12.5 two times daily for ectopy on tele.    Patient weaned to 2L o2 at discharge at night.  Set up with home O2 at night by rehab.  PT saw him and recommend outpatient PT.   Did send with 5 more days of steroids for covid.    2 week Zio placed at discharge per Cardiology recs. Could also consider nuclear stress outpatient once convalesced from COVID. Hospital said would defer to patient's primary cardiologist.