Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Protein total normal, Pulmonary hypertension, Red blood cell sedimentation rate normal, Tricuspid valve incompetence, Troponin
Clinical narrative: 40 yo female received initial Moderna injection on 8/27/2021 and within 20 minutes of the vaccine she developed substernal chest pressure and fluttering. She sat in her car for 10-15 minutes then drove herself home. The chest pain and fluttering continued until she took ASA 325mg. She had some residual chest pain and fluttering during the day. When she awoke on 8/28/2021, the chestpain returned as well as mild heart fluttering. She took another ASA 325mg which did reduce the chest pain to dullness. She stayed on ASA 325mg on Sunday 8/29/2021. One Mondy 8/30/2021 when she again awoke with the chest pain/pressure and heat fluttering she went to urgent care. EKG obtained w/o evidence of STT wave changes/EKG WNL. She came into PCP office later that morning on 8/30/2021. History taken, she denied chest wall tenderness, prior URI, heavy lifting or activity in days or week prior to receiving the vaccine. She was started on Colchicine 0.6mg bid.  Telephone f/u call on 8/31/2021 and she was having chest pain and ASA 325mg added to colchicine bid.  Echocardiogram completed 9/2/2021 Telephone f/u call on 9/3/2021 reporting minimal chest pain, continued intermittent fluttering, no fever, chills, dizziness. Case discussed with cardiologist and GXT and Holter Monitor advised F/U OV 9/7/2021 with report of new symptoms of lightheadedness, difficulty in walking up her stairs in her home w/o fatigue, unable to care for her home d/t decreased endurance and symptoms worsened after drinking a few drinks of caffeinated coffee. She was unable to care for herself for the remaining of the day 2/2 presyncopal symptoms, requiring the assistance of her father. She continued with Colchicine 0.6mg now daily and ASA 325mg.  Patients PLOF is living independently, walks on 2miles/day on treadmill and has 2 story home that she is able to clean, care for outside yard and traverse stairs w/o difficulty. Over the course of the last 2 months she was treated with Colchicine and ASA and then changed to Colchicine and ibuprofen and then changed to just Ibuprofen. She has been on limited activity for last 6 weeks.  F/U OV 9/15/2021 noting improvement in the chest pain/pressure/heart fluttering except when first arising int he morning and readying herself for work. She works from home so she was able to rest during the day if needed. She moved all of her daily care and living to the first floor of the home. GXT and Holter monitor obtained 9/17/2021. She was changed to colchicine 0.6mg daily and ibuprofen 600mg daily when cardiologist evaluated her in stress lab on 9/17/2021.   She had short bicycle ride on 9/30/2021 lasting about 15 minutes, no chest pain with activity but within 4 hours she developed excruciating chest pain which she needed to restart Motrin 600mg and rest and continued need for Bedrest for next 24hr. She was still having pain with sitting erect and couldn't work from home for an additional 48 hours.   She completed cardiology evaluation with Dr. on 10/5/2021 and reviewed holter montior, stress test, echocardiogram. She reported her daily activities are getting easier however anytime she goes to exert herself she has severe reporoducible anterior wall chest pain.  F/U OV 10/20/2021: now off of colchicine and using ibuprofen 600mg bid prn.   OV Cardiologist 1/10/2021 which she reported she attempted to start back training for 1/2 marathon and developed chest pain/palpitations. She was advised that she could bike and walk but no running for a full year.  She has now stopped ibuprofen since 10/6/2021 and has no anterior chest/chest wall pain for one week.  CT scan Chest and screening d-dimer ordered and she is concerned about cost of care for this adverse event.