Age: 20.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Painful respiration, Pyrexia, SARS-CoV-2 test negative, Tobacco user, Troponin increased
Clinical narrative: Please see attached file. Physician Addendum, Specialty: Internal Medicine Cardiovascular Disease, Date of Service: 5/4/2021 10:08 AM, INPATIENT DISCHARGE SUMMARY, Admission Date: 5/3/2021, Discharge Date: 5/4/2021, HOSPITAL SUMMARY, Discharge Diagnosis, Principal Problem: Other acute myocarditis, Active Problems: Chest pain, Tobacco use, Resolved Problems: * No resolved hospital problems. * Reason for Hospitalization, Acute myocarditis after COVID vaccination, Hospital Course - Patient is a very pleasant 20-year-old man without prior medical history who was transferred here from emergency department for further management of chest pain. Patient received his second COVID-19 vaccination on Friday, April 30, 2021 (Pfizer). Later in the evening on Friday, he developed constitutional symptoms, including fever/chills/sweats as well as severe back pain. These symptoms subsided by the following morning but later in the day on May 1, 2021, he developed significant substernal chest pain. The chest pain persisted throughout the weekend. It was worse when he took a deep breath in and also had a positional component. He identified no other aggravating or alleviating factors. When his pain had not resolved, he presented to the emergency department early in the morning on May 3, 2021. On arrival to the outside hospital emergency department, his electrocardiogram was unremarkable, aside from early repolarization abnormality. His troponin was significantly elevated to 7.3. His COVID test was negative. All other lab work was unremarkable, including an undetectable D-dimer. He was transferred here for further management of chest pain and troponin elevation. On arrival here, we completed a CT coronary angiogram, which showed no evidence for coronary stenosis and normal origin of the coronary arteries from the aortic root. An echocardiogram showed preserved left ventricular systolic function and no valvular heart disease. It was, overall, an unremarkable echocardiogram. His troponin was trended and peaked at 7.3. A follow-up troponin after that was 6.4. His presentation is presumed to be related to acute myocarditis secondary to the COVID vaccination. We are obtaining a cardiac MRI as an outpatient on May 4, 2021 (the day after discharge). He will be provided with a one-month supply of colchicine, which he will take daily. We attempted to start him on both Toprol XL and losartan, but we had to discontinue the Toprol XL due to bradycardia (heart rates in the 40-to-50 beats per minute range, increasing only up to 60 beats per minute with activity). He will, therefore, be discharged only on losartan. We will plan to obtain a repeat cardiac MRI in 3-6 months. If that study is favorable, the losartan could be discontinued. Finally, patient had a trip planned with his family to celebrate his 21st birthday in the near future. This trip would obviously involve heavy alcohol consumption. Because alcohol is a cardiotoxin, I advised against such a trip until he has more time to recover from his myocarditis (I also reminded him that heavy alcohol consumption in general is not advised). I provided him a letter that they can use as they cancel their travel plans and seek reimbursement. DISCHARGE EXAM - Admission Weight: Weight: 66.8 kg (147 lb 3.2 oz), Discharge Weight: Weight: 66 kg (145 lb 9.6 oz); Physical Exam: BP 102/65 (BP position: Lying) | Pulse (!) 47 | Temp 98.7 degrees F (37.1 degrees C) | Resp 16 | Ht 175.3 cm (69") | Wt 66 kg (145 lb 9.6 oz) | SpO2 99% | BMI 21.50 kg/m2; GENERAL: well developed, well nourished, in no apparent distress, appears stated age; CHEST: breath sounds are symmetric & normal, no rales or rhonchi; CARDIOVASCULAR: normal rate and rhythm with S1 and S2, there is no S3 or S4 noted, no murmurs or gallops; HEAD: normocephalic, atraumatic; EYES: EOMI, conjunctivae pink, scleral nonicteric; NECK: veins are flat, no bruits, no thyromegaly; LYMPH: no cervical adenopathy; ABDOMEN: no tenderness, masses or hepatosplenomegaly; EXTREMITIES: no edema, cyanosis or clubbing, good distal pulses upper & lower extremities bilaterally; MUSCULOSKELETAL: joints and gait normal; SKIN: warm and dry, normal color, no rashes or lesions; NEURO: awake, alert & oriented; PSYCH: mood pleasant, affect appropriate; Physical Condition at Discharge - Patient's condition is good . Patient was seen by me on the day of discharge. Consultants - None; Procedures performed - See Hospital Course. Pertinent imaging - See hospital course. Test Results Pending at Discharge - Unresulted Labs, No orders found from 4/20/2021 to 5/5/2021. Unresulted Pathology, No orders found from 4/20/2021 to 5/5/2021. Unresulted Imaging, No orders found from 4/20/2021 to 5/5/2021.