Age: 22.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram normal, Fibrin D dimer increased, Limb discomfort
Clinical narrative: Chest Pain, Myopericarditis; From EPIC: From cardiologist healthy man who comes to the ER with left anterior chest discomfort for the last 36 hours or so.  Symptoms are made worse by deep inspiration.  Were improved following self administration of 600 mg of ibuprofen earlier today.  2 days ago he received his second COVID-19 vaccine (Pfizer).  Following day he experienced arm pain muscular aches and pains severe discomfort of the right arm (injection site) later in the day there was nausea and vomiting on one occasion (nonheme).  By last night he was able to eat dinner but subsequently felt short of breath with worsening chest discomfort morning the left arm continued to ache with musculoskeletal pains.  Developed more discomfort in the left anterior chest radiating to the throat made worse by deep inspiration. Does not describe typical sharp catching pain of pericarditis.  No cough sputum bruising bleeding abdominal pain change in color or character of bowels.  Sign in the emergency room he was hemodynamically stable, in sinus rhythm with a normal EKG.Torrey work-up notable for an initial troponin of 1.28 and a follow-up troponin of 2.14. Chest x-ray perfectly normal. Elevated d-dimer. CT angiography negative for pulmonary embolism vascular injury, cardiomegaly, pericardial effusion but the radiologist did note thickening of several right posterior and lateral axillary lymph nodes raising a question of recent right-sided vaccination or injury/infection to the right arm. Presently he is perfectly comfortable able to take a deep inspiration with mild chest discomfort, breathing easily.  I met him in July 2018He came to the emergency room with a 3-day viral syndrome manifested as headache nausea vomiting diarrhea and abdominal discomfort and then developed chest discomfort.  He was found with diffuse mild J-point elevation on EKG consistent with a viral type pericarditis with troponins which rose to a maximum of 10.4.  Work-up for myocarditis was negative.  Echocardiogram perfectly normal.  Symptoms responded to a course of nonsteroidal anti-inflammatory agents and colchicine.  Seen in follow-up of repeat echocardiogram was perfectly healthy.  Our diagnosis was myopericarditis. There is no history of shortness of breath dyspnea on exertion decrement of exercise capacity peripheral edema orthopnea PND palpitations lightheadedness syncope or collapse.  No ill contacts.  He works in a high security position and therefore qualified for early administration of the Pfizer COVID-19 vaccine.  Graph past medical history notable only for the episode of myopericarditis and a remote tonsillectomy. There is no significant family history of sudden cardiac death or unusual heart disease. He takes no medications. Patient was recommended to take 4 weeks of ibuprofen and colchicine if needed for worsening chest pain.  Patient was recommended to follow-up closely with his primary care doctor and check ESR, C-reactive protein as well as renal function.  Needs close follow-up with cardiology as an outpatient.