Age: 19.0
Sex: M
Vaccine: ANTH, HEPA, SMALL, TYP
Symptoms: Blood alkaline phosphatase normal, Blood bilirubin normal, Blood creatine phosphokinase MB increased, Blood lactic acid, C-reactive protein normal
Clinical narrative: Pt evaluated in ED on 20JAN2018 due to male presents to chest pain. States he woke up that morning and felt fine and then while standing felt a little lightheaded and had acute onset of severe 10 out of 10 chest pain. No similar symptoms in past. No stimulant or supplement use. No recent travel, trauma, or illness. Hx significant for smallpox vaccination along with a series of others on 10JAN2018. ED evaluation significant for rising troponin and elevate CPK-MB. He was transferred to another hospital for further eval. Records currently not available. Pt report that they completed multiple chest ultrasounds, EKG, and CT w/ contrast without any pathological findings. No recommendations for medication or f/u. He was discharged this morning. Reports hasn't had chest pain or dizziness since Sat/Sun. This is a 19yoM otherwise healthy presenting to office for f/u chest pain. Patient presented to the ER 20JAN with non-exertional midsternal chest pain associated with LUE weakness in the setting of recent smallpox vaccination 14d prior. Cardiac w/u was initiated at this time, notable for elevated troponins (1.870, and 90min later, 5.750) and CK-MB (28). The patient was then transferred to another hospital, where he was evaluated with CT Chest with contrast and Echocardiogram, both of which were unremarkable. With resolution of his chest pain (no documented troponins), the patient was discharged 2d later with instructions to follow-up in clinic. Records were not available at this clinic visit and the patient was unfortunately lost to f/u. Since the episode 20JAN, patient reports no further episodes of chest pain or difficulty breathing. He has been PT'ing at his own pace, which includes runs and light weightlifting. He reports no SOB, DOE, edema, or palpitations. Acute myocarditis, unspecified: This is a 19yoM otherwise healthy presenting with episode of chest pain and elevated troponins in the setting of recent smallpox vaccination. Submitted consult prior to appointment, deemed probable Post-smallpox-vaccine-associated myopericarditis. Initiated LIMDU (Patient to PT at own pace and to be non-travel x6mo); forms submitted and patient instructed to report to office at hospital. Will repeat cardiac enzymes (troponin/CK-MB). Obtain baseline ESR/CRP. Include patient in Smallpox Vaccine Myopericarditis Registry for long-term follow up. Submitted VAERS form for Smallpox allergy. Patient to receive temporary deferment for Anthrax, JEV, etc - Referring to Internal Medicine (as no Cardiology on island) for follow-up. Patient to be seen 03-17MAR, then again JUL2018 prior to RTFD. Will leave to Internal Medicine discretion whether patient needs local outpatient Cardiology referral or further risk stratification, like exercise stress testing. Will f/u consult; patient may need medevac to MC for Cardiology evaluation. Case management actively involved and will help coordination of care. RTC for f/u 6wks; patient will need close monitoring to ensure appropriate follow-up care and coordination.