Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Blood potassium decreased, COVID-19, Cardiac monitoring, Chronic kidney disease, Condition aggravated
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: MD  Admission Date: 5/30/2022 Discharge Date: 6/3/2022   DISCHARGE DIAGNOSES: 1. Sepsis due to bilateral, bacterial community-acquired pneumonia 2. COVID-19 infection 3. New onset atrial fibrillation 4. Hypokinesis of basal to mid inferior wall of left ventricle 5. Benign essential hypertension 6. Hyperlipidemia 7. Type 2 diabetes mellitus 8. Hypokalemia 9. GERD 10. Hypothyroidism 11. Stage 3a CKD    HOSPITAL COURSE: Patient is a 62-year-old male with history of hypertension, hyperlipidemia, type 2 diabetes mellitus, GERD, hypothyroidism and stage 3a CKD who presented to the ED with worsening shortness of breath.  He had recently traveled for a 2 week trip, and after returning home, developed upper respiratory symptoms and tested positive for COVID-19 on a home test.  He was seen by his PCP, who prescribed him Paxil that at that time.  Beginning on 05/28, he developed low-grade fevers, worsening shortness of breath and dry cough.  Due to worsening symptoms, he presented to the emergency department for further evaluation.  In the emergency department, he was tachycardic and found to be in new onset atrial fibrillation.  Troponins were elevated at 89 and 87, respectively.  Labs revealed a potassium of 3.1, creatinine 1.51 and WBC count 17.7.  EKG was done in the emergency department, and confirmed atrial fibrillation.  CTA thorax with contrast showed bilateral lung consolidation, worse at the right than left, suspicious for infectious pneumonia.  He was given potassium and IV Rocephin in the emergency department, and admitted to the hospitalist service for further care.   Upon admission, the patient remained stable on room air.  He was continued on IV Rocephin and continued on oral minocycline for suspected community-acquired pneumonia.  Blood cultures have remained negative, and patient was unable to produce sputum for sputum culture.  I did add prednisone 30 mg daily due to ongoing dyspnea, which did provide symptomatic benefit.  He will complete a 5 day course of antibiotic, with transition to Ceftin at discharge.  He will be placed on 3 more days of prednisone at discharge, for a total of 5 days.   For his atrial fibrillation, he was started on Eliquis 5 mg twice daily and Cardizem 30 mg four times daily.  Cardizem was transition to Cardizem CD 120 mg daily by time of discharge.  He did convert out of atrial fibrillation to normal sinus rhythm prior to discharge.  An echocardiogram was performed during hospitalization, which revealed an ejection fraction of 52% with evidence of hypokinesis involving the basal to mid inferior wall.  Given wall motion abnormalities, Cardiology was consulted.  They recommended continued rate control with Cardizem and anticoagulation with Eliquis.  They recommend outpatient cardiac MRI and 14 day cardiac monitor at discharge.   He was felt stable for discharge home on 06/03/2022.  He should follow-up with his PCP in 1 week.  He should follow-up with Cardiology in 2 weeks.  ZIO patch was placed prior to discharge.  He will be continued on Eliquis 5 mg twice daily and Cardizem CD 120 mg daily at discharge.  Amlodipine to be discontinued.  Will defer timing of cardiac MRI to Cardiology in the outpatient setting.  He will be placed on 2 days of Ceftin and 3 days of prednisone at discharge to complete 5 days of therapy of each.