Age: 23.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Toxicologic test, Troponin increased, Urine cannabinoids increased, White blood cell disorder
Clinical narrative: 23 yo man in high school when standing, admitted wit acute onset epigastric abdominal pain after a run, found to have mild elevation in troponin, flat at 0.04, dynamic EKG changes admitted or work-up  1. Acute epigastric abdominal pain/elevated troponin: The patient was chest pain free from the time of treatment with Pepcid, magic mouthwash, and Toradol in ED. His echo is without wall motion abnormalities, troponin is flat and remains chest pain free. The patient had a CT PE protocol study and CTA coronary without acute findings. He had a cardiac MRI which showed no acute myocarditis but may have had some delayed contrast enhancement and may represent prior myocarditis. He was started on low dose lisinopril 2.5 mg po daily for cardio-protection, will reduce physical activity with slow return to activity, and follow with cardiology with an urgent exercise stress test as an outpatient. His u tox shows cannabinoids and no other intoxicants, His lipid panel wnl, HDL 65, LDL 84, His TSH is wnl. His CRP and ESR is wnl.    2. Left axillary lymphadenopathy: Discussed with patient lymph nodes seen on CT scan in left axilla and left pectoral region. Patient cofnirmed he had a COVID 19 Moderna vaccine in the left arm on 4/3/2021. Epic documentation notes in the right axilla, but patient is clear that he had the vaccine in the left arm. Axillary lymphadenopathy is not surprising in this situation.   3. Small 4 mm nodules noted on CT scan: The patient had no infectious symptoms, no cough, no fever, and no elevated WBC. He does smoke marijuana but has no tobacco use. He can follow with PCP to further risk stratify the nodules, either with PPD, and consideration of repeat scan in 6-12 months as needed.   4. Mild bilateral gynecomastia: I informed patient this has been found. He is not bothered by this finding and it seems an incidental finding. He can follow with his PCP for further evaluation as needed for this finding.   Inpatient Consultants and summary of recommendations: 1. Seen by Cardiology and CTA coronary followed by MRI and then plan for outpatient exercise stress test planned Discharge vitals:  Temp:  [97.4 °F (36.3 °C)-98.7 °F (37.1 °C)] 97.4 °F (36.3 °C) Pulse:  [55-65] 65 Resp:  [16-18] 17 BP: (108-114)/(61-72) 111/61 SpO2:  [96 %-100 %] 99 % Device (Oxygen Therapy): room air  Pertinent Findings of Physical Exam: as noted in exam  Cognitive Status at Discharge: Baseline Alert and Oriented x 3   Discharge Physical Exam: Physical Exam  Constitutional: He is oriented to person, place, and time. No distress.  Cardiovascular: Normal rate, regular rhythm and normal heart sounds.  Abdominal: Soft. Bowel sounds are normal. He exhibits no distension. There is no abdominal tenderness. There is no rebound and no guarding.  Musculoskeletal: Normal range of motion.        General: No edema.  Neurological: He is alert and oriented to person, place, and time.  Skin: He is not diaphoretic.  Nursing note and vitals reviewed.     Allergies No Known Allergies   PMH PSH Past Medical History No past medical history on file.     Past Surgical History No past surgical history on file.    Social History Family History Social History    Tobacco Use ? Smoking status: Never Smoker ? Smokeless tobacco: Never Used Substance Use Topics ? Alcohol use: Not on file     No family history on file.     Discharge Medications:  Discharge:  Current Discharge Medication List   START taking these medications   Details calcium carbonate (TUMS) 500 mg (200 mg calcium) chewable tablet Take 1 tablet (500 mg total) by mouth daily. Qty: 14 tablet, Refills: 0 Start date: 4/18/2021, End date: 5/2/2021   lisinopriL (PRINIVIL,ZESTRIL) 2.5 mg tablet Take 1 tablet (2.5 mg total) by mouth daily. Qty: 30 tablet, Refills: 0 Start date: 4/20/2021     CONTINUE these medications which have NOT CHANGED   Details emtricitabine-tenofovir, TDF, (TRUVADA) 200-300 mg tablet Take 1 tablet by mouth daily. Qty: 30 tablet, Refills: 0   Associated Diagnoses: Need for prophylaxis against sexually transmitted diseases   clindamycin-benzoyl peroxide (BENZACLIN) 1-5 % gel Apply topically 2 (two) times daily. Qty: 25 g, Refills: 2   Associated Diagnoses: Folliculitis   clindamycin-benzoyl peroxide (DUAC) gel