Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, Cardiac failure, Cardiomegaly, Chest X-ray abnormal
Clinical narrative: Date of Admission  01/25/2022   Date of Discharge  01/28/2022   Reason for Hospitalization   Pt to ED for nonproductive cough and SOB x6 days.  Hospital Course   Patient is a 69 year old female with medical history of hypertension, concentric LVH with dynamic LVOT gradient, hypothyroidism who presents to the emergency department with cough and shortness of breath of 1 week duration. She was noted to be COVID positive 1/25. She also had signs of heart failure exacerbation on admission with CXR revealing bilateral interstitial edema and cardiomegaly. She was in AHRF requiring bipap. She received IV Lasix and initially was placed on a nitroglycerin drip. She responded very well to Lasix diuresis and was weened down to room air with improved feelings of dyspnea and improved functional status. A TTE was obtained revealing EF 55%, no regional wall motion abnormalities, severe LVH with apical sparing concerning for cardiac amyloidosis. A cardiac MRI was completed to further evaluate this amyloidosis, results are pending at the time of discharge. The patient was instructed to follow up in cardiology clinic for further management of possible cardiac amyloidosis. Otherwise she was transitioned to PO Lasix 40 mg daily, which she will continue at discharge. For her COVID, she was given PRN benzonatate for cough and acetaminophen for myalgias. Held off on starting high intensity statin in the setting of myalgias, consider in the outpatient setting. Follow up with cardiology and PCP.   Acute Hypoxic Respiratory Failure- resolved COVID + (1/25)  -s/p Bipap, improved resp status with IV Lasix  - likely 2/2 HF exacerbation vs less likely COVID  - PRN benzonatate for cough  - PRN acetaminophen for myalgias  - diuresis as below   HFpEF exacerbation LVH with apical sparing-  concerning for cardiac amyloidosis  Hypertension  - Continue Lasix 40 PO qday  - Lisinopril 20mg daily  - Metoprolol succinate 25 mg qday   - TTE: EF 55%, no regional wall motion abnormalities, severe LVH with apical sparing concerning for cardiac amyloidosis  - Cardiac MRI pending  - Patient will need f/u in cardiology clinic to further workup cardiac amyloid   Elevated ASCVD  - start high intensity statin when myalgias improve  Discharge Diagnoses      Hypoxia   Pulmonary edema   Heart Failure Exacerbation  Hypertension LVH with apical sparing-  concerning for cardiac amyloidosis  COVID positive state  Other Diagnoses   Ongoing  Abnormal echocardiogram  Anxiety  Benign essential hypertension  BMI 30.0-30.9,adult  Cervical paraspinous muscle spasm  Cervical radicular pain  Chronic migraine without aura  Degenerative arthritis  Degenerative cervical disc  Depression  HTN (hypertension)  Knee pain  Language barrier  Lower extremity edema  Neck pain  Obesity  Osteoarthritis of left glenohumeral joint  Scapular dyskinesis  Shoulder pain  Stenosis of cervical spine with myelopathy  Historical  Pancreatitis, acute  Peptic ulcer disease        Discharge Disposition  Home    Medications  New, Changed, or Refilled Medications  acetaminophen (acetaminophen 500 mg) 1,000 mg, 2 Tablet(s), Oral, q6h, PRN: as needed for pain, 50 Tablet(s), 0 Refill(s)    benzonatate (benzonatate 100 mg) 100 mg, 1 capsule(s), Oral, tid, PRN: Cough, 30 capsule(s), 0 Refill(s)    furosemide (Lasix 40 mg) 40 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 0 Refill(s)    lisinopril (lisinopril 20 mg) 20 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 0 Refill(s)    metoprolol (Metoprolol Succinate ER 25 mg , extended relea 25 mg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 0 Refill(s)      Medications to be Continued  DULoxetine (Cymbalta 30 mg oral delayed release capsule) 30 mg, 1 capsule(s), Oral, bid, Take 1 cap bid. May cause sedation., 60 capsule(s), 2 Refill(s)  Instructions:Take 1 cap bid. May cause sedation.  baclofen (baclofen 10 mg) 10 mg, 1 Tablet(s), Oral, bid, PRN: Muscle Spasm    cholecalciferol (Vitamin D3 1250 mcg (50,000 intl units)) 1,250 mcg, 1 capsule(s), Oral, qWeek, 5 capsule(s), 0 Refill(s)    diclofenac topical (diclofenac 1% topical gel) 2 g, Topical, qid    diphenhydrAMINE-zinc acetate topical (Benadryl Extra Stren See Instructions, Topical as needed at Emgality injection site, 14 g, 0 Refill(s)  Instructions:Topical as needed at Emgality injection site  gabapentin (gabapentin 300 mg) 600 mg, 2 capsule(s), Oral, tid, for 30 day(s), 180 capsule(s), 5 Refill(s)    galcanezumab (Emgality Prefilled Pen 120 mg/mL subcutaneou 120 mg, Subcutaneous, qMonth, for 30 day(s), 1 Each, 11 Refill(s)    ibandronate (ibandronate 150 mg) 150 mg, 1 Tablet(s), Oral, qMonth    levothyroxine (Synthroid 50 mcg (0.05 mg)) 50 mcg, 1 Tablet(s), Oral, Daily, 30 Tablet(s), 4 Refill(s)    omeprazole (omeprazole 40 mg oral delayed release capsule) 40 mg, 1 capsule(s), Oral, bid, for 90 day(s), 180 capsule(s), 3 Refill(s)    teriparatide (Forteo 620 mcg/2.48 mL subcutaneous solution 20 mcg, Subcutaneous, Daily, 1 Each, 11 Refill(s)    topiramate (topiramate 25 mg) 50 mg, 2 Tablet(s), Oral, bid    traMADol (traMADol 50 mg) 50 mg, 1 Tablet(s), Oral, tid, PRN: as needed for pain      Discontinued Medications  carvedilol (carvedilol 6.25 mg) 6.25 mg, 1 Tablet(s), Oral, bid, 60 Tablet(s), 3 Refill(s)       Physical Exam at Discharge  Vitals & Measurements  T: 36.5 °C  TMIN: 36.5 °C  TMAX: 37 °C  HR: 77  RR: 15  BP: 128/68  SpO2: 98%  WT: 77.2 kg  BMI: 31.3      General: a well appearing female in no acute distress  HEENT: no icterus, no conjunctivitis, hearing grossly normal  Cardiovascular: Normal S1 and S2 with normal rate and rhythm.  No murmurs, rubs or gallops are heard.  Pulmonary: Lungs are clear to auscultation in all lung fields without crackles or wheezes.  GI:  Abdomen is soft and non-tender with normal bowel sounds.  Musculoskeletal:  Normal strength throughout.  No deformity.  Neuro:  EOM intact.  Able to move all extremities spontaneously.  Psychiatric: Appropriate mood and affect.  Follow Up Appointments     Follow Up Appt Family Medicine, Clinic Name/Phone: Provider Name: MD, Within 7 Days, No tests   Follow Up Appt Cardiology, Clinic Name/Phone: Provider Name: NO , PREFERENCE, Within 14 Days, No tests, Reason for Follow Up Clin f/u HF and c/f cardiac amyloid    Appointment Type  When  With  Where  Contact Information  Status   02/08/2022 08:30 AM CST MD, Ophthalmology   02/15/2022 09:15 AM CST MD, Spine   03/10/2022 08:40 AM CST FNP, Bone Health   03/17/2022 08:30 AM CDT PA, Interventional Pain    03/29/2022 08:40 AM CDT AHCNS, Neurology   GI Lab 04/27/2022 10:20 AM CDT MD, Digestive Health    Nursing/Other Orders   Heart Healthy (4gm NA, low fat). Ordered on 01/25/22 23:49:00 CST, Meal Start Time Supper 1615 to 1745, Diet Modifications Sodium, 2 gram, Fluid Restriction 2000 ml =  960ml Kitchen/1040ml Nsg   Intake and Output (I&O). 01/25/22 23:49:00 CST, Continuous Order, total every 24 hours   Activity As Tolerated. 01/25/22 23:49:00 CST, Continuous Order, Advance as tolerated   Code Status. Code Status Description: Full Code     Addendum by MD, on January 28, 2022 14:20:11 CST (Verified) I performed the history and examination of the patient and discussed the patient?s management with the resident 1/28/2022. I reviewed the note by the resident and agree with those documented findings and plan of