Age: 82.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Pulmonary hypertension, Red cell distribution width increased, Renal impairment, Respiratory failure, Right ventricular failure
Clinical narrative: Patient with history of COVID vaccines who admitted to hospital with COVID detected PCR.  Provider d/c note:  "84-year-old female with a past medical history significant for atrial fibrillation with RVR currently restarted on Eliquis for 1 week, history of congestive heart failure, GERD, significant GI bleed hypothyroid, coronary artery disease and morbid obesity who presented with shortness of breath for 1 months duration CT scan of the chest done on admission had shown no PE, however shown bilateral possible pneumonia, streptococcal and Legionella pneumonia are negative, does not have any fever,  no elevated white cell count, procalcitonin mildly elevated   Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) Continued improvement in oxygenation 12/26 Attempted thoracentesis today with the help of IR, no significant fluid, CT of the chest  repeated   Evidence of chronic respiratory failure, hypercarbic, pulmonary consultation   12/ 29 Oxygen requirement has gone up a bit, weight is down, however chest x-ray shows worsening right pleural effusion, would attempt to tap it with help of IR   Right-sided thoracentesis being attempted again, however could not get much fluid,  reducing diuresis due to bicarbonate of 50 Improved oxygen requirement   1/4 has lost nearly 11 L     Has lost nearly 10 .5 L to diuresis ,, nearly 40 lb ?  Arranged NIV at home  Acute on chronic CHF with reduced ejection fraction, in the past However, Repeat echocardiogram from 12/22 shows normal LVEF, tricuspid regurg, elevated pulmonary arterial pressure   On IV Lasix, Was on aspirin which is on hold due to questionable history of dark stools   Acute Chronic hypercarbic and hypoxic respiratory failure Most likely due to morbid obesity, with obesity related hypoventilation BiPAP trial, pulmonary consultation, needs sleep test This seems to be primary reason for right-sided clinical heart failure 12/28 has added Zaroxolyn for better diuresis after being consulted by Pulmonary Medicine, 12/29 has lost 5 lb of weight ? , output wise negative by about 4 L since admission  Continued diuresis 12/30 ABG showed 7.41, pCO2 of 79, bicarbonate of 50 Subsequent ABG showed some improvement 1/7 trying to arrange NIV    1/5- by 10 L since admission, lost 15 lb of weight Paroxysmal AFib Continue with Eliquis, Eliquis on hold for possible thoracentesis, CT scan of the chest to be repeated, after discussion with IR Patient currently in AFib, with ventricular rate on the higher side, increased Coreg 6.25  two times a day 1/10 increased Coreg further to 12.5 mg 2 times a day   AKI with CKD Improving now , stable at around 1.8 creatinine 12/30, worsening of renal function, decreased diuresis, Zaroxolyn has been discontinued    Hypothyroid - Continue home levothyroxine   Osteoporosis - Continue calcium + Vitamin D, on Denosumab outpatient   Morbid Obesity - Encourage weight loss, diet, ? Hypoventilation   Depression - Continue home sertraline HLD - Continue home statin   Hx of GI Bleed - Recently restarted Eliquis.  Macrocytic Anemia - Continue home B-12, checked  anemia labs , consistent with iron-deficiency anemia, started on IV Venofer with elevated RDW, finish   1/4 patient has tested COVID positive, was negative on 12/21  Essentially asymptomatic Condition at the time of discharge-  VSS Constitutional:   On room air , no distress, on BiPAP intermittently HENT:  Normocephalic, Atraumatic, Pupils Reactive, Normal oropharynx, Nose normal.  Cardiovascular:  Normal , irregularly irregular rhythm,  Sys murmurs, No rubs, No gallops.  Respiratory:  Normal breath sounds, No respiratory distress, No wheezing, No chest tenderness.  GI:  Bowel sounds normal, Soft, No tenderness, No masses, No pulsatile masses.  Extremities:  Intact distal pulses, + edema, significantly improved since admission No tenderness, No cyanosis, No clubbing.  Neurologic:  Alert & oriented x 3,, No focal deficits noted. Skin:  Warm and dry"