Sex: F
Vaccine: COVID19
Symptoms: Angiogram cerebral normal, Angiogram pulmonary abnormal, Arteriogram carotid abnormal, Cardiac failure acute, Cardiac failure congestive
Clinical narrative: Patient admitted on 4/9/21 (unsure where they received J&J COVID vaccine on 3/6/21)   Per clinical pharmacist internal event report: Pt received Johnson and Johnson Covid vaccine on 3/6/21. Has chronic sub dural hematomas FYI (seen on scans in Feb).  Patient is a 80 y.o. female patient who presented with complaints of dyspnea and BLE edema and was admitted with a principal diagnosis of Acute on chronic congestive heart failure with left ventricular diastolic dysfunction (HCC). Cardiology consulted. Initially diuresed however became hypotensive. Patient had episode of slurred speech and disorientation on 4/11. Code stroke called.  CTH with stable SDH. CTA of head had no acute cerebral occlusion.    Incidentally was found to have bilateral PEs on CTA h/n. Full CTA chest ordered for further evaluation, noted extensive bilateral pulmonary emboli, associated with Rt heart strain. She was started on heparin drip, Dr. cleared with neurosurgery prior to starting on 4/11 given subacute SDH which has been stable on imaging. Heparin transitioned to eliquis.   Additional chart information:  ht: 5'4" weight: 108.3 kg CrCl: 50.3 mL/min platelets since admission: 160 - 173  Admission Diagnosis: Acute on chronic congestive heart failure, unspecified heart failure type (HCC) [I50.9] Expected discharge: 4/14/21  Active Problems:   Hypertension associated with diabetes (HCC)   Gastroesophageal reflux disease without esophagitis   Non-insulin dependent type 2 diabetes mellitus (HCC)   Seizure disorder (HCC)   Dyslipidemia associated with type 2 diabetes mellitus (HCC)   OSA on CPAP   Pulmonary hypertension due to left ventricular diastolic dysfunction (HCC)   Subdural hematoma (HCC)   Class 2 obesity due to excess calories in adult   Dizziness   Acute on chronic diastolic CHF (congestive heart failure) (HCC)  Hospital course: Patient is a 80 y.o. female patient who presented with complaints of dyspnea and BLE edema and was admitted with a principal diagnosis of Acute on chronic congestive heart failure with left ventricular diastolic dysfunction (HCC). Cardiology consulted. Initially diuresed however became hypotensive. Patient had episode of slurred speech and disorientation on 4/11. Code stroke called.  CTH with stable SDH. CTA no acute occlusion. Suspecting breakthrough seizure. Neuro consulting, EEG normal. Titrating up zonegran - patient will discharge on 100mg in AM and 200mg in PM.   Incidentally was found to have bilateral PEs on CTA h/n. Full CTA chest ordered for further evaluation, noted extensive bilateral pulmonary emboli, associated with Rt heart strain. She was started on heparin drip, Dr. cleared with neurosurgery prior to starting on 4/11 given subacute SDH which has been stable on imaging. Heparin transitioned to eliquis. Will need to follow up with PCP.   Valsartan was held on admission for hypotension. Blood pressure has remained well controlled off of all antihypertensives. She will need to follow up with PCP for further management of BP, may need valsartan resumed in near future. Patient is medically stable for discharge to home.