Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Tachypnoea, Troponin, Troponin I increased, White blood cell count normal
Clinical narrative: ED to Hosp-Admission  Current  10/8/2021 - present (7 days)  Non-STEMI (non-ST elevated myocardial infarction) Principal problem   Hospital Problems -   POA      * (Principal) Non-STEMI (non-ST elevated myocardial infarction) Yes  Chief Complaint Patient presents with ? Shortness of Breath  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia and possible mild acute on chronic diastolic heart failure -Patient presented with shortness of breath and cough.  O2 sat was 80% on room air.  He was placed on 2 LPM of O2, now with O2 sat 98%.  Chest x-ray showed minimal hazy opacification in the bases.  He tested positive for COVID-19.  He has history of chronic diastolic heart failure.  He has history of bilateral leg edema.   Severe sepsis secondary to COVID-19 pneumonia  -Patient presented with tachypnea with blunted tachycardia being on beta-blocker, with hypoxia and COVID-19 pneumonia as source of infection. -Patient was started on Decadron in the ER.  Continue Decadron 6 mg once daily.  Patient is agreeable to start remdesivir.  Procalcitonin 0.10.  Patient received ceftriaxone and azithromycin in the ED.  Will  hold further antibiotics.   Acute on chronic diastolic heart failure - looks mildy fluid overloaded on exam.  Will give furosemide 40 mg IV x1 dose.  He takes torsemide 40 mg once daily at home.  Check TTE   NSTEMI -Initial troponin 0.15, EKG did not show any acute changes.  Continue to trend troponins.  Consult cardiology.  At this time, this could be demand ischemia from severe sepsis from COVID-19 from acute on chronic diastolic heart failure but if becomes more elevated, then he may need ischemic work-up   CAD -Continue Plavix, carvedilol, statin   History of atrial fibrillation status post ablation -He follows up with a cardiologist.  Loop recorder in place.  Continue carvedilol.  Monitor on telemetry   History of hemorrhagic stroke History of vertebral basilar insufficiency with bilateral vertebral basilar stenosis -Noted   Hypertension -Carvedilol, losartan and hydralazine   Obstructive sleep apnea -We will order CPAP during hours of sleep   Myasthenia gravis -Continue pyridostigmine   History of Present Illness     Patient is an 83 y.o. male who presented to the ED with dry cough, dyspnea, fever x2 days.  He has a past medical history of hemorrhagic stroke, diastolic heart failure, CAD, history of A. fib status post ablation, myasthenia gravis.  Patient denies any chest pain.  He states that he has good appetite.  He has chronic bilateral leg swelling but not worse than usual.  No diarrhea or abdominal pain.   At the ED, O2 sat was 86% room air.  He was placed on 2 LPM of O2.  Blood pressure was 150/90, RR 28, heart rate 88.  COVID-19 test is positive.  Patient received 2 doses of motor vaccine, last dose in March 2021.  Initial troponin 0 0.15.  EKG did not show any acute changes.  Chest x-ray showed minimal hazy opacification at the lung bases. Patient was given aspirin 325 mg in the ED.  Patient was also given ceftriaxone and azithromycin and dexamethasone.   Patient will be admitted for treatment of acute hypoxic respiratory failure secondary to COVID-19 pneumonia and treatment of a possible NSTEMI