Age: 84.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Delirium, Dysphagia, Dyspnoea, Hypotension, Insomnia
Clinical narrative: Patient up to date on Pfizer COVID vaccination who admitted to hospital with positive COVID test.  Provider discharge summary below:  "84 year old widow with past medical history significant for chronic heart failure with reduced ejection fraction with AICD in setting of ischemic cardiomyopathy with history of coronary artery disease status post CABG and multiple cardiac stents, bioprosthetic aortic valve replacement, peripheral vascular disease, paroxysmal atrial fibrillation on apixaban, ventricular tachycardia, chronic kidney disease, stage 3b and type 2 diabetes mellitus presented with two week history of shortness of breath and cough as well as a near syncopal episode at home.  Patient was found to have lactic acidosis, soft blood pressures and was COVID 19 positive.        Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  With lactic acidosis and tachycardia and some question of COVID 19 pneumonia patient was started on Decadron after given a one liter normal saline fluid bolus.  Admitting team also stated Ceftriaxone and Doxycycline for possibility of pneumonia although CXR was relatively unremarkable and procalcitonin was within normal limits.  Patient developed wide complex tachycardia.  Cardiology was consulted.   Patient was stated on Amiodarone bolus and drip and IV Lidocarine as well as low dose IV Lasix.  His home beta blocker dose was increased.  Patient developed substernal chest pain. Apixaban was held and he was scheduled for a coronary angiogram to assess for ischemic etiology.   He was found to have two tandem left circumflex lesions (70-80% ostial and 90-90% proximal segment stenosis) as well an open stent further down from November 2020.  He had successful PTCA and stenting of the two tandem lesions.  His IV drips were discontinued. He was started on Plavix and continued on low dose Aspirin and Apixaban.  He was continued on oral Amiodarone at 200 mg daily (higher dose than at home) and Metoprolol XL 50 mg daily (higher dos than at home).  He had no further chest pain or tachyaryythmia.  He had some worsening of his renal function with soft blood pressures so diuretics were held as was his low dose ARB.  He received two small fluid boluses with normal saline and his renal function returned back towards baseline.  Patient completed a five day course of Doxycycline and Ceftriaxone for a soft call community acquired pneumonia.  He was also continued on Decadron for COVID 19 and completed 8 days by time of discharge.  He had no signs of hypoxia and was taken out of isolation by time of discharge.     Patient had some sensation of solid foods getting stuck in his throat.  He was seen by speech therapy who recommended a soft diet with liquids when eating solid foods.  No evidence of dysphagia.  Patient was referred to GI as an outpatient to address his possible esophageal dysphagia.    Patient also had insomnia with some sundowning at night.  He had significant confusion when taking his home Ambien.  He was trialed on Trazodone to replace Ambien which helped with sleep and seemed to have less side effects.  This was continued on discharge.     Issues Requiring Follow Up: (Who, what, when, and how communicated?)  Follow-up chronic heart failure with cardiology (patient's home Losartan and Bumex were discontinued with patient to weigh himself daily at home and if gains more than 2 pounds to call his cardiologist - likely will be restarting these medications in the future); follow-up ventricular tachycardia and coronary artery disease with new LCX DES with cardiology, plan to continue DAPT with Eliquis for one month and then discontinue low dose Aspirin; follow-up resolution of COVID 19, Type 2 diabetes and other issues with PCP; follow-up esophageal dysphagia with GI"