Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Blood lactic acid, Blood potassium decreased, COVID-19, Cardiac hypertrophy, Cardiac monitoring
Clinical narrative: Date of Admission: 12/12/2023   Date of Discharge: 12/14/2023   Issues to be Addressed at Follow-up: Ziopatch results    Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   12/12/2023  2:25 PM BLOOD CULTURE 2 Preliminary BLOOD   12/12/2023  2:25 PM BLOOD CULTURE Preliminary BLOOD       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) HYPOTENSION   ? TACHYCARDIA   ? COVID-19 DISEASE   ? ELEVATED TROPONIN I   ? MAJOR NEUROCOGNITIVE DISORDER DUE TO ALZHEIMERS DISEASE (ALZHEIMERS DEMENTIA)   ? HTN (HYPERTENSION)   ? HYPERLIPIDEMIA        Basename Value Date/Time ? CHOLESTEROL       233 02/11/2019 ? TRIGLYCERIDE       57 02/11/2019 ? HDL                76 02/11/2019 ? LDL CALCULATED    146 02/11/2019         Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: This is a 80-year-old female with past medical history of dementia, hypertension, anxiety who presented from clinic for hypotension and tachycardia.  Workup in the emergency department showed a potassium of 3.3.  High-sensitivity troponin 13 and 71 within 34.  Lactic acid 3.2 and downtrended to 0.7.  CBC unremarkable.  UA unremarkable.  COVID-19 positive.  Chest x-ray no acute disease.  EKG showed normal sinus rhythm with a heart rate of 75 bpm.  An echocardiogram was ordered and showed a mildly concentric hypertrophy, normal left systolic function with an LVEF of 60 to 65%.  No further episodes of tachycardia while hospitalized.  Zio patch was placed prior to discharge home.    Patient Active Hospital Problem List:  HYPOTENSION (12/13/2023)  TACHYCARDIA (12/13/2023) -tachycardia and hypotension resolved, unclear etiology, possible vasovagal episode.  -Ziopatch placed on dc    HTN (HYPERTENSION) (4/26/1996) -lisinopril    COVID-19 DISEASE (12/13/2023) -found positive on admission 12/12 -asymptomatic   ELEVATED TROPONIN I (12/13/2023) -demand ischemia in setting of tachycardia and hypotension on admission      BP 101/56  | Pulse 109  | Temp 97.4 °F (36.3 °C)  | Resp 17  | Ht 5' 8"  | Wt 76.2 kg (168 lb)  | SpO2 96%  | Breastfeeding No  | BMI 25.54 kg/m²    Physical Exam: General appearance - alert, well appearing, and in no distress Mental Status - alert, oriented x 3 Chest - clear to auscultation, no wheezes, rales or rhonchi Heart - normal rate, regular rhythm, normal S1, S2, no murmurs, rubs Abdomen - soft, nontender, nondistended, no masses or organomegaly Neurological - motor and sensory grossly normal bilaterally Extremities - no clubbing, cyanosis or edema Skin - warm and dry       Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  Tachycardia, hypotension    Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code       Note Details  Author (M.D.) File Time 12/15/2023  2:52 PM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct  Admit Date 12/12/2023  ED to Hosp-Admission (Discharged) on 12/12/2023  ED to Hosp-Admission (Discharged) on 12/12/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   HYPERLIPIDEMIA  HTN (HYPERTENSION)  MAJOR NEUROCOGNITIVE DISORDER DUE TO ALZHEIMERS DISEASE (ALZHEIMERS DEMENTIA)  HYPOTENSION  TACHYCARDIA  COVID-19 DISEASE  ELEVATED TROPONIN I Care Timeline  12/13   Admitted from ED (Observation) 0152 12/14   Discharged 1501  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 12/14/2023) Medication List at Discharge   calcium carbonate/vitamin D3 600 mg-10 mcg (400 unit) 1 tablet Oral 2 TIMES A DAY, with food  cholecalciferol (vitamin D3)   1,000 Units Oral DAILY  2,000 Units Oral DAILY, or as directed  ergocalciferol (vitamin D2) 300,000 Units Oral ONE TIME, as directed  lisinopril 40 mg Oral DAILY, (PLEASE BE AWARE OF THE NEW TABLET/DIRECTION CHANGE,NOTED 11.27.23)