Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram, Angiogram pulmonary abnormal, Anticoagulant therapy, Asthenia, Atrial fibrillation
Clinical narrative: Patient called c/o shortness of breath on exertion, slight cough, runny nose, weakness and fatigue. States O2 sitting 97 and P 79-80 and O2 walking <88 and P 100's. States had covid vaccine # 1 on 3/4/2021. Completed viral/travel screen which was negative. Patient is a 72 y.o. female with chronic diastolic heart failure, hypertension, hyperlipidemia, hypothyroidism, vitamin D deficiency, depression with anxiety, who presented with shortness of breath on exertion.  CTA chest was performed, showing filling defects in  secondary and tertiary pulmonary arterial branches in bilateral lower lobes as well as right upper lobe.  Patient was admitted for management of acute bilateral pulmonary emboli.  Patient was started on Lovenox 1 mg/kg twice daily; transitioned over to oral apixaban for discharge. TTE obtained, without evidence of right heart strain. Patient is a 72 y.o. female who presents to the office today stating "I do not feel so good".   She mentions noting blurry vision over the past 1 week right eye only with decreased vision.  Denies any eye pain.  Thinks her vision is worse outside in the sun.   In addition, today she states she was up moving around getting ready for today's appointment when all of a sudden she felt a brief slight low light shock pointing to left anterior chest wall.  Denies any chest pain or pressure but reports noting her heart rate was elevated up to 150.  She states her O2 sat at home was 97% on room air.  She checked her blood pressure which was not abnormal but cannot recall the number.   She was recently diagnosed with a PE for which she was hospitalized, see previous note.  She is concerned as she feels perhaps her Covid vaccine initially received on 3/4/2021 could have caused her blood clot.  Her second dose was received on 3/31/2021 and has since not been feeling well EKG in the office with new onset A. fib relation noted, rapid ventricular rate with a pulse of 152 bpm.  911 was called and patient transferred to the ER for further evaluation and recommendations.  Patient currently on Eliquis for PE  Patient, with a past medical history of essential hypertension, mixed hyperlipidemia and grade 1 diastolic dysfunction, as well as acute bilateral pulmonary emboli 3/2021 diagnosed a few days after her first dose of the Pfizer Covid vaccination, now anticoagulated on Eliquis who presented to KMC emergency room on 4/14/2021 from her primary care provider's office after being found in newly diagnosed atrial fibrillation with RVR, rate in the 150s.  Of note, patient had received her second dose of the Pfizer Covid vaccine on 4/10/2021.  She had scheduled this primary care provider appointment due to waxing and waning blurred vision of her right eye, with associated right-sided headache that had been ongoing over the last week.  Patient reports that on the day of arrival she had not felt well, felt slightly weak and fatigued, but denied shortness of breath, chest pain or heart palpitations.  Per ER notes, patient was instructed on vagal maneuvers while she was in the ambulance, and had converted to sinus rhythm by the time of her arrival to the emergency room.  Per review of her telemetry on the day of discharge, patient did have one short episode of PAF on 4/15/2021, spontaneously converting to sinus rhythm, as well was intermittent PACs.  Her home lisinopril was changed to Coreg, without further episodes of RVR and with good blood pressure control.   In regards to her headache, patient underwent an MRI of the brain, which was negative for acute findings; she had no temporal tenderness, and ESR was within normal limits.  She did improve symptomatically with administration of Tylenol and Zofran for her corresponding nausea/vomiting.  On the day of discharge, patient was feeling much better, and stable for discharge.  An appointment with doctor of ophthalmology was offered to patient for 4/16/2021, however due to transportation issues, this was rescheduled for 4/20/2021.  She was instructed on changes in her medication, as well as encouraged to schedule an appointment with her established cardiologist.  All questions and concerns were addressed.