Age: 39.0
Sex: F
Vaccine: COVID19-2
Symptoms: Angiogram pulmonary normal, Asthma, Atrial fibrillation, Blood thyroid stimulating hormone normal, Brain natriuretic peptide normal
Clinical narrative: Patient is a 40 y.o. F with hx of anxiety/depression and ADHD. Recent admit (10/11-10/13/23) for new onset A fib with RVR. EP followed and pt was placed on Eliquis, Flecainide and Cardizem. Pt re-presented on 10/23/23 with CC of palpitations and episodes of A fib (noted on smart watch) with associated chest pain and SOB. Noted to be in A fib with RVR in ED but converted back to NSR and fluid bolus. Per ED, pt uncomfortable about returning home. As such admit to OBS for EP evaluation. S/p ablation 10/23/23. Hospital course complicated by dyspnea with unclear etiology, possibly related to OSA/OHS deconditioning in the setting COVID. Repeat ECHO unchanged, only trivial pericardial effusion, likley reactive to ablation. EP followed. Pulmonology followed, trial prednisone and breathing inhalers for possible asthma exacerbation. Stress test unremarkable. Sniff test negative. CTPA 10/23/23 unremarkable but suboptimal, Q scan with low probability of PE. RT performed NIF which was normal with VC 1950 ml. Pt notes continued shortness of breath on exertion, typically after 5 min. CM to order nurses aid, family called previous day to ensure coverage.    1. A fib: Noted last admit. TSH normal. CHADS2-VASC 1. TTE on 10/13/2023 normal LVEF, no WMA. EP followed and pt initiated Eliquis, Flecainide, and Cardizem. Now presented as above. S/p ablation 10/23/23. Continued home meds. In sinus during admission. EP followed 2. Dyspnea: ongoing with questionable worsening after ablation. Patient notes conversational and exertional dyspnea. No hypoxia. No wheezing; did not improve with prednisone/breathing tx. ECHO 10/13/23 as above. BNP 10/24/23 normal. Unclear etiology, possibly related to OSA/OHS deconditioning in the setting COVID. Repeat ECHO unchanged, only trivial pericardial effusion, likley reactive to ablation. EP followed. Pulmonology followed, trial prednisone and breathing inhalers for possible asthma exacerbation. Stress test unremarkable. Sniff test negative. CTPA 10/23/23 unremarkable but suboptimal, Q scan with low probability of PE. RT performed NIF which was normal with VC 1950 ml. Pt notes continued shortness of breath on exertion, typically after 5 min. CM to order nurses aid, family called previous day to ensure coverage.  3. COVID +:  Not a candidate for paxlovid due to drug interaction. ID followed, remdesivir completed.  4. ADHD/Anxiety/Depression: Continued home Wellbutrin. Vyvanse discontinued on last admit.  5. Mild intermittent Asthma exacerbation: Xopenex scheduled as home med. Ipatroprium neb ordered. Prednisone thru 10/30/23. Ordered xopenex inhaler and neb, ipatropium neb for discharge.  6. Suspected OSA: Suspected on last admit. Often feel tired, fatigued, or sleepy during the daytime? + 1, Observed you stop breathing during sleep? + 1, BMI > 35 +1, Neck circumference > 40 cm + 1, and Patient's score is > 3 implying high risk for OSA. Referral was made for sleep study on last admit.  7. Morbid Obesity:  BMI 46. Recommend lifestyle modification and weight loss.