Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Dyspnoea exertional, Echocardiogram abnormal, Ejection fraction, Electrocardiogram normal
Clinical narrative: MRN:  Name:  Age: 57 y.o. Admit Date: 7/18/2022  6:31 AM Discharge Date:  7/19/2022 Admitting Physician: Dr.  Discharge Physician: MD   Discharge Diagnosis: Principal Problem:   COVID Active Problems:   COPD (chronic obstructive pulmonary disease)   Elevated troponin   Dyspnea   Acute on chronic systolic congestive heart failure   Essential hypertension   S/P CABG (coronary artery bypass graft)       HPI AND HOSPITAL COURSE   History of Present Illness:  As per admission H&P, "Patient is a 57 y.o. male with a history of shortness of breath and dyspnea the spine present for the last 2 days. Patient states has had low-grade temperature at home has noticed shortness of breath worse with exertion no nausea no vomiting patient has a history of 5 vessel CABG. Patient states wife at home is positive for Covid patient is vaccinated patient seen in emergency room tested positive for Covid but had elevated troponin. Patient denies diarrhea denies abdominal pain. Patient being admitted for further evaluation and care.  Has noticed some swelling in feet at times and weight up slightly from baseline."   Hospital Course: Patient, is a 57 y.o. male who presented with shortness of breath.  He was managed for the following:   * COVID COVID-19 infection - patient found to be COVID positive.  He had no hypoxia.  He did receive dose of remdesivir during admission.  He felt well and wished to go home.    Elevated troponin - likely type 2 MI.  Given history of CAD and CABG, cardiology was consulted.  Stress test was performed and was low risk.  He was cleared for discharge home by cardiology.    HTN - BP low normal.  Will hold lisinopril on discharge.  Follow-up with PCP     Physical Exam on the Date of Discharge: Blood pressure (!) 96/61, pulse 71, temperature 98.3 °F (36.8 °C), resp. rate 18, height 6' 5" (195.6 cm), weight 107 kg (236 lb), SpO2 97 %. General - NAD, appears stated age  HEENT - EOMI, PER, MMM, oropharynx clear Chest - lungs clear bilaterally, no w/r/r, normal effort Heart - RRR, NS1S2, no m/r/g Abdomen - Soft, non-tender, non-distended, +BS,  Extremities - warm, no edema Psych - AAOx3, affect appropriate Skin - no rash, dry   Discharge Condition: improved   Disposition: home   CONSULTS DURING ADMISSION:  IP CONSULT TO CARDIOLOGY IP CONSULT TO SOCIAL WORK   IMAGING / PROCEDURES / RESULTS:     Stress Test, Pharmacological,w/Myoview (Lexiscan 0.4 mg IV x 1)   Result Date: 7/19/2022 Interpretation Summary Low Risk Study ECG The baseline ECG displays normal sinus rhythm. Non-diagnostic Lexiscan stress test. Left Ventricle The LV EF is calculated at 54% Procedure lexiscan myoview 1 day The patient was given 0.4 mg  IV of Lexiscan per protocol. There are no significant ST segment changes throughout the injection or recovery period. The patient tolerated the procedure well Procedure was done according to Lexiscan Protocol. The heart was imaged several minutes later. Rest Injection Patient was injected with 10.5mCi of tetrofosmin IV at rest Risk Factors CAD Tobacco Use COPD COVID Stress Findings No chest pain Patient exhibited no arrhythmias during exercise No ischemic ST changes during the stress test. Stress Images There are no significant perfusion defects on rest or stress images and no significant transient ischemic dilatation - images are negative for ischemia or infarction. Stress Injection An additional 32.2 mCi of tetrofosmin IV was injected at peak exercise Stress Supervision Provider: APRN MMode 2D Measurements & Calculations Z-Scores (Vital Signs) Other Measurements & Calculations Conclusion The LV EF is calculated at 54% There are no significant perfusion defects on rest or stress images and no significant transient ischemic dilatation - images are negative for ischemia or infarction.    XR Portable Chest   Result Date: 7/18/2022                                                 Radiology  PATIENT NAME:               MR#:  PROCEDURE DATE:  07/18/2022                       ACCOUNT#:   ACCESSION #:                            ROOM#:  ORDERING PHYS:  Portable chest  Comparison 07/05/2022  History:  Fever  Findings:  Demonstration of postsurgical changes of sternotomy without significant acute abnormality.  Impression:  No acute abnormality.               THIS IS AN ELECTRONICALLY VERIFIED REPORT               7/18/2022 7:43 AM:  MD   MD  DD:  07/18/2022 TD:  07/18/2022 JOB #:                                     Radiology Page 1    of   1                                                          COPY   XR Portable Chest   Result Date: 7/5/2022                                           Radiology  PATIENT NAME:               MR#:  PROCEDURE DATE:  07/05/2022                       ACCOUNT#:  ACCESSION #:                            ROOM#: ORDERING PHYS:    EXAM:  Portable chest dated 07/05/2022.  CLINICAL INDICATION: Chest pain.  PROCEDURE: Portable AP view of the chest.  COMPARISON: None.  FINDINGS:  The heart is normal in size.  The patient is post open heart surgery.  The bones show no acute finding.  The lungs are clear.  IMPRESSION:  No acute finding.                THIS IS AN ELECTRONICALLY VERIFIED REPORT              7/5/2022 10:37 AM:  MD   MD  DD:  07/05/2022 TD:  07/05/2022 JOB #:                                      Radiology Page 1    of   1                                                          COPY   CT Chest Pulmonary Embolism W Contrast   Result Date: 7/18/2022                                                         Radiology  PATIENT NAME:              MR#:  PROCEDURE DATE:  07/18/2022                       ACCOUNT#: ACCESSION #:                            ROOM#:  ORDERING PHYS:  EXAM: CT pulmonary angiogram with IV contrast, 07/18/2022.  COMPARISON:  03/30/2022, 12/19/2021.  INDICATION:  COVID positive, shortness of breath, chest pressure, suspect pulmonary embolism.  TECHNIQUE:  Helical CT images were obtained from the thoracic inlet through the upper abdomen with IV contrast per CT pulmonary angiogram protocol. Computer reconstruction of MIPS and MPR images in coronal and sagittal plane were performed.  Total DLP = 704.2 mGy*cm.  Radiation dose reduction methods were used.  CT lung CAD algorithm was utilized.  FINDINGS:  The central airways are patent.  Lung window demonstrates no focal consolidation or pleural effusion.  Minimal band-like densities seen at bilateral lower lobes, favor atelectasis versus scar.  No definite pulmonary nodule or lesion is identified.  Mediastinal window demonstrates stable appearance of the thyroid gland bilaterally.  No evidence for mediastinal, hilar, or axillary lymphadenopathy is identified by size criteria.  Normal opacification of the thoracic aorta as well as the takeoff the great vessels are noted without focal clinical significant stenosis, dissection, or aneurysm.  Slightly suboptimal opacification of the pulmonary artery is noted. Otherwise no definite abnormal filling defect is seen within the central and segmental portion of the pulmonary arteries.  Postop changes from prior median sternotomy and CABG are noted.  No evidence for pericardial effusion is identified.  Limited evaluation of the upper abdomen demonstrates no gross abnormality.  Bone window demonstrates no evidence for acute osseous abnormality.  No osteoblastic or osteolytic lesion is identified.  Impression: 1.  No abnormal filling defect is seen within the central and segmental portion of the pulmonary artery.  No evidence for acute pulmonary embolism is noted. 2.  No focal consolidation or pleural effusion.  No definite pulmonary nodule or lesion is identified.                  THIS IS AN ELECTRONICALLY VERIFIED REPORT                 7/18/2022 11:25 AM:  MD   MD  DD:  07/18/2022 TD:  07/18/2022 JOB #:                                       Radiology Page 1    of   1                                                          COPY   Limited echocardiogram with contrast   Result Date: 7/19/2022 Interpretation Summary Limited views were obtained. Left Ventricle The left ventricular end-diastolic dimension is 'normal for men (4.2-5.8cm).'. There is normal left ventricular wall thickness. Left ventricular ejection fraction is '50%-55%' based on biplane method. Pericardium/Pleural There is pericardial thickening and/or a small pericardial effusion. There is no pleural effusion. Procedure The exam was diagnostic. Limited /2D MMode adult echocardiogram Limited spectral Doppler interrogation Color flow velocity mapping. Definity used to visualize all left ventricular wall segments. Exam  was performed on 'EPIQ' Examination was completed  in the patients room. MMode 2D Measurements & Calculations Z-Scores(Vital Signs) Classic Z-Scores(Vital Signs) Other Measurements & Calculations Conclusion Left ventricular ejection fraction is '50%-55%' based on biplane method.            LABS AT TIME OF DISCHARGE:   Lab Results Component Value Date   WBC 4.6 07/19/2022   HGB 14.7 07/19/2022   HCT 43.7 07/19/2022   MCV 93.5 07/19/2022     Lab Results Component Value Date   SODIUM 133 (L) 07/19/2022   POTASSIUM 3.7 07/19/2022   MAGNESIUM 1.8 07/18/2022   PHOSPHORUS 2.8 07/18/2022   CHLORIDE 102 07/19/2022   CO2 23 07/19/2022   GLUCOSE 81 07/19/2022   BUN 9 07/19/2022   CREATININE 1.1 07/19/2022   CALCIUM 8.4 (L) 07/19/2022   TBILIRUBIN 0.5 07/19/2022   DBILIRUBIN 0.1 11/30/2016   ALP 54 07/19/2022   AST 25 07/19/2022   ALBUMIN 3.9 07/19/2022     Lab Results Component Value Date   INR 1.1 07/18/2022   INR 1.1 12/19/2021     Microbiology Results (last 14 days)    Procedure Component Value Units Date/Time   SARS-CoV-2, QL, PCR (Rapid) (Abnormal) Collected: 07/18/22 0648   Order Status: Completed Specimen: Throat Updated: 07/18/22 0846     SARS-CoV-2 RNA Detected      Comment:   Reference value:  Undetected   Testing was performed using the System.   Fact sheets for this Emergency Use Authorization (EUA) assay can be found at the following links:       Test Performed by: Lab Director: D.O.      Narrative:     Called to and read back at 08:45 on 07/18/2022,  Symptomatic?->Yes Indications (select all that apply)->Close contact with COVID 19       MEDICATIONS AND ORDERS   Current Discharge Medication List   CONTINUE these medications which have NOT CHANGED   Details rosuvastatin (CRESTOR) 40 mg tablet Take 1 Tablet by mouth At bedtime. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Mixed hyperlipidemia   pantoprazole (PROTONIX) 40 mg DR tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 1   Associated Diagnoses: Gastroesophageal reflux disease without esophagitis   isosorbide mononitrate (IMDUR) 120 mg CR tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: Essential hypertension   promethazine (PHENERGAN) 25 mg tablet Take 1 Tablet by mouth EVERY 6 TO 8 HOURS PRN. Qty: 60 Tablet, Refills: 2   Associated Diagnoses: Cough; Nausea and vomiting   furosemide (LASIX) 40 mg tablet Take 1 Tablet by mouth Twice a day. Qty: 180 Tablet, Refills: 1   Associated Diagnoses: Essential hypertension   tamsulosin (FLOMAX) 0.4 mg capsule Take 1 Capsule by mouth Once Daily. Qty: 90 Capsule, Refills: 3   Associated Diagnoses: Benign prostatic hyperplasia with nocturia   Ranolazine 1,000 mg Tb12 Take 1,000 mg by mouth Twice a day. Qty: 180 Tablet, Refills: 3   Associated Diagnoses: Mixed hyperlipidemia   ondansetron (ZOFRAN-ODT) 4 mg disintegrating tablet Take 1 Tablet by mouth Every 8 hours as needed for Nausea. Qty: 10 Tablet, Refills: 0   Associated Diagnoses: Colitis   dicyclomine (BENTYL) 20 mg tablet Take 1 Tablet by mouth Four times a day as needed for Pain. Qty: 20 Tablet, Refills: 0   Associated Diagnoses: Lower abdominal pain   albuterol (VENTOLIN HFA) 90 mcg/Actuation inhaler Take 2 Puffs by inhalation Every 4 hours as needed (wheezing or shortness of breath). Qty: 1 Each, Refills: 11   Associated Diagnoses: Reactive airway disease, mild intermittent, uncomplicated   guaiFENesin (MUCINEX) 600 mg Take 1 Tablet by mouth Twice a day. Qty: 20 Tablet, Refills: 0   Associated Diagnoses: COPD exacerbation   traZODone (DESYREL) 50 mg tablet Take 1 Tablet by mouth At bedtime. Qty: 90 Tablet, Refills: 1   Associated Diagnoses: Psychophysiological insomnia   tiZANidine (ZANAFLEX) 4 mg tablet Take 1 Tablet by mouth Every 8 hours as needed for Muscle spasms. Qty: 270 Tablet, Refills: 2   Associated Diagnoses: DDD (degenerative disc disease), lumbosacral   citalopram (CELEXA) 40 mg tablet Take 1 Tablet by mouth Daily. Qty: 90 Tablet, Refills: 2   Associated Diagnoses: Dysthymia; Mild episode of recurrent major depressive disorder   famotidine (PEPCID) 20 mg tablet Take 1 Tablet by mouth Twice a day as needed (heartburn). Qty: 60 Tablet, Refills: 0   Associated Diagnoses: Epigastric pain   fluticasone furoate-vilanteroL (BREO ELLIPTA) 100-25 mcg/dose inhaler Take 1 Puff by inhalation Daily. Qty: 1 Each, Refills: 11   Associated Diagnoses: Reactive airway disease, mild intermittent, uncomplicated   metoprolol (LOPRESSOR) 100 mg tablet Take 1 Tablet by mouth Twice a day. Qty: 180 Tablet, Refills: 2   Associated Diagnoses: Essential hypertension   nitroglycerin (NITROSTAT) 0.4 mg SL tablet Take 1 Tab sublingually Every 5 minutes as needed for Chest pain. Qty: 25 Tab, Refills: 5   Associated Diagnoses: Precordial pain; Coronary artery disease involving native coronary artery of native heart with unstable angina pectoris   aspirin 81 mg chewable tablet Take 1 Tab by mouth Daily. Qty: 30 Tab, Refills: 3     STOP taking these medications     lisinopriL (PRINIVIL) 10 mg tablet Comments:  Reason for Stopping: