Age: 17.0
Sex: M
Vaccine: COVID19
Symptoms: Respiratory viral panel, Tricuspid valve incompetence, Troponin I increased, Troponin T increased
Clinical narrative: Please note this patient lives in another state and we do not have access to the vaccine information for that state.  Of note, his mother reported he received the Moderna vaccine, the influenza vaccine and possibly other vaccinations all on 11/14/23.  From Hospital Discharge Note: Admission Date/Time: 11/16/2023 23:14:00 Discharge Date/Time: 11/19/2023 10:15:58  Chief Complaint  Chest pain following COVID vaccine  Patient Narrative  ILLNESS SEVERITY:   The patient is returning to baseline, requires assessment.   PATIENT SUMMARY:  Reason for Hospitalization: COVID vaccine myocarditis    Admission HPI: Chief Complaint:  Chest pain following COVID vaccine    HPI:   Patient is a 17 y/o with autism, ADHD (on Adderall) who presents with acute onset of chest pain 11/16 AM. Of note, he received Moderna vaccine Tuesday. He had a headache 11/15 and 11/16 AM, he began complaining of substernal pain/epigastric pain. This persisted and worsened in the afternoon so he was brought to ED for evaluation at 7:39 PM. Of note, several family members are sick at home with URI symptoms. Patient has had no URI symptoms.   A 12 lead EKG was done on arrival to ED showing ST elevations in the high lateral leads/V5/V6, V1 ST depressions. Troponin I 17,182. CXR from OSH was verbally unremarkable.   Patient describes the chest pain as mid-sternal on arrival, sharp and inconsistent. Sometimes relieved by leaning forward and worsens when laying flat.  Alert and mentating well throughout. On room air on arrival.  No ectopy noted.  No meds/IVF given at OSH, no ASA.   Prior hospitalizations include RSV infection and ED visits for sutures.  Hospital Course: CICU Course (11/16-11/17)  Patient was admitted to CICU from 11/16-11/17. Upon arrival, mentating well, warm and well perfused, with normal cardiorespiratory exam with notably no rub nor gallop. Had ECG obtained that demonstrated diffuse ST-segment elevations (except V1 where ST depression). Troponin 1535 that trended slightly up to 1934 over the course of the next 6 hours. BNP normal at 48. RVP negative. Echo obtained that demonstrated borderline depressed LV function, no pericardial effusion, and normal coronary artery origins. His HR was normal without tachycardia, his blood pressures were normal for age, and patient remained in room air and never required any vasoactive support. Given clinical stability, he was transferred on 11/17.  Course (11-17-Discharge):  Patient was admitted for management of myocarditis thought to be due to his SARS-CoV2 vaccination. He received IVIG and steroids. His IV steroids were transitioned to oral prior to discharge. He had multiple EKGs, echocardiograms, and a cardiac MRI. His MRI results were overall reassuring with mild depressed function and subtle LGE uptake. Troponin level also downtrending; level at discharge 642. His chest pain has much improved, and he is safe for discharge home with close outpatient follow in 2 weeks with an echocardiogram. Provisionally will plan to exercise restrict for ~3-6 months, schedule an exercise stress test in 3 months, and Holter and cMRI at ~6 months. Discharge plan, education, and follow up reviewed with patient and his parents who verbalized understanding; questions and concerns addressed.  Reasons for new, changed, and discontinued medications:  Prednisolone 30mg twice per day for 3 days (last day 11/22 am).  Reasons for new, changed, and discontinued equipment: NA  Relevant Diagnostic Images/Studies:   EKG 11-18-23:  Rate: 80 Axes/P: 47 QRS: 36 T: 58 Intervals/PR : 166 QRS: 84 QT: 354 QTC: 408  Clinical Dx: STEMI  Code Diagnosis  7605 ST-T wave abnormality, pericardial disease  Comparison: Much improved.  CARDIAC MRI 11-17-23: ? Possible myocarditis by magnetic resonance imaging based on a probable thin layer of left ventricular epicardial late gadolinium enhancement. Normal left ventricular T2 value and extracellular volume fraction. ? Normal left ventricular size and systolic function. No regional wall motion abnormalities. ? Normal right ventricular size and systolic function. ? No significant valvular dysfunction. ? No pericardial effusion  Echocardiogram 11-17-23: ? Technically difficult examination due to suboptimal echocardiographic windows. Pulmonary venous return not well seen. ? Normal coronary artery origins by 2D; not well seen with color. ? Trivial tricuspid and mitral regurgitation. ? Normal aortic valve function. ? Normal left ventricular size with borderline depressed systolic function. ? Qualitatively normal right ventricular systolic function. ? No pericardial effusion.    Tests Pending  No tests pending at time of discharge    These tests will be followed by the Primary Service at Discharge after Discharge  Vitals and Discharge Physical  T: 36.7  °C  (Temporal Artery)  HR: 90 (Monitored)  RR: 18  BP: 132/59  SpO2: 93%   Discharge Physical Exam     awake, alert, conversant lying in bed in NAD  MMM, MAE  RRR, S1 split S2, no murmur, rub, click or gallop  LS CTAB with equal aeration, easy WOB  abd soft, NT/ND, no HSM  wwp, brisk CR, 2+ pulses throughout, no edema  Diagnosis List   1. Myocarditis due to COVID-19, 11/18/2023  2. Chest pain, 11/18/2023  Procedure History  No Procedure History  Social History  Smoking Status      No Smoking Status Documented  Allergies   No Known Medication Allergies  Laboratory Results Returned 48 Hours Prior to Discharge       Labs Last 48 Hours      Event Name  Event Result  Date/Time   Troponin T Gen 5 642 ng/L High 11/19/23  Troponin T Gen 5 682 ng/L High 11/18/23  Troponin T Gen 5 607 ng/L High 11/18/23