Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Lymphocytosis, Pacemaker generated rhythm, Pulmonary mass, Troponin normal, White blood cell count increased
Clinical narrative: Narrative: Patient received vaccine on 3/5; routine labwork complted on 3/15/21 elevated white count on labs Patient also had sx of UTI. repeat labs done 4/12 still with elevated WBC;  seen by provider on 4/13 with complaints of CP and took SL nitro 911 called and Patient admitted to the hospital. Of note prior in feb 2021 patient had complaints of CP and declined to go to ER. During hospitalization seen by heme/onc work-up for CLL pending - dc summary below: Primary Discharge Diagnosis Lymphocytosis Secondary Discharge Diagnoses Active Hospital Problems Diagnosis Date Noted * Atypical chest pain 04/13/2021 Priority: High Lymphocytosis 04/13/2021 Priority: High * Lung nodule < 6cm on CT 04/13/2021 * (HFpEF) heart failure with preserved ejection fraction (HCC) 06/13/2019 *Premanent atrial fibrillation (HCC) 06/13/2019 * Essential hypertension 06/12/2019 *History of stroke 06/12/2019 Resolved Hospital Problems No resolved problems to display. Problem list on Day of Discharge Atypical chest pain Assessment & Plan - Resolved with lidocaine patch - Troponin negative x3. EKG V-paced. -Cardiology evaluated. No further inpatient workup needed. *Lymphocytosis Assessment & Plan -WBC in 30s. No lymphadenopathy. Non-contrast CT C/A/P no acute abnormalities. Blood cx no growth. Urine culture contaminated and patient is without urinary symptoms. She has remained afebrile. -Possibly reactive to recent J&J vaccine 3 weeks ago vs CLL. -CLL labs sent per hematology recs. -No infection noted. D/C Antibiotics. -Hematology consulted. F/U with Dr. for CLL test results and further management of lymphocytosis. Lung nodule <6cm on CT Assessment & Plan -Will need OP follow-up. Repeat imagining with PCP. (HFpEF) heart failure with preserved ejection fraction (HCC) Assessment & Plan - TTE 7/2019 EF = 65%. Diastolic dysfunction. -Euvolemic on examination. Continue home medications. Has declined loop diuretic in past. Fluid restrict on discharge. Permanent atrial fibrillation (HCC) Assessment & Plan -History of atril fibrillation status post AV node ablation with insertion of pacemaker. She remains off of anticoagulation per her preference. -Follows with Dr. from cardiology History of stroke Assessment & Plan. -With ongoing mild residual weakness/symptoms. -Continue ASA. Intolerant to statins in past per cardiology notes. Follow-up with PCP. -PT consulted. Uses walker for ambulation. Essential hypertension Assessment & Plan - BP evaluated. - Continue losartan and amlodipine. -Increase HCTZ. Monitor BMP and vials. SUMMARY OF HOSPITALIZATION Presenting Problem/History of Present Illness Precordial chest pain (R07.2) Chest pain (R07.9) This is a 87 yo year-old-female admitted on 4/13/2021 with Precordial chest pain (R07.2) Chest pain (R07.9) Leukocytosis, unspecified type (D72.829) Chest pain, unspecified type (R07.9). Hospital course Patient is an 87 y/o female PMH HFpEF, PAF s/p ablation/PPF (declined AC), CVA, HTN who presented with atypical chest pain. Chest pain reproducible on exam and resolved with lidocaine patch. EKG V-paced. Troponin negative x3. She was seen by cardiology who recommended no further work-up at this time. She will follow-up with Dr. She was also found to have a lymphocytosis to 30. She had the J&J vaccine about 4 weeks go. CT chest abdomen pelvis unremarkable. Urine culture with mixed growth. Patient is without urinary symptoms. Chest x-ray no consolidations. No clear sign of infections Suspicion for CLL. She was seen by hematology who recommended CLL work-up which is pending. She is stable for discharge today with close outpatient hematology follow-up. Case discussed with daughter. I discussed discharge planning and need for close follow-up with hematology. She politely declined SNF even if recommended by PT. She was agreeable to home care which has been arranged by social work. She also has part-time caretaker at home. I answered all questions. Exam on day of Discharge Physical Exam Vitals and nursing note reviewed. Constitutional: General: she is not in acute distress. Appearance: Normal appearance. She is well-developed. HENT: Head: Normocephalic and atraumatic. Eyes: Extraocular Movements: Extraocular movements intact. Pupils: Pupils are equal, round and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal Heart sounds. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: normal breath sounds. No wheezing, rhonchi or rales. Abdominal: General: Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: General: No swelling. Normal range of motion. Cervical back: Normal range of motion and neck supple. Skin: general: Skin is warm and dry. Capillary Refill: Capillary refill takes less than 2 seconds. Neurological: Mental Status: she is alert and oriented to person, place and time. Consults During Admission IP Consult to Cardiology IP Consults to Hematology/Oncology