Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Hypertension, Hypertensive urgency, Myocardial ischaemia, Pulmonary oedema, Troponin I
Clinical narrative: Date of Admission: 9/28/2023   Date of Discharge: 9/30/2023   Issues to be Addressed at Follow-up: Follow up with cardiology on 10/10. Blood pressure control.  Transitioning from lisinopril to entresto but only going home on Valsartan. Stress test in follow up.   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   9/28/2023  7:53 PM TROPONIN I, HIGH SENSITIVITY In process --       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) ACUTE CHF W LVEF UNKNOWN, UNSPECIFIED   ? DEMAND ISCHEMIA   ? COVID-19 DISEASE   ? CKD STAGE 3A (GFR 45-59)   ? HYPERTENSION       On lisinopril 40 and metoprolol 50 mg.  She was on hydrochlorothiazide but that caused increased creatinine.  Hydralazine added     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Patient is an 85 year old female with a history of CKD and HTN who presented with SOB and elevated BNP with CXR showing pulmonary edema, COVID positive and labs showing an elevated BNP and troponin in the setting of SBP very elevated at home and above 200 in ER.  She was admitted and treated with IV lasix and COVID isolation.  The following day her Cr had gone up, BP improved but still elevated and no signs of volume overload on exam.  Lasix and lisinopril stopped and 750ml of IVF provided.  An ECHO from 9/29 shows EF 40-45%, normal RV, mildly dilated LA and IVC with over 50% collapse.  The case was reviewed with cardiology who recommended cardiology follow up and outpatient stress test.  Hydralazine was increased from 20 to 50mg to provide better BP control.  Cr improved on 9/30 so valsartan 40mg was started with plans to eventually transition to Entresto.  BP was much better at the time of discharge but still elevated.  Presentation felt to be HTN urgency not CHF exacerbation.   In terms of COVID, she was not hypoxic and despite a mild cough was asymptomatic.  She will need to maintain COVID isolation at discharge but no treatment was provided/prescribed while in the hospital or at discharge.     Primary Procedures:  ECHOcardiogram   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  HTN urgency   Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code       Note Details  Author (M.D.) File Time 9/30/2023  2:11 PM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 9/28/2023  ED to Hosp-Admission (Discharged) on 9/28/2023  ED to Hosp-Admission (Discharged) on 9/28/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders    Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Hospital Problem List   HYPERTENSION  CKD STAGE 3A (GFR 45-59)  ACUTE CHF W LVEF UNKNOWN, UNSPECIFIED  DEMAND ISCHEMIA  COVID-19 DISEASE Care Timeline  09/28   Admitted from ED (Observation) 1845 09/30   Discharged 1534  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 9/30/2023) Medication List at Discharge   atorvastatin calcium 20 mg Oral DAILY, to prevent heart attacks and strokes  calcium carbonate 500 mg calcium (1,250 mg) TAKE 1 TABLET ORALLY DAILY  colchicine 0.6 mg Take 2 tablets by mouth at the beginning of gout attack, followed by 1 more tablet 1 hour later. Do not exceed 3 tablets total per 24 hours. If pain is not relieved, take 1 tablet 2 times a day for 3 days then stop  hydralazine HCl 50 mg Oral EVERY 8 HOURS  lidocaine 4 % Apply 1 patch to the affected area(s) every 8 hours  metoprolol succinate 50 mg Oral DAILY  multivitamin TAKE 1 TABLET ORALLY DAILY  valsartan 40 mg Oral DAILY