Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: Presyncope, Pulmonary valve incompetence, SARS-CoV-2 test positive, Scan myocardial perfusion, Sinus rhythm
Clinical narrative: I got my second dose of the Moderna vaccine for COVID-19 on 9/16/2021. Later that evening, I began having intermittent chest pains. For the first couple of weeks, the pains came daily. They would last for several minutes (up to 30 minutes, at the most) and then cease, only return again 10 minutes-1 hour later. The frequency gradually decreased over time, but I would still get them about once a week up until I tested positive for COVID-19 on 1/18/2022. On about 9/18/2021, I began having shortness of breath that accompanied my chest pains. This occurred for only a couple of weeks before they finally diminished, though the chest pains remained. Afterwards, I would only occasionally have shortness of breath with chest pains, usually after exertion. On 1/18/2022, I didn't have any COVID-19 symptoms, but I got tested, because I had been directly exposed to the virus by a family member. On maybe 1/19/2022, I developed a severe headache. The headache ended up lasting for a couple of weeks, which was more or less of the duration of my COVID-19 infection. During those 2 weeks, the pain was constant, but it became more sporadic and less severe in intensity in the weeks following. It finally went away completely about a month after its inception. On 1/20/2022, I developed a cough and a burning, sore throat. It also hurt to move my eyes, and at the time of this writing, I still have pain when I move my eyes, though it's much less severe now. On the afternoon or night of 1/20/2022, my chest pains became more severe. While the COVID-19 symptoms were active, the chest pain was almost constant and never went away. Ever since then, I have had the chest pains daily. At the time of this writing, the intensity of the pain is about the same. It's sore like a sharp, squeezing sensation on my heart. Whenever it comes, it sometimes lasts for several hours and sometimes for less than an hour, but never less than 10 minutes. Since my COVID-19 infection, I have also experienced shortness of breath with the chest pains more often, but it's usually during or after exertion. I experienced a traumatic brain injury in 2017, and I have had various health issues resulting from this ever since. Since having COVID-19, I feel that the symptoms of the health issues associated with the brain injury have intensified. I went to my PCP, and I underwent an EKG on 6/2/2022. It was found that I have moderate- level heart valve regurgitation on the aortic, mitral, and tricuspid valves. I also have trace leakage on the pulmonic valve. The aortic arterial pressure (?) was also elevated.  On 7/8/2022, I went to the ER for chest pains and numbness on the left side of my body, plus severe headache. It was determined that I had complex migraine with aura and an atypical chest pain of unknown cause. One of their tests indicated that the descending thoracic aorta was enlarged; it was 3.5, and the normal size is less than 2.1. They gave me two doses of a medication that is normally given to treat migraines intravenously, but I don't remember the name of it; it helped with everything but the chest pains. I was then discharged. I continued having chest pains, and my PCP ordered a nuclear medicine stress test and referred me to a cardiologist. Before the time came for my appointments for the stress test and the visit to the cardiologist, I began having increased lightheadedness, increased balance issues, and near syncope episodes. I began tracking my blood pressure, which was very low. Not only that, but my pulse was also very low. I did this for about a day and called my PCP and left a message informing her of the situation. The following day, which was 8/11/2022, they called me back and told me to go to the ER. When I went to the ER, they determined my blood pressure was at the low end of normal. I wasn't prescribed anything. Instead, they discharged me and told me to just come back if the situation returned. Otherwise, I was to follow up with my PCP. On the morning of 8/12/2022, I passed out several times shortly after getting up. Each time, I fell and hit my head. My son called 911. When the paramedics checked my BP, it was at the low end of normal at first, but then it dropped to 88/53 and then a little lower. I was sent by ambulance to the ER. It was determined that I had bradycardia and hypotension. The incidents of my passing out were caused by hypotension crisis. The tests they ran detected a possible right ventricular conduction delay. They kept me for 24 hours for observation. They diagnosed me with postural orthostatic hypotension, bradycardia. and arrhythmia. They prescribed me midodrine to raise my BP, and it has helped; at this point, I still get low readings, but I have not fainted again. I saw my cardiologist on 8/24/2022; he ran an EKG that showed that my sinus rhythm had returned to normal. He advised me to continue drinking plenty of water and taking the midodrine. I was also told to drink electrolytes, eat plenty of salt, and wear compression socks to increase my BP. He also ordered a ZIO patch for me to wear to keep track of my cardiac activity. I underwent a nuclear medicine stress test on 9/1/2022. According to the results I have received thus far, the left ventricle is in normal condition and the ejection fraction was 71%. However, I have not yet gotten back the results regarding the other parts of my heart. I am scheduled to see my PCP on 9/21/2022, and I should receive word on the rest of the results then. On 9/6/2022, the ZIO patch was placed below my left clavicle. It should be removed either the evening of 9/20/2022 or the morning of 9/21/2022. I am then to mail the readings in, and I may not get the results back for up to a month.