Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Anion gap, Anticoagulant therapy, Blood bicarbonate normal, Blood calcium decreased
Clinical narrative: Hospitalized (1.5.22 - 1.11.22); COVID-19 positive (1.5.22); Fully vaccinated  - moderna x2 d/c summary: Discharge Summary (Physician) ? ? General Medicine  BRIEF OVERVIEW: Discharge Provider:  Primary Care Provider:  Admission Date: 1/6/2022 Discharge Date: 1/11/2022    Active Hospital Problems   Diagnosis Date Noted  ? Hypertensive urgency 01/11/2022 Unknown ? Myocardial injury 01/11/2022 Unknown ? COVID-19 01/08/2022 Yes ? Intractable nausea and vomiting 07/02/2021 Unknown   Resolved Hospital Problems   Diagnosis Date Noted Date Resolved ? Non-STEMI (non-ST elevated myocardial infarction) 01/06/2022 01/11/2022 Unknown    Pre-Existing Active Problems   Diagnosis Date Noted  ? Urinary incontinence 07/02/2021 Unknown ? Chest pain 01/06/2022 Unknown ? Osteoarthritis, localized, knee 09/20/2021 Unknown ? History of colon polyps 09/19/2020 Unknown ? Depression, major, in remission  02/20/2020 Unknown ? RUQ abdominal pain 06/03/2018 Unknown ? DJD (degenerative joint disease), lumbar 05/08/2018 Unknown ? Seasonal allergies 06/01/2017 Unknown ? Cough 05/20/2016 Unknown ? Obstructive sleep apnea 12/04/2015 Unknown ? Essential hypertension, benign 11/23/2015 Unknown ? Chronic pain 11/23/2015 Unknown ? Generalized anxiety disorder 11/23/2015 Unknown ? GERD (gastroesophageal reflux disease) 11/23/2015 Unknown ? Obesity (BMI 30-39.9) 11/23/2015 Unknown     Discharge Disposition:  home or self care    Active Issues Requiring Follow-up: COVID 19, HLD, HTN, nausea & vomiting    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Non-STEMI (non-ST elevated myocardial infarction) [I21.4]   HOSPITAL COURSE: Pt. is a 63 y.o. woman with past medical history significant for hypertension, depression anxiety and bipolar disorder who presented to emergency department for fatigue, vomiting and myalgias.   According to patient she was having fatigue, vomiting and myalgias since 01/04/2022.  Given the symptoms she presented to Ludington emergency department on 01/05/2022.  She denies fever, chills, not, change in taste or smell, chest pain, chest pressure, tightness, exertional shortness of breath, palpitations, diarrhea and urinary symptoms.   In emergency department, blood pressure was very high and bradycardic.  She was afebrile and respiratory condition was stable.  Checked for COVID-19 which was positive.  Initial troponin was mildly elevated at 23 with repeat trended up to 48 and then 165. Given this emergency department physician discussed with Cardiology they recommended to start heparin GTT and transferred for further evaluation.     Cardiology was consulted.  Echocardiogram showed LVEF of 63%, no regional wall motion abnormalities noted no significant valvular dysfunction.  She does felt that elevated troponin is secondary IR cardial injury.  She was noted to have hyperlipidemia.  Cardiology recommended ASA 81mg daily, high intensity statin with follow-up lipid panel in 3 months arranged by PCP.  She was started on Lipitor 40 mg daily.  She received supportive care for COVID-19.  She did not require remdesivir or Decadron.  She had intractable nausea and vomiting.  She was evaluated by GI.  Symptoms overall improved and she was able to tolerate diet prior to discharge.   Continue ASA. Started on lipitor 40mg nightly. PRN compazine. Repeat lipid panel in 3 months. Chlorthalidone stopped. Propranolol decreased to 10mg BID.   She was discharged home in stable condition on 1/11/2022.     CONSULTS / RECOMMENDATION:    Consult Orders (From admission, onward)                IP CONSULT TO GI      Provider:        IP CONSULT TO CARDIOLOGY      Provider: Cardiology                BP 133/70  | Pulse 55  | Temp 36.8 °C (Oral)  | Resp 16  | Ht 1.6 m  | Wt 70 kg  | SpO2 97%  | BMI 27.34 kg/m²    Physical Exam Constitutional:      General: She is not in acute distress. HENT:     Head: Normocephalic.  Eyes:     General: No scleral icterus.    Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:     Rate and Rhythm: Regular rhythm. Bradycardia present.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing or rales.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding or rebound.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: She is alert and oriented to person, place, and time.  H&P: CHIEF COMPLAINT: Non-STEMI (non-ST elevated myocardial infarction)     Assessment/Plan    ASSESSMENT / PLAN:   Non STEMI: Continue heparin GTT Start lipitor 40 mg and ASA 81 mg daily. LDL: 128. A1c 5.1 on 1/5/22 Will obtain echo. Consult cardiology to evaluate.  Smoking:quit 4/4/21 with 50 pack year smoking history.   Bradycardia: will hold Propranolol.   COVID-19 pneumonia: Symptoms onset: 1/4/22 Symptoms: :vomiting, fatigue, myalgias. Tested +ve on 1/5/22 Vaccination status: completed 2 doses, waiting for booster. Tx: as she is on Room air she doesn't qualify for Dexamethasone or remdesivir, will consider both the for respiratory condition declines.   HTN: On chlorthalidone and propranolol. Hold  propranolol for bradycardia and also hold chlorthalidone.    OSA: Lost 170 pounds and not using cpap any more.   Uses medical marijuana for pain and anxiety.   MDD: Buspar, Wellbutrin, PRN xanax, Effexor and Lithium. Follows with community mental health.   Code status: full code   DVT: on heparin GTT for Non STEMI.         HISTORY OF PRESENT ILLNESS: Pt. is a 63 y.o. woman with past medical history significant for hypertension, depression anxiety and bipolar disorder presented to emergency department for fatigue, vomiting and myalgias.   According to patient she was having fatigue, vomiting and myalgias since 01/04/2022.  Given the symptoms she presented to emergency department on 01/05/2022.  She denies fever, chills, not, change in taste or smell, chest pain, chest pressure, tightness, exertional shortness of breath, palpitations, diarrhea and urinary symptoms.   In emergency department, blood pressure was very high and bradycardic.  She was afebrile and respiratory condition was stable.  Checked for COVID-19 which was positive.  Initial troponin was mildly elevated at 23 with repeat trended up to 48 and then 165. Given this emergency department physician discussed with Cardiology they recommended to start heparin GTT and transferred for further evaluation.   At the time of interview is complaining of fatigue.  Denies nausea, vomiting, fever, chills, loss of taste, loss of smell, chest pressure, heaviness, tightness or exertional shortness of breath, shortness of breath, diarrhea and urinary symptoms.   Patient Active Problem List Diagnosis ? Essential hypertension, benign ? Chronic pain ? Generalized anxiety disorder ? GERD (gastroesophageal reflux disease) ? Obesity (BMI 30-39.9) ? Obstructive sleep apnea ? Cough ? Seasonal allergies ? DJD (degenerative joint disease), lumbar ? RUQ abdominal pain ? Depression, major, in remission  ? History of colon polyps ? Urinary incontinence ? Osteoarthritis, localized, knee ? Chest pain ? Non-STEMI (non-ST elevated myocardial infarction) OBJECTIVE: No vitals were available at the time this note was created    Physical Exam Gen: Oriented X 4, not in distress HEENT: Anicteric, PRL Neck: Supple, no palpable thyroid Lungs: CTA, no wheezing appreciated CVS: RRR Abd: NT,  ND, BS +ve. Neuro: no focal neurological deficits noted. Ext: No edema. Skin: no rashes noted Psych: Mood appropriate.