Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Mitral valve incompetence, N-terminal prohormone brain natriuretic peptide increased, Oedema peripheral, Pacemaker generated rhythm, Positive airway pressure therapy
Clinical narrative: HMS DISCHARGE SUMMARY -- Hospital                  Admitted: 10/3/2023 Discharge Date: 10/06/23    PCP Handoff    Recommended Outpatient Testing o RFP in 1 week o Close follow-up with PCP and cardiology   Results Pending At Discharge o None       Clinical Summary   Patient is a 85 y.o. male patient of MD with history of CAD, CHF, CVA, DM2, MI, CKD who presented to Hospital with shortness of breath.   Acute on Chronic HFrEF Acute hypoxemic respiratory failure , resolved Recent CRT-D pulse-generator replacement  Shortness of breath, leg edema Initially required bipap in ED, but now weaned down to RA now Ntprobnp 6,098 Echo (5/2020) EF 30-35% with mild MR, moderate aortic root dilatation Chest x-ray with diffuse airspace opacities more prominent on the right lung compared to the left Obtain CT chest for further evaluation Echo with reduced LVEF of 20-25% Home meds: lasix 40qd, metoprolol, arb,  Received 40mg IV lasix in ED, ordered 40mg lasix BID Cardiology consulted, continue IV lasix and place on entresto with metoprolol.   Entresto prescribed on discharge with Lasix 40 mg twice daily Close outpatient follow-up with Cardiologist   Covid-19 Virus Infection Date of onset of symptoms: states had cough for the past week, decreased appetite Symptoms present on admission: cough, shortness of breath Date of covid positive test: 10/3/2023 Vaccination status: vaccinated Imaging: CXR (10/3) diffuse airspace opacities involving the right lung and to a lesser extent interstitial opacities involving the left lung, findings could be due to pneumonitis right >left  CT pending Oxygen requirements on admission: bipap  Current oxygen requirements: Weaned from 5 L at bedside to RA, no oxygen needed on home O2 evaluation Medical therapy: steroids Received rocephin/azithromycin in ED, continued for now Consultants following: ID Anticipated special isolation end date: 10/13/2023 Procalcitonin wnl and CRP 27.5 Discharge on dexamethasone to complete total of 10 days of dexamethasone  Elevated Troponin Likely due to above and also CRS Trop 162 -- > 156 with negative delta ECG shows paced rhythm, no ischemic changes Monitor on tele   CAD Follows with cardiology  S/p PCI in 1990's  Home meds: clopidrogel, atorvastatin Continued    Acute Blood Loss Anemia Patient with melena noted overnight on 10/3, endorses black stools but not tarry in nature with oral iron intake Hemoglobin of 10.7 on presentation, down to 8.9 Continue to trend hemoglobin every 8 hours No indication for PRBC transfusion at this time but transfusion consent signed at bedside on 10/4 in case it is needed GI consulted, continue dexamethasone, start PPI BID, no endoscopy needed while inpatient No repeat melena noted Discharge on Protonix 40 mg daily and outpatient follow-up with GI if needed   History of CVA Per patient back in 2009 has some residual visual field deficit and balance issues Home meds: statin, clopidrogel Continued  PT/OT following   CKD Stage III Follows with Nephrology outpatient Care  Baseline Cr ~2.1 Cr 2.19 on admission, stable at 2.1 Home meds: sodium bicarb Continued  Avoid nephrotoxins and monitor  Commend RFP 1 week after discharge NIDDM2, uncontrolled with hyperglycemia Peripheral neuropathy HbA1c (8/2023) 9.5 Home meds: Increased tresiba to 26 units nightly, novolog SSI, gabapentin Continued gabapentin   Essential HTN Home meds: Losartan, amlodipine, metoprolol  Continue home metoprolol, amlodipine.  Discharged on Entresto and increased Lasix   Dementia Home meds: aricept Continued