Age: 43.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Angiogram, Arthralgia, Magnetic resonance imaging, Myocarditis, Pain
Clinical narrative: Pt received Pfizer COVID vaccine on 3/26 at facility. Pt presented to the ED on 3/30 for evaluation of chest pain at around 0722 on 3/30.  Per ED provider note, "This patient is a 43 y.o. male who presents to the ED for evaluation of chest pain. The patient drove here two days ago and was feeling well when he went to sleep. He was awoken from sleep early yesterday morning with "intense" left sided chest pain with radiation and tingling sensation down his left arm. The patient says that his pain has since been fairly constant, waxing and waning in intensity. He says that his chest pain is still currently present, mostly localized in his left shoulder, but improved when compared to the pain that woke him up again this morning around 03:00. No reported vomiting, abdominal pain, fevers, chills, cough, or shortness of breath. Patient notes that he received the second dose of the COVID-19 vaccine 4 days ago.    Patient reports family history of cardiac disease in his father. He denies any personal history of cardiac disease, and says that his last cardiac work up was a couple years ago for PVCs. The patient is not a smoker and denies any history of diabetes, hypertension, or high cholesterol. There are no other complaints. There are no other exacerbating or alleviating factors. There are no other reported associated signs or symptoms"  Pt was given nitroglycerin ointment and aspirin chewable 324mg in the ED. "  In addition, "This is a 43-year-old male presenting to the emergency department with just over 24 hours of left-sided chest pain with radiation into the left shoulder and down the left arm.  Symptoms were more severe prior to the patient's arrival to the hospital.  He was given nitroglycerin and aspirin upon arrival here.  EKG shows subtle ST abnormality in the inferior lateral leads.  Troponin is elevated at 11. Differential includes non ST-elevation myocardial infarction, myopericarditis.  Patient will be admitted to telemetry.  He will undergo a cardiac catheterization today."    Pt was admitted, and per hospitalist note on 4/1, "Patient presented hospital with chest pain and EKG changes-there was initial concern for NSTEMI.  Had cardiac catheterization with clean coronaries.  Then thought to have pericarditis.  Patient had trivial pericardial effusion on echocardiogram.  Had MRI that demonstrated myocarditis as well.  Patient improved on colchicine and NSAID therapy.  Discussion had with cardiology will continue this and to be tapered in the office setting.  Will continue NSAIDs for approximately 2 weeks then begin tapering.  Will likely need colchicine for approximately 3 months.  Patient was placed on beta-blocker to help with symptomatic treatment and help alleviate plain. Patient was started on metoprolol, was cautioned side-effects of hypotension, bradycardia, exercise intolerance .Patient should monitor heart rate and blood pressure daily. Hold if heart rate <50 or blood pressure less than 100 systolic and notify provider.     Patient was advised he may follow-up with Dr.  Caution GI upset, nausea vomiting diarrhea.  If diarrhea with colchicine would recommend back down to daily from b.i.d. treatment.     Patient was ambulatory and functional without significant symptoms, vital signs within tolerable limits, and agreeable to discharge plan.. Patient ultimately discharged in stable condition. All questions answered to apparent satisfaction. Patient cautioned side effects of medications. Patient was instructed if reoccurrence or any concerning symptoms to contact provider or present to nearest emergency department based on acuity. Patient and family voiced understanding of recommendations and in agreement with discharge plan."