Age: 18.0
Sex: M
Vaccine: COVID19
Symptoms: C-reactive protein increased, Capillary nail refill test, Cardiac imaging procedure normal, Chest X-ray normal, Chest pain
Clinical narrative: From hospital discharge note:  Admission Date/Time: 10/20/2023 15:45:00 Discharge Date/Time: 10/24/2023 14:00:17  Chief Complaint  myopericarditis  Patient Narrative     ILLNESS SEVERITY:   The patient is returning to baseline, requires assessment.   PATIENT SUMMARY:  Reason for Hospitalization: myopericarditis    Admission HPI: Patient is an 18 y/o otherwise healthy male with a history of acne who presenting with myocarditis. He received the COVID and influenza vaccines 3 days ago (Tues, 10/17). He was well until two days ago when he developed muscle aches. Then, yesterday developed substernal chest pain that was worse with inspiration. Family called the PCP's office given the pain was not subsiding; the nursing line referred him to the local ED.    His physical exam was overall unremarkable by report. CBC with WBC 13.8, lytes unremarkable, normal D-Dimer (281). PT and INR mildly elevated (16.2, 1.3). Troponin was elevated at 542 (repeat levels 644, 640) and CRP elevated at 117.6. RVP was negative for influenza, COVID, and RSV. TSH was wnl. CK 269. CXR negative. EKG NSR with early repolarization. TTE showed low-normal EF of ~50% with no WMA and no pericardial effusion. He received indomethacin and Tylenol in the ED with resolution of pain. Also received 1L NS bolus.   Plan was then for him to be admitted to the cardiology service upon discussion. While en-route with EMS, ST changes noted on ECG and patient re-routed to the ED. Received 325 mg ASA in transport. There, repeat labs showed uptrending troponin to 790, elevated CRP (12.7). BNP 93. WBC 10.8, CMP with mildly elevated AST (88). ECG with diffuse ST changes. TTE w/mildly depressed LV function, EF 49%.    No documented fever (though felt hot at times); no night sweats, HA, rhinorrhea, cough, SOB, emesis, abdominal pain, diarrhea, or constipation. No syncope, palpitations, or exercise intolerance. Eating and drinking a little less than usual. No recent illnesses. Has never had anything like this before.  Hospital Course: Patient remained hemodynamically stable throughout his admission.  He was treated with two IVIG infusions (on 10/20 and 10/21) and a five day course of steroids which he will complete at home. ECGs and troponin were trended and are improving.  He has occasional single PVC's and PAC's, no runs of ectopy. His troponin peaked at 918 on 10/20 and had trended down to 472 prior to discharge. A cardiac MRI was completed while inpatient which demonstrated normal function and no LGE. (full report below).   Given the risk of arrhythmias and a sudden cardiac event, patient will be exercise restricted for 3 months but will need to be cleared by cardiology prior to resuming exercise.  A letter was provided to excuse him from gym class until further notice.   Patient will return to hospital on Fri. 10/27 for labs (Troponin and CRP). A Holter monitor will be mailed to his house to wear for 7 days and he will follow up in 2-3 weeks.  The plan was discussed in detail with patient and his mother.  All questions and concerns were addressed, and they agree with discharge and follow up plan.   Reasons for new, changed, and discontinued medications:  see above Reasons for new, changed, and discontinued equipment: NA   Relevant Diagnostic Images/Studies:   Cardiac MRI 10/23: ? Normal biventricular size and systolic function. No regional wall motion abnormalities. ? No MRI evidence of active myocarditis. No myocardial late gadolinium enhancement. ? No significant valvular dysfunction. ? Normal coronary artery origins. ? No pericardial effusion. ? Findings communicated to the care team at the time of interpretation.  Discharge Echo 10/22: ? Normal left ventricular size and systolic function. No regional wall motion abnormalities. Interval improvement in ejection fraction. EF 57.6% ? Qualitatively normal right ventricular systolic function. ? Normal valvular function.  Tests Pending  No tests pending at time of discharge    These tests will be followed by the Primary Service at Discharge after Discharge  Vitals and Discharge Physical  T: 37.1  °C  (Temporal Artery)  HR: 95 (Monitored)  RR: 20  BP: 112/68  SpO2: 98%   Discharge Physical Exam   gen: well appearing, lying in crib/sitting in chair, in no acute distress  cv: rrr, normal S1/S2, no murmur, gallop or rub, + pulses, wwp, cap refill < 3 sec  resp:  CTAB, comfortable WOB  abd: soft, nondistended  extremities: maew, good UE/LE strength bilaterally  neuro: appropriate for age  Diagnosis List   1. Chest pain, 10/20/2023  2. Myocarditis, 10/21/2023  Procedure History  No Procedure History  Social History  Smoking Status      No Smoking Status Documented  Allergies   No known allergies  Laboratory Results Returned 48 Hours Prior to Discharge  Labs Last 48 Hours      Event Name  Event Result  Date/Time   Hematocrit 42 % 10/23/23  Troponin T Gen 5 472 ng/L High 10/24/23  Troponin T Gen 5 566 ng/L High 10/23/23  Troponin T Gen 5 660 ng/L High 10/23/23