Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: Mitral valve calcification, Oesophageal stenosis, Oesophagitis, Pain, Palpitations
Clinical narrative: Office Visit 5/4/2021 screening laboratory testing for COVID-19 virus +1 more Dx Cough  ? Diarrhea ? Fatigue Reason for Visit  ED to Hosp-Admission Discharged  5/5/2021 - 5/17/2021 (12 days)    Last attending  Treatment team Pneumonia due to COVID-19 virus Principal problem   Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes       Asthma without status asthmaticus Yes       Systemic lupus erythematosus (CMS/HCC) Yes   Overview Signed 12/1/2020  7:46 AM       Note: Document: 08/22/19 - Consults Rheumatology           Paroxysmal atrial fibrillation (CMS/HCC) Yes       Atrial fibrillation with RVR (CMS/HCC) Yes       Esophageal stricture Yes        Hospital Course     HPI:   patient is an 81 y.o. female with pmh of COPD and HTN presented to the ER with complaint of palpitations. She reports since her second covid short on 4/29, she's been feeling "ill." she states she's been having diarrhea, chills, fatigue, and cough. In the ER, she was found to be in afib with RVR. She was given a one time dose of cardizem but then spontaneously converted to NSR. She is not hypoxic but admits to increased cough and occasional dyspnea. CTA was done in the ER due to elevated D dimer. Pulm embolism was ruled out, however, she was found to have bilateral infiltrates concerning for viral pna   Hospital Course:   Please send details from consultation note from hematology gastroenterology   81-year-old Caucasian female she had a history of COPD hypertension she was admitted through the emergency room on May 6 with a chief complaint of palpitation chest discomfort.  She was found to have A. fib with RVR with underlying history of paroxysmal atrial fibrillation.  Patient was admitted and atrial fibrillation is rate controlled in maintain with increase his Lopressor.  ACS is ruled out by cardiac enzyme patient was found to have a COVID-19 pneumonia fortunately patient oxygen saturation remained good continue having mild cough.  And initially she was not started any dexamethasone or any antiviral remdesivir.  But over the time patient actually having mild wheezing shortness of breath but oxygen saturation remained stable so then dexamethasone was started.  Heart rate was pretty controlled with current medication Lopressor anticoagulation did not start since patient was found to have a severe thrombocytopenia.  Patient was seen by hematologist recommend to bone marrow biopsy thought that the sudden drop possible from infectious source.  So then that point Heparin Olympic Eliquis was not started.  Over the time patient platelet count back to normal platelet count 1 75,000 Eliquis started 2 days ago.  Since she looked tolerating Eliquis heart rate is well controlled after adding dexamethasone she is underlying history of COPD her wheezing is much improved and she is currently on DuoNeb.  In the history of asthma without status asthmaticus patient will be discharged home with continue current medication Decadron for 5 more days started Eliquis 5 mg 2 times daily since she is tolerating and platelet count is normal I recommend to check CBC for platelet count in 5 days.  This patient will benefit to see hematologist outpatient although she refused to do a bone marrow biopsy.  She is having chronic low back pain and currently on narcotics recommend to follow-up with PCP to change his narcotic medication..  Initially she had a CTA chest done which was normal although D-dimer was mildly elevated negative for pulmonary embolism and a mild infiltration concerning viral pneumonia so bacterial antibiotic was not started.  Stable to be discharged home she was having intermittent low-grade fever for almost like 5 to 10 days.  The fever is totally gone now.  She is clinically stable new medication is adjusting increase Lopressor 50 mg 2 times daily.  Eliquis 5 mg p.o. twice daily and she is going to go home with Decadron only for 5 days..  Patient also have underlying history of chronic dysphagia patient was seen by gastroenterology recommend to follow-up outpatient in 2 to 3 weeks Follow-up PCP in 5 days, follow-up with hematology as scheduled