Age: 73.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Fatigue, Fibrin D dimer, Hypoventilation, Hypoxia, Left ventricular dysfunction
Clinical narrative: Hospitalized (11.20.21 - currently still admitted);  COVID-19 positive (11.20.21); fully vaccinated Admitted 11.20.21.   HISTORY OF PRESENT ILLNESS: Patient is a 73 y.o. female with history of prior takotsubo cardiomyopathy with recovered ejection fraction, type 2 diabetes mellitus with neuropathy, sciatica on chronic Norco, hypothyroidism presents initially to Sparrow Ionia with cough and fatigue found to have a reduced ejection fraction of 18% and found to be COVID positive.  She is transferred to Hospital for admission by Cardiology as troponins were significantly elevated in setting of new reduced ejection fraction.  She was started on heparin drip.  Denies chest pain or shortness of breath.  She does endorse a cough, diarrhea, congestion, body aches x2 weeks.  She is fully vaccinated against COVID.  Her home Bumex 1 mg daily has been continued.  She was initially on room air upon admission. She is now hypoxic requiring 3 L of oxygen so Cardiology requests Medicine take over as primary service. She already received remdesivir x1 dose. Pt clarifies that her symptoms have been present x2 weeks so remdesivir will be discontinued and decadron will be started. Chest x-ray repeated today, appears unchanged compared to 2 days ago, left-sided airspace disease noted, no overt heart failure.  Pt has been NPO for possible cardiac cath but this is on hold due to her hypoxia, will resume diet. Blood sugars have trended down in setting of NPO status while receiving 60 units lantus nightly. Will adjust insulin regimen. Pt also requests her home norco which she takes chronically for sciatica.  Covid pneumonia with hypoxia - currently requiring 3L O2 via NC (does not use oxygen at baseline) ?degree of OSA/obesity hypoventilation - s/p vaccination x 2 in 03/2020 - sx started two weeks ago, positive test 11/20  - CXR on 11/20/21 shows mild burden of airspace disease (lateral aspect of left lung field), cardiomegaly without definite heart failure - CXR on 11/22/21 with no significant change in the chest - s/p IV remdesivir, will d/c as symptoms began two weeks ago  - Start decadron 6 mg po x10 days  - Monitor and trend CRP, D-Dimer - Supportive care measures, o2, tessalon perles, encourage proning  Troponin Elevation  - Troponin at Sparrow 717-- >660, Troponin here 251-- >230, on heparin gtt per cardiology, appreciate cardiology input  - EKG on 11/20/21 shows NSR with chronic inferior q waves, QTc 450 - Echo on 11/21/21 shows EF 18% (down from 59%). Severe LV dysfx w/ predominantly global hypokinesis (apical ballooning cardiomyopathy VS. CAD) - Per Cardio: DDX: myocarditis, takotsubo cardiomyopathy -pt denies chest pain or SOB -tele  Progress Note from 11.30.21: Assessment & Plan: No acute events reported overnight. Sitting in chair and breathing comfortable on room air. Patient denies any concerns and awaiting placement.  # COVID-19 PNA  Vaccinated against COVID-19 (3/2020) and testing positive 11/20. CXR (11/20) with mild burden of airspace disease in lateral aspect of left midlung field. ID was consulted by cardiology and patient completed 5 days of Remdesivir.  ---Decadron (6 mg PO daily day #9) and discontinue as respiratory issue now resolved ---out of isolation as symptoms started 2 weeks prior to admission  # Acute on Chronic Combined Heart Failure Echo (11/2021) with LVEF 18%, RV mildly decreased. History of stress-induced cardiomyopathy with return to normal EF in the past. Cardiology consulted and suspect COVID-19 may have triggered stress cardiomyopathy again, but given co-morbid conditions, ischemic cardiomyopathy a possibility. Cardiology consulted and have signed off with recommendations for outpatient stress CMR ---Bumex (1 mg daily), standing weights (if possible), fluid restriction  ---Lipitor (80 mg HS), ASA (81 mg daily), Coreg (3.125 mg BID), Losartan (12.5 mg daily)