I received the 1st Pfizer COVID vaccine on January 5, 2021 at the Care Center where I work as medical director.  I did not have any symptoms until the next morning where developed fatigue, malaise, weakness and dyspnea while walking through the house which is extremely unusual for me.  I measured a room air SpO2 of 84% was able to borrow an oxygen concentrator from a friend to help with the acute hypoxia.  Symptoms slowly resolved over the following 3 days and is able to return to work only noting some mild fatigue as the day progressed into the afternoon. The 2nd Pfizer COVID vaccine was administered on January 26, 2021 and I experienced slightly increased fatigue over the next week but also noted episodes of central chest pain with rapid dyspnea and low exercise tolerance while shoveling snow which was very concerning my mind and atypical. On the morning of February 9, 20-1 as rapid work at 0645 when he became very weak with severe palpitations, tremulousness and sensation of being on the verge of syncope with impending doom which I have never ever experienced in my life before.  I was barely able to make it through a meeting at the hospital that morning due to the continued palpitations, tremulousness, weakness and fatigue.  I immediately walked over to the emergency department and was seen by Dr. who performed cardiac workup and noted elevated blood pressures, oxygen level of 90% on room air as well as abnormal EKG, elevated troponin and mild renal insufficiency.  He is able to coordinate an echocardiogram urgently that day and my LVEF was found to be 40% with evidence of dilated left and right ventricles with thickened myocardial walls.  Dr. talked with Dr. who was the cardiologist on-call at Medical Center that day.  The working diagnosis at that time was acute cardiomyopathy uncertain etiology and was scheduled for a nuclear stress test at Hospital on February 10, 2021.  Results of that study showed perfusion deficits suggesting 3 vessel disease and an LVEF of 43% which was very concerning to cardiology. I saw Dr. later that afternoon for an urgent cardiology consultation at his clinic where he recommended angiography to workup the problem. Cardiac angiography was completed on February 12, 2021 at Medical Center where the coronary arteries were fortunately found to be completely patent but the evidence pointed to a dilated cardiomyopathy with impaired LVEF. The next study was a cardiac MRI performed at Hospital on February 26, 2021 where it was confirmed that I had impaired ejection fraction with LVEF of 40% and RV EF of 30% with dilated ventricles and an apical aneurysm. I saw Cardiology again on March 12, 2021 and was started on carvedilol because of the findings of the cardiac MRI and diagnosis of dilated cardiomyopathy with heart failure. My exercise tolerance at the time of this writing has decreased by 75%.  I cannot shovel snow for more than 5 minutes without developing a constricting central chest pain with radiation up into the left neck and shoulder.  Chest pain resolved after resting for 5 minutes.  I have dyspnea when traversing more than 2 flights of stairs, become fatigued by early afternoon which significantly affects my ability to work long hours as required by a hospitalist.  I have not written my mountain bike yet this spring due to the very poor stamina with rapid fatigue when performing normal activities.