Presented to the ED with complaints of shortness of breath for the past 1 week that has been gradually worsening especially with exertion.  Endorses sick contact in his son, with home he has been living, who currently has COVID-19 pneumonia and receiving ecmo.  Of note, patient was recently discharged from hospital on 06/29/2021 for acute hypoxic respiratory failure secondary to acute on chronic CHF exacerbation as well as AKI on CKD.  79-year-old female with past medical history of endometrial cancer status post radiation therapy and multiple abdominal surgeries, status post hysterectomy, hypertension, anxiety, hyperlipidemia, mitral valve regurgitation status post clipping, aortic valve stenosis status post TAVR, PFO, pulmonary hypertension, coronary artery disease, hypothyroidism, GERD, C-section x4, sacral decubitus ulcer, immobility/bedridden, wheelchair dependent, hypothyroidism, and multiple admissions for small bowel obstruction presented to the emergency department complaints of persistent shortness of breath especially with laying supine.  Patient reports that she was her usual state of health until approximately 1 and half weeks ago when she went to a specialty Clinic for evaluation of shortness of breath.  Patient reports that she had abnormality in her mitral valve and was told that she will need surgical intervention.  Patient is unsure as to what exact issue she has with her mitral valve however she describes it as a possible prolapse.  Regardless, patient reports that over the past 4 days, despite compliance with Lasix as well as her diet, she has had persistent shortness of breath.  Patient is wheelchair-bound however, at baseline, is able to move around her wheelchair without much difficulty however, over the last 4 days, she has had significant shortness of breath.  She has not noticed any worsening lower extremity swelling however, reports that this morning, she came out of the bathroom and was very short of breath.  She was seen by her home nurse who told her that her lips were blue and that she needs to seek help and go to the emergency department for further evaluation.   Upon arrival to the emergency department, patient was found to have acute respiratory failure most likely secondary to acute on chronic heart failure, sepsis secondary to COVID-19, leukopenia, anemia, thrombocytopenia, elevated D-dimer, metabolic acidosis, elevated troponin secondary to type 2 MI, elevated BNP, and transaminitis all present on admission.  EKG independently reviewed and consistent with new T-wave inversions in V2 and V3.  Last echocardiogram from 06/2021 consistent with normal EF of 60%, prostatic aortic valve, severe mitral regurgitation, and severe pulmonary hypertension.  Patient reports that she was vaccinated for COVID-19 1 month ago.  Reports that she had a low-grade fever of 99 approximately 2 days ago and took Tylenol for it.  Patient also reports that she has been having nonproductive cough however, does not report any rigors or chills.  Chest x-ray was independently reviewed and consistent with pulmonary vascular congestion and interstitial edema.  There was also small left-sided pleural effusion.  There were patchy airspace opacities in bilateral regions concerning for possible edema however, superimposed infection could not be definitively ruled out.   endometrial cancer status post radiation therapy and multiple abdominal surgeries, status post hysterectomy, hypertension, anxiety, hyperlipidemia, mitral valve regurgitation status post clipping, aortic valve stenosis status post TAVR, PFO, pulmonary hypertension, coronary artery disease, hypothyroidism, GERD, C-section x4, sacral decubitus ulcer, immobility/bedridden, wheelchair dependent, hypothyroidism, and multiple admissions for small bowel obstruction 7/21/2021 tested positive 7/26/2021: patient discharged.