Patient is a 66 y.o. female patient of MD with history of COPD, CKD, type 2 diabetes, hypertension presented to Doctors Hospital with SOB Discharge Diagnoses: Acute on chronic respiratory failure with hypoxia Multifactorial including COVID, severe Pulm HTN, COPD exacerbation Required BiPAP-- > non-heated Hiflo, Pulm following Wears 4L of O2 at baseline Attempted to wean down over the weekend but requirement went up but contines to wean down Continue diuresis  Pulmonary on board Repeat Home O2 eval done; qualifies for 6L as new requirement   Covid-19 Pneumonia Date of onset of symptoms: 1-2 Days prior to admission Symptoms present on admission: SOB, Hypoxia Date of covid positive test: 01/12/2023 Vaccination status: vaccinated Imaging: CTPA study no PE small right pleural effusion with small right lung base consolidation. Oxygen requirements on admission: BIPAP Current oxygen requirements: Heated hiflo  Medical therapy: steroids at present Consultants following: ID, pulmonology Anticipated special isolation end date: 01/22/2023  Completed abx, remdesivir and dexa ID on board   Acute COPD exacerbation Patient has history of COPD, baseline 4L O2 Uses Breo Ellipta 200-25 MCG at home Start Symbicort and Spiriva,  needed albuterol inhalation Completed steroid   Acute Diastolic Congestive Heart failure Severe tricuspid valve regurgitation Severe pulmonary hypertension No previous history of CHF Presented with lower extremity edema and effusion on CT chest Echo showed EF 66%, significant pulmonary hypertension with estimated right ventricular systolic pressure 47 mmHg right chamber mildly enlarged slight systolic function reduced. Not on diuretics at home. CT with signs of right-sided heart failure Updated ECHO showed EF 55-60% with septal flattening consistent with RV volume and pressure overload with severely dilated and reduced function of RV with severe functional tricuspid valve regurgitation with hepatic vein systolic flow reversal.  Severe hypertension noted with RVSP 90 Cardiology consulted?change could be related to COVID-19 infection. Recommend gentle diuresis for what appears to be right-sided failure.   Needs further cardiac work up, RHC when stable on OP basis Continue lasix for diuresis Pulm on board History of CAD S/p PCI to OM and RCA Continue Lipitor Not taking aspirin, resume   CKD stage III Baseline creatinine 1.3-1.4, this am 1.46 Monitor renal function    Essential Hypertension On lisinopril 10 mg at home Currently being held while on IV diuretics due to underlying CKD As needed hydralazine. BP stable.  DM 2 w hyperglycemia Last hemoglobin A1c 5.7 on glipizide and Actos at home both being held Will have to discontinue Actos due to CHF prior to discharge Glu elevated to do decadron, add lantus cont SSI\    Abnormal CT CT showed irregular parenchymal density seen in the right apex measuring up to 15 mm which appears more pronounced compared with prior exam.  Which may represent scarring.  However nodular scarring and malignant etiology cannot be excluded.  Correlation and continued follow-up imaging with possible PET/CT imaging may be considered. Pulmonology consulted as above   Can have outpatient follow-up and biopsy as clinically warranted   Tobacco abuse.  Cessation has been advised Continue NRT