CHIEF COMPLAINT: pericardial effusion

PRESENT ILLNESS: 46 y/o M with no significant PMHx who was transferred to [**Hospital1 18**]
for urgent pericardiocentesis for pericardial effusion with
tamponade physiology. Patient was in his usual state of health
until early [**Month (only) 1096**] when he developed persistent low-grade
fevers (99.5 to 100.5). He then developed right-sided arm pain,
which prompted him to present to an OSH ED, where CXR showed
cardiomegaly. Lyme serologies and a Monospot were negative. On
exam, he had evidence of left-sided otitis media and was treated
with 10-days of Amoxicillin therapy. He then presented to his
PCP, [**Name10 (NameIs) 1023**] repeated CXR and found persistent cardiomegaly. Patient
was then referred to BIDN for echo today. This revealed
pericardial effusion with tamponade physiology; pulsus paradoxus
was 10. Pt was then transferred here for urgent
pericardiocentesis.
.
In the cath lab, the patient underwent pericardial drain
placement, with subsequent drainage of 500 cc from pericardium.
BP was stable the entire time; however, patient has remained
persistently tachycardic to the 120's. He received 3L IVF's
prior to pericardiocentesis.  RHC was performed before and after
pericardiocentesis and reportedly did not show significant
change in pressures, raising concern for potential constrictive
physiology.
.
On arrival to the ICU, the patient denied any complaints. He
reports that, aside from his persistent fevers and right-sided
arm pain, he has not experienced any other symptoms.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or pre-syncope.
.
ROS: The patient denies a history of prior stroke/TIA, deep
venous thrombosis or pulmonary embolus. He denies bleeding at
the time of prior procedures or surgeries. Denies headaches or
vision changes. No cough or upper respiratory symptoms. Denies
chest pain, dizziness or lightheadedness; no palpitations.
Denies shortness of breath. No nausea or vomiting, denies
abdominal pain. No dysuria or hematuria. No change in bowel
movements or bloody stools. Denies muscle weakness, myalgias or
neurologic complaints. No exertional buttock or calf pain.
.

MEDICAL HISTORY: * CABG: None
* PERCUTANEOUS CORONARY INTERVENTIONS: None
* PACING/ICD: None
.
PAST MEDICAL & SURGICAL HISTORY:
1. s/p ORIF right lateral malleolar fracture (right ankle
fracture, [**2106-7-25**])
2. s/p Removal of syndesmotic screws from right ankle ([**2106-10-28**])

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
VITALS: Temp 99.9 BP 155/86 HR 101 RR 22 SaO2 96% on 2LNC
GENERAL: Appears in no acute distress. Alert and interactive.
HEENT: Normocephalic, atraumatic. EOMI. PERRL. Mucous membranes
moist. No xanthalesma.
NECK: Supple without lymphadenopathy. LVP difficult to assess.
CVS: PMI located in the 5th intercostal space, mid-clavicular
line. Regular rhythm, without murmurs or gallops. S1 and S2
normal. No S3 or S4. Tachycardic. Audible friction rub.
Hyperdynamic precordium.
RESP: Respirations unlabored, no accessory muscle use. Clear to
auscultation bilaterally without adventitious sounds. No
wheezing, rhonchi or crackles. Stable inspiratory effort.
ABD: soft, non-tender, non-distended, with normoactive bowel
sounds. No palpable masses or peritoneal signs. Abdominal aorta
not enlarged to palpation, no bruit.
EXTR: no cyanosis, clubbing or edema, 2+ peripheral pulses
DERM: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSE EXAM:
Right: DP 2+
Left: DP 2+

FAMILY HISTORY: Denies family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; grandmother with diabetes (died at age
81), uncle with diabetes.

SOCIAL HISTORY: Patient lives at home with his wife, works as a [**Name (NI) 51873**] of a
software company. Two children, son and daughter. [**Name (NI) 4084**] smoking
history. Rare alcohol use; no recreational substance use.
Exercises 2-4 times weekly.
Acute idiopathic pericarditis,Cardiac tamponade,Fever, unspecified,Other specified cardiac dysrhythmias
Ac idiopath pericarditis,Cardiac tamponade,Fever NOS,Cardiac dysrhythmias NEC
Admission Date:  [**2114-12-25**]              Discharge Date:   [**2114-12-28**]

Date of Birth:  [**2068-5-15**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4327**]
Chief Complaint:
pericardial effusion

Major Surgical or Invasive Procedure:
right heart catheterization and pericardiocentesis

History of Present Illness:
46 y/o M with no significant PMHx who was transferred to [**Hospital1 18**]
for urgent pericardiocentesis for pericardial effusion with
tamponade physiology. Patient was in his usual state of health
until early [**Month (only) 1096**] when he developed persistent low-grade
fevers (99.5 to 100.5). He then developed right-sided arm pain,
which prompted him to present to an OSH ED, where CXR showed
cardiomegaly. Lyme serologies and a Monospot were negative. On
exam, he had evidence of left-sided otitis media and was treated
with 10-days of Amoxicillin therapy. He then presented to his
PCP, [**Name10 (NameIs) 1023**] repeated CXR and found persistent cardiomegaly. Patient
was then referred to BIDN for echo today. This revealed
pericardial effusion with tamponade physiology; pulsus paradoxus
was 10. Pt was then transferred here for urgent
pericardiocentesis.
.
In the cath lab, the patient underwent pericardial drain
placement, with subsequent drainage of 500 cc from pericardium.
BP was stable the entire time; however, patient has remained
persistently tachycardic to the 120's. He received 3L IVF's
prior to pericardiocentesis.  RHC was performed before and after
pericardiocentesis and reportedly did not show significant
change in pressures, raising concern for potential constrictive
physiology.
.
On arrival to the ICU, the patient denied any complaints. He
reports that, aside from his persistent fevers and right-sided
arm pain, he has not experienced any other symptoms.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or pre-syncope.
.
ROS: The patient denies a history of prior stroke/TIA, deep
venous thrombosis or pulmonary embolus. He denies bleeding at
the time of prior procedures or surgeries. Denies headaches or
vision changes. No cough or upper respiratory symptoms. Denies
chest pain, dizziness or lightheadedness; no palpitations.
Denies shortness of breath. No nausea or vomiting, denies
abdominal pain. No dysuria or hematuria. No change in bowel
movements or bloody stools. Denies muscle weakness, myalgias or
neurologic complaints. No exertional buttock or calf pain.
.


Past Medical History:
* CABG: None
* PERCUTANEOUS CORONARY INTERVENTIONS: None
* PACING/ICD: None
.
PAST MEDICAL & SURGICAL HISTORY:
1. s/p ORIF right lateral malleolar fracture (right ankle
fracture, [**2106-7-25**])
2. s/p Removal of syndesmotic screws from right ankle ([**2106-10-28**])

Social History:
Patient lives at home with his wife, works as a [**Name (NI) 51873**] of a
software company. Two children, son and daughter. [**Name (NI) 4084**] smoking
history. Rare alcohol use; no recreational substance use.
Exercises 2-4 times weekly.


Family History:
Denies family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; grandmother with diabetes (died at age
81), uncle with diabetes.

Physical Exam:
ADMISSION EXAM
VITALS: Temp 99.9 BP 155/86 HR 101 RR 22 SaO2 96% on 2LNC
GENERAL: Appears in no acute distress. Alert and interactive.
HEENT: Normocephalic, atraumatic. EOMI. PERRL. Mucous membranes
moist. No xanthalesma.
NECK: Supple without lymphadenopathy. LVP difficult to assess.
CVS: PMI located in the 5th intercostal space, mid-clavicular
line. Regular rhythm, without murmurs or gallops. S1 and S2
normal. No S3 or S4. Tachycardic. Audible friction rub.
Hyperdynamic precordium.
RESP: Respirations unlabored, no accessory muscle use. Clear to
auscultation bilaterally without adventitious sounds. No
wheezing, rhonchi or crackles. Stable inspiratory effort.
ABD: soft, non-tender, non-distended, with normoactive bowel
sounds. No palpable masses or peritoneal signs. Abdominal aorta
not enlarged to palpation, no bruit.
EXTR: no cyanosis, clubbing or edema, 2+ peripheral pulses
DERM: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSE EXAM:
Right: DP 2+
Left: DP 2+

Pertinent Results:
ADMISSION RESULTS

[**2114-12-24**] 09:50AM BLOOD WBC-9.6 RBC-4.16* Hgb-12.3* Hct-36.8*
MCV-88 MCH-29.5 MCHC-33.4 RDW-12.7 Plt Ct-394
[**2114-12-25**] 09:34PM BLOOD Neuts-73.9* Lymphs-18.0 Monos-6.9 Eos-0.9
Baso-0.2
[**2114-12-25**] 09:34PM BLOOD PT-14.9* PTT-29.8 INR(PT)-1.4*
[**2114-12-25**] 09:34PM BLOOD Glucose-108* UreaN-8 Creat-0.9 Na-139
K-4.4 Cl-106 HCO3-28 AnGap-9
[**2114-12-25**] 09:34PM BLOOD ALT-33 AST-19 LD(LDH)-137 AlkPhos-152*
TotBili-1.2
[**2114-12-25**] 09:34PM BLOOD Albumin-3.4* Calcium-8.4 Phos-3.4 Mg-2.0
[**2114-12-24**] 09:50AM BLOOD TSH-0.85
[**2114-12-25**] 04:54PM BLOOD Lactate-0.8

PERTINENT LABS AND STUDIES
[**2114-12-25**] 06:00PM PERICARDIAL FLUID WBC-763* Hct,Fl-5* Polys-57*
Lymphs-33* Monos-0 Macro-10*
[**2114-12-25**] 06:00PM PERICARDIAL FLUID TotProt-5.4 Glucose-91
LD(LDH)-530 Amylase-24 Albumin-3.3
[**2114-12-25**] PERICARDIAL FLUID negative for malignant cells
[**2114-12-25**] ECHOCARDIOGRAM Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. There is a large pericardial
effusion, most prominent outside of the lateral and posterior
walls. There is right ventricular diastolic collapse, consistent
with impaired fillling/tamponade physiology. IMPRESSION: Large
pericardial effusion, most suitable for pericardiocentesis via
the lateral intercostal approach.
[**2114-12-25**] CXR  Comparison is made with prior study performed 4
hours earlier. There has been decrease in size in cardiac
silhouette, now mildly enlarged.  There is mild
pneumopericardium. If any, there are small bilateral pleural
effusions. Aside from left lower lobe atelectasis, the lungs are
clear. There is no pneumothorax.
[**2114-12-25**] CXR There are low lung volumes.  Moderate-to-severe
enlargement of the cardiac silhouette appears unchanged compared
to the prior study. The mediastinal and hilar contours are
within normal limits. Pulmonary vascularity is not engorged. No
focal consolidation, pleural effusion, or pneumothorax is
present. There are no acute osseous abnormalities. IMPRESSION:
Unchanged enlargement of the cardiac silhouette without evidence
of pulmonary vascular congestion.
[**2114-12-26**] ECHOCARDIOGRAM Regional left ventricular wall motion is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion. The mitral valve leaflets
are structurally normal. There is no mitral valve prolapse. The
estimated pulmonary artery systolic pressure is normal. There is
a moderate sized pericardial effusion mostly located adjacent to
the lateral and inferior walls. There is a trivial amount of
pericardial fluid anterior to the right ventricle. There are no
echocardiographic signs of tamponade.

Compared with the prior study (images reviewed) of [**2114-12-25**],
the effusion is smaller and there is no echocardiographic
evidence of tamponade.

PENDING STUDIES:****
[**2114-12-25**] blood cultures x3
[**2114-12-25**] PERICARDIAL FLUID
[**2114-12-25**] URINE CULTURE
[**2114-12-25**] 06:00PM PERICARDIAL FLUID ADENOSINE DEAMINASE,
FLUID-PND
[**2114-12-26**] 06:46PM PERICARDIAL FLUID MYCOPLASMA PNEUMONIAE DNA,
PCR-PND


Brief Hospital Course:
IMPRESSION/PLAN: 46 y/o M with no significant PMHx who was
transferred to [**Hospital1 18**] for urgent pericardiocentesis for
pericardial effusion with tamponade physiology in the setting of
persistent fevers.

# Pericardial Effusion - Mr. [**Name14 (STitle) 51874**] was transferred to [**Hospital1 18**] from
an OSH to have the pericardial fluid drained.  500cc of fluid
was drained during the initial tap and subsequently drained an
additional 120cc prior to removal.  A RHC was also performed at
the time of pericardiocentesis which showed elevated right and
left filling pressures with equilization of diastolic pressures.
 Repeat echo after the drain was placed showed a smaller
effusion with no evidence of tamponade physiology.  Another echo
was obtained after the drain was removed showed smaller effusion
with no echocardiographic evidence of tamponade.  He was started
on ibuprofen during this admission to reduce pericardial
inflammation, which he will continue for 3 weeks.  The etiology
of the effusion remains unclear at the time of discharge.  Given
that he has been having persistent fevers of unknown origin as
well as the new pericardial effusion, an infectious etiology was
thought to be most likely, however we also considered thyroid
disease (had a normal TSH), malignancy and rheumatologic
disease.  ID was consulted, as discussed below.  His HIV test
was negative, PPD was placed and was also negative, [**Doctor First Name **] was
negative.  ESR and CRP were elevated at 87 and 203,
respectively.  The pericardial fluid had no growth and showed 1+
PMNs with no organisms on gram stain, there were no AFB.  The
rest of his infectious work-up was unrevealing, as described
below.

# Fever of unknown origin - He has had persistent fevers of
unknown origin for several weeks now. CXR did not show clear
evidence of an infectious process. He reportedly had tests for
Lyme and Monospot which were negative at OSH.  The fevers were
thought to be related to his pericardial effusion.  Infection
was thought to be the primary cause, with viral etiologies being
the most likely cause (echovirus, adenovirus, coxsackievirus,
parvovorus).  Numerous serologies were ordered to evaluate for
these infections, which were still pending at the time of
discharge, Lyme was tested again and was negative.  As mentioned
above, HIV and PPD were negative.  It is also possible that his
fevers are caused by malignancy or rheumatologic disease,
although he has no additional signs/symptoms to suggest either
of these diagnoses.

# Tachycardia - Patient had sinus tachycardia during the first 2
days of admission, which was noted to be somewhat correlated
with when he had low grade fevers.  He remained asymptomatic
during these episodes.  He appeared euvoluemic.  The tachycardia
had resolved at the time of discharge, he was also afebrile for
36 hours prior to discharge.

# Code status this admission - FULL CODE

#Transitional issues:
-Follow-up parvovirus, mycoplasma serologies and mcyoplasma PCR
-Follow-up pericardial fluid viral culture
-Will see ID after discharge regarding his ongoing fevers and
recent pericardial effusion

Medications on Admission:
none

Discharge Medications:
1. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours for 3 weeks: After 3 weeks, take as needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
Pericardial effusion with pericardiocentesis
Fevers of unknown origin


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname **],

It was a pleasure taking care of you during your admission to
[**Hospital1 18**].  You were admitted to the Cardiac Intensive Care Unit
because you had fluid around your heart, called a pericardial
effusion, which was drained. As you know, you had been having
fevers of unclear origin for a number of weeks which we think is
from the same process that caused your pericardial effusion.
Numerous tests are still pending and we don't have a clear cause
for the fevers and effusion, although the most likely cause
would be a virus.  At the time of discharge, your effusion was
smaller and there was no evidence that it wasi nterfering with
your heart function.  You will follow-up with the infectious
disease clinic after discharge.

Please note the following changes to your medications:
START ibuprofen 400mg by mouth every 8 hours for 3 weeks, then
as needed for pain


Followup Instructions:
Department: BIDHC [**Location (un) **]
When: THURSDAY [**2115-1-3**] at 9:15 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10604**], MD [**Telephone/Fax (1) 3329**]
Building: [**Location (un) 3966**] ([**Location (un) 55**], MA) [**Location (un) 551**]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

Department: INFECTIOUS DISEASE
When: THURSDAY [**2115-1-10**] at 11:30 AM
With: [**First Name8 (NamePattern2) 1955**] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 457**]
Building: LM [**Hospital Unit Name **] [**Hospital 1422**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{'Acute idiopathic pericarditis,Cardiac tamponade,Fever, unspecified,Other specified cardiac dysrhythmias'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: pericardial effusion

PRESENT ILLNESS: 46 y/o M with no significant PMHx who was transferred to [**Hospital1 18**]
for urgent pericardiocentesis for pericardial effusion with
tamponade physiology. Patient was in his usual state of health
until early [**Month (only) 1096**] when he developed persistent low-grade
fevers (99.5 to 100.5). He then developed right-sided arm pain,
which prompted him to present to an OSH ED, where CXR showed
cardiomegaly. Lyme serologies and a Monospot were negative. On
exam, he had evidence of left-sided otitis media and was treated
with 10-days of Amoxicillin therapy. He then presented to his
PCP, [**Name10 (NameIs) 1023**] repeated CXR and found persistent cardiomegaly. Patient
was then referred to BIDN for echo today. This revealed
pericardial effusion with tamponade physiology; pulsus paradoxus
was 10. Pt was then transferred here for urgent
pericardiocentesis.
.
In the cath lab, the patient underwent pericardial drain
placement, with subsequent drainage of 500 cc from pericardium.
BP was stable the entire time; however, patient has remained
persistently tachycardic to the 120's. He received 3L IVF's
prior to pericardiocentesis.  RHC was performed before and after
pericardiocentesis and reportedly did not show significant
change in pressures, raising concern for potential constrictive
physiology.
.
On arrival to the ICU, the patient denied any complaints. He
reports that, aside from his persistent fevers and right-sided
arm pain, he has not experienced any other symptoms.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or pre-syncope.
.
ROS: The patient denies a history of prior stroke/TIA, deep
venous thrombosis or pulmonary embolus. He denies bleeding at
the time of prior procedures or surgeries. Denies headaches or
vision changes. No cough or upper respiratory symptoms. Denies
chest pain, dizziness or lightheadedness; no palpitations.
Denies shortness of breath. No nausea or vomiting, denies
abdominal pain. No dysuria or hematuria. No change in bowel
movements or bloody stools. Denies muscle weakness, myalgias or
neurologic complaints. No exertional buttock or calf pain.
.

MEDICAL HISTORY: * CABG: None
* PERCUTANEOUS CORONARY INTERVENTIONS: None
* PACING/ICD: None
.
PAST MEDICAL & SURGICAL HISTORY:
1. s/p ORIF right lateral malleolar fracture (right ankle
fracture, [**2106-7-25**])
2. s/p Removal of syndesmotic screws from right ankle ([**2106-10-28**])

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
VITALS: Temp 99.9 BP 155/86 HR 101 RR 22 SaO2 96% on 2LNC
GENERAL: Appears in no acute distress. Alert and interactive.
HEENT: Normocephalic, atraumatic. EOMI. PERRL. Mucous membranes
moist. No xanthalesma.
NECK: Supple without lymphadenopathy. LVP difficult to assess.
CVS: PMI located in the 5th intercostal space, mid-clavicular
line. Regular rhythm, without murmurs or gallops. S1 and S2
normal. No S3 or S4. Tachycardic. Audible friction rub.
Hyperdynamic precordium.
RESP: Respirations unlabored, no accessory muscle use. Clear to
auscultation bilaterally without adventitious sounds. No
wheezing, rhonchi or crackles. Stable inspiratory effort.
ABD: soft, non-tender, non-distended, with normoactive bowel
sounds. No palpable masses or peritoneal signs. Abdominal aorta
not enlarged to palpation, no bruit.
EXTR: no cyanosis, clubbing or edema, 2+ peripheral pulses
DERM: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSE EXAM:
Right: DP 2+
Left: DP 2+

FAMILY HISTORY: Denies family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; grandmother with diabetes (died at age
81), uncle with diabetes.

SOCIAL HISTORY: Patient lives at home with his wife, works as a [**Name (NI) 51873**] of a
software company. Two children, son and daughter. [**Name (NI) 4084**] smoking
history. Rare alcohol use; no recreational substance use.
Exercises 2-4 times weekly. 

### Response:
{'Acute idiopathic pericarditis,Cardiac tamponade,Fever, unspecified,Other specified cardiac dysrhythmias'}
