CHIEF COMPLAINT: Endocarditis

PRESENT ILLNESS: 45 year old male with a history of
IVDA, Hepatitis B&C, found to have aortic and mitral valve
vegetations on echocardiogram. Endocarditis initially treated
with Vancomycin, Ciprofloxacin and Daptomycin at [**Hospital 17436**] Hospital.
Antibiotic coverage changed to Vancomycin/Gentamycin at [**Hospital1 89177**]

MEDICAL HISTORY: Hepatitis B, Hepatitis C, Depression,
IVDA(patient states he uses Herion/Cocaine 2x/wk x5 mo)-last use
2weeks ago (urine tox screen at [**Hospital 17436**] Hosp positive for
opiates),
left arm abcess, C4-5 fx-diving accident
Past Surgical History: Shoulder repair,
Nissen Fundoplication-[**2120**]
vasectomy

MEDICATION ON ADMISSION: Medications at home: Zoloft 100 Daily

ALLERGIES: Vicodin

PHYSICAL EXAM: Temp 97.2  Pulse: 96   Resp: 16     O2 sat: 97%-RA
B/P  Right: 110/41  Left:
Height:  5'[**20**]"   Weight: 83.9 kg

FAMILY HISTORY: adopted-no known cardiovascular disease

SOCIAL HISTORY: Lives with: alone
Occupation: works at [**Company 22957**]-computers
Tobacco: quit 1 mo ago (2ppd x20ys)
ETOH: quit 10yrs ago (1 quart QOD)
Herion/Cocaine 2x/wk x5 mo
Acute and subacute bacterial endocarditis,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Bacteremia,Congestive heart failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Cellulitis and abscess of upper arm and forearm,Acute posthemorrhagic anemia,Cocaine abuse, unspecified,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Personal history of alcoholism
Ac/subac bact endocard,Hpt B chrn wo cm wo dlta,Bacteremia,CHF NOS,Other streptococcus,Cellulitis of arm,Ac posthemorrhag anemia,Cocaine abuse-unspec,Depressive disorder NEC,History of tobacco use,Hx of alcoholism
Admission Date:  [**2122-1-22**]              Discharge Date:   [**2122-2-4**]

Date of Birth:  [**2076-10-28**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Vicodin

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Endocarditis

Major Surgical or Invasive Procedure:
[**2122-1-30**]
1. Aortic valve replacement with a size 23-mm St. [**Male First Name (un) 923**]
    Regent mechanical valve.
2. Mitral valve replacement with a size 29 St. [**Male First Name (un) 923**]
    mechanical valve.
[**2122-1-29**] Cardiac catheterization


History of Present Illness:
45 year old male with a history of
IVDA, Hepatitis B&C, found to have aortic and mitral valve
vegetations on echocardiogram. Endocarditis initially treated
with Vancomycin, Ciprofloxacin and Daptomycin at [**Hospital 17436**] Hospital.
Antibiotic coverage changed to Vancomycin/Gentamycin at [**Hospital1 89177**]


Past Medical History:
Hepatitis B, Hepatitis C, Depression,
IVDA(patient states he uses Herion/Cocaine 2x/wk x5 mo)-last use
2weeks ago (urine tox screen at [**Hospital 17436**] Hosp positive for
opiates),
left arm abcess, C4-5 fx-diving accident
Past Surgical History: Shoulder repair,
Nissen Fundoplication-[**2120**]
vasectomy


Social History:
Lives with: alone
Occupation: works at [**Company 22957**]-computers
Tobacco: quit 1 mo ago (2ppd x20ys)
ETOH: quit 10yrs ago (1 quart QOD)
Herion/Cocaine 2x/wk x5 mo

Family History:
adopted-no known cardiovascular disease


Physical Exam:
Temp 97.2  Pulse: 96   Resp: 16     O2 sat: 97%-RA
B/P  Right: 110/41  Left:
Height:  5'[**20**]"   Weight: 83.9 kg

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x] MMM, anicteric
Neck:  Supple [x] Full ROM [x] no JVD or LA
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur 3/6 systolic murmur
Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x]
Extremities: Warm [x], well-perfused [x]  Edema: none
Left forearm with incised abcess site-draining seropurulent
fluid
Track marks visible on both arms
Varicosities: None [x]
Neuro: Grossly intact, nonfocal exam
Pulses:
Femoral      Right: 2+ Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit  radiated murmur bilat


Pertinent Results:
[**2122-2-4**] 05:05AM BLOOD WBC-12.0* RBC-3.25* Hgb-8.8* Hct-28.0*
MCV-86 MCH-27.2 MCHC-31.6 RDW-17.4* Plt Ct-510*
[**2122-2-2**] 05:19AM BLOOD WBC-11.5* RBC-3.07* Hgb-8.3* Hct-25.7*
MCV-84 MCH-27.2 MCHC-32.5 RDW-17.4* Plt Ct-340
[**2122-2-4**] 05:05AM BLOOD PT-32.2* PTT-76.0* INR(PT)-3.2*
[**2122-2-3**] 10:20AM BLOOD PT-24.7* PTT-56.0* INR(PT)-2.4*
[**2122-2-2**] 05:19AM BLOOD PT-16.0* PTT-26.4 INR(PT)-1.4*
[**2122-2-1**] 04:59AM BLOOD PT-13.4 INR(PT)-1.1
[**2122-1-30**] 01:01PM BLOOD PT-13.8* PTT-34.7 INR(PT)-1.2*
[**2122-1-30**] 11:57AM BLOOD PT-15.3* PTT-36.5* INR(PT)-1.3*
[**2122-1-30**] 05:03AM BLOOD PT-12.2 PTT-24.6 INR(PT)-1.0
[**2122-2-4**] 05:05AM BLOOD Glucose-97 UreaN-12 Creat-0.7 Na-133
K-4.8 Cl-101 HCO3-28 AnGap-9
[**2122-2-2**] 05:19AM BLOOD Glucose-85 UreaN-21* Creat-0.7 Na-132*
K-4.9 Cl-99 HCO3-28 AnGap-10

Intra-op TEE [**2122-1-30**]

Conclusions
Prebypass
The left atrium is dilated. No spontaneous echo contrast is seen
in the body of the left atrium or left atrial appendage. No
spontaneous echo contrast is seen in the body of the right
atrium. A patent foramen ovale is present.
Left ventricular wall thicknesses are normal. The left
ventricular cavity is moderately dilated. Overall left
ventricular systolic function is normal (LVEF>55%). [Intrinsic
left ventricular systolic function is likely more depressed
given the severity of valvular regurgitation.]
Right ventricular chamber size and free wall motion are normal.
The number of aortic valve leaflets cannot be determined. The
aortic valve is abnormal. There are two moderate-sized
vegetations on the aortic valve. Severe (4+) aortic
regurgitation is seen. There is no evidence of aortic root
abscess or any aortic to RA/RV fistula.
The mitral valve leaflets are structurally normal. There is a
large vegetation on the mitral valve anterior leaflet and
appears perforated. Severe (4+) mitral regurgitation is seen.
There is a small pericardial effusion.
Dr. [**First Name (STitle) **] was notified in person of the results on [**Known firstname **]
before bypass.

Postbypass:
Patient is on epinehrine 0.04mcg/kg/min, norepinephrine 0.1
mcg/kg/min and vasopressin 4units/hour.
His RV systolic function appears normal at the time of chest
closure.
LVEF 50% .
The mechanical prostheses at the mitral and aortic position are
in situ, stable and functioning well with acceptable resting
gradients (means at 10mm of Hg) and classic washing jets. Intact
thoracic aorta.


Brief Hospital Course:
This 45-year-old patient with a known history of drug abuse
presented with bacterial
endocarditis involving both the aortic and mitral valves.  He
was transferred from an outside hospital, and a transesophageal
echo confirmed severe regurgitation with a
destroyed aortic valve leaflet with multiple vegetations and
vegetation on the mitral valve anterior leaflet with further
destruction and mitral regurgitation.  There was no clear-cut
abscess or any fistula seen from the aortic root to other
cardiac [**Doctor Last Name 1754**].  He was initially managed with IV antibiotics,
but given his severe destruction of both the aortic and mitral
valve leaflets, he was taken to the
operating room on an urgent basis for aortic and mitral valve
replacements and possible homograft placement if there was any
abscess in the aortic root. Peoperatively, multiple discussions
were had with the patient and the family,
emphasizing the need for complete abstinence from drugs after
surgery, and the patient and the family were very focused on him
staying away from drugs. Preoperatively, he also had a coronary
angiogram with injection of only the left coronary artery which
was disease-free.  The right coronary artery was not injected
given the presence of a large vegetation at the right coronary
leaflet, close to the right coronary ostium.  The bacteria
involved was Strep viridans.  He also had a left arm abscess
which grew MRSA.  After about 10 days of antibiotic
treatment, he was taken to the operating room on [**2122-1-30**] where
the patient underwent aortic valve replacement with a size 23-mm
St. [**Male First Name (un) 923**] Regent mechanical valve and Mitral valve replacement
with a size 29 St. [**Male First Name (un) 923**] mechanical valve. Overall the patient
tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring. POD 1 found the patient extubated, alert
and oriented and breathing comfortably.  The patient was
neurologically intact and hemodynamically stable on no inotropic
or vasopressor support. Beta blocker was initiated and the
patient was gently diuresed toward the preoperative weight.  He
was started on Coumadin for double mechanical valves and Heparin
drip was also started on post operative day 3 unitl INR was
greater than 2.5. The patient was transferred to the telemetry
floor for further recovery.  Chest tubes and pacing wires were
discontinued without complication. The infectious disease team
was following closely.  He was continued on Gentamycin and
Ceftriaxone with end dates as noted. Right upper quandrant US
was performed [**2-4**] to rule out choleystasis while on Ceftriaxone
and this was unchanged from previous US with no acute process
seen. All other liver function tests were improving at the time
of discharge. The patient was evaluated by the physical therapy
service for assistance with strength and mobility.  His PICC
line was pulled [**2-2**] due to being in preoperatively while he was
infected and was replaced by IR on [**2-4**] for long term
antibiotics.  By the time of discharge on POD 6 the patient was
ambulating freely, the wound was healing well and pain was
controlled with oral analgesics.  The patient was discharged to
[**Hospital1 **] Hopsital in good condition with appropriate
follow up instructions including appointments and lab draws.

Medications on Admission:
Medications at home: Zoloft 100 Daily

Meds on transfer:
Heparin 5000''' SC
Vancomycin 1gm Q8hr
Gentamycin 80mg Q8hrs
Zoloft 100 QD
Lorazepam 2mg IV Q4hrs/prn
MSO4 2mg IV Q4hrs/PRN


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
5. metoprolol tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
6. sertraline 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. white petrolatum-mineral oil     Cream Sig: One (1) Appl
Topical [**Hospital1 **] (2 times a day).
8. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
9. ceftriaxone in dextrose,iso-os 2 gram/50 mL Piggyback Sig:
One (1)  Intravenous Q24H (every 24 hours) for 1 months: End
date [**2122-3-5**].
10. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
11. gentamicin in NaCl (iso-osm) 80 mg/50 mL Piggyback Sig: One
(1)  Intravenous Q8H (every 8 hours) for 2 weeks: End date
[**2122-2-19**].
12. Coumadin 5 mg Tablet Sig: 1-2 Tablets PO once a day: Give as
directed for INR goal 3.0-3.5 for mech AVR/Mech MVR. Tablet(s)
13. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2222**] - [**Location (un) 538**]

Discharge Diagnosis:
Endocarditis
s/p mechanical AVR and MVR this admission
PMH:
Hepatitis B, Hepatitis C, Depression,
IVDA(patient states he uses Herion/Cocaine 2x/wk x5 mo),
left arm abcess, C4-5 fx-diving accident
Past Surgical History: Shoulder repair,
Nissen Fundoplication-[**2120**]
vasectomy


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema 1+


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2122-2-23**]
10:30
Provider: [**First Name4 (NamePattern1) 2482**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2122-3-16**] 11:00
Surgeon: Dr [**First Name (STitle) **] [**Telephone/Fax (1) 170**] Date/Time:[**2122-2-23**] 2:00
Infectious disease: Dr [**Last Name (STitle) 977**] [**Telephone/Fax (1) 457**] Date: [**2122-2-4**] 12:00
PM

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) 4467**] after discharge from rehab [**Telephone/Fax (1) 89563**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication Mechanical AVR and MVR
Goal INR 3.0-3.5
First draw
Please check INR monday, wednesday and friday for two weeks and
then decrease to twice a week for two weeks then weekly and prn
as needed based on results - to be dosed by rehab physician [**Name Initial (PRE) **]
[**Name10 (NameIs) **] arrange management with PCP at discharge

Please check BUN/Creatinine 2X per week while on Gent then
weekly after Gent course completed
Check weekly Gent peak and trough (goal trough <1, goal peak
[**2-20**]), CBC, ESR, LFT's and CRP
***Please check gent peak and trough in 3 days***
All laboratory results should be faxed to Infectious disease
R.Ns. at ([**Telephone/Fax (1) 1353**]
All questions regarding outpatient antibiotics should be
directed
to the infectious disease R.Ns. at ([**Telephone/Fax (1) 1354**]


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2122-2-4**]
{'Acute and subacute bacterial endocarditis,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Bacteremia,Congestive heart failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Cellulitis and abscess of upper arm and forearm,Acute posthemorrhagic anemia,Cocaine abuse, unspecified,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Personal history of alcoholism'}


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: Endocarditis

PRESENT ILLNESS: 45 year old male with a history of
IVDA, Hepatitis B&C, found to have aortic and mitral valve
vegetations on echocardiogram. Endocarditis initially treated
with Vancomycin, Ciprofloxacin and Daptomycin at [**Hospital 17436**] Hospital.
Antibiotic coverage changed to Vancomycin/Gentamycin at [**Hospital1 89177**]

MEDICAL HISTORY: Hepatitis B, Hepatitis C, Depression,
IVDA(patient states he uses Herion/Cocaine 2x/wk x5 mo)-last use
2weeks ago (urine tox screen at [**Hospital 17436**] Hosp positive for
opiates),
left arm abcess, C4-5 fx-diving accident
Past Surgical History: Shoulder repair,
Nissen Fundoplication-[**2120**]
vasectomy

MEDICATION ON ADMISSION: Medications at home: Zoloft 100 Daily

ALLERGIES: Vicodin

PHYSICAL EXAM: Temp 97.2  Pulse: 96   Resp: 16     O2 sat: 97%-RA
B/P  Right: 110/41  Left:
Height:  5'[**20**]"   Weight: 83.9 kg

FAMILY HISTORY: adopted-no known cardiovascular disease

SOCIAL HISTORY: Lives with: alone
Occupation: works at [**Company 22957**]-computers
Tobacco: quit 1 mo ago (2ppd x20ys)
ETOH: quit 10yrs ago (1 quart QOD)
Herion/Cocaine 2x/wk x5 mo 

### Response:
{'Acute and subacute bacterial endocarditis,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Bacteremia,Congestive heart failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Cellulitis and abscess of upper arm and forearm,Acute posthemorrhagic anemia,Cocaine abuse, unspecified,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Personal history of alcoholism'}
