CHIEF COMPLAINT: Transfer from OSH for Aortic Abscess

PRESENT ILLNESS: Mr. [**Known lastname 16905**] is an 83 year old man with a PMH significant for
DM2, COPD, PVD, AS, AI needing valve replacement who presented
to OSH with fatigue and dyspnea thought to be related to his
valvulopathy and CHF +/- related to MI or PNA. He was initially
treated with Levofloxacin. Subsequently, Strep Viridans grew
from blood cultures (1 out of 2 bottles)and he underwent a TTE
which showed only AS and AI. He then suffered from respiratory
failure (thought to be related to his AI/CHF) requiring
intubation. A TEE then found a 1.5 x 2 cm abscess in the NCC
region of the Aorta abutting the LA. Culture data from his S.
Viridans then came back sensitive to Cefalosporins and he was
started on Rocephin and given a dose of Aminoglycosides. He was
subsequently transferred to BIMDC for probably surgery to his
Aortic root and valve.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: Ceftriaxone 2g IV q24'
Synthroid 50mcg daily
Protonix
ASA 81 mg daily
Heparin SC 5000u TID
Ativan/Morphine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: [**Age over 90 **]F 115/52 105 16 100% O2 Sats AC 700x14 Fio2 0.5 PEEP 5
GEN: Pt intubated, alert. Responds to questions with head nods.
Follows commands (hand squeeze on appropriate side)
HEENT: Pinpoint pupils, MMM
NECK: Supple, No LAD, No JVD
CV: RR, NL rate. NL S1, S2. III/VI HSM RUSB; II/VI Diastolic
rumble, rubs or [**Last Name (un) 549**]. 2+ pulses throughout.
LUNGS: Occasional ronchi BL, No W/C
ABD: Soft, [**Name (NI) **] (pt alert enough to respond to commands and
stimuli) Slightly distended. NL BS. Liver enlarged to 2cm below
ribs and palpable spleen.
EXT: No edema. 2+ DP pulses BL
SKIN: Sternal scar from prior surgery; Bilat leg scars (medial)
from bypass [**Doctor First Name **]. CCY scar on Abd.
NEURO: CN 2-12 grossly intact. Preserved sensation throughout.
[**1-19**]+ reflexes, equal BL. Normal coordination. Gait assessment
deferred

FAMILY HISTORY: Father died of CAD in 50's; Mother died in 80s (unknown)

SOCIAL HISTORY: Married. Pt is primary caregiver [**First Name (Titles) **] [**Last Name (Titles) 68154**] wife. Quit [**Name2 (NI) **] 40+
yrs ago; Rare ETOH
Streptococcal septicemia,Acute and subacute bacterial endocarditis,Septic shock,Acute respiratory failure,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Personal history of tobacco use,Family history of ischemic heart disease,Encounter for palliative care,Unspecified disorders of arteries and arterioles
Streptococcal septicemia,Ac/subac bact endocard,Septic shock,Acute respiratry failure,CHF NOS,Chr airway obstruct NEC,Atrial fibrillation,DMII wo cmp nt st uncntr,Periph vascular dis NOS,History of tobacco use,Fam hx-ischem heart dis,Encountr palliative care,Arterial disease NOS
Admission Date:  [**2161-6-3**]              Discharge Date:   [**2161-6-5**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
Transfer from OSH for Aortic Abscess

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mr. [**Known lastname 16905**] is an 83 year old man with a PMH significant for
DM2, COPD, PVD, AS, AI needing valve replacement who presented
to OSH with fatigue and dyspnea thought to be related to his
valvulopathy and CHF +/- related to MI or PNA. He was initially
treated with Levofloxacin. Subsequently, Strep Viridans grew
from blood cultures (1 out of 2 bottles)and he underwent a TTE
which showed only AS and AI. He then suffered from respiratory
failure (thought to be related to his AI/CHF) requiring
intubation. A TEE then found a 1.5 x 2 cm abscess in the NCC
region of the Aorta abutting the LA. Culture data from his S.
Viridans then came back sensitive to Cefalosporins and he was
started on Rocephin and given a dose of Aminoglycosides. He was
subsequently transferred to BIMDC for probably surgery to his
Aortic root and valve.

Social History:
Married. Pt is primary caregiver [**First Name (Titles) **] [**Last Name (Titles) 68154**] wife. Quit [**Name2 (NI) **] 40+
yrs ago; Rare ETOH

Family History:
Father died of CAD in 50's; Mother died in 80s (unknown)

Physical Exam:
[**Age over 90 **]F 115/52 105 16 100% O2 Sats AC 700x14 Fio2 0.5 PEEP 5
GEN: Pt intubated, alert. Responds to questions with head nods.
Follows commands (hand squeeze on appropriate side)
HEENT: Pinpoint pupils, MMM
NECK: Supple, No LAD, No JVD
CV: RR, NL rate. NL S1, S2. III/VI HSM RUSB; II/VI Diastolic
rumble, rubs or [**Last Name (un) 549**]. 2+ pulses throughout.
LUNGS: Occasional ronchi BL, No W/C
ABD: Soft, [**Name (NI) **] (pt alert enough to respond to commands and
stimuli) Slightly distended. NL BS. Liver enlarged to 2cm below
ribs and palpable spleen.
EXT: No edema. 2+ DP pulses BL
SKIN: Sternal scar from prior surgery; Bilat leg scars (medial)
from bypass [**Doctor First Name **]. CCY scar on Abd.
NEURO: CN 2-12 grossly intact. Preserved sensation throughout.
[**1-19**]+ reflexes, equal BL. Normal coordination. Gait assessment
deferred


Pertinent Results:
[**2161-6-3**] 05:40PM   PT-15.0* PTT-34.5 INR(PT)-1.3*
[**2161-6-3**] 05:40PM   PLT COUNT-181
[**2161-6-3**] 05:40PM   NEUTS-91.8* LYMPHS-4.2* MONOS-3.7 EOS-0.1
BASOS-0.1
[**2161-6-3**] 05:40PM   WBC-24.6* RBC-4.18* HGB-13.1* HCT-38.6*
MCV-92 MCH-31.4 MCHC-34.0 RDW-13.3
[**2161-6-3**] 05:40PM   TSH-1.5
[**2161-6-3**] 05:40PM   ALBUMIN-3.1* CALCIUM-8.2* PHOSPHATE-4.5
MAGNESIUM-2.1
[**2161-6-3**] 05:40PM   CK-MB-2 cTropnT-0.18*
[**2161-6-3**] 05:40PM   LIPASE-53
[**2161-6-3**] 05:40PM   ALT(SGPT)-83* AST(SGOT)-54* LD(LDH)-266*
CK(CPK)-136 ALK PHOS-134* AMYLASE-118* TOT BILI-1.4
[**2161-6-3**] 05:40PM   GLUCOSE-166* UREA N-31* CREAT-1.7* SODIUM-141
POTASSIUM-4.5 CHLORIDE-105 TOTAL CO2-23 ANION GAP-18
[**2161-6-3**] 05:59PM   O2 SAT-98
[**2161-6-3**] 05:59PM   LACTATE-1.6
[**2161-6-3**] 05:59PM   TYPE-ART PO2-140* PCO2-35 PH-7.42 TOTAL
CO2-23 BASE XS-0
[**2161-6-3**] 06:00PM   O2 SAT-66
[**2161-6-3**] 06:00PM   TYPE-MIX
[**2161-6-3**] 10:18PM URINE  RBC-21-50* WBC-0-2 BACTERIA-MOD
YEAST-NONE EPI-0-2
[**2161-6-3**] 10:18PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2161-6-3**] 10:18PM URINE  COLOR-Amber APPEAR-Cloudy SP [**Last Name (un) 155**]-1.023
.
TEE ([**2161-6-3**] in RI): EF 30%. Eccentric AI. 1.5-2cm abscess in
NCC area --> [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 68155**] communication with aorta. Mod TR, Mild
MR.
.
EKG: AFib with rate 100. Nl Axis and intervals. RBBB. PVCs.
.
TTE Conclusions:  The left atrium is normal in size. There is
mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is top normal/borderline dilated.
Overall left ventricular systolic function is low normal (LVEF
50-55%). Right ventricular chamber size and free wall motion are
normal. The aortic root is markedly dilated. The ascending aorta
is moderately dilated. The number of aortic valve leaflets
cannot be determined. The aortic valve leaflets are moderately
thickened. There is at least moderate aortic valve stenosis.
Mild (1+) aortic regurgitation is seen. An echodense mass is
seen in the posterior aortic root at the noncoronary sinus of
Valsalva, protruding into the left atrium and measuring 1.8 by
1.7 cm. The mitral valve leaflets are mildly thickened. There is
no mitral valve prolapse. There is a small to
moderate sized pericardial effusion. There are no
echocardiographic signs of tamponade. Impression: aortic root
abscess/phlegmon
.
TEE GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was monitored by a nurse [**First Name (Titles) **] [**Last Name (Titles) 9833**]
throughout the procedure. No TEE related complications. Resting
tachycardia (HR>100bpm). The rhythm appears to be atrial
fibrillation. Echocardiographic results were reviewed with the
houseofficer caring for the patient. Left pleural effusion.
Conclusions: No spontaneous echo contrast or thrombus is seen in
the body of the left atrium or left atrial appendage. No atrial
septal defect is seen by 2D or color Doppler. LV systolic
function appears depressed. Right ventricular systolic function
is normal. The sinuses of Valsalva are dilated. There are
complex (>4mm) atheroma in the ascending aorta, aortic arch, and
descending aorta. The aortic valve leaflets are severely
thickened/deformed. The severity of the aortic stenosis was not
determined. There are two moderate-sized regions of
inflammation/vegetation (0.8 cm each) on the left and
non-coronary
cusps of the aortic valve at the area of leaflet coaptation. An
aortic annular abscess is seen (0.8 - 1.2 cm), in the region of
the left and non-coronary cusps. Moderate to severe (3+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. No mass or vegetation is seen on the mitral valve.
Mild (1+) mitral regurgitation is seen. The tricuspid valve
leaflets are mildly thickened. There is a trivial/physiologic
pericardial effusion.
.

Brief Hospital Course:
ASSESSMENT: The patient is an 83 year old man with CAD s/p CABG,
HTN, DMII, [**Hospital 2182**] transferred from OSH with aortic valve
endocarditis and abscess.
.
# AV Endocarditis/Abscess:  Evidence of this per TEE at OSH in
conjunction with fevers.  Pt grew Strep Viridans 1/2 bottles
sensitive to Cephalosporins.  Has hx of AVD to native valve.  Pt
now hemodynamically stable on low dose of Levophed.  CP free.
TTE/TEE at [**Hospital1 18**] revealed 2 abscesses at aortic root and
preserved EF.  We continu Ceftriaxone 2mg daily (discussed with
ID) and added additional antibiotics (Vancomycin and Flagyl).
CT surgery was made aware of patient and prepared to discuss
options with family but felt that his prognosis was grim. He
expired on HD #1.  Family was en route but was updated
frequently.  At time of death, he required 3 pressors and could
not maintain his BP.  In addition, his heart rate was >160.
.
# AFib:  Unclear of duration, but has been documented to be in
and out of AFib since admission to OSH.
- Rate poorly controlled and we held on nodal agents at first
given risk of heart block in setting of abscess.  PRN BB was
given eventually despite pressors for HR >140s.
- We held Coumadin or Heparin gtt anticoagulation given
intracranial bleed in past but will administer Sub Cutaneous
Heparin 5000 units TID
.
# Respiratory failure:  Secondary to AI/CHF.  On vent throughout
admission until time of death.
.
# DM2:  RISS and QACHS FS
.
# Hypothyroidism: Levothyroxine at transfer dose
.
# FEN: NPO (nutrition consult pending); No need for IVFs given
Swan #s;
.
# PPx: Heparin Sub Cu, PPI
.
# CODE: FULL CODE
.
# COMM: With son, pt, wife
.
# DISP: Expired.  Family aware.  RI transfer MD aware.
.

Medications on Admission:
Ceftriaxone 2g IV q24'
Synthroid 50mcg daily
Protonix
ASA 81 mg daily
Heparin SC 5000u TID
Ativan/Morphine


Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired
{'Streptococcal septicemia,Acute and subacute bacterial endocarditis,Septic shock,Acute respiratory failure,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Personal history of tobacco use,Family history of ischemic heart disease,Encounter for palliative care,Unspecified disorders of arteries and arterioles'}


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: Transfer from OSH for Aortic Abscess

PRESENT ILLNESS: Mr. [**Known lastname 16905**] is an 83 year old man with a PMH significant for
DM2, COPD, PVD, AS, AI needing valve replacement who presented
to OSH with fatigue and dyspnea thought to be related to his
valvulopathy and CHF +/- related to MI or PNA. He was initially
treated with Levofloxacin. Subsequently, Strep Viridans grew
from blood cultures (1 out of 2 bottles)and he underwent a TTE
which showed only AS and AI. He then suffered from respiratory
failure (thought to be related to his AI/CHF) requiring
intubation. A TEE then found a 1.5 x 2 cm abscess in the NCC
region of the Aorta abutting the LA. Culture data from his S.
Viridans then came back sensitive to Cefalosporins and he was
started on Rocephin and given a dose of Aminoglycosides. He was
subsequently transferred to BIMDC for probably surgery to his
Aortic root and valve.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: Ceftriaxone 2g IV q24'
Synthroid 50mcg daily
Protonix
ASA 81 mg daily
Heparin SC 5000u TID
Ativan/Morphine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: [**Age over 90 **]F 115/52 105 16 100% O2 Sats AC 700x14 Fio2 0.5 PEEP 5
GEN: Pt intubated, alert. Responds to questions with head nods.
Follows commands (hand squeeze on appropriate side)
HEENT: Pinpoint pupils, MMM
NECK: Supple, No LAD, No JVD
CV: RR, NL rate. NL S1, S2. III/VI HSM RUSB; II/VI Diastolic
rumble, rubs or [**Last Name (un) 549**]. 2+ pulses throughout.
LUNGS: Occasional ronchi BL, No W/C
ABD: Soft, [**Name (NI) **] (pt alert enough to respond to commands and
stimuli) Slightly distended. NL BS. Liver enlarged to 2cm below
ribs and palpable spleen.
EXT: No edema. 2+ DP pulses BL
SKIN: Sternal scar from prior surgery; Bilat leg scars (medial)
from bypass [**Doctor First Name **]. CCY scar on Abd.
NEURO: CN 2-12 grossly intact. Preserved sensation throughout.
[**1-19**]+ reflexes, equal BL. Normal coordination. Gait assessment
deferred

FAMILY HISTORY: Father died of CAD in 50's; Mother died in 80s (unknown)

SOCIAL HISTORY: Married. Pt is primary caregiver [**First Name (Titles) **] [**Last Name (Titles) 68154**] wife. Quit [**Name2 (NI) **] 40+
yrs ago; Rare ETOH 

### Response:
{'Streptococcal septicemia,Acute and subacute bacterial endocarditis,Septic shock,Acute respiratory failure,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Personal history of tobacco use,Family history of ischemic heart disease,Encounter for palliative care,Unspecified disorders of arteries and arterioles'}
