CHIEF COMPLAINT: transfer for aortic valve abscess on TTE

PRESENT ILLNESS: Patient is a 29M with IVDU, MV and AV strep viridans
endocarditis, s/p mitral and aortic valve replacement 6/[**2124**]. He
is transferred from [**Hospital1 **] after a potential aortic valve
abscess was seen on surveillance TTE. Since having his valves
replaced, he denies further IVDA. He was hospitalized "weeks
ago" at LGH for cellulitis, and again about 4-5 weeks ago
presumably for another episode of IE. No records accompany this
patient who is admittedly unclear about the details of his
complicated course. He was feeling weak with sores on his feet
and hands which prompted this recent treatment course. He has
been at [**Hospital1 **] for 4 of a projected 6-8wk course of
ampicillin/rifampin, though we do not know the bug. Today, a TTE
showed questionable mitral regurgitation and a possible aortic
valve abscess. He denies ongoing IVDA, and feels at his
baseline.
.
He initially had strep viridans MV IE [**9-/2123**] treated with
parenteral antibiotics. He was hospitalized at [**Hospital1 18**] from
[**Date range (1) 85496**]/11 with streptococcus viridans blood stream infection
found to later be MV and AV endocarditis. While iniitally
planning for conservative management with antibiotics, he
developed complete heart block, respiratory and heart failure,
necessitating AVR/MVR with St. [**Male First Name (un) 923**] mechanical valves. Completed
4 weeks of post op ceftriaxone and 2 weeks gentamycin. Felt to
be initiated by IV cocaine abuse.

MEDICAL HISTORY: -Aortic and mitral valve endocarditis s/p Aortic and Mitral
valve
replacement
-Viridin streptococcal endocarditis
-PICC line infection - Stenotrophomonas/Enterobacter cloacae
-Anxiety
-Depression
-Asthma
-surgery for pilonidal cyst
-s/p Hernia repair

MEDICATION ON ADMISSION: - buprenorphin/naloxone [**9-6**] SL [**Hospital1 **]
- ativan 0.5mg qh8prn, hs
- ampicillin 2000mg q4hr
- nicotine patch 21 daily
- colace 100BID
- tylenol 650mg q4hr
- rifampin 600mg QD
- buspirone 20mg daily
- warfarin13mg daily

ALLERGIES: Advil / Aspirin

PHYSICAL EXAM: Pulse: 87 Resp:14  O2 sat:96%RA
B/P  119/45
Height: 73 inches     Weight: 101kg

FAMILY HISTORY: Father died at age 57 of an abdominal aortic aneurysm (heavy
smoker). Mother had [**Name2 (NI) 499**] cancer with a colectomy, GF died of
asbestos

SOCIAL HISTORY: Was living with his mother prior to hospitalization. Smoking
about 1/2PPD, no ETOH or drugs. Trying to get SSI
Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute and subacute bacterial endocarditis,Ventricular fibrillation,Other and unspecified infection due to central venous catheter,Cellulitis and abscess of leg, except foot,Other candidiasis of other specified sites,Aortic valve disorders,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other fluid overload,Anemia, unspecified,Thrombocytopenia, unspecified,Asthma, unspecified type, unspecified,Dysthymic disorder,Coronary atherosclerosis of native coronary artery,Opioid type dependence, unspecified,Tobacco use disorder
React-cardiac dev/graft,Ac/subac bact endocard,Ventricular fibrillation,Oth/uns inf-cen ven cath,Cellulitis of leg,Candidiasis site NEC,Aortic valve disorder,Enterococcus group d,Abn react-artif implant,Abn react-procedure NEC,Fluid overload NEC,Anemia NOS,Thrombocytopenia NOS,Asthma NOS,Dysthymic disorder,Crnry athrscl natve vssl,Opioid dependence-unspec,Tobacco use disorder
Admission Date:  [**2125-3-13**]              Discharge Date:   [**2125-3-28**]

Date of Birth:  [**2096-2-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Advil / Aspirin

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
transfer for aortic valve abscess on TTE

Major Surgical or Invasive Procedure:
[**2125-3-16**] Redo sternotomy/Bentall procedure ( [**Street Address(2) 6158**]. [**Male First Name (un) 923**]
mechanical valve/graft composite)/removal MV vegetation


History of Present Illness:
Patient is a 29M with IVDU, MV and AV strep viridans
endocarditis, s/p mitral and aortic valve replacement 6/[**2124**]. He
is transferred from [**Hospital1 **] after a potential aortic valve
abscess was seen on surveillance TTE. Since having his valves
replaced, he denies further IVDA. He was hospitalized "weeks
ago" at LGH for cellulitis, and again about 4-5 weeks ago
presumably for another episode of IE. No records accompany this
patient who is admittedly unclear about the details of his
complicated course. He was feeling weak with sores on his feet
and hands which prompted this recent treatment course. He has
been at [**Hospital1 **] for 4 of a projected 6-8wk course of
ampicillin/rifampin, though we do not know the bug. Today, a TTE
showed questionable mitral regurgitation and a possible aortic
valve abscess. He denies ongoing IVDA, and feels at his
baseline.
.
He initially had strep viridans MV IE [**9-/2123**] treated with
parenteral antibiotics. He was hospitalized at [**Hospital1 18**] from
[**Date range (1) 85496**]/11 with streptococcus viridans blood stream infection
found to later be MV and AV endocarditis. While iniitally
planning for conservative management with antibiotics, he
developed complete heart block, respiratory and heart failure,
necessitating AVR/MVR with St. [**Male First Name (un) 923**] mechanical valves. Completed
4 weeks of post op ceftriaxone and 2 weeks gentamycin. Felt to
be initiated by IV cocaine abuse.

Cardiac surgery was consulted for evaluation of redo
sternotomy/Bentall.


Past Medical History:
-Aortic and mitral valve endocarditis s/p Aortic and Mitral
valve
replacement
-Viridin streptococcal endocarditis
-PICC line infection - Stenotrophomonas/Enterobacter cloacae
-Anxiety
-Depression
-Asthma
-surgery for pilonidal cyst
-s/p Hernia repair


Social History:
Was living with his mother prior to hospitalization. Smoking
about 1/2PPD, no ETOH or drugs. Trying to get SSI

Family History:
Father died at age 57 of an abdominal aortic aneurysm (heavy
smoker). Mother had [**Name2 (NI) 499**] cancer with a colectomy, GF died of
asbestos

Physical Exam:
Pulse: 87 Resp:14  O2 sat:96%RA
B/P  119/45
Height: 73 inches     Weight: 101kg

General:A&Ox3, NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [x] grade II/VI
Sternum: well healed sternotomy scar evident. Sternum stable.
Abdomen: Soft [x] non-distended [x] non-tender [x]  +BS [x]
Extremities: Warm [x], well-perfused [x]  Edema-none
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Radial       Right:2+   Left:2+
Carotid Bruit -none  Right:2+    Left:2+


Pertinent Results:
Admission labs:
[**2125-3-12**] 11:20PM BLOOD WBC-5.2 RBC-3.99*# Hgb-11.0*# Hct-32.9*#
MCV-83 MCH-27.7 MCHC-33.5 RDW-14.2 Plt Ct-199
[**2125-3-12**] 11:20PM BLOOD Neuts-60.3 Lymphs-22.6 Monos-5.6 Eos-9.7*
Baso-1.7
[**2125-3-13**] 04:27AM BLOOD PT-25.5* PTT-46.2* INR(PT)-2.4*
[**2125-3-12**] 11:20PM BLOOD ESR-20*
[**2125-3-12**] 11:20PM BLOOD Glucose-86 UreaN-11 Creat-0.8 Na-137
K-4.6 Cl-105 HCO3-23 AnGap-14
[**2125-3-13**] 04:27AM BLOOD ALT-18 AST-26 AlkPhos-107 TotBili-0.2
[**2125-3-13**] 04:27AM BLOOD Calcium-8.7 Phos-3.7 Mg-2.1
[**2125-3-12**] 11:20PM BLOOD CRP-68.6*
[**2125-3-12**] 11:20PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2125-3-12**] 11:39PM BLOOD Lactate-0.8

Tee [**2125-3-16**]:PRE-BYPASS:
This study is limited due to acoustic shadowing from mechanical
valves in the aortic & mitral positions.No spontaneous echo
contrast or thrombus 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. No atrial septal defect is seen by
2D or color Doppler. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. Overall
left ventricular systolic function is normal (LVEF>55%). The
sinuses of Valsalva are dilated. A mechanical aortic valve
prosthesis is present and not well seated. Abnormal rocking
motion is noted. A paravalvular aortic valve leak is present.
The aortic valve prosthesis appears abnormal. An aortic annular
abscess is seen. Significant aortic regurgitation is present,
but cannot be quantified.
A bileaflet mitral valve prosthesis is present. The motion of
the mitral valve prosthetic leaflets appears normal. A small
paravalvular mitral prosthesis leak is present in what appears
to be originating behind the posterior leaflet. This is more
than the typical washing jet seen in this type of mechanical
valve. A typical washing jet is noted originating behind the
anterior leaflet. A 1.1 x 1.5cm echodensity is seen in junction
with the ventricular side of the anterior leaflet of the
mechanical mitral valve prosthesis.There is no pericardial
effusion. Dr. [**Last Name (STitle) **] was notified in person of the
results in the operating room.

POSTBYPASS:
The patient is AV paced on a phenylephrine infusion.
Biventricular function is maintained. EF 55%. There is a well
seated mechanical valve in the mitral position. Peak and Mean
Gradients across the mitral prosthesis are 7mmHg & 3mmHg,
respectively with a cardiac output of 7.8L/m. There are
characteristic washing jets noted. The echodensity noted
prebypass is no longer present.There is a well seated mechanical
valve in the aortic position. The study is limited due to the
presence of acoustic shadowing from the aortic valve conduit &
mechanical valve in the mitral position. There is no AI. Peak &
mean gradients across the valve are 28 & 14mmHg,
respectively.The remaining aorta is intact.The remaining valves
are unchanged. I certify that I was present for this procedure
in compliance with HCFA regulations.
Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2125-3-16**] 14:49


[**2125-3-28**] 03:50AM BLOOD WBC-7.0 RBC-2.93* Hgb-7.6* Hct-23.0*
MCV-79* MCH-26.1* MCHC-33.3 RDW-14.3 Plt Ct-408
[**2125-3-28**] 03:50AM BLOOD PT-36.3* INR(PT)-3.5*
[**2125-3-28**] 03:50AM BLOOD PT-36.3* INR(PT)-3.5*
[**2125-3-28**] 03:50AM BLOOD Glucose-97 UreaN-24* Creat-1.6* Na-139
K-4.3 Cl-102 HCO3-29 AnGap-12



[**2125-3-16**] 10:45 am TISSUE      EXPLANTED AORTIC VALVE TISSUE.

   GRAM STAIN (Final [**2125-3-16**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.

   TISSUE (Final [**2125-3-20**]):
      ENTEROCOCCUS SP..
         Isolated from broth media only, INDICATING VERY LOW
NUMBERS OF
         ORGANISMS.
         Reported to and read back by [**Doctor Last Name 87957**],D (X42950)
[**2125-3-18**] AT 1055.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ENTEROCOCCUS SP.
                             |
AMPICILLIN------------   <=2 S
PENICILLIN G----------     4 S
VANCOMYCIN------------     1 S

   ANAEROBIC CULTURE (Final [**2125-3-22**]):    NO ANAEROBES ISOLATED.


   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.

   POTASSIUM HYDROXIDE PREPARATION (Final [**2125-3-19**]):
      NO FUNGAL ELEMENTS SEEN.





[**2125-3-17**] 12:21 pm BLOOD CULTURE      Source: Line-right tlc.

                            **FINAL REPORT [**2125-3-23**]**

   Blood Culture, Routine (Final [**2125-3-23**]):    NO GROWTH.







Brief Hospital Course:
29 y/o man with hx of IV drug use and endocarditis requiring
mechanical MV and AV replacment [**7-16**] found to have persistent
endocarditis of both prosthetic valves with near frank
dehiscence of AV; currently hemodynamically stable and feeling
well.
.
# AORTIC AND MITRAL VALVE ENDOCARDITIS:  Patient with large
mitral valve vegetation and "near-frank" dehiscence of aortic
valve on TEE/TTE, with at least moderate valvular AR.  He had no
evidence of acute on chronic CHF on admission.  Blood cultures
returned positive for enterococcus faecium (sensitive to
vancomycin), coag-negative staph (sensitive to vanco and
gentamycin), gram negative rods, and yeast.  On admission, his
PICC line was pulled.  He was started on vancomycin, gentamycin,
cefepime, and ambisome, per infectious disease recommendations.
On day 3 of admission, he underwent Bentall Aortic Root
replacement with a mechanical composite graft and removal of
vegetation from mechanical mitral valve.
.
Underwent surgery with Dr. [**First Name (STitle) **] on [**3-16**], please see operative
report for further details. He was transferred to the CVICU in
stable condition on titrated phenylephrine and propofol drips.
Extubated early the following morning and transferred to the
floor on POD #2 to begin increasing his activity level. Gently
diuresed toward his preop weight. Beta blockade titrated and
coumadin resumed for his double mechanical heart valves. Chest
tubes and pacing wires removed per protocol. PICC line in place
for continued abx therapy for endocarditis.Seen daily by ID
service as well as consult by chronic pain service.
Postoperative renal dysfunction followed closely along with drug
monitoring of antibiotics. His creatnine was 1.6 prior to
discharge and Gentamicin frequency had been decreased per ID
recommendations the day prior to discharge. Lab monitoring and
length of duration of antibiotics per ID. Cleared for discharge
by Dr.[**First Name (STitle) **] to [**Hospital **] rehab on POD # 12. All f/u appts
advised. Target INR 2.5-3.5 for mechanical heart valves.



Medications on Admission:
- buprenorphin/naloxone [**9-6**] SL [**Hospital1 **]
- ativan 0.5mg qh8prn, hs
- ampicillin 2000mg q4hr
- nicotine patch 21 daily
- colace 100BID
- tylenol 650mg q4hr
- rifampin 600mg QD
- buspirone 20mg daily
- warfarin13mg daily

Discharge Medications:
1. metoprolol tartrate 25 mg [**Hospital1 8426**] Sig: 0.5 [**Hospital1 8426**] PO BID (2
times a day).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. ranitidine HCl 150 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO BID (2
times a day).
4. warfarin 1 mg [**Hospital1 8426**] Sig: daily [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] DAILY
(Daily).
5. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. hydromorphone 2 mg [**Last Name (Titles) 8426**] Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*40 [**Last Name (Titles) 8426**](s)* Refills:*0*
7. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
8. lorazepam 0.5 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO Q8H (every 8
hours) as needed for severe anxiety.
Disp:*40 [**Last Name (Titles) 8426**](s)* Refills:*0*
9. nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
10. acetaminophen 325 mg [**Last Name (Titles) 8426**] Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
11. morphine 30 mg [**Last Name (Titles) 8426**] Extended Release Sig: One (1) [**Last Name (Titles) 8426**]
Extended Release PO Q8H (every 8 hours).
12. cyclobenzaprine 10 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO TID (3
times a day).
13. buspirone 10 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO BID (2 times a
day).
14. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO Q8H (every
8 hours).
15. micafungin 100 mg Recon Soln Sig: One (1) Recon Soln
Intravenous Q24H (every 24 hours) for 1 doses: last dose
[**2125-3-28**].
16. warfarin 5 mg [**Month/Day/Year 8426**] Sig: One (1) [**Month/Day/Year 8426**] PO ONCE (Once) for
1 doses.
17. heparin, porcine (PF) 10 unit/mL Syringe Sig: One (1) ML
Intravenous PRN (as needed) as needed for line flush.
18. ampicillin sodium 2 gram Recon Soln Sig: One (1) Recon Soln
Injection Q4H (every 4 hours): End date= [**2125-4-27**] per ID.
19. Outpatient Lab Work
WEEKLY: CBC with diff, BUN/Creatinine, LFTs
Twice weekly: Gent Peak and Trough 1/2 hour prior to dosing
20. gentamicin in NaCl (iso-osm) 80 mg/50 mL Piggyback Sig: One
(1)  Intravenous Q24H (every 24 hours): Gent trough goal<1. Once
Creatnine <1, please increase dosing to q 12h. Last dose=
[**2125-4-27**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] State Hospital

Discharge Diagnosis:
s/p redo sternotomy/ Bentall procedure/ rem. MV vegetation
Viridin streptococcal endocarditis
PICC line infection - Stenotrophomonas/Enterobacter cloacae
Anxiety
Depression
Asthma
left leg cellulitis


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Edema ............


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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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:
You are scheduled for the following appointments:
Surgeon: [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD [**Last Name (Titles) **] 2A, [**Telephone/Fax (1) 170**] [**2125-4-17**] @
1:15 pm
Cardiologist:Dr. [**Last Name (STitle) 23097**]  [**4-10**] @ 2:15 pm
ID: [**First Name11 (Name Pattern1) 3049**] [**Last Name (NamePattern4) 14666**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2125-4-3**]
1:30
ID: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4091**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2125-4-24**] 10:00
Eye clinic(for glasses) [**Telephone/Fax (1) 253**] [**4-12**] @ 1:00 pm,  [**Hospital Ward Name 23**] 5

Please call to schedule appointments with your :
Primary Care Dr. [**Last Name (STitle) 67391**] in [**5-10**] weeks

**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/MVR
Goal INR 2.5-3.5
First draw day is first day at rehab [**2125-3-29**]
*** please arrange for coumadin/INR Atrius followup prior to
discharge from rehab

laboratory monitoring required:
WEEKLY:
CBC with diff
BUN/Creatinine
LFTs
Gentamicin twice weekly: Peak and Trough 1/2 hour prior to dose

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:[**2125-3-28**]
{'Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute and subacute bacterial endocarditis,Ventricular fibrillation,Other and unspecified infection due to central venous catheter,Cellulitis and abscess of leg, except foot,Other candidiasis of other specified sites,Aortic valve disorders,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other fluid overload,Anemia, unspecified,Thrombocytopenia, unspecified,Asthma, unspecified type, unspecified,Dysthymic disorder,Coronary atherosclerosis of native coronary artery,Opioid type dependence, unspecified,Tobacco use disorder'}


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 for aortic valve abscess on TTE

PRESENT ILLNESS: Patient is a 29M with IVDU, MV and AV strep viridans
endocarditis, s/p mitral and aortic valve replacement 6/[**2124**]. He
is transferred from [**Hospital1 **] after a potential aortic valve
abscess was seen on surveillance TTE. Since having his valves
replaced, he denies further IVDA. He was hospitalized "weeks
ago" at LGH for cellulitis, and again about 4-5 weeks ago
presumably for another episode of IE. No records accompany this
patient who is admittedly unclear about the details of his
complicated course. He was feeling weak with sores on his feet
and hands which prompted this recent treatment course. He has
been at [**Hospital1 **] for 4 of a projected 6-8wk course of
ampicillin/rifampin, though we do not know the bug. Today, a TTE
showed questionable mitral regurgitation and a possible aortic
valve abscess. He denies ongoing IVDA, and feels at his
baseline.
.
He initially had strep viridans MV IE [**9-/2123**] treated with
parenteral antibiotics. He was hospitalized at [**Hospital1 18**] from
[**Date range (1) 85496**]/11 with streptococcus viridans blood stream infection
found to later be MV and AV endocarditis. While iniitally
planning for conservative management with antibiotics, he
developed complete heart block, respiratory and heart failure,
necessitating AVR/MVR with St. [**Male First Name (un) 923**] mechanical valves. Completed
4 weeks of post op ceftriaxone and 2 weeks gentamycin. Felt to
be initiated by IV cocaine abuse.

MEDICAL HISTORY: -Aortic and mitral valve endocarditis s/p Aortic and Mitral
valve
replacement
-Viridin streptococcal endocarditis
-PICC line infection - Stenotrophomonas/Enterobacter cloacae
-Anxiety
-Depression
-Asthma
-surgery for pilonidal cyst
-s/p Hernia repair

MEDICATION ON ADMISSION: - buprenorphin/naloxone [**9-6**] SL [**Hospital1 **]
- ativan 0.5mg qh8prn, hs
- ampicillin 2000mg q4hr
- nicotine patch 21 daily
- colace 100BID
- tylenol 650mg q4hr
- rifampin 600mg QD
- buspirone 20mg daily
- warfarin13mg daily

ALLERGIES: Advil / Aspirin

PHYSICAL EXAM: Pulse: 87 Resp:14  O2 sat:96%RA
B/P  119/45
Height: 73 inches     Weight: 101kg

FAMILY HISTORY: Father died at age 57 of an abdominal aortic aneurysm (heavy
smoker). Mother had [**Name2 (NI) 499**] cancer with a colectomy, GF died of
asbestos

SOCIAL HISTORY: Was living with his mother prior to hospitalization. Smoking
about 1/2PPD, no ETOH or drugs. Trying to get SSI 

### Response:
{'Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute and subacute bacterial endocarditis,Ventricular fibrillation,Other and unspecified infection due to central venous catheter,Cellulitis and abscess of leg, except foot,Other candidiasis of other specified sites,Aortic valve disorders,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other fluid overload,Anemia, unspecified,Thrombocytopenia, unspecified,Asthma, unspecified type, unspecified,Dysthymic disorder,Coronary atherosclerosis of native coronary artery,Opioid type dependence, unspecified,Tobacco use disorder'}
