CHIEF COMPLAINT: fever, malaise

PRESENT ILLNESS: This is a 35 y/o male without signif PMH who p/w fever, chills,
and progressive myalgias x 15 days. His symptoms were a/w
dizziness, palpitations, nausea, body aches, and back pain. He
also had night sweats and poor appetite. He was seen at [**Hospital 11507**] Clinic, where he was told he had the flu and given
tylenol and instructed to take in good fluids, which he did. His
symptoms persisted, and 4 days later he was evaluated at
[**Hospital 8**] hospital, where he was again told he had the flu.
Finally a friend referred him to her PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], whom he met
on Wednesday. Blood and urine tests were performed and he was
given cipro, which he took on Wed and Thurs. He represented to
Dr. [**Last Name (STitle) **] on Friday where he was told he had a urinary
infection. His antibiotics were switched to amoxicillin. On
Friday night, after taking amox, he developed a new cough,
pleuritic chest pain, and shortness of breath. He went to the
bathroom, had diarrhea x1, and also vomited x 1 (? hemoptysis,
brown-red). These symptoms were new from his previous
fevers/chills/myalgias picture. He was again seen at his PCP's
office today, where temp was 103.2, and by report he looked
unwell. Complained of CP, and was referred to the ED.
.
In ED: 99.5 115 133/55 22 97%RA. Exam showed bilateral basilar
crackles with diaporesis. Possible pericardial rub. No abdominal
tednerness. No pulsus. Labs were significant for CK 1000 MB 10.3
Trop 0.62. WBC count 22.0. LFTs mildly elevated. Laxtate 1.5.
EKG showed sinus tachy with very minimal ST depressions in
V4-V6. Cards was consulted and felt presentation was most c/w
viral myocarditis. Cards fellow performed echo, which showed
probable mild hypokinesis of the apex and distal anterior wall
and mild mitral regurgitation. Blood cultures were drawn and her
received vanc and levo for possible PNA. Pt also received ASA x
1 and lipitor. Dr.[**First Name (STitle) **] was consulted for vegetation on the
aortic valve and valvular replacement secondary to endocarditis.
Blood Cx came back positive for Staph coag neg. He was scheduled
for the OR [**11-16**]. During the overnight period prior to surgery,
Mr.[**Known lastname 13119**] [**Last Name (Titles) 68039**] with acute pulmonary edema. He was
intubated and emergently taken to the OR for an AVR.

MEDICAL HISTORY: remote kidney infection

MEDICATION ON ADMISSION: occasional ibuprofen
cipro ([**11-8**] - [**11-9**])
amoxicillin x 1 ([**11-10**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 5'9"  126.4 kg
VS: 99.8 115 116/43 38 94% 2L --> 96% on 4L
GEN: big young diaphoretic male in NAD
HEENT: NC/AT. MM slightly dry. O/P clear.
NECK: JVP elevated to below angle of jaw. No bruits
COR: tachycardic and regular, unable to appreciate any m/r/g
PULM: crackles at L base otherwise CTAB
ABD: obese S/NT/ND + BS
EXT: WWP, trace edema
NEURO: A+O x 3, grossly non-focal

FAMILY HISTORY: DM in mom and brother. Aunt with Breast CA

SOCIAL HISTORY: Originally from El [**Country 19118**], immigrated in [**2114**]. Works at [**Company 68326**] in fruit division. Non smoker, occasional EtOH. Denies
IVDU. Lives in [**Location (un) **] with family.
Acute and subacute bacterial endocarditis,Acute diastolic heart failure,Other staphylococcal septicemia,Sepsis,Ventricular fibrillation,Congenital insufficiency of aortic valve,Intestinal infection due to Clostridium difficile,Hyposmolality and/or hyponatremia,Aortic valve disorders,Other ill-defined heart diseases,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Anemia, unspecified,Unspecified disorder of joint, lower leg,Family history of malignant neoplasm of breast
Ac/subac bact endocard,Ac diastolic hrt failure,Staphylcocc septicem NEC,Sepsis,Ventricular fibrillation,Cong aorta valv insuffic,Int inf clstrdium dfcile,Hyposmolality,Aortic valve disorder,Ill-defined hrt dis NEC,Abn react-artif implant,Elev transaminase/ldh,Anemia NOS,Joint dis NOS-l/leg,Family hx-breast malig
Admission Date:  [**2130-11-11**]              Discharge Date:   [**2130-11-28**]

Date of Birth:  [**2095-7-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
fever, malaise

Major Surgical or Invasive Procedure:
[**2130-11-16**]  AVR ( [**Street Address(2) 11688**]. [**Male First Name (un) 923**] Regent mechanical)/ pericardial
patch repair of annular abscess


History of Present Illness:
This is a 35 y/o male without signif PMH who p/w fever, chills,
and progressive myalgias x 15 days. His symptoms were a/w
dizziness, palpitations, nausea, body aches, and back pain. He
also had night sweats and poor appetite. He was seen at [**Hospital 11507**] Clinic, where he was told he had the flu and given
tylenol and instructed to take in good fluids, which he did. His
symptoms persisted, and 4 days later he was evaluated at
[**Hospital 8**] hospital, where he was again told he had the flu.
Finally a friend referred him to her PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], whom he met
on Wednesday. Blood and urine tests were performed and he was
given cipro, which he took on Wed and Thurs. He represented to
Dr. [**Last Name (STitle) **] on Friday where he was told he had a urinary
infection. His antibiotics were switched to amoxicillin. On
Friday night, after taking amox, he developed a new cough,
pleuritic chest pain, and shortness of breath. He went to the
bathroom, had diarrhea x1, and also vomited x 1 (? hemoptysis,
brown-red). These symptoms were new from his previous
fevers/chills/myalgias picture. He was again seen at his PCP's
office today, where temp was 103.2, and by report he looked
unwell. Complained of CP, and was referred to the ED.
.
In ED: 99.5 115 133/55 22 97%RA. Exam showed bilateral basilar
crackles with diaporesis. Possible pericardial rub. No abdominal
tednerness. No pulsus. Labs were significant for CK 1000 MB 10.3
Trop 0.62. WBC count 22.0. LFTs mildly elevated. Laxtate 1.5.
EKG showed sinus tachy with very minimal ST depressions in
V4-V6. Cards was consulted and felt presentation was most c/w
viral myocarditis. Cards fellow performed echo, which showed
probable mild hypokinesis of the apex and distal anterior wall
and mild mitral regurgitation. Blood cultures were drawn and her
received vanc and levo for possible PNA. Pt also received ASA x
1 and lipitor. Dr.[**First Name (STitle) **] was consulted for vegetation on the
aortic valve and valvular replacement secondary to endocarditis.
Blood Cx came back positive for Staph coag neg. He was scheduled
for the OR [**11-16**]. During the overnight period prior to surgery,
Mr.[**Known lastname 13119**] [**Last Name (Titles) 68039**] with acute pulmonary edema. He was
intubated and emergently taken to the OR for an AVR.




Past Medical History:
remote kidney infection

Social History:
Originally from El [**Country 19118**], immigrated in [**2114**]. Works at [**Company 68326**] in fruit division. Non smoker, occasional EtOH. Denies
IVDU. Lives in [**Location (un) **] with family.

Family History:
DM in mom and brother. Aunt with Breast CA

Physical Exam:
5'9"  126.4 kg
VS: 99.8 115 116/43 38 94% 2L --> 96% on 4L
GEN: big young diaphoretic male in NAD
HEENT: NC/AT. MM slightly dry. O/P clear.
NECK: JVP elevated to below angle of jaw. No bruits
COR: tachycardic and regular, unable to appreciate any m/r/g
PULM: crackles at L base otherwise CTAB
ABD: obese S/NT/ND + BS
EXT: WWP, trace edema
NEURO: A+O x 3, grossly non-focal


Pertinent Results:
PRE-BYPASS:
1. No atrial septal defect is seen by 2D or color Doppler.
2. Overall left ventricular systolic function is severely
depressed (LVEF= 15 %).
3. The aortic root is mildly dilated at the sinus level. The
aortic valve is bicuspid. There is no aortic valve stenosis.
Severe (4+) aortic regurgitation is seen. Endocarditic lesions
are noted on both cusps and in the aortic root. Both cusps are
completely destroyed.
4. The mitral valve leaflets are structurally normal. An
eccentric, posteriorly directed jet of Mild to moderate ([**2-1**]+)
mitral regurgitation is seen.
5. There is a trivial/physiologic pericardial effusion.

Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] was notified in person of the results.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including Phenylephrine and
Epinephrine
1. A mechanical Valve is well seated in the Aortic position.
Leaflets open well, trace washing jets are noted. No significant
AI. Peak Gradient about 15 mm of Hg.
2. LV function is slightly improved. RV function is unchanged.
3. Aorta is intact post decannulation.
4. Other findings are unchanged.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 928**] [**Name8 (MD) 929**], MD, MD,
Interpreting physician [**Last Name (NamePattern4) **] [**2130-11-16**] 09:07
[**Known lastname **],[**Known firstname **] [**Medical Record Number 68327**] M  35  [**2095-7-30**]

Radiology Report CHEST (PA & LAT) Study Date of [**2130-11-27**] 10:46
AM

[**Last Name (LF) **],[**First Name3 (LF) **] TSURG FA6A [**2130-11-27**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 68328**]
Reason: evaluate pleural effusions and atelectasis



[**Hospital 93**] MEDICAL CONDITION:
   35 year old man with s/p AVR (endocarditis)
REASON FOR THIS EXAMINATION:
   evaluate pleural effusions and atelectasis

Final Report
REASON FOR EXAMINATION: Followup of a patient after aortic valve
replacement.

PA and lateral upright chest radiograph was reviewed in
comparison to multiple
prior chest radiographs dating back to [**2130-11-11**].

The post-sternotomy wires are unremarkable. The replaced aortic
valve is in
expected position. There is no significant short interval change
in bibasilar
atelectasis and small pleural effusion. No evidence of failure
is present on
the current radiograph. There is no pneumothorax or apical
hematoma.

DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**]
Approved: MON [**2130-11-27**] 1:58 PM

[**2130-11-28**] 02:18AM BLOOD WBC-9.6 RBC-3.58* Hgb-10.5* Hct-30.9*
MCV-87 MCH-29.2 MCHC-33.8 RDW-14.3 Plt Ct-676*
[**2130-11-27**] 12:32PM BLOOD Neuts-69.7 Lymphs-17.3* Monos-7.6
Eos-4.9* Baso-0.4
[**2130-11-28**] 02:18AM BLOOD Plt Ct-676*
[**2130-11-28**] 02:18AM BLOOD PT-30.2* INR(PT)-3.1*
[**2130-11-28**] 02:18AM BLOOD Glucose-104 UreaN-17 Creat-1.2 Na-133
K-4.2 Cl-98 HCO3-28 AnGap-11
[**2130-11-28**] 02:18AM BLOOD Vanco-24.9*
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 68329**]Portable TTE
(Complete) Done [**2130-11-27**] at 4:31:16 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2095-7-30**]
Age (years): 35 M  Hgt (in): 69
BP (mm Hg): 111/71  Wgt (lb): 268
HR (bpm): 95  BSA (m2): 2.34 m2
Indication: Ao valve Endocarditis. S/p #23 [**Hospital3 9642**] AVR.
ICD-9 Codes: V43.3, 424.0, 424.2
Test Information
Date/Time: [**2130-11-27**] at 16:31    Interpret MD: [**Name6 (MD) **] [**Name8 (MD) 4082**], MD
Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**Name2 (NI) 27490**]
[**Last Name (un) 27491**]
Doppler: Full Doppler and color Doppler Test Location: West CCU
Contrast: None Tech Quality: Suboptimal
Tape #: 2008W053-0:55 Machine: Vivid [**8-7**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  3.3 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  4.8 cm  <= 5.2 cm
Left Atrium - Peak Pulm Vein S:  0.5 m/s
Left Atrium - Peak Pulm Vein D:  0.7 m/s
Right Atrium - Four Chamber Length:  *6.0 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  1.1 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.8 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Sinus Level:  3.5 cm  <= 3.6 cm
Aorta - Ascending:  3.0 cm  <= 3.4 cm
Aorta - Arch:  3.0 cm  <= 3.0 cm
Aorta - Descending Thoracic:  2.4 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *2.9 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *34 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  18 mm Hg
TR Gradient (+ RA = PASP):  <= 20 mm Hg  <= 25 mm Hg

Findings
This study was compared to the prior study of [**2130-11-17**].
LEFT ATRIUM: Normal LA and RA cavity sizes.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA.

LEFT VENTRICLE: Normal LV wall thickness and cavity size. Low
normal LVEF.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
Paradoxic septal motion consistent with prior cardiac surgery.

AORTA: Normal diameter of aorta at the sinus, ascending and arch
levels. Normal descending aorta diameter. No 2D or Doppler
evidence of distal arch coarctation.

AORTIC VALVE: Bileaflet aortic valve prosthesis (AVR). AVR well
seated, normal leaflet/disc motion and transvalvular gradients.
Trace AR. [The amount of AR is normal for this AVR.]

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
mitral annular calcification. Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR.
Normal PA systolic pressure.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized.
No PS. Physiologic PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.
Suboptimal image quality - bandages, defibrillator pads or
electrodes. Suboptimal image quality as the patient was
difficult to position. Suboptimal image quality - body habitus.

Conclusions
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thicknesses and cavity size normal.Overall left
ventricular systolic function is low normal (LVEF 50-55%). Right
ventricular chamber size and free wall motion are normal. A
bileaflet aortic valve prosthesis is present. The aortic valve
prosthesis appears well seated, with normal leaflet/disc motion
and transvalvular gradients. Trace aortic regurgitation is seen.
[The amount of regurgitation present is normal for this
prosthetic aortic valve.] The mitral valve leaflets are mildly
thickened. Mild (1+) mitral regurgitation is seen. The estimated
pulmonary artery systolic pressure is normal. There is no
pericardial effusion.

IMPRESSION: Suboptimal image quality. Well seated bileaflet
aortic valve prosthesis with normal function. Mild mitral
regurgitation.
Compared with the prior study (images reviewed) of [**2130-11-17**],
biventricular systolic function is improved and the heart rate
is slower.

CLINICAL IMPLICATIONS:
Based on [**2129**] AHA endocarditis prophylaxis recommendations, the
echo findings indicate prophylaxis IS recommended. Clinical
decisions regarding the need for prophylaxis should be based on
clinical and echocardiographic data.
  Electronically signed by [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4083**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2130-11-27**] 16:51



Brief Hospital Course:
Admitted from ER [**11-11**]. Blood cultures were sent, cardiology
consulted and an echo was done. Diagnosed with myopericarditis.
Diuresed for pulmonary edema and vanco/gent/cipro continued for
gram positive bacteremia. TEE done [**11-13**] showed bicuspid AV,
severe AI with flail leaflet,and root abscess. PR interval
became prolonged. Dental consult and repeat echo done.Scans
planned to evaluate for septic emboli, but had worsening AI on
echo [**11-15**]. Early AM [**11-16**] developed hypoxia necessitating
urgent intubation, and hypotension requiring pressor support.
Brought emergently to the OR and underwent surgery with Dr.
[**First Name (STitle) **]. Flagyl started for C. diff. Transferred to the CVICU on
Epinephrine, Phenylephrine, Milrinone and Propofol drips to
optimize BP and CO/CI, as Mr.[**Known lastname 13119**] was very vasodilated due
to bacteremic sepsis. Adequate oxygenation required high levels
of PEEP. He initially remained febrile, and surveillance Cxs
were obtained. He remained on Vanco/Gentamicin for coag negative
staph endocarditis, and Flagyl for C. diff. Over the next
several days all inotropes and pressors were weaned to off.
Mr.[**First Name (Titles) **] [**Last Name (Titles) 5058**] neurologically intact, following commands to
verbal cues. POD#3 all sedation was weaned off in an attempt to
possibly extubate. His weaning trial ultimately failed at that
time. He was sedated again and rested with continued aggressive
diuresis. POD#4 CXR showed LLL collapse and he was bronched
therapeutically in the hope of optimizing a successful
extubation. Minimal secretions were noted and all airways were
patent. TTE performed at bedside showed anterior hypokinesis,
unchanged from the previous echo performed on #1, with an LVEF
~25-30%. He was eventually re-extubated on POD 6.  The patient
was transferred to the step down unit on POD 8.  He made
excellent progress with physical therapy, showing good strength
and balance.  He was gently diuresed toward his preoperative
weight.  Blood cultures dated [**2130-11-21**] showed no growth.  Per
infectious disease recommendations, the patient will be
contninued on vancomycin for six weeks post-op as well as
flagyl.
He had a repeat echo on [**11-27**] which showed the prosthetic valve
is seated well and his EF has improved to 50-55%.  He was
discharged to rehab in stable condition on POD#12.

stop [**11-21**]

Medications on Admission:
occasional ibuprofen
cipro ([**11-8**] - [**11-9**])
amoxicillin x 1 ([**11-10**])


Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q4H (every 4 hours) as needed.
7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day): Continue while on Vanco.  End date:[**12-28**].
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.
9. Vancomycin 1,000 mg Recon Soln Sig: 1250 (1250) mg
Intravenous Q 12H (Every 12 Hours): Complete 6 week course.  End
date is: [**2130-12-28**].
10. Coumadin 2.5 mg Tablet Sig: One (1) Tablet PO once a day:
Titrate for INR goal of 3. Tablet(s)


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
s/p AVR/ patch repair of annular abscess
endocarditis
AI
aortic annular abscess
C. diff.
acute diastolic heart failure


Discharge Condition:
good


Discharge Instructions:
shower daily and pat incisions dry
no lotions, creams, or powders on any incision
no driving for one month
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 100, redness, or drainage

Followup Instructions:
see Dr. [**Last Name (STitle) **] in [**2-1**] weeks
see Dr. [**Last Name (STitle) **] ( cardiology) in [**3-5**] weeks
see Dr. [**First Name (STitle) **] in 4 weeks  ([**Telephone/Fax (1) 170**]) please call for appt.
Dr. [**Last Name (STitle) 438**] [**Telephone/Fax (1) 457**] (infectious disease) 3 weeks
weekly CBC, BUN, Cr, LFTs as well as vanc trough faxed to
[**Telephone/Fax (1) 432**]


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

Completed by:[**2130-11-28**]
{'Acute and subacute bacterial endocarditis,Acute diastolic heart failure,Other staphylococcal septicemia,Sepsis,Ventricular fibrillation,Congenital insufficiency of aortic valve,Intestinal infection due to Clostridium difficile,Hyposmolality and/or hyponatremia,Aortic valve disorders,Other ill-defined heart diseases,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Anemia, unspecified,Unspecified disorder of joint, lower leg,Family history of malignant neoplasm of breast'}


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: fever, malaise

PRESENT ILLNESS: This is a 35 y/o male without signif PMH who p/w fever, chills,
and progressive myalgias x 15 days. His symptoms were a/w
dizziness, palpitations, nausea, body aches, and back pain. He
also had night sweats and poor appetite. He was seen at [**Hospital 11507**] Clinic, where he was told he had the flu and given
tylenol and instructed to take in good fluids, which he did. His
symptoms persisted, and 4 days later he was evaluated at
[**Hospital 8**] hospital, where he was again told he had the flu.
Finally a friend referred him to her PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], whom he met
on Wednesday. Blood and urine tests were performed and he was
given cipro, which he took on Wed and Thurs. He represented to
Dr. [**Last Name (STitle) **] on Friday where he was told he had a urinary
infection. His antibiotics were switched to amoxicillin. On
Friday night, after taking amox, he developed a new cough,
pleuritic chest pain, and shortness of breath. He went to the
bathroom, had diarrhea x1, and also vomited x 1 (? hemoptysis,
brown-red). These symptoms were new from his previous
fevers/chills/myalgias picture. He was again seen at his PCP's
office today, where temp was 103.2, and by report he looked
unwell. Complained of CP, and was referred to the ED.
.
In ED: 99.5 115 133/55 22 97%RA. Exam showed bilateral basilar
crackles with diaporesis. Possible pericardial rub. No abdominal
tednerness. No pulsus. Labs were significant for CK 1000 MB 10.3
Trop 0.62. WBC count 22.0. LFTs mildly elevated. Laxtate 1.5.
EKG showed sinus tachy with very minimal ST depressions in
V4-V6. Cards was consulted and felt presentation was most c/w
viral myocarditis. Cards fellow performed echo, which showed
probable mild hypokinesis of the apex and distal anterior wall
and mild mitral regurgitation. Blood cultures were drawn and her
received vanc and levo for possible PNA. Pt also received ASA x
1 and lipitor. Dr.[**First Name (STitle) **] was consulted for vegetation on the
aortic valve and valvular replacement secondary to endocarditis.
Blood Cx came back positive for Staph coag neg. He was scheduled
for the OR [**11-16**]. During the overnight period prior to surgery,
Mr.[**Known lastname 13119**] [**Last Name (Titles) 68039**] with acute pulmonary edema. He was
intubated and emergently taken to the OR for an AVR.

MEDICAL HISTORY: remote kidney infection

MEDICATION ON ADMISSION: occasional ibuprofen
cipro ([**11-8**] - [**11-9**])
amoxicillin x 1 ([**11-10**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 5'9"  126.4 kg
VS: 99.8 115 116/43 38 94% 2L --> 96% on 4L
GEN: big young diaphoretic male in NAD
HEENT: NC/AT. MM slightly dry. O/P clear.
NECK: JVP elevated to below angle of jaw. No bruits
COR: tachycardic and regular, unable to appreciate any m/r/g
PULM: crackles at L base otherwise CTAB
ABD: obese S/NT/ND + BS
EXT: WWP, trace edema
NEURO: A+O x 3, grossly non-focal

FAMILY HISTORY: DM in mom and brother. Aunt with Breast CA

SOCIAL HISTORY: Originally from El [**Country 19118**], immigrated in [**2114**]. Works at [**Company 68326**] in fruit division. Non smoker, occasional EtOH. Denies
IVDU. Lives in [**Location (un) **] with family. 

### Response:
{'Acute and subacute bacterial endocarditis,Acute diastolic heart failure,Other staphylococcal septicemia,Sepsis,Ventricular fibrillation,Congenital insufficiency of aortic valve,Intestinal infection due to Clostridium difficile,Hyposmolality and/or hyponatremia,Aortic valve disorders,Other ill-defined heart diseases,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Anemia, unspecified,Unspecified disorder of joint, lower leg,Family history of malignant neoplasm of breast'}
