CHIEF COMPLAINT: 

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 57041**] is a 23-year-old
male patient with a known congenital bicuspid aortic valve.
He underwent a balloon valvuloplasty at age 15 at [**Hospital 86**]
[**Hospital3 1810**].  He has been followed by serial
echocardiograms over the years and has been asymptomatic.
He, however, presented to St. [**Hospital 15000**] Hospital in [**Location (un) **], [**State 16269**], where he lives in [**2137-10-9**] complaining of a
number of days of onset of fever, chills and arthralgias.  He
initially had withdrawn himself from IV narcotics and felt
that his symptoms were secondary to opiate withdrawal.
However, workup revealed that he had aortic valve
endocarditis.  The bacteria was methicillin sensitive staph
aureus.  He was treated at that time during his course with a
six-week treatment course of intravenous nafcillin.  During
the time in the hospital, he had significant mental status
changes.  His head CT revealed multiple infarcts as well as
hemorrhages.  His abdominal CAT scan also revealed splenic
and renal infarcts.  He completed his antibiotic course and
was discharged from the hospital in mid [**Month (only) 359**].  He was
referred to the [**Location (un) 86**] Adult Congenital Heart Service at
[**Hospital3 1810**] for followup.  He presented on [**12-11**], underwent complete evaluation.  An echocardiogram at that
time revealed two large abscesses adjacent to the sinuses of
Valsalva which communicated with the aorta and possibly into
the left ventricle.  He was then admitted to [**Hospital1 346**] on [**2137-12-11**], for an aortic
valve and roof replacement due to abscess formation status
post endocarditis.

MEDICAL HISTORY: Congenital bicuspid aortic valve
status post valvuloplasty at age 15.  The patient has a
history of IV drug abuse, apparently quit approximately two
months prior to admission to the hospital.  Also, alcohol use
which he ceased two months prior to admission and positive
smoker.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute and subacute bacterial endocarditis,Congenital insufficiency of aortic valve,Acquired cardiac septal defect,Opioid type dependence, continuous,Thoracic aneurysm without mention of rupture,Aneurysm of other visceral artery,Personal history of other diseases of circulatory system,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Alcohol abuse, in remission
Ac/subac bact endocard,Cong aorta valv insuffic,Acq cardiac septl defect,Opioid dependence-contin,Thoracic aortic aneurysm,Visceral aneurysm NEC,Hx-circulatory dis NEC,Mth sus Stph aur els/NOS,Alcohol abuse-in remiss
Admission Date: [**2137-12-11**]        Discharge Date: [**2137-12-28**]

Date of Birth:  [**2114-4-25**]        Sex:  M

Service:  [**Last Name (un) 7081**]


HISTORY OF PRESENT ILLNESS:  [**Known firstname **] [**Known lastname 57041**] is a 23-year-old
male patient with a known congenital bicuspid aortic valve.
He underwent a balloon valvuloplasty at age 15 at [**Hospital 86**]
[**Hospital3 1810**].  He has been followed by serial
echocardiograms over the years and has been asymptomatic.
He, however, presented to St. [**Hospital 15000**] Hospital in [**Location (un) **], [**State 16269**], where he lives in [**2137-10-9**] complaining of a
number of days of onset of fever, chills and arthralgias.  He
initially had withdrawn himself from IV narcotics and felt
that his symptoms were secondary to opiate withdrawal.
However, workup revealed that he had aortic valve
endocarditis.  The bacteria was methicillin sensitive staph
aureus.  He was treated at that time during his course with a
six-week treatment course of intravenous nafcillin.  During
the time in the hospital, he had significant mental status
changes.  His head CT revealed multiple infarcts as well as
hemorrhages.  His abdominal CAT scan also revealed splenic
and renal infarcts.  He completed his antibiotic course and
was discharged from the hospital in mid [**Month (only) 359**].  He was
referred to the [**Location (un) 86**] Adult Congenital Heart Service at
[**Hospital3 1810**] for followup.  He presented on [**12-11**], underwent complete evaluation.  An echocardiogram at that
time revealed two large abscesses adjacent to the sinuses of
Valsalva which communicated with the aorta and possibly into
the left ventricle.  He was then admitted to [**Hospital1 346**] on [**2137-12-11**], for an aortic
valve and roof replacement due to abscess formation status
post endocarditis.

PAST MEDICAL HISTORY:  Congenital bicuspid aortic valve
status post valvuloplasty at age 15.  The patient has a
history of IV drug abuse, apparently quit approximately two
months prior to admission to the hospital.  Also, alcohol use
which he ceased two months prior to admission and positive
smoker.

PHYSICAL EXAMINATION:  On admission to the hospital,
neurologically, he was alert and oriented, but did note some
short-term memory loss.  His lungs were clear to auscultation
bilaterally.  His cardiac examination is regular rate and
rhythm with a grade 3/6 systolic ejection murmur.  His
abdomen was unremarkable.  His extremities were warm without
edema.

His electrocardiogram revealed sinus tachycardia with no
ischemic changes or conduction abnormalities.

Over the next few days, the patient was evaluated for
concurrent symptoms.  He had a neurology consultation and an
MRI of his head and was found to have a question of mycotic
aneurysm.  As a result of these findings, he was seen by the
Neurosurgery Service and went to the neuro interventional
suite where he underwent cerebral angiography which was
normal.  Infectious Disease Service was also consulted to
assist with medication management.  It was their
recommendation to continue with intravenous oxacillin
throughout his hospital course preoperatively.

The Hepatobiliary Surgery Service was consulted due to
hepatic pseudoaneurysm which were also noted on his abdominal
CT scan.  He was taken to the interventional radiology suite
where he underwent successful pseudoaneurysm embolization by
Dr. [**First Name (STitle) **].  He tolerated this well without any post procedure
complications.  The patient underwent transesophageal
echocardiogram on [**12-18**] which revealed essentially the
same pathology previously identified on his prior
echocardiogram.  The patient was seen also on [**12-18**] by
the Addiction Medicine Service due to his IV drug use
history.

The patient was ultimately taken to the operating room on
[**2137-12-20**], where he underwent Bentall procedure with
a 27 mm homograft, a VSD closure, debridement of an aortic
root abscess.  Postoperatively, he was on intravenous
propofol drip for sedation and was transported to the cardiac
surgery recovery unit in good condition.  He was kept
intubated over night and weaned from mechanical ventilation
and extubated early on postoperative day one.  Pain Service
was consulted to assist with his postoperative pain
management.

He was transferred from the Intensive Care Unit to the
telemetry floor on postoperative day three.  He had begun
with physical therapy and progressed with ambulation.  He had
remained on intravenous antibiotics while we were awaiting
the final operative cultures of the valve.  He continued to
progress from a physical therapy standpoint well.  He
remained hemodynamically stable on beta blockers and
diuretics and progressed well from a pulmonary toilet
standpoint.  His chest tubes were discontinued on
postoperative day two.  He was ultimately weaned off all of
his narcotics and pain adequately controlled with
nonsteroidal anti-inflammatory drugs.  He was continuing to
be followed by the Infectious Disease staff.  Dr. [**Last Name (STitle) **]
saw the patient again yesterday, and it was his
recommendation to place the patient on dicloxacillin orally
for discharge and to continue that for at least a month until
he follows up with Dr. [**Last Name (STitle) **] in the outpatient Infectious
Disease Clinic.  The patient was also given influenza vaccine
upon Dr.[**Name (NI) 19995**] recommendation.  The patient has remained
hemodynamically stable and is presently ready to be
discharged home on postoperative day eight.

CONDITION TODAY:  Neurologically, he is alert and oriented
without any apparent neurologic deficit.  His lungs are clear
to auscultation bilaterally.  His cardiac examination is
regular rate and rhythm.  His sternal incision is clean with
no drainage and no erythema.  His abdomen is soft, nontender
and nondistended with positive bowel sounds.  His extremities
are warm with trace edema bilaterally.  He is ambulating
independently.

DISCHARGE MEDICATIONS:
1. Zantac 150 mg p.o. b.i.d.
2. Aspirin enteric coated 81 mg p.o. once daily
3. Vitamin C 500 mg p.o. b.i.d.
4. Niferex 150 mg p.o. once daily
5. Ibuprofen 600 mg p.o. q.6 hours p.r.n. pain.
6. Bacitracin ointment topically q.i.d. as needed to his skin
   lesions.
7. Atenolol 25 mg p.o. once daily.
8. Dicloxacillin 500 mg p.o. q.6 hours.  He is to continue
   taking the dicloxacillin until he sees Dr. [**Last Name (STitle) **] in
   followup at the Infectious Disease Clinic.

Most recent laboratory values include potassium of 4.5, BUN
of 14, creatinine of 0.7.  His most recent hematocrit was
28.2.

DISCHARGE DIAGNOSES:
1. Congenital bicuspid aortic valve.
2. Aortic valve endocarditis.
3. Intravenous drug abuse.
4. Multiple cerebellar infarcts.
5. Splenic, hepatic and renal infarcts.

The patient is to followup with the drug rehabilitation
program called SPARC program in his home town area.  He has
an appointment with that service on [**12-31**] at 12:30 p.m.
This is located at [**Location (un) 57042**] in [**Last Name (un) 36812**], [**Numeric Identifier 57043**].  Phone number for this center is [**Telephone/Fax (1) 57044**].  The
patient is also to followup with Dr. [**Last Name (STitle) **] from the
Infectious Disease Service in one month.  He is to followup
with Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **], cardiac surgeon, in one month.
He is to followup with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 32622**] in one month
from the [**Location (un) 86**] Adult Congenital Heart Service at [**Hospital3 18242**].

CONDITION ON DISCHARGE:  Good.



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern1) 5664**]
MEDQUIST36
D:  [**2137-12-28**] 11:16:47
T:  [**2137-12-28**] 11:53:50
Job#:  [**Job Number 57045**]
{'Acute and subacute bacterial endocarditis,Congenital insufficiency of aortic valve,Acquired cardiac septal defect,Opioid type dependence, continuous,Thoracic aneurysm without mention of rupture,Aneurysm of other visceral artery,Personal history of other diseases of circulatory system,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Alcohol abuse, in remission'}


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: 

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 57041**] is a 23-year-old
male patient with a known congenital bicuspid aortic valve.
He underwent a balloon valvuloplasty at age 15 at [**Hospital 86**]
[**Hospital3 1810**].  He has been followed by serial
echocardiograms over the years and has been asymptomatic.
He, however, presented to St. [**Hospital 15000**] Hospital in [**Location (un) **], [**State 16269**], where he lives in [**2137-10-9**] complaining of a
number of days of onset of fever, chills and arthralgias.  He
initially had withdrawn himself from IV narcotics and felt
that his symptoms were secondary to opiate withdrawal.
However, workup revealed that he had aortic valve
endocarditis.  The bacteria was methicillin sensitive staph
aureus.  He was treated at that time during his course with a
six-week treatment course of intravenous nafcillin.  During
the time in the hospital, he had significant mental status
changes.  His head CT revealed multiple infarcts as well as
hemorrhages.  His abdominal CAT scan also revealed splenic
and renal infarcts.  He completed his antibiotic course and
was discharged from the hospital in mid [**Month (only) 359**].  He was
referred to the [**Location (un) 86**] Adult Congenital Heart Service at
[**Hospital3 1810**] for followup.  He presented on [**12-11**], underwent complete evaluation.  An echocardiogram at that
time revealed two large abscesses adjacent to the sinuses of
Valsalva which communicated with the aorta and possibly into
the left ventricle.  He was then admitted to [**Hospital1 346**] on [**2137-12-11**], for an aortic
valve and roof replacement due to abscess formation status
post endocarditis.

MEDICAL HISTORY: Congenital bicuspid aortic valve
status post valvuloplasty at age 15.  The patient has a
history of IV drug abuse, apparently quit approximately two
months prior to admission to the hospital.  Also, alcohol use
which he ceased two months prior to admission and positive
smoker.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute and subacute bacterial endocarditis,Congenital insufficiency of aortic valve,Acquired cardiac septal defect,Opioid type dependence, continuous,Thoracic aneurysm without mention of rupture,Aneurysm of other visceral artery,Personal history of other diseases of circulatory system,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Alcohol abuse, in remission'}
