CHIEF COMPLAINT: Mitral Regurg/SOB

PRESENT ILLNESS: Mr [**Known lastname 6884**] is a 34yo male with a history of rheumatic heart
disease, IV drug abuse, and recently enterococcal endocarditis
in [**May 2174**]. He now has severe mitral regurg associated with
increasing shortness of breath with minimal activity.Dr.[**Last Name (STitle) 914**]
was consulted for MVR.

MEDICAL HISTORY: 1.Rheumatic Fever
2. s/p endocarditis [**2163**] (IVDU)
3. s/p pericarditis [**2161**]
4. s/p ear surgery
5. s/p foot debridements for MRSA infection
6. negative for HIV at [**Hospital3 **] [**5-13**]
7. Hepatitis C
8. Enterococcal Endocarditis diagnosed at [**Hospital1 3494**] in [**Month (only) **],
patient non compliant with antibiotics, admitted here late [**Month (only) **],
c/b valve destruction and renal septic emboli
9. fungemia with PICC line
10. tooth abcesses
11. CKD stage II
12. ADHD
13. bipolar disorder
14. CT scan in [**6-/2174**] showed emphysematous changes and a right
lower lobe nodule
15. h/o injection drug use
16. fibromyalgia

MEDICATION ON ADMISSION: Methadone 20(2), Lyrica NF 100(2),Zolpidem 10qhslisinopril
10(1), Atenolol 25(1), Colace 200(2), Dilauded ?dose

ALLERGIES: Penicillins / Erythromycin / Compazine / Aspirin / Ssri
&Antipsych,Atyp,Dop&Serotonin Antag / Maois  Non-Selective &
Irreversible / Codeine

PHYSICAL EXAM: Discharge Physical Exam:
VSS: T:98'2,BP:100/61, P:63,RR:18, O2SAT:94% R/A
General: A&O x3, NAD
HEENT: AT/NC, wnl
CVS:RRR
LUNGS: decreased at right base, ess. CTA, Right thoracotomy site
C/D/I
ABD: soft, NT, +BS, midline incision with steri strips/C/D/I.
EXT:warm, neg. C/C/E
Right groin: staples intact, incision C/D/I

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for current tobacco use- 2cig/day.
He has been drinking 1 qrt vodka/day for the last 2 weeks
because he ran out of lyrica for pain, but says he normally
drinks moderately. He is presently living his male partner
independently.  [**Name2 (NI) **] has smoked two to six cigarettes daily over
the past 20 years.  He states he has not used any illicit drugs
since using amphetamines approximately 2 yrs ago.
Mitral valve disorders,Pneumonitis due to inhalation of food or vomitus,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Accidental puncture or laceration during a procedure, not elsewhere classified,Acute posthemorrhagic anemia,Cellulitis and abscess of trunk,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, unspecified,Chronic kidney disease, Stage II (mild)
Mitral valve disorder,Food/vomit pneumonitis,Peritoneum injury-closed,Accidental op laceration,Ac posthemorrhag anemia,Cellulitis of trunk,Abn react-surg proc NEC,Chrnc hpt C wo hpat coma,Thrombocytopenia NOS,Chro kidney dis stage II
Admission Date:  [**2175-4-19**]              Discharge Date:   [**2175-5-3**]

Date of Birth:  [**2140-11-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Erythromycin / Compazine / Aspirin / Ssri
&Antipsych,Atyp,Dop&Serotonin Antag / Maois  Non-Selective &
Irreversible / Codeine

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Mitral Regurg/SOB

Major Surgical or Invasive Procedure:
[**4-19**] Minimal Invasive Mitral Valve Repair (30mm CE Band)
[**4-19**] Exploratory laparotomy and cauterization of liver
lacerations with temporary abdominal closure.
[**4-21**] Exploratory laparotomy with removal of intra-abdominal
packing and cauterization of liver lacerations. Closure of the
abdomen.


History of Present Illness:
Mr [**Known lastname 6884**] is a 34yo male with a history of rheumatic heart
disease, IV drug abuse, and recently enterococcal endocarditis
in [**May 2174**]. He now has severe mitral regurg associated with
increasing shortness of breath with minimal activity.Dr.[**Last Name (STitle) 914**]
was consulted for MVR.

Past Medical History:
1.Rheumatic Fever
2. s/p endocarditis [**2163**] (IVDU)
3. s/p pericarditis [**2161**]
4. s/p ear surgery
5. s/p foot debridements for MRSA infection
6. negative for HIV at [**Hospital3 **] [**5-13**]
7. Hepatitis C
8. Enterococcal Endocarditis diagnosed at [**Hospital1 3494**] in [**Month (only) **],
patient non compliant with antibiotics, admitted here late [**Month (only) **],
c/b valve destruction and renal septic emboli
9. fungemia with PICC line
10. tooth abcesses
11. CKD stage II
12. ADHD
13. bipolar disorder
14. CT scan in [**6-/2174**] showed emphysematous changes and a right
lower lobe nodule
15. h/o injection drug use
16. fibromyalgia


Social History:
Social history is significant for current tobacco use- 2cig/day.
He has been drinking 1 qrt vodka/day for the last 2 weeks
because he ran out of lyrica for pain, but says he normally
drinks moderately. He is presently living his male partner
independently.  [**Name2 (NI) **] has smoked two to six cigarettes daily over
the past 20 years.  He states he has not used any illicit drugs
since using amphetamines approximately 2 yrs ago.


Family History:
There is no family history of premature coronary artery disease
or sudden death.


Physical Exam:
Discharge Physical Exam:
VSS: T:98'2,BP:100/61, P:63,RR:18, O2SAT:94% R/A
General: A&O x3, NAD
HEENT: AT/NC, wnl
CVS:RRR
LUNGS: decreased at right base, ess. CTA, Right thoracotomy site
C/D/I
ABD: soft, NT, +BS, midline incision with steri strips/C/D/I.
EXT:warm, neg. C/C/E
Right groin: staples intact, incision C/D/I


Pertinent Results:
[**2175-4-30**] 06:30AM BLOOD WBC-11.0 RBC-3.26* Hgb-9.7* Hct-29.6*
MCV-91 MCH-29.7 MCHC-32.7 RDW-16.0* Plt Ct-658*
[**2175-4-19**] 02:37PM BLOOD WBC-12.4*# RBC-2.70*# Hgb-8.7*#
Hct-25.7*# MCV-95 MCH-32.2* MCHC-33.8 RDW-14.3 Plt Ct-104*
[**2175-4-25**] 03:41AM BLOOD PT-13.7* PTT-28.5 INR(PT)-1.2*
[**2175-5-1**] 09:13AM BLOOD Glucose-127* UreaN-9 Creat-1.0 Na-136
K-4.6 Cl-102 HCO3-24 AnGap-15
[**2175-4-19**] 07:16PM BLOOD Glucose-186* UreaN-12 Creat-0.8 Na-141
K-5.4* Cl-118* HCO3-17* AnGap-11
[**2175-4-26**] 02:54AM BLOOD ALT-51* AST-57* LD(LDH)-271* AlkPhos-89
Amylase-79 TotBili-0.4
[**2175-4-30**] 06:30AM BLOOD Vanco-18.5
[**2175-4-27**] 09:34AM BLOOD Vanco-12.5
[**2175-4-21**] 03:05AM BLOOD HEPARIN DEPENDENT ANTIBODIES-

[**2175-4-28**] 5:10 pm SWAB      Source: umbilicus.
GRAM STAIN (Final [**2175-4-28**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
NO MICROORGANISMS SEEN.
WOUND CULTURE (Final [**2175-4-30**]):    NO GROWTH.
ANAEROBIC CULTURE (Preliminary):    NO GROWTH.

[**2175-4-25**] 12:36 pm BLOOD CULTURE ( MYCO/F LYTIC BOTTLE)
      Source: Line-Aline.
BLOOD/FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.
BLOOD/AFB CULTURE (Preliminary):    NO MYCOBACTERIA ISOLATED.

[**2175-4-25**] 10:37 am BLOOD CULTURE      Source: Line-Aline.
                            **FINAL REPORT [**2175-5-1**]**
Blood Culture, Routine (Final [**2175-5-1**]):    NO GROWTH.
   RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2175-5-2**] 11:33 AM
[**Hospital 93**] MEDICAL CONDITION:
34 year old man s/p mvr
REASON FOR THIS EXAMINATION:
asssess for effusions/infiltrates
HISTORY: Post-cardiac surgery.

FINDINGS: In comparison with study of [**4-29**], the central catheter
has been removed. Streaks of atelectasis or fibrosis are again
seen in the right lung. However, no evidence of acute pneumonia.
No vascular congestion or pleural effusion.

DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**]
Approved: TUE [**2175-5-2**] 1:11 PM
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 28383**] (Complete)
Done [**2175-4-19**] at 1:07:10 PM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**]
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2140-11-8**]
Age (years): 34 M  Hgt (in): 75
BP (mm Hg): 120/70  Wgt (lb): 190
HR (bpm): 70  BSA (m2): 2.15 m2
Indication: Intraoperative TEE for MVR--minimally invasive
ICD-9 Codes: 424.90, 786.05, 440.0, 424.0
Test Information
Date/Time: [**2175-4-19**] at 13:07    Interpret MD: [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**],
MD
Test Type: TEE (Complete)
3D imaging. Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 6507**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW5-: Machine: [**Pager number 28384**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *6.9 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  60% to 65%  >= 55%
Aorta - Annulus:  2.5 cm  <= 3.0 cm
Aorta - Sinus Level:  3.4 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.9 cm  <= 3.0 cm
Aorta - Ascending:  *3.6 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.0 cm  <= 2.5 cm

Findings
Multiplanar reconstructions were generated and confirmed on an
independent workstation.

LEFT ATRIUM: Dilated LA. Good (>20 cm/s) LAA ejection velocity.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. Normal interatrial
septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Severely dilated LV
cavity. Overall normal LVEF (>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Mildly dilated
ascending aorta. Normal descending aorta diameter. Simple
atheroma in descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Moderate
to severe (3+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

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

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient. See Conclusions for post-bypass data
The post-bypass study was performed while the patient was
receiving vasoactive infusions (see Conclusions for listing of
medications).
Conclusions
PRE-BYPASS:
1. The left atrium is dilated. No atrial septal defect is seen
by 2D or color Doppler.
2. Left ventricular wall thicknesses are normal. The left
ventricular cavity is severely dilated. Overall left ventricular
systolic function is normal (LVEF>55%).
3. Right ventricular chamber size and free wall motion are
normal.
4. The ascending aorta is mildly dilated. There are simple
atheroma in the descending thoracic aorta.
5. The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation.
6. The mitral valve leaflets are mildly thickened. Moderate to
severe (3+) mitral regurgitation is seen. The is a leaflet
[**Pager number 11368**] at the posterior medial commissure with a
posteriorly directed jet of mitral regurgitaton. A centrally
directed jet is noted at the point of coaptation.
7. There is no pericardial effusion.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine and was
in normal sinus rhythm.
1. A well-seated mitral annuloplasty ring is seen with normal
leaflet motion and gradients (mean gradient = 6 mmHg). MVA is
2.6cm2 by PHT. There is no valvular systolic anterior motion
([**Male First Name (un) **]). No mitral regurgitation is seen.
2. Regional and global left ventricular systolic function are
normal.
3. Right ventricular systolic function is normal.
4. Aortic contours are intact post-decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

CT ABD W&W/O C; CT PELVIS W&W/O C
Reason: assess for bleeding, injury to liver
[**Hospital 93**] MEDICAL CONDITION:
34 year old man s/p MVR with traumatic injury to liver with
angiocath intraop, now with distended abdomen, dropping
hematocrit.
REASON FOR THIS EXAMINATION:
assess for bleeding, injury to liver
CONTRAINDICATIONS for IV CONTRAST: None.

CLINICAL INDICATION: MVR with traumatic injury to liver.

TECHNIQUE: MDCT images are acquired from the lung bases to the
pubic symphysis with and without intravenous contrast.

FINDINGS: Comparison is made to a prior study dated [**2174-6-22**].
Bilateral consolidation seen at the lung bases. The right chest
tube is seen with minimal air within the right pleural space.
Previously noted right lower lobe nodule is not again seen on
image #11 of series 4, unchanged since the prior exam.

There is significant hemoperitoneum. Hyperattenuation is noted
immediately about the liver, though no clear liver injury is
identified. There does appear to be a splenic laceration, well
seen on image #26 of series 4.

The adrenal glands, pancreas, gallbladder appear grossly
unremarkable. The left kidney appears grossly normal. Small
hypoattenuating foci seen within the right kidney, which are too
small to characterize but likely represent simple cysts.
Scattered subcentimeter periportal and peripancreatic lymph
nodes are incidentally noted.

The visualized bowel appears grossly unremarkable. Pelvic
structures appear grossly normal. Foley catheter is seen within
the bladder.

No suspicious lytic or blastic bony lesions are seen.
IMPRESSION:
1. Moderate hemoperitoneum. There is no clear injury to the
liver. However, there does appear to be a splenic laceration.
These findings are discussed with [**First Name8 (NamePattern2) **] [**Doctor Last Name **] at the time of
dictation.
2. Bibasilar consolidation seen.
3. Stable right lower lobe pulmonary nodule.
The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Pathology Examination
Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 28385**],[**Known firstname **]       [**2140-11-8**]    34 Male      [**Numeric Identifier 28386**] [**Numeric Identifier **]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
[**Last Name (NamePattern1) 2093**] Description by:   DR. [**Last Name (STitle) **]. [**Doctor Last Name **], [**Doctor Last Name 15785**],[**Doctor First Name **]/cofc
SPECIMEN SUBMITTED: liver biopsy.
Procedure date     Tissue received     Report Date    Diagnosed
by
[**2175-4-19**] [**2175-4-20**] [**2175-4-24**] DR. [**Last Name (STitle) **]. [**Doctor Last Name **]/mb????????????
Previous biopsies:    [**Numeric Identifier 28387**]  TEETH.
  [**-6/2659**]  TEETH (29,30)
  [**-4/3031**]  RIGHT UPPER BACK.
DIAGNOSIS:
Liver, needle biopsies:1.  Moderate portal and mild
lobular/periportal mixed cell inflammation (grade 2).2.
Moderate steatosis, without balloon degeneration or
intracytoplasmic hyalin. 3.  Trichrome stain: Increased portal
and focal periportal fibrosis (stage 2).4.  Iron stain: No
stainable iron.
Note:  The findings are most consistent with chronic hepatitis
C.  The mixed inflammation is suggestive of an additional drug
effect.  There are no features of ischemic disease or abscesses.
Clinical: Pre-operation diagnosis:  Liver injury.
Post-operation diagnosis:  Liver injury.  HCV, polysubstance
IVDU.
Gross:  The specimen is received in one formalin container,
labeled with the patient's name "[**Known lastname 6884**], [**Known firstname 1726**]" and the medical
record number.  It consists of two tan-yellow tissue cores
ranging in sizes from 0.4 cm to 0.6 cm.  Entirely submitted in
A.


Brief Hospital Course:
On [**2175-4-19**] Mr [**Known lastname 6884**] went to the OR and underwent minimally
invasive Mitral Valve repair with #30mm [**Doctor Last Name **] band. Please
refer to Dr[**Last Name (STitle) 5305**] operative note for further details. Cross
clamp time was 71", cardiopulmonary bypass time was 93". Mr.[**Known lastname 6884**]
was transferred to the CVICU intubated, requiring Propofol and
Neosynephrine drips to optimimize blood pressure and cardiac
output. Mr.[**Known lastname 28388**] immediate post operative course was
complicated by hemodynamic instability due to anemia with
hematocrit dropping from 35 to 16. The addition of Levophed was
required and serial monitoring of hematocrit,platlets, and
fibrinogen ensued, along with transfusion of multiple blood
products.CT csan of the abdomen revealed extensive
hemoperitoneum with no obvious source. He was taken back to the
OR where Dr.[**First Name (STitle) **] performed an exploratory laparotomy. Upon
exploration a liver evulsion and splenic laceration was
identified and cauterized.Please refer to Dr[**Location (un) **] operative
report for further details. The patient was transferred back to
the CVICU with his abdomen packed,left open due to high bladder
pressures and in anticipation of further resuscitation
requirements. [**4-21**] Mr.[**Known lastname 6884**] was taken back to the OR to have his
abdomen washed out and closed. ID was consulted due to
postoperative fevers and in light of his recent hixtory of
endocarditis.ABX regiment and serial pan cultures were
performed. ID continued to follow throughout his hospital
admission.The next few days the patient remained in the CVICU
sedated to protect him from DTs due to his current extensive
drug and alcohol abuse.[**4-25**] Mr.[**Known lastname 6884**] was extubated without
incident.He continued to remain febrile and on ABX regiment
until cultures revealed haemophilus in his sputum. His right
groin incision demonstrated purulent drainage that required a
wound vac for several days. On POD#8 he was stable, doing well
and was transferred to the floor. The remainder of his
postoperative course was essentially uneventful. POD#13 the
right groin was closed and staples put into place, to be removed
at follow up. Addiction services was consulted for
recommendations prior to discharge. ID signed off after
recommending the discontinuation of all ABX. Pt was doing well
and it was felt he was ready to be discharged to home on
[**2175-5-3**]. As discussed with Addiction services, a plan for pain
meds for discharge was discussed and and Mr.[**Known lastname 6884**] is required to
follow up with his PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] in one week. He has also been
recommended to follow up withDr.[**Doctor Last Name 914**], Dr.[**First Name (STitle) **], and
Dr.[**Last Name (STitle) **] as documented in his discharge instructions.

Medications on Admission:
Methadone 20(2), Lyrica NF 100(2),Zolpidem 10qhslisinopril
10(1), Atenolol 25(1), Colace 200(2), Dilauded ?dose

Discharge Medications:
1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
6. Methadone 10 mg Tablet Sig: Two (2) Tablet PO twice a day.
Disp:*28 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Mitral Regurgitation s/p Minimal Invasive Mitral Valve Repair
Liver Lacerations s/p Exploratory Laparotomy and Cauterization
of liver lacerations
PMH: Endocarditis, Rheumatic Heart Disease, Pericarditis [**2161**],
h/o MRSA s/p foot debridements, Hepatitis C, h/o IVDU, Chronic
Kidney Disease, ADHD, Bipolar disorder, Fibromyalgia, s/p Ear
surgery


Discharge Condition:
Good


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks
Dr. [**First Name (STitle) **] in 2 weeks
Dr. [**Last Name (STitle) **] in [**1-8**] weeks
Dr. [**Last Name (STitle) **] in 1 week



Completed by:[**2175-5-3**]
{'Mitral valve disorders,Pneumonitis due to inhalation of food or vomitus,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Accidental puncture or laceration during a procedure, not elsewhere classified,Acute posthemorrhagic anemia,Cellulitis and abscess of trunk,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, unspecified,Chronic kidney disease, Stage II (mild)'}


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: Mitral Regurg/SOB

PRESENT ILLNESS: Mr [**Known lastname 6884**] is a 34yo male with a history of rheumatic heart
disease, IV drug abuse, and recently enterococcal endocarditis
in [**May 2174**]. He now has severe mitral regurg associated with
increasing shortness of breath with minimal activity.Dr.[**Last Name (STitle) 914**]
was consulted for MVR.

MEDICAL HISTORY: 1.Rheumatic Fever
2. s/p endocarditis [**2163**] (IVDU)
3. s/p pericarditis [**2161**]
4. s/p ear surgery
5. s/p foot debridements for MRSA infection
6. negative for HIV at [**Hospital3 **] [**5-13**]
7. Hepatitis C
8. Enterococcal Endocarditis diagnosed at [**Hospital1 3494**] in [**Month (only) **],
patient non compliant with antibiotics, admitted here late [**Month (only) **],
c/b valve destruction and renal septic emboli
9. fungemia with PICC line
10. tooth abcesses
11. CKD stage II
12. ADHD
13. bipolar disorder
14. CT scan in [**6-/2174**] showed emphysematous changes and a right
lower lobe nodule
15. h/o injection drug use
16. fibromyalgia

MEDICATION ON ADMISSION: Methadone 20(2), Lyrica NF 100(2),Zolpidem 10qhslisinopril
10(1), Atenolol 25(1), Colace 200(2), Dilauded ?dose

ALLERGIES: Penicillins / Erythromycin / Compazine / Aspirin / Ssri
&Antipsych,Atyp,Dop&Serotonin Antag / Maois  Non-Selective &
Irreversible / Codeine

PHYSICAL EXAM: Discharge Physical Exam:
VSS: T:98'2,BP:100/61, P:63,RR:18, O2SAT:94% R/A
General: A&O x3, NAD
HEENT: AT/NC, wnl
CVS:RRR
LUNGS: decreased at right base, ess. CTA, Right thoracotomy site
C/D/I
ABD: soft, NT, +BS, midline incision with steri strips/C/D/I.
EXT:warm, neg. C/C/E
Right groin: staples intact, incision C/D/I

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for current tobacco use- 2cig/day.
He has been drinking 1 qrt vodka/day for the last 2 weeks
because he ran out of lyrica for pain, but says he normally
drinks moderately. He is presently living his male partner
independently.  [**Name2 (NI) **] has smoked two to six cigarettes daily over
the past 20 years.  He states he has not used any illicit drugs
since using amphetamines approximately 2 yrs ago. 

### Response:
{'Mitral valve disorders,Pneumonitis due to inhalation of food or vomitus,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Accidental puncture or laceration during a procedure, not elsewhere classified,Acute posthemorrhagic anemia,Cellulitis and abscess of trunk,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, unspecified,Chronic kidney disease, Stage II (mild)'}
