CHIEF COMPLAINT: Generalized malaise, increased fatigue, adn chest discomfort on
[**3-12**].
On [**3-16**] severe chest pain prompting presentation to ED.

PRESENT ILLNESS: Mr. [**Known lastname 11270**] is a 52 yo male patinet s/p AVR on [**2119-2-20**] with Dr.
[**Last Name (STitle) **]. He was discharged home on [**2119-3-1**] after a post-op
course complicated by atrial fibrillation.
He notes that at hoemon [**3-12**] he noticed increased fatigue,
maliase, and sternal pain.  On [**3-16**] he awoke with extreme chest
pain and was brought to an OSH via ambulance.  Workup for PE via
chest CT was negative but revealed mediastinal fibrosis and left
pleural effusion.  Later that day he began draining large
amounts of purulent drainage from his sternal icision.  He was
startedon vancomycin and was transferred to the [**Hospital1 18**] for
further management and treatment.

MEDICAL HISTORY: aortic stenosis
Type 2 DM
HTN
s/p L fem bypass [**2095**]
s/p MVA with multiple orthopedic injuries
nephrolitihiasis
Hyperlipidimia

MEDICATION ON ADMISSION: Serax.
Vicodin
Vancomycin 1 gram IV BID.
Ceftazidine 1 gm IV q8h.
Glipizide 5 daily.
Colace 100 [**Hospital1 **].
Crestor 10 daily.
Lopressor 25 [**Hospital1 **].

ALLERGIES: Zestril

PHYSICAL EXAM: On presentation:
General: male patient in siginificant pain.
Neuro: Grossly intact.
Pulm: CTAB.  Decreased bilateral bases with left greater tahn
right.
CV: RRR.
Abd: soft, non-tender.
Extremities: warm.
Sternal incision: reddened areas at upper aspect.  Small open
area draining copious amounts of purulent drainage.

FAMILY HISTORY: 

SOCIAL HISTORY: ETOH: socially.
Tob: quit 4 years ago.
Other postoperative infection,Mediastinitis,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation,Heart valve replaced by other means,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Other postop infection,Mediastinitis,Abn react-anastom/graft,Atrial fibrillation,Heart valve replac NEC,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2119-3-17**]              Discharge Date:   [**2119-3-29**]

Date of Birth:  [**2067-8-18**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Zestril

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Generalized malaise, increased fatigue, adn chest discomfort on
[**3-12**].
On [**3-16**] severe chest pain prompting presentation to ED.

Major Surgical or Invasive Procedure:
sternal wound debridement and bilateral pectoralis major muscle
advancement/flaps


History of Present Illness:
Mr. [**Known lastname 11270**] is a 52 yo male patinet s/p AVR on [**2119-2-20**] with Dr.
[**Last Name (STitle) **]. He was discharged home on [**2119-3-1**] after a post-op
course complicated by atrial fibrillation.
He notes that at hoemon [**3-12**] he noticed increased fatigue,
maliase, and sternal pain.  On [**3-16**] he awoke with extreme chest
pain and was brought to an OSH via ambulance.  Workup for PE via
chest CT was negative but revealed mediastinal fibrosis and left
pleural effusion.  Later that day he began draining large
amounts of purulent drainage from his sternal icision.  He was
startedon vancomycin and was transferred to the [**Hospital1 18**] for
further management and treatment.

Past Medical History:
aortic stenosis
Type 2 DM
HTN
s/p L fem bypass [**2095**]
s/p MVA with multiple orthopedic injuries
nephrolitihiasis
Hyperlipidimia

Social History:
ETOH: socially.
Tob: quit 4 years ago.

Physical Exam:
On presentation:
General: male patient in siginificant pain.
Neuro: Grossly intact.
Pulm: CTAB.  Decreased bilateral bases with left greater tahn
right.
CV: RRR.
Abd: soft, non-tender.
Extremities: warm.
Sternal incision: reddened areas at upper aspect.  Small open
area draining copious amounts of purulent drainage.

Pertinent Results:
[**2119-3-23**] 12:15PM BLOOD WBC-10.4 RBC-3.75* Hgb-10.3* Hct-31.9*
MCV-85 MCH-27.4 MCHC-32.2 RDW-15.5 Plt Ct-406
[**2119-3-17**] 04:37PM BLOOD Neuts-80.4* Lymphs-9.7* Monos-2.4
Eos-7.2* Baso-0.2
[**2119-3-27**] 05:25AM BLOOD PT-17.2* PTT-28.2 INR(PT)-1.9
[**2119-3-23**] 12:15PM BLOOD Glucose-133* UreaN-8 Creat-0.6 Na-134
K-4.3 Cl-100 HCO3-29 AnGap-9
[**2119-3-24**] 06:38AM BLOOD ALT-31 AST-35 LD(LDH)-292* AlkPhos-105
TotBili-0.4
[**2119-3-22**] 04:01AM BLOOD Calcium-8.2* Phos-3.5 Mg-1.5*

Brief Hospital Course:
Mr. [**Known lastname 11270**] was transferred in from an OSH facility on [**2119-3-17**].
He was noted to have copious amounts of sternal drainage.  A
palstic surgery consult was obtained for probable sternal wound
debridement adn flap.
On [**2119-3-19**] he proceede to teh OR and underwent a sternal wound
irrigation and debridement with bilateral pectoral major
advancement flaps.  Please see op note for full details.
He was successfully weened and extubated on the evening of his
operative day.  On POD two a PICC was placed for long-term abx
administration.
On POD five he was transferred to the telemetry floor for
further management/recovery.
He remained on a heparin drip with PO coumadin through POD 6
when his INR reached 2.0 and his heparin was discontinued.
PODs six through ten he continued to have one remaining JP drain
in place, monitored by plastics.  Last JP removed on POD 10.
Dr. [**Last Name (STitle) **] to follow anti-coagulation regimen.


Medications on Admission:
Serax.
Vicodin
Vancomycin 1 gram IV BID.
Ceftazidine 1 gm IV q8h.
Glipizide 5 daily.
Colace 100 [**Hospital1 **].
Crestor 10 daily.
Lopressor 25 [**Hospital1 **].

Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
3. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 7 days.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Glipizide 5 mg Tab, Sust Release Osmotic Push Sig: One (1)
Tab, Sust Release Osmotic Push PO DAILY (Daily).
Disp:*30 Tab, Sust Release Osmotic Push(s)* Refills:*2*
7. Rosuvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
Disp:*60 Tablet(s)* Refills:*0*
9. Zinc Sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily) for 1 months.
Disp:*30 Capsule(s)* Refills:*0*
10. Hydromorphone HCl 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H ()
as needed.
Disp:*50 Tablet(s)* Refills:*0*
11. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*0*
12. Oxacillin Sodium 10 g Recon Soln Sig: Two (2) grams
Injection Q4H (every 4 hours) for 6 weeks: LD [**4-29**].


Discharge Disposition:
Home With Service

Facility:
[**Hospital 5065**] Healthcare

Discharge Diagnosis:
mediastinitis
s/p sternal debridement
s/p bilateral pectoralis major advancement/flaps
s/p AVR(mechanical) [**2119-2-20**]


Discharge Condition:
good

Discharge Instructions:
keep your incision clean and dry
do not apply creams, lotions, powders, or ointments to your
incisions.
Wash incisions daily with soap and water.
No heavy lifting greater than 10 pounds.
No swimming or tub bathing.
No driving.


Followup Instructions:
follow up in plastic surgery clinic in
follow up with Dr. [**Last Name (STitle) **] in [**3-3**] weeks
follow up with Dr. [**Last Name (STitle) **] in [**3-3**] weeks
{'Other postoperative infection,Mediastinitis,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation,Heart valve replaced by other means,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}


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: Generalized malaise, increased fatigue, adn chest discomfort on
[**3-12**].
On [**3-16**] severe chest pain prompting presentation to ED.

PRESENT ILLNESS: Mr. [**Known lastname 11270**] is a 52 yo male patinet s/p AVR on [**2119-2-20**] with Dr.
[**Last Name (STitle) **]. He was discharged home on [**2119-3-1**] after a post-op
course complicated by atrial fibrillation.
He notes that at hoemon [**3-12**] he noticed increased fatigue,
maliase, and sternal pain.  On [**3-16**] he awoke with extreme chest
pain and was brought to an OSH via ambulance.  Workup for PE via
chest CT was negative but revealed mediastinal fibrosis and left
pleural effusion.  Later that day he began draining large
amounts of purulent drainage from his sternal icision.  He was
startedon vancomycin and was transferred to the [**Hospital1 18**] for
further management and treatment.

MEDICAL HISTORY: aortic stenosis
Type 2 DM
HTN
s/p L fem bypass [**2095**]
s/p MVA with multiple orthopedic injuries
nephrolitihiasis
Hyperlipidimia

MEDICATION ON ADMISSION: Serax.
Vicodin
Vancomycin 1 gram IV BID.
Ceftazidine 1 gm IV q8h.
Glipizide 5 daily.
Colace 100 [**Hospital1 **].
Crestor 10 daily.
Lopressor 25 [**Hospital1 **].

ALLERGIES: Zestril

PHYSICAL EXAM: On presentation:
General: male patient in siginificant pain.
Neuro: Grossly intact.
Pulm: CTAB.  Decreased bilateral bases with left greater tahn
right.
CV: RRR.
Abd: soft, non-tender.
Extremities: warm.
Sternal incision: reddened areas at upper aspect.  Small open
area draining copious amounts of purulent drainage.

FAMILY HISTORY: 

SOCIAL HISTORY: ETOH: socially.
Tob: quit 4 years ago. 

### Response:
{'Other postoperative infection,Mediastinitis,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation,Heart valve replaced by other means,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
