<s>[INST] I am 51, 5 11 180lbs and had a double bypass 16 years ago after angio and stent failed. About 2 months ago, I had valve replacement (mechanical). The surgeon also had to repair an aneurism and remove part of a LEAD WIRE left in my ascending aorta from a procedure done 16 years ago! I have had a few related problems since then. I was actually admitted back into the hospital for 8 days because the chest tube was removed prematurely so that they could send me home. Approximately 1000ccs of blood fluid had accumulated in my chest cavity. I was on coumadin so they had to take me off of it, drain the fluid (only 700 of the 1000ccs), and then place me back on coumadin and get my INR back up. I have been recuperating and doing well, but have recently in the last 4 or 5 days been feeling pain around my left lung again and running a low-grade fever from 99 to 101 for about a day or two. JUST TONIGHT, I started noticing that my heart would skip a beat every 5 to 15 seconds or so. I am wondering what could be causing this all of a sudden. Am I okay? And will I live through the night? The on-call doctor I spoke with tonight (McKinstry) was flippant about the whole thing and said I should just go to the office in the morning and get an EKG. He was rude and impatient and did not care. Can you provide me with a little peace of mind and perhaps a little insight as to my condition so that I may be able to sleep tonight? [/INST] Hello thanks for posting at Chat Doctor. I have gone through the history provided. Since you have a mechanical valve you are put on warfarin. Due to the chest tube placement and subsequent removal I suppose you have got a hemothorax which means blood in the outer covering of the lungs. So the fluid inside the lungs might as well be blood. This may have happened due to the instrumentation (initial placement of the best tune then removal and second 700 cc removal) and also because you are on Coumadin. Other reason for the fluid collection can also be infection due to chest tune placement (foreign body inside chest cavity). Since you got chest pain around your left lung and also fever, I suppose the fluid has collected again and might as well be infected. There is no emergency at present, and you can go to see your doctor in the morning. I recommend a chest x-ray to see if there is fluid collection again in the chest cavity. If there is persistent fluid, then it may be removed and sent for analysis to rule out infection and establish the cause of reaccumulation of fluid. Phase revert with the chest x-ray and pleural fluid reports. Wishing you good healthRegards </s>