CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 61 year old male with a history of hypertension and chronic (3+)
mitral regurgitation which has become more severe. He reports
that he has experienced worsening exertional dyspnea and fatigue
with activity over the past year.
He is able to walk a few blocks without getting tired and
tolerates his ADLs, but he has difficulty walking uphill or
climbing stairs. He also describes feeling occasional
palpitations that have awakened him during the night within the
past six months. Cardiac surgery was consulted to evaluate for
surgical intervention.

MEDICAL HISTORY: mitral regurgitation s/p mitral valve repair
PMH:
Hyperlipidemia
Hypertension
Malaria
Tuberculosis

MEDICATION ON ADMISSION: ENALAPRIL MALEATE -  (Prescribed by Other Provider) - 5 mg
Tablet
- 1 Tablet(s) by mouth twice daily
Medications - OTC
ACETAMINOPHEN [TYLENOL] -  (Prescribed by Other Provider) -
Dosage uncertain, PRN
FLAXSEED OIL -  (Prescribed by Other Provider) - Dosage
uncertain
IBUPROFEN [ADVIL] -  (Prescribed by Other Provider) - Dosage
uncertain, PRN
OMEGA-3 FATTY ACIDS [FISH OIL] -  (Prescribed by Other Provider)
- Dosage uncertain

ALLERGIES: Amoxicillin

PHYSICAL EXAM: Pulse:69 Resp:18  O2 sat:99/RA
B/P  Right:176/98    Left:165/93
Height:5'6"     Weight:140 lbs

FAMILY HISTORY: mother had CAD and an MI in her late 60s-early 70s

SOCIAL HISTORY: Lives with: Wife
Occupation: research associate at [**Hospital1 **] [**Location (un) 86**]
Tobacco:quit [**6-3**] year ago
ETOH:occasionally
Mitral valve disorders,Acute posthemorrhagic anemia,Cardiac complications, not elsewhere classified,Atrial flutter,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of tuberculosis
Mitral valve disorder,Ac posthemorrhag anemia,Surg compl-heart,Atrial flutter,Secundum atrial sept def,Hypertension NOS,Hyperlipidemia NEC/NOS,Abn react-surg proc NEC,Prsnl hst tuberculosis
Admission Date:  [**2185-1-3**]              Discharge Date:   [**2185-1-8**]

Date of Birth:  [**2123-6-4**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Amoxicillin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Shortness of breath


Major Surgical or Invasive Procedure:
[**2185-1-3**] Mitral Valve Repair with 28 mm Ring


History of Present Illness:
61 year old male with a history of hypertension and chronic (3+)
mitral regurgitation which has become more severe. He reports
that he has experienced worsening exertional dyspnea and fatigue
with activity over the past year.
He is able to walk a few blocks without getting tired and
tolerates his ADLs, but he has difficulty walking uphill or
climbing stairs. He also describes feeling occasional
palpitations that have awakened him during the night within the
past six months. Cardiac surgery was consulted to evaluate for
surgical intervention.


Past Medical History:
mitral regurgitation s/p mitral valve repair
PMH:
Hyperlipidemia
Hypertension
Malaria
Tuberculosis


Social History:
Lives with: Wife
Occupation: research associate at [**Hospital1 **] [**Location (un) 86**]
Tobacco:quit [**6-3**] year ago
ETOH:occasionally


Family History:
mother had CAD and an MI in her late 60s-early 70s


Physical Exam:
Pulse:69 Resp:18  O2 sat:99/RA
B/P  Right:176/98    Left:165/93
Height:5'6"     Weight:140 lbs

General:NAD, alert and cooperative
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular []  Murmur II-III/VI systolic murmur
across precordium and radiating into both carotids
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm x[], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right: +1  Left:+1
DP           Right:+2   Left:+2
PT           [**Name (NI) 167**]: +2  Left:+2
Radial       Right:+1   Left:+2

Carotid Bruit        Right/Left:murmur radiates to both carotids


Pertinent Results:
Intra-op TEE
Pre CPB:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium or left atrial appendage.
A small patent foramen ovale is likely present.
There is moderate symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Overall left ventricular
systolic function is mildly depressed (LVEF= 40 %). [Intrinsic
left ventricular systolic function is likely more depressed
given the severity of valvular regurgitation.]
Right ventricular chamber size and free wall motion are normal.
The ascending aorta is mildly dilated. There are simple atheroma
in the aortic arch. There are complex (>4mm) atheroma in the
descending thoracic aorta.
There are three aortic valve leaflets. There is no aortic valve
stenosis. No aortic regurgitation is seen.
Severe (4+) mitral regurgitation is seen with two jets, one
anterior and the other posterior, the anterior jet appears more
significant although due to the coanda effect it is difficult to
quantify either. There is a ruptured chord at P1-P2. Pulmonary
vein flow exhibits systolic reversal.
Dr. [**Last Name (STitle) **] was notified in person of the results.

Post CPB:
The cardiac output is 3.4L/min, the patient is in NSR on an
epinephrine infusion.
The LVEF is 30-35%.
There is a mitral annuloplasty ring. There is trace to mild
mitral regurgitation. The mitral valve as a peak/mean gradient
of 6/2mmHg.
The visible contours of the thoracic aorta are intact.
There is no aortic insufficiency.
[**2185-1-8**] 03:57AM BLOOD WBC-7.6 RBC-3.07* Hgb-9.2* Hct-26.5*
MCV-86 MCH-29.9 MCHC-34.6 RDW-14.3 Plt Ct-223
[**2185-1-8**] 03:57AM BLOOD PT-31.6* PTT-36.3* INR(PT)-3.2*
[**2185-1-8**] 03:57AM BLOOD Glucose-119* UreaN-31* Creat-1.4* Na-136
K-4.3 Cl-102 HCO3-26 AnGap-12
[**2185-1-3**] 09:49PM BLOOD ALT-14 AST-34 AlkPhos-22* Amylase-28
TotBili-0.2
[**2185-1-3**] 09:49PM BLOOD Lipase-31
[**2185-1-8**] 03:57AM BLOOD Calcium-8.2* Phos-2.9 Mg-2.1

Brief Hospital Course:
The patient was brought to the operating room on [**2185-1-3**] where
the patient underwent Mitral Valve Repair with Dr. [**Last Name (STitle) **].  See
operative note for further details.  Overall the patient
tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.  The patient
was transferred to the telemetry floor for further recovery.
Chest tubes and pacing wires were discontinued without
complication.  The patient was evaluated by the physical therapy
service for assistance with strength and mobility.  He was
hypertensive on the floor and Coreg, Enalapril and Norvasc were
titrated for better blood pressure control. He went into a rapid
atrial fibrillation on POD# 3 and was bolused with Amiodarone.
He was put on oral Amiodarone with rate controlled atrial
fibrillation at the time of discharge.

 He was started on Coumadin for atrial fibrillation and will be
followed by our office this weekend.We will arrange for his PCP
or cardiologist to follow this on Monday [**1-10**]. INR was 3.4 at
the time of discharge with a goal INR of 2.0-3.0. Pt was
instructed to hold dose for today and tomorrow and dosing for
Monday [**1-10**] will be arranged with VNA after labwork is
complete.

By the time of discharge on POD #5 the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.  The patient was discharged to home with VNA in good
condition with appropriate follow up instructions.

Medications on Admission:
ENALAPRIL MALEATE -  (Prescribed by Other Provider) - 5 mg
Tablet
- 1 Tablet(s) by mouth twice daily
Medications - OTC
ACETAMINOPHEN [TYLENOL] -  (Prescribed by Other Provider) -
Dosage uncertain, PRN
FLAXSEED OIL -  (Prescribed by Other Provider) - Dosage
uncertain
IBUPROFEN [ADVIL] -  (Prescribed by Other Provider) - Dosage
uncertain, PRN
OMEGA-3 FATTY ACIDS [FISH OIL] -  (Prescribed by Other Provider)
- Dosage uncertain


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
2. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*100 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
5. warfarin 1 mg Tablet Sig: 1-2 Tablets PO Once Daily at 4 PM:
Take as instructed for INR goal [**3-3**] for A fib on Mon [**1-10**]; do
not take Sat [**1-8**] and Sunday [**1-9**].
Disp:*60 Tablet(s)* Refills:*0*
6. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
8. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
9. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400 mg [**Hospital1 **] x 2 weeks then 400 mg daily x 2 weeks then as
directed by your cardiologist.
Disp:*120 Tablet(s)* Refills:*0*
10. enalapril maleate 20 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*1*
11. Coreg 25 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
mitral regurgitation s/p mitral valve repair
postop A Fib
PMH:
Hyperlipidemia
Hypertension
Malaria
Tuberculosis


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**\

****Target INR for A Fib 2.0-3.0
 First blood draw Monday [**1-10**] with results called to the
cardiac surgery office [**Telephone/Fax (1) 170**] prior to 4 pm.
 We will arrange for your cardiologist or PCP to followup
coumadin dosing/INR on that day.



Followup Instructions:
You are scheduled for the following appointments:
Surgeon Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] [**2184-2-4**] at 1:30 PM
Cardiologist Dr. [**Last Name (STitle) 1923**],[**First Name3 (LF) **] [**2184-2-3**] at 3:00 PM

Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] B. [**Telephone/Fax (1) 2573**] in [**5-3**] weeks



Completed by:[**2185-1-8**]
{'Mitral valve disorders,Acute posthemorrhagic anemia,Cardiac complications, not elsewhere classified,Atrial flutter,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of tuberculosis'}


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: Shortness of breath

PRESENT ILLNESS: 61 year old male with a history of hypertension and chronic (3+)
mitral regurgitation which has become more severe. He reports
that he has experienced worsening exertional dyspnea and fatigue
with activity over the past year.
He is able to walk a few blocks without getting tired and
tolerates his ADLs, but he has difficulty walking uphill or
climbing stairs. He also describes feeling occasional
palpitations that have awakened him during the night within the
past six months. Cardiac surgery was consulted to evaluate for
surgical intervention.

MEDICAL HISTORY: mitral regurgitation s/p mitral valve repair
PMH:
Hyperlipidemia
Hypertension
Malaria
Tuberculosis

MEDICATION ON ADMISSION: ENALAPRIL MALEATE -  (Prescribed by Other Provider) - 5 mg
Tablet
- 1 Tablet(s) by mouth twice daily
Medications - OTC
ACETAMINOPHEN [TYLENOL] -  (Prescribed by Other Provider) -
Dosage uncertain, PRN
FLAXSEED OIL -  (Prescribed by Other Provider) - Dosage
uncertain
IBUPROFEN [ADVIL] -  (Prescribed by Other Provider) - Dosage
uncertain, PRN
OMEGA-3 FATTY ACIDS [FISH OIL] -  (Prescribed by Other Provider)
- Dosage uncertain

ALLERGIES: Amoxicillin

PHYSICAL EXAM: Pulse:69 Resp:18  O2 sat:99/RA
B/P  Right:176/98    Left:165/93
Height:5'6"     Weight:140 lbs

FAMILY HISTORY: mother had CAD and an MI in her late 60s-early 70s

SOCIAL HISTORY: Lives with: Wife
Occupation: research associate at [**Hospital1 **] [**Location (un) 86**]
Tobacco:quit [**6-3**] year ago
ETOH:occasionally 

### Response:
{'Mitral valve disorders,Acute posthemorrhagic anemia,Cardiac complications, not elsewhere classified,Atrial flutter,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of tuberculosis'}
