CHIEF COMPLAINT: Lower extremity edema and congestive heart
failure.

PRESENT ILLNESS: This is a 54 year old gentleman
with coronary artery disease, status post inferior myocardial
infarction, congestive heart failure and ejection fraction of
30%.  Automatic implanted cardioverter defibrillator,
question of constrictive cardiac physiology, Hodgkin's
disease, status post radiation therapy, hypothyroidism, and
hypercholesterolemia.  The patient was also noted to have an
increase in weight of approximately 20 lb over the last month
as well as increasing fatigue and pedal edema.  His Lasix was
initially increased to 80 mg from 40 mg q.d. but did not help
with the increasing lower extremity pitting edema.

MEDICAL HISTORY: The patient's past medical history
includes coronary artery disease, status post inferior
myocardial infarct in [**2115**] complicated by left ventricular
thrombus and embolic cerebrovascular accident, status post
stent of the left circumflex coronary artery in [**2123-4-1**],
congestive heart failure with mitral and tricuspid
regurgitation, automatic implanted cardioverter defibrillator
placed in [**2123-4-1**] for inducible ventricular tachycardia,
history of superficial femoral artery thrombosis, Hodgkin's
disease diagnosed at the age of 27, status post mantle
radiation therapy and splenectomy, hypercholesterolemia,
cervical discectomy requiring five days of postoperative
intubation and hypothyroidism.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Mitral valve disorders,Diseases of tricuspid valve,Constrictive pericarditis,Congestive heart failure, unspecified,Hemorrhage complicating a procedure,Cirrhosis of liver without mention of alcohol,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins
Mitral valve disorder,Tricuspid valve disease,Constrictiv pericarditis,CHF NOS,Hemorrhage complic proc,Cirrhosis of liver NOS,Mth sus Stph aur els/NOS,Inf mcrg rstn pncllins
Admission Date:  [**2123-7-29**]       Discharge Date:  [**2123-9-6**]

Date of Birth:   [**2069-5-9**]       Sex:  M

Service:

CHIEF COMPLAINT:  Lower extremity edema and congestive heart
failure.

HISTORY OF PRESENT ILLNESS:  This is a 54 year old gentleman
with coronary artery disease, status post inferior myocardial
infarction, congestive heart failure and ejection fraction of
30%.  Automatic implanted cardioverter defibrillator,
question of constrictive cardiac physiology, Hodgkin's
disease, status post radiation therapy, hypothyroidism, and
hypercholesterolemia.  The patient was also noted to have an
increase in weight of approximately 20 lb over the last month
as well as increasing fatigue and pedal edema.  His Lasix was
initially increased to 80 mg from 40 mg q.d. but did not help
with the increasing lower extremity pitting edema.

PAST MEDICAL HISTORY:  The patient's past medical history
includes coronary artery disease, status post inferior
myocardial infarct in [**2115**] complicated by left ventricular
thrombus and embolic cerebrovascular accident, status post
stent of the left circumflex coronary artery in [**2123-4-1**],
congestive heart failure with mitral and tricuspid
regurgitation, automatic implanted cardioverter defibrillator
placed in [**2123-4-1**] for inducible ventricular tachycardia,
history of superficial femoral artery thrombosis, Hodgkin's
disease diagnosed at the age of 27, status post mantle
radiation therapy and splenectomy, hypercholesterolemia,
cervical discectomy requiring five days of postoperative
intubation and hypothyroidism.

PREOPERATIVE MEDICATIONS:
1.  Synthroid 0.125 mcg q. AM
2.  Lasix 80 mg q. AM
3.  Captopril 12.5 mg t.i.d.
4.  Lipitor 10 mg p. QM
5.  Carvedilol .125 mg b.i.d.

ALLERGIES:  No known drug allergies

PHYSICAL EXAMINATION:  Initial blood pressure was 110/60,
heartrate 70, respiratory rate 16, 98% on room air.  General:
He was awake and alert in no acute distress.  Head, eyes,
ears, nose and throat:  He was pupils are equal, round, and
reactive to light, extraocular muscles intact.  Mouth and
oropharynx were clear without exudates or erythema.
Jugulovenous distension to upper jaw.  Neck was supple, no
left axis deviation or masses.  Heart:  Regular rate and
rhythm, normal S1 and S2, 3 to 4 tricuspid regurgitation and
2 to 4 mitral regurgitation radiation to axilla.  Pulmonary
clear to auscultation bilaterally.  Abdomen was distended,
soft, nontender, good bowel sounds.  Scrotal edema and Foley
catheter was in place at the time of physical.  Extremities:
+3 pitting edema bilaterally.  Neurological was alert and
oriented times three, no focal neurological defects.

LABORATORY DATA:  Initial labs included a white blood cell
count of 7.1, hematocrit of 33.9, sodium 128, potassium 4.8,
chloride 92, and carbon dioxide of 28.  A BUN was 36,
creatinine .1.

HOSPITAL COURSE:  The patient from admission until [**2123-8-9**] was under the care of Cardiology and was managed for
cardiovascular and current heme but also for the other
aspects of this past medical history.  On [**8-9**],
cardiothoracic surgery felt that the patient was ready for
surgery and explained to the patient that the surgery would
be high risk.  The patient understood and wished to proceed
with the surgery.

On examination for surgery, the patient was found to have
massive edema, lower legs greater than the upper extremities
and was found to have a III to IV systolic murmur and on
transthoracic echocardiogram was found to have +3 mitral
regurgitation and +4 tricuspid regurgitation.  At
catheterization the patient was found to have a 35% ejection
fraction, 3+ mitral regurgitation and constrictive
physiology.  The surgical plan was to repair the tricuspid
valve and the mitral valve and perform pericardiectomy.

On [**8-10**], the patient was brought to the Operating Room and
a mitral valve replacement and tricuspid valve replacement
was performed using a 31 mm St. Jude valve for the mitral
valve and a 33 mm St. Jude valve for the tricuspid.  A
pericardiectomy was also performed.  The patient was then
admitted to the Coronary Intensive Care Unit with the
pericardium left open.  On [**8-13**], the patient was operated
on to close the chest wall.  Anesthesia was general and the
patient tolerated the procedure well.  Postoperatively the
patient continued to be intubated and on [**8-14**],
electrophysiology was consulted to manage the heart pacing.
The patient continued postoperatively to be intubated and on
[**8-17**] had a right internal jugular vein cordis changed over
wire to the triple lumen catheter.  The patient tolerated the
procedure well with good blood return of all ports and the
line tips of the previous line sent for cultures.

On [**8-18**], the patient had a transesophageal echocardiogram
for atrial tachycardia, atrial flutter, question of atrial
thrombus and findings concluded no atrial thrombus and the
patient wire is seen in the right atrium.  On [**8-25**], the
patient returned to the Operating Room for tracheostomy and a
percutaneous endoscopic gastrostomy tube placement.  The
patient tolerated the procedures well and was returned back
to the Cardiac Intensive Care Unit.  The patient continued to
be intubated and on [**8-31**], was transferred to the Stepdown
Unit on [**Hospital Ward Name 121**] 6.  The patient at that point was then switched
from Heparin to Coumadin and the PTT, PT/INR continued to be
monitored.  On [**9-1**], the patient was evaluated for
pulmonary congestion in which a culture was sent.  On [**9-2**], the patient was evaluated for discharge planning.  On
[**9-3**], the sputum cultures came back as
Methicillin-resistant Staphylococcus aureus positive and the
patient was started on a course of Vancomycin 1 mg q.d.  On
[**9-5**], the patient was re-evaluated for discharge on
[**9-6**] to [**Hospital1 **] Rehabilitation Center.

The discharge physical were vital signs with temperature
maximum of 96.9, heartrate 79, respiratory rate 20, 100% SAO2
on 30% tracheostomy, blood pressure was 105/58, intakes for
the day were 1800, output included urine output of 1,000 and
chest tube of 280.  The patient's physical therapy level was
roughly 1.  The patient was alert and oriented with no acute
distress.  Cardiovascularly, he was regular rate and rhythm
with no murmurs appreciated.  Respiratory rate was clear to
auscultation bilaterally.  Abdomen was soft, nontender,
nondistended with positive bowel sounds.  Percutaneous
endoscopic gastrostomy tube was in place.  Extremities had no
peripheral edema with slight swelling.  Incision for the
chest tube and the percutaneous endoscopic gastrostomy were
intact, clean and dry.

On [**9-5**], he had a PT of 14.2, PTT of 61.2 and INR of 1.3.

DISCHARGE MEDICATIONS:
1.  Albuterol metered dose inhaler 2 puffs q. 6 hours prn
2.  Coumadin 7.5 mg p.o. q.d.  Check PT/PTT q.d.
3.  Amiodarone 400 mg per gastrostomy q.d.
4.  Miconazole powder to skin folds b.i.d.
5.  Nystatin S/S p.o. b.i.d.
6.  Synthroid 0.125 mg via percutaneous endoscopic
gastrostomy q.d.
7.  Captopril 6.25 mg per percutaneous endoscopic gastrostomy
t.i.d., hold for systemic blood pressure less than 90
8.  Fleets enema p.r. q.d. prn
9.  Anusol cream t.i.d. prn
10. Bicitra 30 ml per percutaneous endoscopic gastrostomy
t.i.d.
11. Heparin drip titrated for a PTT between 60 and 80 until
the INR is greater than 2.5 and then discontinue.  Heparin
levels at discharge were 600 units/hr check PT/PTT q.d.
12. Zantac 150 mg p.o. q.d.
13. Vancomycin 1 gm b.i.d. times ten days
14. Tylenol 650 mg per percutaneous endoscopic gastrostomy q.
6 hours prn

CONDITION ON DISCHARGE:  Fair but with tracheostomy,
percutaneous endoscopic gastrostomy tube and
Methicillin-resistant Staphylococcus aureus positive sputum.
Significant events or complications during the stay included
prolonged intubation, percutaneous endoscopic gastrostomy
tube and tracheostomy on [**8-25**], Methicillin-resistant
Staphylococcus aureus sputum on [**9-3**] treated with
Vancomycin.

PRIMARY DISCHARGE DIAGNOSIS:
1.  Mitral valve replacement and tricuspid valve replacement

SECONDARY DIAGNOSIS:
1.  Coronary artery disease
2.  Status post myocardial infarction
3.  Congestive heart failure
4.  Automatic implanted cardioverter defibrillator placement
in [**2123-4-1**]
5.  History of superficial femoral artery thrombosis
6.  Hodgkin's disease diagnosed at age 27
7.  Hypercholesterolemia
8.  Hypothyroidism

DISPOSITION:  Staff facility location is [**Hospital1 21979**].  Contact person is [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 98131**], Pager #[**Telephone/Fax (1) 98132**].





                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern1) 33068**]
MEDQUIST36

D:  [**2123-9-5**]  18:18
T:  [**2123-9-5**]  19:30
JOB#:  [**Job Number 98133**]
{'Mitral valve disorders,Diseases of tricuspid valve,Constrictive pericarditis,Congestive heart failure, unspecified,Hemorrhage complicating a procedure,Cirrhosis of liver without mention of alcohol,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins'}


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: Lower extremity edema and congestive heart
failure.

PRESENT ILLNESS: This is a 54 year old gentleman
with coronary artery disease, status post inferior myocardial
infarction, congestive heart failure and ejection fraction of
30%.  Automatic implanted cardioverter defibrillator,
question of constrictive cardiac physiology, Hodgkin's
disease, status post radiation therapy, hypothyroidism, and
hypercholesterolemia.  The patient was also noted to have an
increase in weight of approximately 20 lb over the last month
as well as increasing fatigue and pedal edema.  His Lasix was
initially increased to 80 mg from 40 mg q.d. but did not help
with the increasing lower extremity pitting edema.

MEDICAL HISTORY: The patient's past medical history
includes coronary artery disease, status post inferior
myocardial infarct in [**2115**] complicated by left ventricular
thrombus and embolic cerebrovascular accident, status post
stent of the left circumflex coronary artery in [**2123-4-1**],
congestive heart failure with mitral and tricuspid
regurgitation, automatic implanted cardioverter defibrillator
placed in [**2123-4-1**] for inducible ventricular tachycardia,
history of superficial femoral artery thrombosis, Hodgkin's
disease diagnosed at the age of 27, status post mantle
radiation therapy and splenectomy, hypercholesterolemia,
cervical discectomy requiring five days of postoperative
intubation and hypothyroidism.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Mitral valve disorders,Diseases of tricuspid valve,Constrictive pericarditis,Congestive heart failure, unspecified,Hemorrhage complicating a procedure,Cirrhosis of liver without mention of alcohol,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins'}
