CHIEF COMPLAINT: Increased fatigue

PRESENT ILLNESS: 51 y/o male with history of heart murmur and diagnosed with
mitral valve prolapse 20+ years ago. Followed by echo's with
recent echo showing severe mitral regurgitation and bileaflet
mitral valve prolapse. Pt. c/o increased fatigue and decreased
exercise tolerance.

MEDICAL HISTORY: Mitral Valve Regurgitation and prolapse, Hepatic Cyst, Prostate
biopsy c/b sepsis, Hypercholesterolemia, Depresssion, s/p
Tonisllectomy, s/p right inguinal hernia repair

MEDICATION ON ADMISSION: Zoloft, Multivitamin, Selenium, Glucosamine, Simvastatin

ALLERGIES: Bactrim / Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Gen: Well-developed, well-nourished male in no acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear bilaterally
Heart: Regular rate and rhythm with 3/6 syst. murmur
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

FAMILY HISTORY: Denies premature CAD.

SOCIAL HISTORY: Denies tobacco use. Admits to occ. ETOH.
Mitral valve disorders,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified
Mitral valve disorder,Pure hypercholesterolem,Depressive disorder NEC
Admission Date:  [**2162-1-13**]              Discharge Date:   [**2162-1-17**]

Date of Birth:  [**2110-12-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Bactrim / Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Increased fatigue

Major Surgical or Invasive Procedure:
[**2162-1-13**] Mitral Valve Repair (P2 resection and [**Company 1543**] 28mm
Annuloplasty ring)

History of Present Illness:
51 y/o male with history of heart murmur and diagnosed with
mitral valve prolapse 20+ years ago. Followed by echo's with
recent echo showing severe mitral regurgitation and bileaflet
mitral valve prolapse. Pt. c/o increased fatigue and decreased
exercise tolerance.

Past Medical History:
Mitral Valve Regurgitation and prolapse, Hepatic Cyst, Prostate
biopsy c/b sepsis, Hypercholesterolemia, Depresssion, s/p
Tonisllectomy, s/p right inguinal hernia repair

Social History:
Denies tobacco use. Admits to occ. ETOH.

Family History:
Denies premature CAD.

Physical Exam:
Gen: Well-developed, well-nourished male in no acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear bilaterally
Heart: Regular rate and rhythm with 3/6 syst. murmur
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

Pertinent Results:
[**2162-1-13**] 11:55AM   UREA N-15 CREAT-0.7 CHLORIDE-114* TOTAL
CO2-25
[**2162-1-13**] 12:07PM   HGB-9.9* calcHCT-30
[**2162-1-13**] 12:07PM   GLUCOSE-134* LACTATE-2.4* NA+-137 K+-3.9
CL--107
[**2162-1-13**] 12:13PM   PT-15.8* PTT-29.3 INR(PT)-1.4*
[**2162-1-13**] 12:13PM   PLT COUNT-193
[**2162-1-15**] 06:55AM BLOOD WBC-14.2* RBC-3.18* Hgb-10.0* Hct-28.9*
MCV-91 MCH-31.6 MCHC-34.7 RDW-13.9 Plt Ct-177
[**2162-1-15**] 06:55AM BLOOD Plt Ct-177
[**2162-1-15**] 06:55AM BLOOD Glucose-125* UreaN-16 Creat-1.0 Na-137
K-4.5 Cl-102 HCO3-31 AnGap-9
[**2162-1-13**] Echo: PRE-BYPASS: The left atrium is mildly dilated. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). Right ventricular chamber size and free wall motion
are normal. The diameters of aorta at the sinus, ascending and
arch levels are normal. The aortic valve is bicuspid. There is
no aortic valve stenosis. Trace aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. The mitral
regurgitation vena contracta is >=0.7cm. Severe (4+) mitral
regurgitation is seen. Due to the eccentric nature of the
regurgitant jet, its severity may be significantly
underestimated (Coanda effect). There is no pericardial
effusion. Dr. [**Last Name (STitle) **] was notified in person of the results on
[**Known firstname **] [**Known lastname **] at 10AM.. Post_Bypass: Intact thoracic aortic
contour. Normal biventricular systolic function. EF 55% There is
a ring in the mitral annulus which seems stable and functioning
well. No MR [**First Name8 (NamePattern2) **] [**Last Name (Titles) **]. Mean gradient 4mm of HG across the mitral
valve. Rest of the findings similar to preCPB

cxr
[**2162-1-17**] 07:00AM BLOOD WBC-10.1 RBC-2.79* Hgb-8.9* Hct-25.5*
MCV-91 MCH-32.0 MCHC-35.1* RDW-14.2 Plt Ct-271
[**2162-1-13**] 11:55AM BLOOD WBC-16.7*# RBC-3.66* Hgb-11.9* Hct-31.8*
MCV-87 MCH-32.5* MCHC-37.4* RDW-13.8 Plt Ct-230
[**2162-1-17**] 07:00AM BLOOD Glucose-93 UreaN-22* Creat-1.0 Na-139
K-4.3 Cl-102 HCO3-28 AnGap-13
[**2162-1-14**] 03:03AM BLOOD Glucose-131* UreaN-14 Creat-0.8 Na-138
K-4.3 Cl-107 HCO3-26 AnGap-9
[**2162-1-15**] 06:55AM BLOOD Mg-2.2

Brief Hospital Course:
Mr. [**Known lastname **] was a same day admit after undergoing pre-operative
work-up as an outpatient. On day of admission he was brought
directly to the operating room where he underwent a mitral valve
repair. Please see operative report for surgical details.
Following surgery he was transferred to the CVICU for invasive
monitoring in stable condition. Later that day he was weaned
from sedation, awoke neurologically intact and extubate. On
post-op day one he was started on beta blockers and diuretics
and gently diuresed towards his pre-op weight. Later on this day
he was transferred to the telemetry floor for further care.
Chest tubes and epicardial pacing wires were removed per
protocol.
Physical therapy was consulted to work on strength and
conditioning. He continued to progress and was ready to be
discharged home by POD 4.

Medications on Admission:
Zoloft, Multivitamin, Selenium, Glucosamine, Simvastatin

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. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA, [**Hospital1 1559**]

Discharge Diagnosis:
Mitral Valve Regurgitation s/p Mitral Valve Repair
PMH: Hepatic Cyst, Prostate biopsy c/b sepsis,
Hypercholesterolemia, Depresssion, s/p Tonisllectomy, s/p right
inguinal hernia repair

Discharge Condition:
Good

Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.

Followup Instructions:
Dr. [**Last Name (STitle) **] in 3 weeks at [**Hospital1 **] MC in 2 weeks. call [**Telephone/Fax (1) 55958**] for appt
Dr. [**Last Name (STitle) 5874**] in [**2-2**] weeks
Dr. [**Last Name (STitle) 8049**] in [**1-1**] weeks



Completed by:[**2162-1-17**]
{'Mitral valve disorders,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified'}


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: Increased fatigue

PRESENT ILLNESS: 51 y/o male with history of heart murmur and diagnosed with
mitral valve prolapse 20+ years ago. Followed by echo's with
recent echo showing severe mitral regurgitation and bileaflet
mitral valve prolapse. Pt. c/o increased fatigue and decreased
exercise tolerance.

MEDICAL HISTORY: Mitral Valve Regurgitation and prolapse, Hepatic Cyst, Prostate
biopsy c/b sepsis, Hypercholesterolemia, Depresssion, s/p
Tonisllectomy, s/p right inguinal hernia repair

MEDICATION ON ADMISSION: Zoloft, Multivitamin, Selenium, Glucosamine, Simvastatin

ALLERGIES: Bactrim / Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Gen: Well-developed, well-nourished male in no acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear bilaterally
Heart: Regular rate and rhythm with 3/6 syst. murmur
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

FAMILY HISTORY: Denies premature CAD.

SOCIAL HISTORY: Denies tobacco use. Admits to occ. ETOH. 

### Response:
{'Mitral valve disorders,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified'}
