CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 75 year old female s/p percutaneous valvuloplasty in [**2117**], which
she had done quite well since then until [**Month (only) 216**] when she began
to experience exertional
dyspnea, orthopnea and lower extremity edema.  She also notes a
25 pound weight gain this year which she attributes to steroid
treatment of polymyalgia rheumatica.  She is referred for
surgical evaluation of her mitral valve disease.

MEDICAL HISTORY: Rheumatic heart disease
Mitral valve stenosis s/p mitral valvuloplasty [**2116**] [**Hospital3 **]
Aortic stenosis
Community acquired pneumonia
Right carpal tunnel release
Diverticulitis
Atrial fibrillation-on Coumadin
Hypertension
Polymalgia rheumatica
T 11 compression fracture
Hyperlipidemia
Bilateral Knee replacements
Left cataract surgery
Partial hysterectomy
Tonsillectomy

MEDICATION ON ADMISSION: Toprol XL 12.5mg daily
alendronate 70mg weekly (Sunday)
cyclobenzaprine prn
lovenox
furosemide 60mg daily
lisiinopril 20mg daily
KCl 10mEq [**Hospital1 **]
simvastatin 40mg daily
warfarin 1-2mg daily for a-fib
Calcium Carbonate, Vit D3 600/400, two tabs daily
Centrum Silver daily
Omega 3 FA daily
aspirin 81mg daily
prednisone 5mg (last dose [**10-10**])

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 89 Resp: 18  O2 sat: 100%RA
B/P 102/52

FAMILY HISTORY: father  died of an MI at age 53

SOCIAL HISTORY: Lives with:husband
Occupation:Retired paraprofessional from food dept
Tobacco:denies
ETOH:denies
Rheumatic mitral insufficiency,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Unspecified pleural effusion,Unspecified disease of pericardium,Atrial fibrillation,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Polymyalgia rheumatica,Other and unspecified hyperlipidemia,Knee joint replacement,Encounter for therapeutic drug monitoring,Other specified retention of urine
Rheumatic mitral insuff,Acute kidney failure NOS,Urin tract infection NOS,Ac posthemorrhag anemia,Pleural effusion NOS,Pericardial disease NOS,Atrial fibrillation,Long-term use anticoagul,Hypertension NOS,Polymyalgia rheumatica,Hyperlipidemia NEC/NOS,Joint replaced knee,Therapeutic drug monitor,Oth spcf retention urine
Admission Date:  [**2127-10-30**]              Discharge Date:   [**2127-11-11**]

Date of Birth:  [**2052-2-23**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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


Major Surgical or Invasive Procedure:
[**2127-11-4**] Mitral valve replacement ([**First Name8 (NamePattern2) 11599**] [**Male First Name (un) 923**] Porcine) and
aortic valve exploration


History of Present Illness:
75 year old female s/p percutaneous valvuloplasty in [**2117**], which
she had done quite well since then until [**Month (only) 216**] when she began
to experience exertional
dyspnea, orthopnea and lower extremity edema.  She also notes a
25 pound weight gain this year which she attributes to steroid
treatment of polymyalgia rheumatica.  She is referred for
surgical evaluation of her mitral valve disease.


Past Medical History:
Rheumatic heart disease
Mitral valve stenosis s/p mitral valvuloplasty [**2116**] [**Hospital3 **]
Aortic stenosis
Community acquired pneumonia
Right carpal tunnel release
Diverticulitis
Atrial fibrillation-on Coumadin
Hypertension
Polymalgia rheumatica
T 11 compression fracture
Hyperlipidemia
Bilateral Knee replacements
Left cataract surgery
Partial hysterectomy
Tonsillectomy


Social History:
Lives with:husband
Occupation:Retired paraprofessional from food dept
Tobacco:denies
ETOH:denies


Family History:
father  died of an MI at age 53


Physical Exam:
Pulse: 89 Resp: 18  O2 sat: 100%RA
B/P 102/52

General: anxious in NAD, WGWN, appears younger than stated age
Skin: Dry [x] intact [x]
HEENT: PERRLA [] R -RRL, L -slowly reactive s/p cataract surgery
EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [] crackles bilateral bases
Heart: RRR []  Irregular [x]  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+
[x]
Extremities: Warm [x], well-perfused [x]  Edema 1+ edema
bilaterally
Varicosities: left > right
Neuro: Grossly intact
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: NP  Left: NP
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right:    Left:
no bruits


Pertinent Results:
[**2127-11-11**] 04:50AM BLOOD Hct-29.3*
[**2127-11-9**] 04:30AM BLOOD WBC-11.3* RBC-3.16* Hgb-9.2* Hct-26.7*
MCV-85 MCH-29.2 MCHC-34.5 RDW-17.4* Plt Ct-196
[**2127-11-11**] 04:50AM BLOOD PT-23.4* PTT-97.0* INR(PT)-2.2*
[**2127-11-10**] 04:30AM BLOOD PT-20.1* PTT-71.5* INR(PT)-1.9*
[**2127-11-9**] 04:30AM BLOOD PT-17.3* PTT-46.1* INR(PT)-1.5*
[**2127-11-8**] 06:13AM BLOOD PT-15.9* PTT-37.1* INR(PT)-1.4*
[**2127-11-7**] 04:36AM BLOOD PT-14.9* INR(PT)-1.3*
[**2127-11-6**] 05:09AM BLOOD PT-15.8* INR(PT)-1.4*
[**2127-11-5**] 03:08AM BLOOD PT-15.3* PTT-31.8 INR(PT)-1.3*
[**2127-11-4**] 12:43PM BLOOD PT-16.1* PTT-37.7* INR(PT)-1.4*
[**2127-11-11**] 04:50AM BLOOD Glucose-114* UreaN-33* Creat-1.2* Na-138
K-3.9 Cl-101 HCO3-26 AnGap-15
[**2127-11-10**] 04:30AM BLOOD Glucose-101* UreaN-42* Creat-1.4* Na-136
K-4.1 Cl-100 HCO3-26 AnGap-14
[**2127-11-9**] 04:30AM BLOOD Glucose-93 UreaN-49* Creat-1.6* Na-134
K-3.8 Cl-99 HCO3-25 AnGap-14

TEE [**2127-11-4**]
Conclusions
The left atrium is moderately dilated. There is mild symmetric
left ventricular hypertrophy with normal cavity size and global
systolic function (LVEF>55%). Due to suboptimal technical
quality, a focal wall motion abnormality cannot be fully
excluded. The right ventricular cavity is mildly dilated The
aortic valve is not well seen. A well seated bioprosthetic
mitral valve prosthesis is present. No mitral regurgitation is
seen. There is a trivial pericardial effusion. There is a
prominent left pleural effusion


Brief Hospital Course:
Admitted preoperatively for heparin bridge from coumadin and was
found to have elevted creatinine 2.4 and BUN 62.  Renal was
consulted and she was hydrated with improvement of renal
function.  She was found to have urinary tract infection which
was treated with ciprofloxacin preoperatively.  On [**2127-11-4**] she
was brought to the operating room and underwent mitral valve
replacement, see operative report for further details.  She
received vancomycin for perioperative antibiotics and was
transfered to the intensive care unit for post operative
management.  In the first twenty four hours she was weaned from
sedation, awoke neurologically intact, and was extubated without
complications.  She continued to progress on post operative day
one and was started on diuretics and betablockers.  She was
transferred to the floor and was started on coumadin that
evening for atrial fibrillation.  Heparin was initiated as a
bridge to coumadin.  On post operative day two chest tubes,
foley and epicardial wires were removed, however due to failure
to void her foley was reinserted.  Physical therapy worked with
her on strength and mobility.  On post operative day three she
was transfused with blood for post operative anemia with
appropriate rise in hematocrit.  Echo was performed and revealed
no pericardial effusion.  The patient continued to progress and
was discharged to rehab on POD 5.  All follow-up was advised.

Medications on Admission:
Toprol XL 12.5mg daily
alendronate 70mg weekly (Sunday)
cyclobenzaprine prn
lovenox
furosemide 60mg daily
lisiinopril 20mg daily
KCl 10mEq [**Hospital1 **]
simvastatin 40mg daily
warfarin 1-2mg daily for a-fib
Calcium Carbonate, Vit D3 600/400, two tabs daily
Centrum Silver daily
Omega 3 FA daily
aspirin 81mg daily
prednisone 5mg (last dose [**10-10**])


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. metoprolol tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
6. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
7. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 4
days. Tab Sust.Rel. Particle/Crystal(s)
8. furosemide 10 mg/mL Solution Sig: Four (4)  Injection twice a
day for 4 days: 40mg [**Hospital1 **] x 4 days.
9. furosemide 20 mg Tablet Sig: Three (3) Tablet PO once a day:
begin furosemide 60mg daily when IV doses are complete.
10. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day: begin
KCl 20mEq daily when IV lasix is complete and PO begins.
11. warfarin 1 mg Tablet Sig: One (1) Tablet PO once a day: MD
to dose daily for goalINR [**12-25**] for a-fib.
12. Outpatient Lab Work
Labs: PT/INR for Coumadin ?????? indication Atrial fibrillation
Goal INR 2.0-2.5
First draw [**2127-11-12**]
Rehab physician to manage coumadin while at rehab - please set
up with coumadin clinic when being discharged from rehab
please check PT/INR monday and wednesday and friday
13. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
14. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
15. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Mitral valve stenosis s/p MVR
Pre operative acute renal failure (cr 2.4)
Atrial fibrillation
Rheumatic heart disease
Aortic stenosis
Community acquired pneumonia
Right carpal tunnel release
Diverticulitis
Hypertension
Polymalgia rheumatica
T 11 compression fracture
Hyperlipidemia


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with 1 assist
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] Thrusday [**12-4**] at 1:15 pm
Cardiologist: Dr [**Last Name (STitle) **] [**12-16**] at 9:45 am

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) 26225**] in [**2-24**] weeks [**Telephone/Fax (1) 72383**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication Atrial fibrillation
Goal INR 2.0-2.5
First draw [**2127-11-12**]
Rehab physician to manage coumadin while at rehab - please set
up with coumadin clinic when being discharged from rehab
please check PT/INR monday and wednesday and friday



Completed by:[**2127-11-11**]
{'Rheumatic mitral insufficiency,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Unspecified pleural effusion,Unspecified disease of pericardium,Atrial fibrillation,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Polymyalgia rheumatica,Other and unspecified hyperlipidemia,Knee joint replacement,Encounter for therapeutic drug monitoring,Other specified retention of urine'}


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: 75 year old female s/p percutaneous valvuloplasty in [**2117**], which
she had done quite well since then until [**Month (only) 216**] when she began
to experience exertional
dyspnea, orthopnea and lower extremity edema.  She also notes a
25 pound weight gain this year which she attributes to steroid
treatment of polymyalgia rheumatica.  She is referred for
surgical evaluation of her mitral valve disease.

MEDICAL HISTORY: Rheumatic heart disease
Mitral valve stenosis s/p mitral valvuloplasty [**2116**] [**Hospital3 **]
Aortic stenosis
Community acquired pneumonia
Right carpal tunnel release
Diverticulitis
Atrial fibrillation-on Coumadin
Hypertension
Polymalgia rheumatica
T 11 compression fracture
Hyperlipidemia
Bilateral Knee replacements
Left cataract surgery
Partial hysterectomy
Tonsillectomy

MEDICATION ON ADMISSION: Toprol XL 12.5mg daily
alendronate 70mg weekly (Sunday)
cyclobenzaprine prn
lovenox
furosemide 60mg daily
lisiinopril 20mg daily
KCl 10mEq [**Hospital1 **]
simvastatin 40mg daily
warfarin 1-2mg daily for a-fib
Calcium Carbonate, Vit D3 600/400, two tabs daily
Centrum Silver daily
Omega 3 FA daily
aspirin 81mg daily
prednisone 5mg (last dose [**10-10**])

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 89 Resp: 18  O2 sat: 100%RA
B/P 102/52

FAMILY HISTORY: father  died of an MI at age 53

SOCIAL HISTORY: Lives with:husband
Occupation:Retired paraprofessional from food dept
Tobacco:denies
ETOH:denies 

### Response:
{'Rheumatic mitral insufficiency,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Unspecified pleural effusion,Unspecified disease of pericardium,Atrial fibrillation,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Polymyalgia rheumatica,Other and unspecified hyperlipidemia,Knee joint replacement,Encounter for therapeutic drug monitoring,Other specified retention of urine'}
