CHIEF COMPLAINT: Increased fatigue

PRESENT ILLNESS: This is a 55 year old man with Staphylococcus aureus
endocarditis who presents with increased fatigue and mitral
regurgitation on echo (4+) with vegetations noted.  He presents
for repair of his mitral valve.

MEDICAL HISTORY: Endocarditis, MVP (myxomatous), renal calculi, [**10-2**] MVA, s/p
tonsillectomy, uvulectomy, vasectomy

MEDICATION ON ADMISSION: Nafcillin

ALLERGIES: Codeine / Zithromax

PHYSICAL EXAM: 

FAMILY HISTORY: Father with MVR at age 78

SOCIAL HISTORY: Works as a carpenter, lives with wife
Quit smoking [**2139**]
No alcohol
no recreational drug use
Mitral valve insufficiency and aortic valve insufficiency,Acute and subacute bacterial endocarditis,Heart disease, unspecified,Coronary atherosclerosis of native coronary artery,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Personal history of tobacco use
Mitral/aortic val insuff,Ac/subac bact endocard,Heart disease NOS,Crnry athrscl natve vssl,Mth sus Stph aur els/NOS,History of tobacco use
Admission Date:  [**2173-10-7**]              Discharge Date:   [**2173-10-10**]

Date of Birth:  [**2118-1-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Codeine / Zithromax

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Increased fatigue

Major Surgical or Invasive Procedure:
Mitral valve repair (38 mm CE PhysioRing)


History of Present Illness:
This is a 55 year old man with Staphylococcus aureus
endocarditis who presents with increased fatigue and mitral
regurgitation on echo (4+) with vegetations noted.  He presents
for repair of his mitral valve.

Past Medical History:
Endocarditis, MVP (myxomatous), renal calculi, [**10-2**] MVA, s/p
tonsillectomy, uvulectomy, vasectomy

Social History:
Works as a carpenter, lives with wife
Quit smoking [**2139**]
No alcohol
no recreational drug use

Family History:
Father with MVR at age 78

Pertinent Results:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *7.2 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.2 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  1.1 cm  0.6 - 1.1 cm
Left Ventricle - Diastolic Dimension:  *7.1 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55% to 60%  >= 55%

Findings
LEFT ATRIUM: Marked LA enlargement. No spontaneous echo contrast
in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. No spontaneous echo contrast or
thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. No spontaneous echo
contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA and extending into the RV. No ASD
by 2D or color Doppler. Prominent Eustachian valve (normal
variant).

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness. Severely
dilated LV cavity. Overall normal LVEF (>55%). [Intrinsic LV
systolic function likely depressed given the severity of
valvular regurgitation.]

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Normal
descending aorta diameter. Simple atheroma in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets. No AS. Mild (1+) AR. Eccentric AR jet
directed toward the anterior mitral leaflet.

MITRAL VALVE: Severely thickened/deformed mitral valve leaflets.
Partial mitral leaflet flail. Mitral leaflets fail to fully
coapt. Torn mitral chordae. No MS. [**Name13 (STitle) 650**] (4+) MR.
Uninterpretable LV inflow pattern due to MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with physiologic PR.

PERICARDIUM: Trivial/physiologic pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-CPB:1. The left atrium is markedly dilated. No spontaneous
echo contrast is seen in the body of the left atrium or left
atrial appendage. No spontaneous echo contrast or thrombus is
seen in the body of the left atrium or left atrial appendage. No
spontaneous echo contrast is seen in the left atrial appendage.
No atrial septal defect is seen by 2D or color Doppler.
2. Left ventricular wall thicknesses are normal. The left
ventricular cavity is severely dilated. Overall left ventricular
systolic function is normal (LVEF>55%). [Intrinsic left
ventricular systolic function is likely more depressed given the
severity of valvular regurgitation.]
3. Right ventricular chamber size and free wall motion are
normal. There is a thebesian valve seen at the entrance to the
coronary sinus.
4. There are simple atheroma in the descending thoracic aorta.
5. There are three aortic valve leaflets. The aortic valve
leaflets are mildly thickened. There is no aortic valve
stenosis. Mild (1+) aortic regurgitation is seen. The aortic
regurgitation jet is eccentric, directed toward the anterior
mitral leaflet.
6. The mitral valve leaflets are severely thickened/deformed.
There is partial mitral leaflet flail. The mitral valve leaflets
do not fully coapt. Torn mitral chordae are present. Severe (4+)
mitral regurgitation is seen. There is systolic flow reversal
seen in the LUPV. The annulus is enlarged and measures 4.2 cm.
7. There is a trivial/physiologic pericardial effusion.

POST-CPB: On infusions of epinephrine and nitroglycerine:
1. Mitral valve annulopasty ring is present and well seated.
There is no evidence of mitral regurgitation, prolapse or flail.
Gradient across valve was 1mmHg.
2. Prior to coming off CBP, there was visible air in left
ventricle with inferior wall dyskinesis, which improved with
nitroglycerin and inotropic support. Inferior wall post bypass
is normal.
3. Maintained biventricular function.
4. Aortic regurgitation remains mild 1+.
5. Aortic contours are intact post decannulation.


Brief Hospital Course:
Mr. [**Known lastname **] was admitted after undergoing a mitral valve repair
with a 38 mm CE PhysioRing.  He did well post-operatively and
his lines and drains were removed.  He was transferred to the
floor on POD1.  He continued to do well as he completed his
antibiotic course and was discharged home on POD3 in good
condition with follow up instructions

Medications on Admission:
Nafcillin

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 1
weeks.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. 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*
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
9. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
10. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] homecare and hospice

Discharge Diagnosis:
Mitral regurgitation, endocarditis


Discharge Condition:
Good


Discharge Instructions:
Shower daily, no bathing or swimming for 1 month
No creams, lotions, or powders to any incisions
No driving for 1 month
No lifting > 10 lbs. for 10 weeks

Followup Instructions:
F/U with Dr. [**Last Name (STitle) 914**] in 4 wks
F/U with cardiologist in [**1-30**] wks
F/U with Dr. [**Last Name (STitle) 32848**] in [**1-30**] wks
{'Mitral valve insufficiency and aortic valve insufficiency,Acute and subacute bacterial endocarditis,Heart disease, unspecified,Coronary atherosclerosis of native coronary artery,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Personal history of tobacco use'}


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: This is a 55 year old man with Staphylococcus aureus
endocarditis who presents with increased fatigue and mitral
regurgitation on echo (4+) with vegetations noted.  He presents
for repair of his mitral valve.

MEDICAL HISTORY: Endocarditis, MVP (myxomatous), renal calculi, [**10-2**] MVA, s/p
tonsillectomy, uvulectomy, vasectomy

MEDICATION ON ADMISSION: Nafcillin

ALLERGIES: Codeine / Zithromax

PHYSICAL EXAM: 

FAMILY HISTORY: Father with MVR at age 78

SOCIAL HISTORY: Works as a carpenter, lives with wife
Quit smoking [**2139**]
No alcohol
no recreational drug use 

### Response:
{'Mitral valve insufficiency and aortic valve insufficiency,Acute and subacute bacterial endocarditis,Heart disease, unspecified,Coronary atherosclerosis of native coronary artery,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Personal history of tobacco use'}
