CHIEF COMPLAINT: Heart murmur

PRESENT ILLNESS: Mr. [**Known lastname **] is a 37 year old male who was recently noted to have a
significant change in long standing history of heart murmur. A
follow up echocardiogram revealed bicuspid aortic valve with
severe aortic insufficiency. It was also notable for a dilated
aortic root and ascending aortic aneurysm measuring 7.5
centimeters. Subsequent chest CT scan confirmed marked
dilatation of the ascending thoracic aorta measuring up to 8.4 x
8.5 cm. In preperation for cardiac surgical intervention, he
underwent coronary CT angiogram which showed a left dominant
system and normal coronary arteries.

MEDICAL HISTORY: Biscuspid Aortic Valve, Aortic Insufficiency, Aortic Aneurysm,
History of Migraine Headaches, Asthma, Chronic Rhinitis

MEDICATION ON ADMISSION: Atenolol 50 tid, Lyrica 50 [**Hospital1 **], Magnesium 250 qd, MVI,
Wellbutrin 100 tid, [**Doctor First Name **] 180 qd, Advair, Albuterol, Astelin,
Flonase

ALLERGIES: Sulfa (Sulfonamides) / Bentyl / Demerol

PHYSICAL EXAM: Vitals: 110/50, 76, 12
General: WDWN male in no acute distress
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, [**4-19**] diastolic murmur throught
precordium
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally(bounding)
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Denies premature coronary artery disease

SOCIAL HISTORY: Denies tobacco. Admits to only social ETOH. Currently lives with
his partner and works in data and information management.
Congenital insufficiency of aortic valve,Thoracic aneurysm without mention of rupture,Asthma, unspecified type, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Chronic rhinitis
Cong aorta valv insuffic,Thoracic aortic aneurysm,Asthma NOS,Migrne unsp wo ntrc mgrn,Chronic rhinitis
Admission Date:  [**2165-12-31**]              Discharge Date:   [**2166-1-6**]

Date of Birth:  [**2128-2-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides) / Bentyl / Demerol

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Heart murmur

Major Surgical or Invasive Procedure:
[**2165-12-31**] Bentall Procedure utilizing a 25mm St. [**Male First Name (un) 923**] Mechanical
Aortic Valved Graft


History of Present Illness:
Mr. [**Known lastname **] is a 37 year old male who was recently noted to have a
significant change in long standing history of heart murmur. A
follow up echocardiogram revealed bicuspid aortic valve with
severe aortic insufficiency. It was also notable for a dilated
aortic root and ascending aortic aneurysm measuring 7.5
centimeters. Subsequent chest CT scan confirmed marked
dilatation of the ascending thoracic aorta measuring up to 8.4 x
8.5 cm. In preperation for cardiac surgical intervention, he
underwent coronary CT angiogram which showed a left dominant
system and normal coronary arteries.

Past Medical History:
Biscuspid Aortic Valve, Aortic Insufficiency, Aortic Aneurysm,
History of Migraine Headaches, Asthma, Chronic Rhinitis


Social History:
Denies tobacco. Admits to only social ETOH. Currently lives with
his partner and works in data and information management.

Family History:
Denies premature coronary artery disease

Physical Exam:
Vitals: 110/50, 76, 12
General: WDWN male in no acute distress
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, [**4-19**] diastolic murmur throught
precordium
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally(bounding)
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

Pertinent Results:
[**2166-1-6**] 09:10AM BLOOD WBC-4.9
[**2166-1-6**] 06:30AM BLOOD WBC-3.7* RBC-3.32* Hgb-8.7* Hct-26.6*
MCV-80* MCH-26.0* MCHC-32.6 RDW-17.3* Plt Ct-322
[**2166-1-6**] 06:30AM BLOOD PT-37.0* PTT-51.7* INR(PT)-3.9*
[**2166-1-6**] 06:30AM BLOOD Plt Ct-322
[**2165-12-31**] 12:56PM BLOOD PT-15.5* PTT-51.8* INR(PT)-1.4*
[**2165-12-31**] 12:56PM BLOOD Plt Ct-216
[**2166-1-6**] 06:30AM BLOOD Glucose-93 UreaN-16 Creat-1.4* Na-135
K-4.2 Cl-97 HCO3-29 AnGap-13
[**2165-12-31**] 02:06PM BLOOD UreaN-12 Creat-1.2 Cl-112* HCO3-25
[**2166-1-6**] 06:30AM BLOOD Mg-1.9

RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2166-1-4**] 9:51 PM

CHEST (PA & LAT)

Reason: assess for cardiopulmonary process

[**Hospital 93**] MEDICAL CONDITION:
37 year old man s/p Bentall procedure (AVR garft) POD4 with
fever
REASON FOR THIS EXAMINATION:
assess for cardiopulmonary process
CHEST SINGLE VIEW ON [**1-4**]

HISTORY: Status post AV graft with fever.

FINDINGS: A prosthetic aortic valve, sternotomy wires, and
mediastinal clips are unchanged. There continues to be bibasilar
volume loss with small bilateral effusions that are not
significantly changed compared to the prior day. There is no new
infiltrate.

DR. [**First Name (STitle) **] [**Doctor Last Name **]
Approved: SUN [**2166-1-5**] 9:51 AM

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 74530**] (Complete)
Done [**2165-12-31**] at 11:50:51 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Last Name (Prefixes) 413**], [**First Name3 (LF) 412**]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2128-2-24**]
Age (years): 37 M  Hgt (in): 70
BP (mm Hg): 110/50  Wgt (lb): 165
HR (bpm): 70  BSA (m2): 1.93 m2
Indication: Intraop Bentall evaluate valves, aortic contours,
ventricular function
ICD-9 Codes: 441.2, 424.1
Test Information
Date/Time: [**2165-12-31**] at 11:50    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2007AW2-: Machine: 2
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *6.0 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  3.9 cm
Left Ventricle - Fractional Shortening:  0.35  >= 0.29
Left Ventricle - Ejection Fraction:  50% to 60%  >= 55%
Left Ventricle - Peak Resting LVOT gradient:  3 mm Hg  <= 10 mm
Hg
Aorta - Annulus:  2.9 cm  <= 3.0 cm
Aorta - Ascending:  *8.2 cm  <= 3.4 cm
Aorta - Arch:  2.3 cm  <= 3.0 cm
Aorta - Descending Thoracic:  1.9 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  1.0 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  4 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  2 mm Hg
Aortic Valve - Valve Area:  5.5 cm2  >= 3.0 cm2
Mitral Valve - Peak Velocity:  0.7 m/sec
Mitral Valve - Mean Gradient:  1 mm Hg
Mitral Valve - Pressure Half Time:  71 ms
Mitral Valve - MVA (P [**1-15**] T):  2.8 cm2
Mitral Valve - E Wave:  0.7 m/sec
Mitral Valve - A Wave:  0.7 m/sec
Mitral Valve - E/A ratio:  1.00
Mitral Valve - E Wave deceleration time:  200 ms  140-250 ms

Findings
LEFT ATRIUM: LA not well visualized.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

LEFT VENTRICLE: Mild symmetric LVH. Moderately dilated LV
cavity. Overall normal LVEF (>55%).

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

AORTA: Markedly dilated aortic sinus. Markedly dilated ascending
aorta. Normal aortic arch diameter. Normal descending aorta
diameter. Simple atheroma in descending aorta.

AORTIC VALVE: Bicuspid aortic valve. No AS. AR vena contracta is
>0.6cm. Severe (4+) AR.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR. [**First Name (Titles) **] [**Last Name (Titles) **]S. Trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) PR.

PERICARDIUM: No 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. No TEE related complications.
Conclusions
Pre bypass: There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity is moderately dilated.
Overall left ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
The aortic root is markedly dilated at the sinus level with
complete absence of the sinotubular junction. The ascending
aorta is markedly dilated with a large ascending arotic
aneurysm. The distal aspect cannot be appreciated, but the
aortic arch size appears normal at the mid and distal extent.
There are simple atheroma in the descending thoracic aorta. The
aortic valve is bicuspid. There is no aortic valve stenosis. The
aortic regurgitation vena contracta is >0.6cm. Severe (4+)
aortic regurgitation is seen. The mitral valve appears
structurally normal with trivial mitral regurgitation. Trivial
mitral regurgitation is seen.

Post Bypass: Patient is a paced on phenylepherine infusion.
Biventricular function is normal. Aortic valve mechanical
prosthethesis insitu peak gradient 10, mean 5 mm Hg with cardiac
output 6.4 bp 104/60. No perivavlular leaks or aortic
insufficiency seen. Prosthetic graft material well positioned in
ascending aorta, aortic arch and descending aortic contours
intact. MR remains trace. Remaining exam is unchanged. All
findings discussed with surgeons at the time of the exam.
I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2165-12-31**] 13:22

Cardiology Report ECG Study Date of [**2165-12-31**]  2:14:40 PM


Sinus rhythm. Since tracing of [**2165-12-26**] the QRS voltage in leads
I and aVL
is diminished. ST-T wave abnormalities are less prominent.


Read by: [**Last Name (LF) **],[**First Name3 (LF) 900**] A.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
78 156 96 [**Telephone/Fax (2) 74531**]7

 [**Hospital1 69**]
[**Location (un) 86**], [**Telephone/Fax (1) 15701**]

Pathology Examination

Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 74532**],[**Known firstname **]       [**2128-2-24**]    37 Male      [**-7/4946**] [**Numeric Identifier **]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (Prefixes) 413**]
Gross Description by:   DR. [**Last Name (STitle) **]. [**Doctor Last Name 9529**]/dif



SPECIMEN SUBMITTED: aorta, aorta, AORTIC VALVE.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2165-12-31**] [**2165-12-31**] [**2166-1-2**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) 40336**]/cma??????

DIAGNOSIS:

I.  Aorta (A-B):

Medial myxoid degenerative change.

II.  Aortic valve (C):

Fibrosis and myxoid degenerative change.

Clinical:  Aortic regurgitation.

Gross:  The specimen is received fresh in two parts, both
labeled with "[**Known lastname **] [**Known firstname **]" the medical record number and the
date.



Part 1 is additionally labeled "aorta" and consists of multiple
fragments of thin white tissue measuring 8.9 x 4.5 x 1.2 cm in
aggregate. Representative sections of the specimen are submitted
into A-B.



Part 2 is additionally labeled "aortic valve" and consists of
two fragments of thin white tissue measuring 2.5 x 1.8 x 0.3 cm
in aggregate.  Representative sections are submitted in C.


Brief Hospital Course:
Mr. [**Known lastname **] was admitted and brought directly to the operating
room where Dr. [**Last Name (STitle) 1290**] performed a Bentall procedure utilizing
a mechanical aortic valved graft. For surgical details, please
see seperate dictated operative note. Following the operation,
he was brought to the CVICU for invasive monitoring. Within 24
hours, he awoke neurologically intact and was extubated without
incident. He maintained stable hemodynamics and transferred to
the SDU on postoperative day one. Beta blockade was resumed and
advanced as tolerated. He remained in a normal sinus rhythm.  He
was placed on coumadin and heparin for his mechanical valve. He
continued to progress and was ready for discharge home with VNA
POD 6.  Plan for INR deaw [**1-8**] with results to Dr [**Last Name (STitle) **] office.


Medications on Admission:
Atenolol 50 tid, Lyrica 50 [**Hospital1 **], Magnesium 250 qd, MVI,
Wellbutrin 100 tid, [**Doctor First Name **] 180 qd, Advair, Albuterol, Astelin,
Flonase

Discharge Medications:
1. Outpatient [**Name (NI) **] Work
PT/INR - please draw mon/wed/fri and prn
Fax results to Christiaan [**Doctor Last Name **] Damme at Dr.[**Name (NI) 28382**] office at
([**Telephone/Fax (1) 74533**]. phone ([**Telephone/Fax (1) 74534**].
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*
4. 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:*0*
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Bupropion 100 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*90 Tablet(s)* Refills:*0*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
8. Astelin 137 mcg Aerosol, Spray Sig: Two (2) sprays Nasal
twice a day.
Disp:*qs qs for 1 month * Refills:*0*
9. [**Doctor First Name **]-D 24 Hour 180-240 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
10. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation every six (6) hours as needed for shortness of breath
or wheezing.
Disp:*qs qs* Refills:*0*
11. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
Two (2) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*120 Disk with Device(s)* Refills:*0*
12. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal [**Hospital1 **] (2 times a day).
Disp:*qs qs* Refills:*00*
13. Lyrica 50 mg Capsule Sig: One (1) Capsule PO bid ().
Disp:*60 Capsule(s)* Refills:*0*
14. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
15. Rynatan 9-25 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*
16. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day:
please take 2 mg [**1-7**] and have labs drawn [**1-8**] for further
dosing by Dr [**Last Name (STitle) **] office.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Biscuspid Aortic Valve, Aortic Insufficiency, Aortic Aneurysm -
s/p Bentall Procedure, History of Migraine Headache, Asthma,
Chronic Rhinitis


Discharge Condition:
Good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
PT/INR for coumadin dosing - please draw monday and wednesday
and friday - goal INR 2.5-3.0 for mechanical AVR

Followup Instructions:
Dr. [**Last Name (STitle) 1290**] in one month, please call for appt
Dr. [**Last Name (STitle) **] in [**2-16**] weeks, please call for appt
An INR should be drawn by the VNA on Monday [**2166-1-6**] and faxed
to Christiaan [**Doctor Last Name **] Damme at Dr.[**Name (NI) 28382**] office ([**Telephone/Fax (1) 74533**].
Phone ([**Telephone/Fax (1) 74535**].  Spoke to [**Last Name (un) 74536**] [**First Name8 (NamePattern2) **] [**Location (un) 4597**] on [**2166-1-3**]
15:54.



Completed by:[**2166-1-6**]
{'Congenital insufficiency of aortic valve,Thoracic aneurysm without mention of rupture,Asthma, unspecified type, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Chronic rhinitis'}


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: Heart murmur

PRESENT ILLNESS: Mr. [**Known lastname **] is a 37 year old male who was recently noted to have a
significant change in long standing history of heart murmur. A
follow up echocardiogram revealed bicuspid aortic valve with
severe aortic insufficiency. It was also notable for a dilated
aortic root and ascending aortic aneurysm measuring 7.5
centimeters. Subsequent chest CT scan confirmed marked
dilatation of the ascending thoracic aorta measuring up to 8.4 x
8.5 cm. In preperation for cardiac surgical intervention, he
underwent coronary CT angiogram which showed a left dominant
system and normal coronary arteries.

MEDICAL HISTORY: Biscuspid Aortic Valve, Aortic Insufficiency, Aortic Aneurysm,
History of Migraine Headaches, Asthma, Chronic Rhinitis

MEDICATION ON ADMISSION: Atenolol 50 tid, Lyrica 50 [**Hospital1 **], Magnesium 250 qd, MVI,
Wellbutrin 100 tid, [**Doctor First Name **] 180 qd, Advair, Albuterol, Astelin,
Flonase

ALLERGIES: Sulfa (Sulfonamides) / Bentyl / Demerol

PHYSICAL EXAM: Vitals: 110/50, 76, 12
General: WDWN male in no acute distress
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, [**4-19**] diastolic murmur throught
precordium
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally(bounding)
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Denies premature coronary artery disease

SOCIAL HISTORY: Denies tobacco. Admits to only social ETOH. Currently lives with
his partner and works in data and information management. 

### Response:
{'Congenital insufficiency of aortic valve,Thoracic aneurysm without mention of rupture,Asthma, unspecified type, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Chronic rhinitis'}
