CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 70 year old male with a history of mitral regurgitation,
paroxysmal atrial fibrillation and moderate pulmonary
hypertension who went to see his cardiologist on [**2167-12-17**] and
complained of becoming hoarse, short of breath, weak and
experiencing palpitations. In [**2163-7-7**] he had an episode of
paroxysmal atrial fibrillation for which he was admitted to
EMMC, and at that time he had an echocardiogram which showed
severe mitral regurgitation. He complains of a 12 pound wt gain
in 12 days, and 3+ bilateral ankle edema.  He went to see his
cardiologist and was prescribed Digoxin and Lasix, six days
after taken the medication his edema resolved and his weight was
back to his normal. Since the initiation of medications he
denies any further symptoms of weight gain or bilateral ankle
edema. He can walk up to two miles with experiencing shortness
of breath. Cardiac catheteterization showed ramus disease and
referred for surgery.

MEDICAL HISTORY: Mitral valve and tricuspid valve regurgitation
Paroxysmal Atrial Fibrillation
coronary artery disease
Diastolic heart failure
Herpes Zoster left lower mandible [**2163**]
BLE varicosities
Urinary retention [**2166**] secondary to BPH since resolved
s/p Tonsillectomy at age 9

MEDICATION ON ADMISSION: DIGOXIN - (Prescribed by Other Provider) - 250 mcg Tablet - one
Tablet(s) by mouth daily
FUROSEMIDE [LASIX] - (Prescribed by Other Provider) - 40 mg
Tablet - one Tablet s) by mouth daily
POTASSIUM CHLORIDE [KLOR-CON 10] - (Prescribed by Other
Provider) - 10 mEq Tablet Sustained Release - 2 (Two) Tablet(s)
by mouth daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: per PAT chart
Height:5'[**67**]"     Weight:165 lbs

FAMILY HISTORY: Father had a CABG at the age of 65 and Aortic anyersum repair at
age

SOCIAL HISTORY: Race:caucasian
Last Dental Exam: week ago, office has dental clearance
Lives with:wife
Occupation:orthopedic surgery
Tobacco:quit at age 30
ETOH:bottle of wine every two weeks
Chronic diastolic heart failure,Paroxysmal ventricular tachycardia,Atrioventricular block, complete,Acute posthemorrhagic anemia,Mitral valve disorders,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases
Chr diastolic hrt fail,Parox ventric tachycard,Atriovent block complete,Ac posthemorrhag anemia,Mitral valve disorder,Tricuspid valve disease,Crnry athrscl natve vssl,Chr pulmon heart dis NEC
Admission Date:  [**2168-3-1**]              Discharge Date:   [**2168-3-10**]

Date of Birth:  [**2097-11-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2168-3-1**] Mitral Valve Replacement (33mm St. [**Male First Name (un) 923**] Epic), Tricuspid
valve repair (32mm CE MC3 Ring)

History of Present Illness:
70 year old male with a history of mitral regurgitation,
paroxysmal atrial fibrillation and moderate pulmonary
hypertension who went to see his cardiologist on [**2167-12-17**] and
complained of becoming hoarse, short of breath, weak and
experiencing palpitations. In [**2163-7-7**] he had an episode of
paroxysmal atrial fibrillation for which he was admitted to
EMMC, and at that time he had an echocardiogram which showed
severe mitral regurgitation. He complains of a 12 pound wt gain
in 12 days, and 3+ bilateral ankle edema.  He went to see his
cardiologist and was prescribed Digoxin and Lasix, six days
after taken the medication his edema resolved and his weight was
back to his normal. Since the initiation of medications he
denies any further symptoms of weight gain or bilateral ankle
edema. He can walk up to two miles with experiencing shortness
of breath. Cardiac catheteterization showed ramus disease and
referred for surgery.

Past Medical History:
Mitral valve and tricuspid valve regurgitation
Paroxysmal Atrial Fibrillation
coronary artery disease
Diastolic heart failure
Herpes Zoster left lower mandible [**2163**]
BLE varicosities
Urinary retention [**2166**] secondary to BPH since resolved
s/p Tonsillectomy at age 9

Social History:
Race:caucasian
Last Dental Exam: week ago, office has dental clearance
Lives with:wife
Occupation:orthopedic surgery
Tobacco:quit at age 30
ETOH:bottle of wine every two weeks

Family History:
Father had a CABG at the age of 65 and Aortic anyersum repair at
age

Physical Exam:
VS: per PAT chart
Height:5'[**67**]"     Weight:165 lbs

General:NAD
Skin: Dry [x] intact [x]healing scab LLE shin
HEENT: PERRLA [x] EOMI [x]anicteric sclera;OP unremarkable
Neck:  Supple [x] Full ROM [x]no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR []  very Irregular;  Murmur III/VI SEM heard best at
apex
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema: trace BLE
Varicosities:BLE, with mild chronic venous stasis changes
None [x]
Neuro: Grossly intact[x]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: 1+  Left: 1+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right:  -  Left:-

Pertinent Results:
[**2168-2-29**] Chest CT: 1. Minimal aortic arch calcification,
predominately at the arch. No aneurysmal dilatation. 2.
Cardiomegaly. 3. Coronary artery disease. 4. Liver and renal
hypodensities, likely cysts.

[**2168-3-2**] Echo: Prebypass: The left atrium is markedly dilated. No
spontaneous echo contrast is seen in the body of the left atrium
or left atrial appendage. The right atrium is dilated. No
spontaneous echo contrast is seen in the body of the right
atrium. No atrial septal defect is seen by 2D or color Doppler.
Left ventricular wall thicknesses are normal. The left
ventricular cavity is severely dilated. Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is mildly depressed (LVEF= 45-50%). [Intrinsic
left ventricular systolic function is likely more depressed
given the severity of valvular regurgitation.] Right ventricular
chamber size is normal with borderline normal free wall
function. [Intrinsic right ventricular systolic function is
likely more depressed given the severity of tricuspid
regurgitation.] The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Trace aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. The mitral valve leaflets are elongated. There is
moderate/severe posterior leaflet mitral valve prolapse. An
eccentric, anteriorly directed jet of severe (4+) mitral
regurgitation is seen. Due to the eccentric nature of the
regurgitant jet, its severity may be significantly
underestimated (Coanda effect). Tricuspid valve prolapse is
present. The tricuspid valve leaflets fail to fully coapt.
Moderate to severe [3+] tricuspid regurgitation is seen. There
is no pericardial effusion.
Postbypass: The patient is on infusions of epinephrine and
nitroglycerin and is V-paced. There is a new bioprosthetic valve
which is well-seated in the mitral position. There is no
evidence of regurgitation or stenosis (peak gradient 4 mmHg with
a CO of 3.8 L/min). There is a new tricuspid valve annuloplasty
ring with no evidence of stenosis of regurgitation. Overall left
ventricular function is now moderately depressed (LVEF = 35-40%)
with paradoxical septal motion from V-pacing. The thoracic aorta
is intact.

[**2168-2-29**] 01:31PM BLOOD WBC-4.2 RBC-4.61 Hgb-14.9 Hct-44.0 MCV-95
MCH-32.4* MCHC-34.0 RDW-14.1 Plt Ct-159
[**2168-3-10**] 04:40AM BLOOD WBC-7.6 RBC-3.37* Hgb-10.9* Hct-30.9*
MCV-92 MCH-32.3* MCHC-35.2* RDW-14.6 Plt Ct-396
[**2168-2-29**] 01:31PM BLOOD PT-14.2* PTT-26.7 INR(PT)-1.2*
[**2168-3-9**] 02:34AM BLOOD PT-15.5* PTT-52.2* INR(PT)-1.4*
[**2168-3-9**] 11:54AM BLOOD PT-17.4* PTT-60.2* INR(PT)-1.6*
[**2168-3-10**] 04:40AM BLOOD PT-20.9* PTT-91.9* INR(PT)-1.9*
[**2168-2-29**] 01:31PM BLOOD UreaN-25* Creat-1.2 Na-142 K-4.4 Cl-102
HCO3-31 AnGap-13
[**2168-3-10**] 04:40AM BLOOD Glucose-87 UreaN-21* Creat-0.9 Na-136
K-4.3 Cl-103 HCO3-23 AnGap-14
[**2168-3-1**] 04:32PM BLOOD ALT-12 AST-35 AlkPhos-43 Amylase-31
TotBili-0.6
[**2168-3-9**] 02:34AM BLOOD Calcium-8.6 Phos-3.1 Mg-1.9

Brief Hospital Course:
Mr. [**Known lastname 19704**] was a same day admit and on [**3-1**] underwent surgery
with Dr. [**Last Name (STitle) **]. Please see operative report for surgical
details. Following surgery he was transferred to the CVICU in
stable condition on titrated epinephrine, nitroglycerin and
propofol drips. On post-op day one he was weaned from sedation,
awoke neurologically intact and extubated. Remained in CVICU for
management of his chronic atrial fibrillation and blood pressure
control but was transferred to the step-down floor later on
post-op day one. Coumadin was started on [**3-3**] with a Heparin
bridge. On post-op day three he had two self-limiting runs of VT
and was transferred back to the CVICU for closer telemetry
monitoring. EP was consulted and he had no further episodes of
VT. He had possible evidence of complete heart block with
question need for pacemaker but this was deemed not necessary by
EP. However they did recommend that he not be placed on beta
blockade.  He remained mostly bradycardic in atrial
fibrillation. Chest tubes and epicardial pacing wires were
removed per protocol. He returned to the step-down floor on
[**2168-3-9**]. During his post-op course he worked with physical
therapy for strength and mobility. His Coumadin was titrated to
a goal therapeutic INR of [**3-9**].5. EP advised patient to follow-up
with Dr. [**Last Name (STitle) **] in 2 weeks. He appeared suitable for
discharge home with VNA services on post-op day nine with the
appropriate medications and follow-up appointments. His PCP will
follow his INR and adjust Coumadin accordingly. Results from VNA
can be called to [**Telephone/Fax (1) 87820**], tha office of Dr. [**Last Name (STitle) 87821**].  Per
the office of Dr. [**Last Name (STitle) 87821**], he was referred to Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 87822**] office for cardiology follow-up and an appointment
was arranged.  By post-oerative day nine he was ready for
discharge to home.

Medications on Admission:
DIGOXIN - (Prescribed by Other Provider) - 250 mcg Tablet - one
Tablet(s) by mouth daily
FUROSEMIDE [LASIX] - (Prescribed by Other Provider) - 40 mg
Tablet - one Tablet s) by mouth daily
POTASSIUM CHLORIDE [KLOR-CON 10] - (Prescribed by Other
Provider) - 10 mEq Tablet Sustained Release - 2 (Two) Tablet(s)
by mouth daily

Medications - OTC
ASCORBIC ACID [VITAMIN C] -  (Prescribed by Other Provider) -
500 mg Capsule, Sustained Release - one Capsule(s) by mouth
daily
ASPIRIN - (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - one Tablet(s) by mouth daily
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - (Prescribed by Other
Provider) - 1,000 unit Capsule - one Capsule(s) by mouth daily
MULTIVITAMIN-MINERALS-LUTEIN [CENTRUM SILVER] -  (Prescribed by
Other Provider) -   Tablet - one Tablet(s) by mouth daily

Discharge Medications:
1. 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*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*2*
4. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily).
Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*
9. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day:
Indication: Atrial Fibrillation
Goal INR 2.0-2.5
Your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 87821**], [**First Name3 (LF) **] follow your INR and adjust Coumadin
dose accordingly.
Disp:*30 Tablet(s)* Refills:*2*

Discharge Disposition:
Home With Service

Facility:
Community Health and Counseling Services

Discharge Diagnosis:
Mitral valve and tricuspid valve regurgitation s/p Mitral Valve
Replacement and Tricuspid valve repair
Past medical history:
Paroxysmal Atrial Fibrillation
Diastolic heart failure
Herpes Zoster left lower mandible [**2163**]
BLE varicosities
Urinary retention [**2166**] secondary to BPH since resolved
s/p Tonsillectomy at age 9

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Edema: none

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) **] on [**3-24**] @ 1:30PM
Cardiologist: Dr. [**First Name8 (NamePattern2) 189**] [**Last Name (NamePattern1) 59660**] on Monday [**2-26**] at 1PM
EP: Dr. [**Last Name (STitle) **] on [**4-29**] at 1PM

Please call to schedule appointments with your
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 87821**] in [**5-10**] weeks

**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 on [**2168-3-11**] with subsequent INR draws on Monday,
Wednesday, Friday.
Results to be called to Dr. [**Last Name (STitle) 87821**] office at [**Telephone/Fax (1) 87820**]. In
addition, they may be faxed to [**Telephone/Fax (1) 87823**].



Completed by:[**2168-3-10**]

Name:  [**Known lastname 13936**],[**Known firstname 422**] [**Last Name (NamePattern1) **]            Unit No:   [**Numeric Identifier 13937**]

Admission Date:  [**2168-3-1**]              Discharge Date:   [**2168-3-10**]

Date of Birth:  [**2097-11-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 741**]
Addendum:
The following sentence does not pertain to Dr. [**Known lastname **] and was
added to his discharge summary in error, "Per the office of Dr.
[**Last Name (STitle) 13938**], he was referred to Dr. [**First Name8 (NamePattern2) 9539**]
[**Last Name (NamePattern1) 13939**] office for cardiology follow-up and an appointment
was arranged."

Discharge Disposition:
Home With Service

Facility:
Community Health and Counseling Services

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2168-3-10**]
{'Chronic diastolic heart failure,Paroxysmal ventricular tachycardia,Atrioventricular block, complete,Acute posthemorrhagic anemia,Mitral valve disorders,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases'}


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: 70 year old male with a history of mitral regurgitation,
paroxysmal atrial fibrillation and moderate pulmonary
hypertension who went to see his cardiologist on [**2167-12-17**] and
complained of becoming hoarse, short of breath, weak and
experiencing palpitations. In [**2163-7-7**] he had an episode of
paroxysmal atrial fibrillation for which he was admitted to
EMMC, and at that time he had an echocardiogram which showed
severe mitral regurgitation. He complains of a 12 pound wt gain
in 12 days, and 3+ bilateral ankle edema.  He went to see his
cardiologist and was prescribed Digoxin and Lasix, six days
after taken the medication his edema resolved and his weight was
back to his normal. Since the initiation of medications he
denies any further symptoms of weight gain or bilateral ankle
edema. He can walk up to two miles with experiencing shortness
of breath. Cardiac catheteterization showed ramus disease and
referred for surgery.

MEDICAL HISTORY: Mitral valve and tricuspid valve regurgitation
Paroxysmal Atrial Fibrillation
coronary artery disease
Diastolic heart failure
Herpes Zoster left lower mandible [**2163**]
BLE varicosities
Urinary retention [**2166**] secondary to BPH since resolved
s/p Tonsillectomy at age 9

MEDICATION ON ADMISSION: DIGOXIN - (Prescribed by Other Provider) - 250 mcg Tablet - one
Tablet(s) by mouth daily
FUROSEMIDE [LASIX] - (Prescribed by Other Provider) - 40 mg
Tablet - one Tablet s) by mouth daily
POTASSIUM CHLORIDE [KLOR-CON 10] - (Prescribed by Other
Provider) - 10 mEq Tablet Sustained Release - 2 (Two) Tablet(s)
by mouth daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: per PAT chart
Height:5'[**67**]"     Weight:165 lbs

FAMILY HISTORY: Father had a CABG at the age of 65 and Aortic anyersum repair at
age

SOCIAL HISTORY: Race:caucasian
Last Dental Exam: week ago, office has dental clearance
Lives with:wife
Occupation:orthopedic surgery
Tobacco:quit at age 30
ETOH:bottle of wine every two weeks 

### Response:
{'Chronic diastolic heart failure,Paroxysmal ventricular tachycardia,Atrioventricular block, complete,Acute posthemorrhagic anemia,Mitral valve disorders,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases'}
