CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 61 y/o male with hypertension c/o one week of exertional chest
pressure and shortness of breath. Admitted at OSH, ruled out for
myocardial infarction, but found to have severe mitral
regurgitation. Referred for cardiac surgery.

MEDICAL HISTORY: Mitral Regurgitaion, Hypertension, Hypercholesterolemia, Mild
Obesity

MEDICATION ON ADMISSION: Lisinopril 10mg qd, Lasix 40mg qd, Lopressor 25mg qd, Aspirin
325mg qd, MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 87 16 134/74 5'9"
Gen: WDWN male in NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR 2/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: NC

SOCIAL HISTORY: Denies tobacco use. Admits to several ETOH drinks with dinner.
Mitral valve disorders,Acute on chronic systolic heart failure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Pure hypercholesterolemia,Phlebitis and thrombophlebitis of superficial veins of upper extremities
Mitral valve disorder,Ac on chr syst hrt fail,Surg compl-heart,Atrial fibrillation,Abn react-surg proc NEC,Hypertension NOS,Pure hypercholesterolem,Phlbts sprfc vn up extrm
Admission Date:  [**2174-4-8**]              Discharge Date:   [**2174-4-13**]

Date of Birth:  [**2112-12-28**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2174-4-8**] Mitral valve repair with a [**Doctor Last Name 4726**]-Tex neocord and mitral
valve annuloplasty with 30 mm Physio annuloplasty ring

History of Present Illness:
61 y/o male with hypertension c/o one week of exertional chest
pressure and shortness of breath. Admitted at OSH, ruled out for
myocardial infarction, but found to have severe mitral
regurgitation. Referred for cardiac surgery.

Past Medical History:
Mitral Regurgitaion, Hypertension, Hypercholesterolemia, Mild
Obesity

Social History:
Denies tobacco use. Admits to several ETOH drinks with dinner.

Family History:
NC

Physical Exam:
VS: 87 16 134/74 5'9"
Gen: WDWN male in NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR 2/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**4-12**] CXR:
[**4-8**] Echo: PRE-BYPASS: The left atrium is mildly dilated. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium or left atrial appendage. No atrial septal defect is
seen by 2D or color Doppler. The left ventricular cavity is
mildly dilated. The right ventricular cavity is mildly dilated
with moderate global free wall hypokinesis. The ascending,
transverse and descending thoracic aorta are normal in diameter
. There are simple atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. The aortic valve leaflets
are mildly thickened. There is no aortic valve stenosis. Trace
aortic regurgitation is seen. The mitral valve leaflets are
myxomatous. The mitral valve leaflets are elongated. There is
partial mitral leaflet flail. An eccentric, posteriorly directed
jet of Severe (4+) mitral regurgitation is seen. There is no
pericardial effusion. POST CPB: 1. Improved global biventricular
systolic function with inotropic support. EF = 45-50%. 2.
Annuloplasty ring in mitral position. Well seates and stable,
with good leaflet excursion. 3. Gortex chord visualized in the
LV cavity attached to the undersurface of the anterior mitral
leaflet, with chordal [**Male First Name (un) **] without any LVOT gradient. 4. Trace
perivalvular mitral regurgitation regurgitation at 7 o'clock
position which was conf0ormed with 3D echcoardiography.

[**2174-4-8**] 10:50AM BLOOD WBC-19.1*# RBC-3.68* Hgb-11.2* Hct-32.8*
MCV-89 MCH-30.5 MCHC-34.2 RDW-14.5 Plt Ct-321
[**2174-4-12**] 09:10AM BLOOD WBC-10.7 RBC-3.28* Hgb-10.0* Hct-29.1*
MCV-89 MCH-30.4 MCHC-34.3 RDW-13.8 Plt Ct-258
[**2174-4-8**] 10:50AM BLOOD PT-15.3* PTT-31.9 INR(PT)-1.3*
[**2174-4-8**] 11:55AM BLOOD Glucose-218* UreaN-20 Creat-0.9 Na-141
K-4.1 Cl-104 HCO3-27 AnGap-14
[**2174-4-12**] 09:10AM BLOOD Glucose-86 UreaN-21* Creat-0.8 Na-138
K-4.1 Cl-99 HCO3-30 AnGap-13
[**2174-4-12**] 09:10AM BLOOD Calcium-8.7 Phos-3.5 Mg-2.1

Brief Hospital Course:
Mr. [**Known lastname 77804**] was a same day admit after undergoing all
pre-operative work-up prior to admission. On day of admission he
was brought 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. Within 24 hours he was weaned
from sedation, awoke neurologically intact and extubated. He
continued to progress, physical therapy worked with him on
stregth and mobility.  On POD 1 he was startedon beta blockers
and amiodarone for atrial fibrillation that converted to normal
sinus rhythm.  He was gently diuresed towards his preoperative
weight.  He was transferred to the floor on POD 3 were he
received the rest of his post op care.  He was treated with IV
vancomycin for right arm phlebitis, which improved and his WBC
was normal.  He was discharged home on POD 6 on oral antibiotics
with follow up wound check on [**2174-4-15**] with NP.

Medications on Admission:
Lisinopril 10mg qd, Lasix 40mg qd, Lopressor 25mg qd, Aspirin
325mg qd, MVI

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:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. 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*
4. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*
6. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): please take 400mg twice a day for 5 days then decrease
to 400mg once a day for 7 days then decrease to 200mg daily and
follow with cardiologist .
Disp:*80 Tablet(s)* Refills:*0*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Keflex 500 mg Capsule Sig: One (1) Capsule PO every six (6)
hours for 10 days.
Disp:*40 Capsule(s)* Refills:*0*
9. Potassium Chloride 10 mEq Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO once a day for 7 days.
Disp:*7 Tablet Sustained Release(s)* Refills:*0*

Lisinopril was not restarted due to blood pressure


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
Mitral Regurgitaion s/p Mitral Valve Repair
Acute on chronic systolic heart failure
Post-operative Atrial Fibrillation
PMH: Hypertension, Hypercholesterolemia, Mild Obesity


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**]

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 11493**] in [**1-30**] weeks
Dr. [**Last Name (STitle) **] in [**12-29**] weeks
[**Hospital Ward Name 121**] 6 wound check - Friday [**4-15**] with NP/PA for evaluation
of arm please call in am with time [**Telephone/Fax (1) 3071**]



Completed by:[**2174-4-13**]
{'Mitral valve disorders,Acute on chronic systolic heart failure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Pure hypercholesterolemia,Phlebitis and thrombophlebitis of superficial veins of upper extremities'}


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: Dyspnea on exertion

PRESENT ILLNESS: 61 y/o male with hypertension c/o one week of exertional chest
pressure and shortness of breath. Admitted at OSH, ruled out for
myocardial infarction, but found to have severe mitral
regurgitation. Referred for cardiac surgery.

MEDICAL HISTORY: Mitral Regurgitaion, Hypertension, Hypercholesterolemia, Mild
Obesity

MEDICATION ON ADMISSION: Lisinopril 10mg qd, Lasix 40mg qd, Lopressor 25mg qd, Aspirin
325mg qd, MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 87 16 134/74 5'9"
Gen: WDWN male in NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR 2/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: NC

SOCIAL HISTORY: Denies tobacco use. Admits to several ETOH drinks with dinner. 

### Response:
{'Mitral valve disorders,Acute on chronic systolic heart failure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Pure hypercholesterolemia,Phlebitis and thrombophlebitis of superficial veins of upper extremities'}
