CHIEF COMPLAINT: Occassional palpitations

PRESENT ILLNESS: This is a 62 year old female with longstanding history of mitral
valve  prolapse. Most recent echocardiogram in [**2106-7-28**]
showed severe mitral
regurgitation. At baseline, she is very active and remains
asymptomatic. She denies chest pain, shortness of breath,
palpitations, orthopnea, PND and pedal edema. Cardiac surgery
consulted for Mitral Valve repair/Replacement.

MEDICAL HISTORY: Hyperlipidemia
Hypertension
Mitral valve prolapse
Osteoporosis
Diabetes mellitus - Borderline
s/p Left knee surgery
s/p Appendectomy

MEDICATION ON ADMISSION: Lipitor 10 mg daily, Calcium with Vitamin D,
Actonel 35mg Every Friday, Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 5 months ago
Lives with: Husband
Occupation: Lives on a farm, rides horses on a daily basis
Tobacco: Denies
ETOH: Social, 1 drink daily
Mitral valve disorders,Rupture of chordae tendineae,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Other iatrogenic hypotension
Mitral valve disorder,Chordae tendinae rupture,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Iatrogenc hypotnsion NEC
Admission Date:  [**2106-9-27**]              Discharge Date:   [**2106-10-1**]

Date of Birth:  [**2043-12-15**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Occassional palpitations


Major Surgical or Invasive Procedure:
Minimally invasive mitral valve repair using a right mini
thoracotomy and posterior leaflet (P2) triangular resection with
a ring annuloplasty using an [**Doctor Last Name **] Physio 2 34-mm annuloplasty
ring, serial #[**Serial Number 87505**], model #5200. [**2106-9-27**]


History of Present Illness:
This is a 62 year old female with longstanding history of mitral
valve  prolapse. Most recent echocardiogram in [**2106-7-28**]
showed severe mitral
regurgitation. At baseline, she is very active and remains
asymptomatic. She denies chest pain, shortness of breath,
palpitations, orthopnea, PND and pedal edema. Cardiac surgery
consulted for Mitral Valve repair/Replacement.


Past Medical History:
Hyperlipidemia
Hypertension
Mitral valve prolapse
Osteoporosis
Diabetes mellitus - Borderline
s/p Left knee surgery
s/p Appendectomy


Social History:
Race: Caucasian
Last Dental Exam: 5 months ago
Lives with: Husband
Occupation: Lives on a farm, rides horses on a daily basis
Tobacco: Denies
ETOH: Social, 1 drink daily


Family History:
No premature coronary artery disease


Physical Exam:
Admission Physical Exam

Pulse: 57 SB Resp: 16 O2 sat:100%
B/P  Right: 156/84    Left: 155/75
Height: 62"    Weight: 115

General: WDWN In NAD
Skin: Warm[X] Dry [X] intact [X]
HEENT: NCAT[X] PERRLA [X] EOMI [X] Sclera anicteric. OP
Unremarkable.
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] III/VI systolic murmur
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  No Edema
Varicosities: None [X]
Neuro: Grossly intact, MAE [**3-31**] strengths,nonfocal exam

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       Murmur radiates bilaterally


Pertinent Results:
[**2106-9-28**] 01:50AM BLOOD WBC-15.7* RBC-3.42* Hgb-10.0* Hct-28.7*
MCV-84 MCH-29.4 MCHC-35.0 RDW-13.9 Plt Ct-178
[**2106-9-27**] 02:02PM BLOOD WBC-14.8*# RBC-3.61* Hgb-10.3* Hct-30.6*
MCV-85 MCH-28.5 MCHC-33.6 RDW-13.5 Plt Ct-166
[**2106-9-27**] 02:02PM BLOOD PT-13.3 PTT-27.8 INR(PT)-1.1
[**2106-9-28**] 01:50AM BLOOD Glucose-100 UreaN-14 Creat-0.7 Na-137
K-3.9 Cl-107 HCO3-23 AnGap-11
[**2106-9-27**] 02:02PM BLOOD UreaN-15 Creat-0.7 Na-141 K-4.0 Cl-114*
HCO3-24 AnGap-7*

[**2106-9-27**] ECHO
Pre CPB:
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.
Left ventricular wall thicknesses are normal. 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.
There are simple atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. There is no aortic valve
stenosis. Trace aortic regurgitation is seen.
There is moderate/severe posterior leaflet mitral valve prolapse
with an anteriorly directed jet. Both mitral leaflets are
severely myxomatous. Severe (4+) mitral regurgitation is seen.
Dr. [**Last Name (STitle) 914**] was notified in person of the results.

Post CPB:
There is a mitral ring in place.
There is trace MR. The peak gradient across the mitral valve is
9 and the mean gradient is 5mmHg.
There is trace aortic regurgitation.
The visible contours of the thoracic aorta are intact.

Brief Hospital Course:
On [**2106-9-27**] Ms.[**Known lastname **] was taken to the Operating Room and
underwent a minimally invasive mitral valve repair using a right
mini thoracotomy and posterior leaflet (P2) triangular resection
with a ring annuloplasty using an [**Doctor Last Name **] Physio 2
34-mm annuloplasty ring with Dr.[**Last Name (STitle) 914**]. Please refer to
operative report for further details. She tolerated the
procedure well and was transferred to the CVICU intubated and
sedated in critical but stable condition.

She awoke neurologically intact and was extubated without
difficulty. Beta-[**Last Name (LF) **], [**First Name3 (LF) **], a statin and diuresis were
initiated. Anti-inflammatory medications were started per
protocol. All lines and drains were discontinued in a timely
fashion. On POD# 1 she was transferred to the step down unit for
further monitoring. Physical Therapy was consulted for
evaluation of strength and mobility. She continued to make
steady progress and was discharged home on postoperative day
three. She will follow-up with Dr. [**Last Name (STitle) 914**], her cardiologist and
her primary care physician as an outpatient. As per Dr. [**Last Name (STitle) 914**],
she will take motrin 600mg every eight hours for three months.

Medications on Admission:
Lipitor 10 mg daily, Calcium with Vitamin D,
Actonel 35mg Every Friday, Multivitamin


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for miniMAZE for 3 months.
Disp:*270 Tablet(s)* Refills:*0*
3. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*2*
5. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
6. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 5 days.
Disp:*5 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
8. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation for 1 months.
Disp:*60 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
home health and hospice of [**Location (un) **]

Discharge Diagnosis:
Severe mitral regurgitation.
s/p Minimally invasive mitral valve repair/annuloplasty
Hyperlipidemia
Hypertension
Mitral valve prolapse
Osteoporosis
Diabetes mellitus - Borderline


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Edema


Discharge Instructions:
1)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
2)Please NO lotions, cream, powder, or ointments to incisions
3)Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

4)No driving for approximately 2 weeks and while taking
narcotics. This will be discussed at follow up appointment with
surgeon when you will be able to drive.
5)You may resume your actonel as per presurgery
6)Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**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) 914**] ([**Telephone/Fax (1) 170**]) on [**2106-10-26**] at 1:15pm
Cardiologist:Dr. [**Last Name (STitle) **] on [**2106-10-28**] at 10:20am

Please call to schedule appointments with:
Primary Care: Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) 13013**] ([**Telephone/Fax (1) 10862**]in [**11-28**] 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**




Completed by:[**2106-10-1**]
{'Mitral valve disorders,Rupture of chordae tendineae,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Other iatrogenic hypotension'}


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: Occassional palpitations

PRESENT ILLNESS: This is a 62 year old female with longstanding history of mitral
valve  prolapse. Most recent echocardiogram in [**2106-7-28**]
showed severe mitral
regurgitation. At baseline, she is very active and remains
asymptomatic. She denies chest pain, shortness of breath,
palpitations, orthopnea, PND and pedal edema. Cardiac surgery
consulted for Mitral Valve repair/Replacement.

MEDICAL HISTORY: Hyperlipidemia
Hypertension
Mitral valve prolapse
Osteoporosis
Diabetes mellitus - Borderline
s/p Left knee surgery
s/p Appendectomy

MEDICATION ON ADMISSION: Lipitor 10 mg daily, Calcium with Vitamin D,
Actonel 35mg Every Friday, Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 5 months ago
Lives with: Husband
Occupation: Lives on a farm, rides horses on a daily basis
Tobacco: Denies
ETOH: Social, 1 drink daily 

### Response:
{'Mitral valve disorders,Rupture of chordae tendineae,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Other iatrogenic hypotension'}
