CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 57 yo male who was found to have heart murmur. Subsequent TTE
revealed MR/MS [**First Name (Titles) 151**] [**Last Name (Titles) **]. HTN, and a possible vegetation seen on
anterior MV [**Last Name (Titles) **]. TEE then done. Cath did not show CAD. He
does heavy physical labor and walks one mile daily with mild
DOE.

MEDICAL HISTORY: Past Medical History:
mitral regurgitation
mitral stenosis
hyperlipidemia
benign brain tumor ( resect. [**2156**])
pneumothorax ( age 23)
prior pneumonia
tobacco abuse
colon polyps
hemorrhoids
Past Surgical History:
resect. brain tumor [**2156**]
R ing. herniorrhaphy (childhood)

MEDICATION ON ADMISSION: None

ALLERGIES: Penicillins / yellow jackets

PHYSICAL EXAM: Pulse:58    97% O2 sat
B/P 116/75
Height: 6'3"    Weight: 178

FAMILY HISTORY: non-contrib.; mother had CABG and CVA at 85

SOCIAL HISTORY: Last Dental Exam: 1 yr ago
Lives with:alone (has a son)
Occupation:physical laborer
Tobacco:smokes one ppd currently x 30 yrs
ETOH:sober 5 years
Mitral stenosis with insufficiency,Cardiac complications, not elsewhere classified,Acute posthemorrhagic anemia,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Personal history of benign neoplasm of the brain,Personal history of tobacco use
Mitral stenosis w insuff,Surg compl-heart,Ac posthemorrhag anemia,Chr pulmon heart dis NEC,Hyperlipidemia NEC/NOS,Atrial fibrillation,Abn react-artif implant,Hx benign neoplasm brain,History of tobacco use
Admission Date:  [**2166-4-22**]              Discharge Date:   [**2166-4-28**]

Date of Birth:  [**2108-8-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / yellow jackets

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

Major Surgical or Invasive Procedure:
[**2166-4-22**] - Mitral Valve Replacement (St. [**Male First Name (un) 923**] Mechanical Valve)


History of Present Illness:
57 yo male who was found to have heart murmur. Subsequent TTE
revealed MR/MS [**First Name (Titles) 151**] [**Last Name (Titles) **]. HTN, and a possible vegetation seen on
anterior MV [**Last Name (Titles) **]. TEE then done. Cath did not show CAD. He
does heavy physical labor and walks one mile daily with mild
DOE.

Past Medical History:
Past Medical History:
mitral regurgitation
mitral stenosis
hyperlipidemia
benign brain tumor ( resect. [**2156**])
pneumothorax ( age 23)
prior pneumonia
tobacco abuse
colon polyps
hemorrhoids
Past Surgical History:
resect. brain tumor [**2156**]
R ing. herniorrhaphy (childhood)


Social History:
Last Dental Exam: 1 yr ago
Lives with:alone (has a son)
Occupation:physical laborer
Tobacco:smokes one ppd currently x 30 yrs
ETOH:sober 5 years


Family History:
non-contrib.; mother had CABG and CVA at 85


Physical Exam:
Pulse:58    97% O2 sat
B/P 116/75
Height: 6'3"    Weight: 178

General:tall, thin, NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]anicteric sclera;OP unremarkable
Neck:  Supple [x] Full ROM []no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur- 2/6 SEM radiates
throughout
chest to carotids
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x];no HSM
Extremities: Warm [x], well-perfused [x]  Edema-none
 Varicosities: None [x]
Neuro: Grossly intact;MAE [**5-8**] 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 bilat.carotids


Pertinent Results:
[**2166-4-22**] ECHO
PREBYPASS: The left atrium is moderately dilated. Left
ventricular wall thickness, cavity size, and global systolic
function are normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The ascending, transverse and
descending thoracic aorta are normal in diameter and free of
significant atherosclerotic plaque. The diameters of aorta at
the sinus, ascending and arch levels are normal. The aortic
valve leaflets (3) appear structurally normal with good [**Month/Day/Year **]
excursion and no aortic stenosis or aortic regurgitation. The
mitral valve leaflets are severely thickened/deformed. The
mitral valve shows characteristic rheumatic deformity. There is
no pericardial effusion. Mean mitral valve gradient was 13mm Hg
with MVA of 1.2 by PHT. Severe MR is present. Normal LV Function
with LVEF > 55%

POSTBYPASS: Normal functioning mechanical [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] bileaflet
dilting disc valve. No significant MR. [**First Name (Titles) **] [**Last Name (Titles) **] motion. No
stenosis (gradient = 3 mmHg). Normal LV systolic function with
LVEF > 55% and no significant wall motion abnormalities.

[**2166-4-26**] 06:45AM BLOOD WBC-7.1 RBC-3.19* Hgb-10.3* Hct-29.4*
MCV-92 MCH-32.3* MCHC-35.0 RDW-13.6 Plt Ct-258
[**2166-4-25**] 06:00AM BLOOD WBC-8.5 RBC-3.05* Hgb-10.1* Hct-28.0*
MCV-92 MCH-33.2* MCHC-36.1* RDW-13.7 Plt Ct-175
[**2166-4-28**] 04:27AM BLOOD PT-32.2* INR(PT)-3.2*
[**2166-4-27**] 01:17PM BLOOD PT-26.0* INR(PT)-2.5*
[**2166-4-27**] 03:19AM BLOOD PT-24.2* PTT-36.4* INR(PT)-2.3*
[**2166-4-26**] 06:45AM BLOOD PT-19.7* PTT-29.6 INR(PT)-1.8*
[**2166-4-25**] 06:00AM BLOOD PT-15.9* INR(PT)-1.4*
[**2166-4-24**] 04:09AM BLOOD PT-14.1* PTT-27.9 INR(PT)-1.2*
[**2166-4-23**] 02:37AM BLOOD PT-13.3 PTT-27.6 INR(PT)-1.1
[**2166-4-22**] 11:45AM BLOOD PT-14.2* PTT-27.1 INR(PT)-1.2*
[**2166-4-22**] 10:50AM BLOOD PT-14.7* PTT-26.7 INR(PT)-1.3*
[**2166-4-28**] 04:27AM BLOOD UreaN-22* Creat-1.1 Na-134 K-4.6 Cl-101
[**2166-4-27**] 03:19AM BLOOD UreaN-17 Creat-1.0 Na-137 K-4.5 Cl-100
[**2166-4-26**] 06:45AM BLOOD Glucose-102* UreaN-20 Creat-1.1 Na-137
K-4.8 Cl-98 HCO3-33* AnGap-11
[**2166-4-28**] 04:27AM BLOOD Mg-2.2

Brief Hospital Course:
Mr. [**Known lastname 90205**] was admitted to the [**Hospital1 18**] on [**2166-4-22**] for surgical
management of his mitral valve disease.  He was taken to the
operating room where he underwent a mitral valve replacement
using a St. [**Male First Name (un) 923**] mechanical valve. Please see operative note for
details. Postoperatively he was taken to the intensive care unit
for monitoring. Over the next several hours, he awoke
neurologically intact and extubated. He was started on beta
blockade and amiodarone for atrial fibrillation. A heparin drip
was started as a bridge to Coumadin for his mechanical valve
with a goal INR of 2.5-3.5. Heparin was discontinued when his
INR was therapuetic. He was in sinus rhythm on discharge.  Chest
tubes and pacing wires were discontinued without complication.
He was evaluated by physical therapy for strength and
conditioning. He was slow to wean from oxygen therapy, but was
stable on room air by discharge.  On postoperative day 6 he was
discharged to [**First Name8 (NamePattern2) 2048**] [**Last Name (NamePattern1) **] House in [**Location (un) 86**].

Medications on Admission:
None

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*75 Tablet(s)* Refills:*0*
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
5. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. warfarin 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): MD
to dose daily for goal INR 2.5-3.5 for mechanical mitral valve.
Disp:*60 Tablet(s)* Refills:*2*
7. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x 1 week, then 400mg daily x 1 week, then
200mg daily until further instructed.
8. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
9. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).


Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] house

Discharge Diagnosis:
Past Medical History:
mitral regurgitation
mitral stenosis
hyperlipidemia
benign brain tumor ( resect. [**2156**])
pneumothorax ( age 23)
prior pneumonia
tobacco abuse
colon polyps
hemorrhoids
Past Surgical History:
resect. brain tumor [**2156**]
Ring herniorrhaphy (childhood)


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with percocet
Incisions:
Sternal - healing well, no erythema or drainage
No 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 provided.
4) No driving for approximately one month and while taking
narcotics. Driving will be discussed at follow up appointment
with surgeon when you will likely be cleared to drive.
5) No lifting more than 10 pounds for 10 weeks
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) **] on [**2166-5-22**] at 9am at [**Hospital3 **]
Cardiologist: Dr. [**Last Name (STitle) 31888**] on [**2166-6-5**] at 1pm.

Please call to schedule appointments with your
Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**] [**Telephone/Fax (1) 90206**] in [**4-8**] 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 is mechanical mitral
valve
Goal INR 2.5-3.5
First draw [**2166-4-29**], then daily until INR consistently within
stable range.
Will need coumadin follow up upon discharge from rehab.



Completed by:[**2166-4-28**]
{'Mitral stenosis with insufficiency,Cardiac complications, not elsewhere classified,Acute posthemorrhagic anemia,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Personal history of benign neoplasm of the brain,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: Dyspnea on exertion

PRESENT ILLNESS: 57 yo male who was found to have heart murmur. Subsequent TTE
revealed MR/MS [**First Name (Titles) 151**] [**Last Name (Titles) **]. HTN, and a possible vegetation seen on
anterior MV [**Last Name (Titles) **]. TEE then done. Cath did not show CAD. He
does heavy physical labor and walks one mile daily with mild
DOE.

MEDICAL HISTORY: Past Medical History:
mitral regurgitation
mitral stenosis
hyperlipidemia
benign brain tumor ( resect. [**2156**])
pneumothorax ( age 23)
prior pneumonia
tobacco abuse
colon polyps
hemorrhoids
Past Surgical History:
resect. brain tumor [**2156**]
R ing. herniorrhaphy (childhood)

MEDICATION ON ADMISSION: None

ALLERGIES: Penicillins / yellow jackets

PHYSICAL EXAM: Pulse:58    97% O2 sat
B/P 116/75
Height: 6'3"    Weight: 178

FAMILY HISTORY: non-contrib.; mother had CABG and CVA at 85

SOCIAL HISTORY: Last Dental Exam: 1 yr ago
Lives with:alone (has a son)
Occupation:physical laborer
Tobacco:smokes one ppd currently x 30 yrs
ETOH:sober 5 years 

### Response:
{'Mitral stenosis with insufficiency,Cardiac complications, not elsewhere classified,Acute posthemorrhagic anemia,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Personal history of benign neoplasm of the brain,Personal history of tobacco use'}
