CHIEF COMPLAINT: mitral and tricuspid regurgitation

PRESENT ILLNESS: This 68 year old female experiences paroxysmal episodes of
atrial fibrillation. She has been on amiodarone since at least
[**2142**]. She had a recurrence of atrial fibrillation the spring of
thids year, associated with progressive shortness of breath and
chest pain.  She had an extensive work up at that time including
a cardiac catheterization, transthoracic echocardiogram,
transesophageal echocardiogram and a stress test.

MEDICAL HISTORY: paroxysmal atrial fibrillation
mitral valve regurgitation/ prolapse
hypertension
coronary artery disease
basal and squamous cell skin carcinomas
hematuria (cystoscopy negative)
 varicose veins with stasis
bilateral feet neuropathy
s/p appendectomy
s/p cholecystectomy
s/p reduction mammoplasties
s/p total abdominal hysterectomy
s/p phlebectomies

MEDICATION ON ADMISSION: ***COUMADIN 3 mg MWF, 2 mg T TH S,S - last dose [**2147-10-7**]
ASA 82 mg daily
amiodarone 200 mg daily - stopped 1 week ago
amlodipine 2.5 mg daily
lasix 20 mg daily
atenolol 50 mg daily
HCTZ 25 mg daily - stopped 1 week ago

ALLERGIES: lisinopril / Iodine

PHYSICAL EXAM: Pulse:82 Resp:18  O2 sat: 100% RA
B/P  Right: 118/77   Left:
Height: 64"    Weight:160

FAMILY HISTORY: Grandfather with DM and MI in his 50's
Father with HTN and CAD

SOCIAL HISTORY: Patient lives alone. She works in Food and Beverage Services as
a manager.
-Tobacco history: denied
-ETOH: occasional
-Illicit drugs: denied
Mitral valve disorders,Cardiac complications, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Atrial fibrillation,Other second degree atrioventricular block,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Unspecified glaucoma,Long-term (current) use of anticoagulants
Mitral valve disorder,Surg compl-heart,Idio periph neurpthy NOS,Atrial fibrillation,Av block-2nd degree NEC,Hypertension NOS,Crnry athrscl natve vssl,Glaucoma NOS,Long-term use anticoagul
Admission Date:  [**2147-10-11**]              Discharge Date:   [**2147-10-20**]

Date of Birth:  [**2079-5-29**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
lisinopril / Iodine

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
mitral and tricuspid regurgitation

Major Surgical or Invasive Procedure:
[**2147-10-12**] - 1. Radical mitral valve repair with a extensive
posterior leaflet (P2) triangular resection with plasty of the
P3 segment of the posterior leaflet and ring annuloplasty using
a 36-mm [**Doctor Last Name **] physio II ring. Ring data: model number 5200,
serial #[**Serial Number 96775**].
2. Tricuspid valve valvuloplasty with a 32-mm [**Doctor Last Name **] MC cubed
ring, model #4900, serial #[**Serial Number 96776**].
3. Full left-sided Maze procedure with resection of left atrial
appendage using the Atricure synergy bipolar RF system and the
cryo cath.


History of Present Illness:
This 68 year old female experiences paroxysmal episodes of
atrial fibrillation. She has been on amiodarone since at least
[**2142**]. She had a recurrence of atrial fibrillation the spring of
thids year, associated with progressive shortness of breath and
chest pain.  She had an extensive work up at that time including
a cardiac catheterization, transthoracic echocardiogram,
transesophageal echocardiogram and a stress test.

 Ultimately, she was diuresed, her amiodarone was increased to
200 mg daily and she underwent cardioversion which restored
sinus rhythm at which point she felt significantly better. She
continued on Coumadin. Shenow states to Dr. [**Last Name (STitle) **] she feels
periodic shortness of breath with significant
exertion or climbing stairs and feels her energy level is
declining.  She was noted to be back in AF at her most recent
visit and has been followed by Dr. [**Last Name (STitle) **]. She is reporting
increasing shortness of breath over the past month. She is
admitted now for a Heparin bridge with plans for surgery in the
AM.

Past Medical History:
paroxysmal atrial fibrillation
mitral valve regurgitation/ prolapse
hypertension
coronary artery disease
basal and squamous cell skin carcinomas
hematuria (cystoscopy negative)
 varicose veins with stasis
bilateral feet neuropathy
s/p appendectomy
s/p cholecystectomy
s/p reduction mammoplasties
s/p total abdominal hysterectomy
s/p phlebectomies

Social History:
Patient lives alone. She works in Food and Beverage Services as
a manager.
-Tobacco history: denied
-ETOH: occasional
-Illicit drugs: denied


Family History:
Grandfather with DM and MI in his 50's
Father with HTN and CAD

Physical Exam:
Pulse:82 Resp:18  O2 sat: 100% RA
B/P  Right: 118/77   Left:
Height: 64"    Weight:160

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]anicteric sclera
Neck:  Supple [x] Full ROM [x]no JVD appreciated
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular [x]  Murmur [x] grade 3/6 systolic
radiates best to apex and B carotids
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] no HSM; well healed scars
Extremities: Warm [x], well-perfused [x]  Edema [] none
Varicosities: severe BLE, multiple healed tiny sites
Neuro: Grossly intact [x]; MAE [**5-4**] strengths, nonfocal exam
Pulses:
Femoral      Right:2+    Left:2+
DP           Right:1+    Left:1+
PT           [**Name (NI) 167**]:trace Left:trace
Radial       Right:2+    Left:2+

Carotid Bruit       murmur radiates to B carotids


Pertinent Results:
ECHO [**2147-10-12**]
PREBYPASS:
The left atrium is markedly dilated. The coronary sinus is
dilated. No spontaneous echo contrast or thrombus is seen in the
body of the left atrium or left atrial appendage. The left
atrial appendage emptying velocity is depressed (<0.2m/s). No
thrombus is seen in the left atrial appendage. The right atrium
is markedly dilated. No atrial septal defect is seen by 2D or
color Doppler.

Left ventricular wall thicknesses are normal. The left
ventricular cavity size is top normal/borderline dilated.
Overall left ventricular systolic function is mildly depressed
(LVEF= 45%) with intrinsic function depressed in the presence of
MR.

The aortic valve leaflets (3) are mildly thickened. There is no
aortic valve stenosis. Mild to moderate ([**1-1**]+) aortic
regurgitation is seen.

The mitral valve leaflets are myxomatous. There is
moderate/severe bileaflet mitral valve prolapse. Moderate to
severe (3+) mitral regurgitation is seen.

The tricuspid valve is abnormal. Moderate to severe [3+]
tricuspid regurgitation is seen. IVC is dilated and is not
changing in size with ventilation.

There is no pericardial effusion. Dr. [**Last Name (STitle) 914**] was notified in
person at the time of the study.

POSTBYPASS:
The patient is AV paced on Milrinone, Norepinephrine and
Vasopressin infusions. Biventricular function is maintatined.
There are no wall motion abnormalities.

There is a well seated annuloplasty ring in the mitral position.
There is mild mitral regurgitation. There is no stenosis. There
is no evidence of [**Male First Name (un) **] or LVOTO obstruction.

There is a well seated annuloplasty ring in the tricuspid
position. There is trace tricuspid regurgitation. There is no
stenosis.

The mild to moderate aortic insufficiency is unchanged. The
aorta remains intact.
[**2147-10-18**] 05:11AM BLOOD WBC-5.9 RBC-3.71* Hgb-10.4* Hct-32.1*
MCV-86 MCH-28.1 MCHC-32.6 RDW-14.3 Plt Ct-239
[**2147-10-19**] 04:10AM BLOOD PT-16.0* INR(PT)-1.4*
[**2147-10-19**] 04:10AM BLOOD PT-16.0* INR(PT)-1.4*
[**2147-10-18**] 05:11AM BLOOD PT-15.8* PTT-26.5 INR(PT)-1.4*
[**2147-10-17**] 04:54AM BLOOD PT-16.7* PTT-27.0 INR(PT)-1.5*
[**2147-10-16**] 01:43AM BLOOD PT-14.8* PTT-26.6 INR(PT)-1.3*
[**2147-10-15**] 01:54AM BLOOD Plt Ct-139*
[**2147-10-15**] 01:54AM BLOOD PT-14.5* PTT-27.9 INR(PT)-1.2*
[**2147-10-14**] 09:10AM BLOOD PT-14.2* PTT-26.8 INR(PT)-1.2*
[**2147-10-19**] 04:10AM BLOOD UreaN-12 Creat-0.5 Na-140 K-3.9 Cl-103
[**2147-10-20**] 06:15AM BLOOD WBC-10.3# RBC-4.10* Hgb-11.7* Hct-35.8*
MCV-87 MCH-28.4 MCHC-32.6 RDW-14.6 Plt Ct-333
[**2147-10-20**] 06:15AM BLOOD PT-20.1* INR(PT)-1.8*
[**2147-10-20**] 06:15AM BLOOD Glucose-93 UreaN-13 Creat-0.7 Na-138
K-4.4 Cl-102 HCO3-27 AnGap-13

Brief Hospital Course:
Ms. [**Known lastname 21721**] was admitted to the [**Hospital1 18**] on [**2147-10-11**] for surgical
management of her mitral and tricuspid valve disease. She was
placed on Heparin as she had been off Coumadin for 4 days. She
was worked up in the usual preoperative manner.

On [**2147-10-12**], she was taken to the Operating Room where she
underwent mitral and tricuspid valve repair as well as a MAZE
procedure and left atrial appendage ligation. Please see
operative note for details. Postoperatively she was taken to the
intensive care unit for monitoring on Vasopressin, Milrinone and
levophed infusions. She remained sedated and intubated
overnight. Slowly her pressors were weaned.

On postoperative day one, she awoke neurologically intact and
was extubated. Beta blockade, aspirin and a statin were resumed.
However, soon afterwards she experienced Wenckebach dysrhythmia
and her beta blockade was held.  The Electrophysiology Service
was consulted.  They felt that a permanent pacemaker was not
warranted after her rhythm recovered but they felt beta blockade
should be held for at least two weeks.  She will be discharged
with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts Monitor and will follow up with Dr.
[**Last Name (STitle) **].  Her epicardial wires were removed as were CTs
without incident.

Coumadin was resumed for her history of atrial fibrillation.
Physical Therapy worked with her for strength and mobility.  She
was diuresd towards her preoperative weight.

Arrangements were made for Coumadin to be managed by [**Hospital 191**]
[**Hospital 2786**] clinic for Dr. [**Last Name (STitle) **].  The goal INR is 2-2.5.

Medications on Admission:
***COUMADIN 3 mg MWF, 2 mg T TH S,S - last dose [**2147-10-7**]
ASA 82 mg daily
amiodarone 200 mg daily - stopped 1 week ago
amlodipine 2.5 mg daily
lasix 20 mg daily
atenolol 50 mg daily
HCTZ 25 mg daily - stopped 1 week ago


Discharge Medications:
1. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
2. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain for 4 weeks.
Disp:*50 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. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever, pain.
5. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day.
Disp:*30 Tablet, ER Particles/Crystals(s)* Refills:*2*
6. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 2 days.
Disp:*4 Tablet(s)* Refills:*0*
7. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day: resume
daily dosing after 1 week course of [**Hospital1 **] dosing.
Disp:*30 Tablet(s)* Refills:*2*
8. warfarin 1 mg Tablet Sig: as directed Tablet PO once a day:
take daily as directed based upon INR results.
Disp:*100 Tablet(s)* Refills:*2*
9. Outpatient Lab Work
Labs: PT/INR for Coumadin ?????? indication atrial fibrillation
Goal INR 2-2.5
First draw [**2147-10-21**]
Results to phone [**Telephone/Fax (1) 2173**], [**Company 191**] coumadin clinic for Dr.
[**Last Name (STitle) **]
10. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
Disp:*30 Tablet(s)* Refills:*2*
11. furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day
for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
coronary artery disease
mitral regurgitation
tricuspid regurgitation
s/p mitral valve repair, MAZE,tricuspid repair, ligation of left
atrial appendage
paroxysmal atrial fibrillation
hypertension
basal cell carcinoma skin
squamous cell carcinoma skin
varicose veins with venous stasis
s/p bilateral phlebectomies
s/p appendectomy
s/p cholecystectomy
s/p reduction mammoplasties
s/p total abdominal hysterectomy


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:
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**]

*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) 914**] ([**Telephone/Fax (1) 170**]) on [**2147-11-28**] 1:15
Cardiologist: Dr. [**Last Name (STitle) **] on [**2147-10-24**] 4:20
[**First Name11 (Name Pattern1) 1521**] [**Last Name (NamePattern1) 1522**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 250**] Date/Time:[**2147-11-16**] 11:00

Please call to schedule appointments with:
Primary Care: Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] ([**Telephone/Fax (1) 250**]) in [**4-4**] 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 2-2.5
First draw [**2147-10-21**]
Results to phone [**Telephone/Fax (1) 2173**], [**Company 191**] coumadin clinic for Dr.
[**Last Name (STitle) **]


Completed by:[**2147-10-20**]
{'Mitral valve disorders,Cardiac complications, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Atrial fibrillation,Other second degree atrioventricular block,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Unspecified glaucoma,Long-term (current) use of anticoagulants'}


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: mitral and tricuspid regurgitation

PRESENT ILLNESS: This 68 year old female experiences paroxysmal episodes of
atrial fibrillation. She has been on amiodarone since at least
[**2142**]. She had a recurrence of atrial fibrillation the spring of
thids year, associated with progressive shortness of breath and
chest pain.  She had an extensive work up at that time including
a cardiac catheterization, transthoracic echocardiogram,
transesophageal echocardiogram and a stress test.

MEDICAL HISTORY: paroxysmal atrial fibrillation
mitral valve regurgitation/ prolapse
hypertension
coronary artery disease
basal and squamous cell skin carcinomas
hematuria (cystoscopy negative)
 varicose veins with stasis
bilateral feet neuropathy
s/p appendectomy
s/p cholecystectomy
s/p reduction mammoplasties
s/p total abdominal hysterectomy
s/p phlebectomies

MEDICATION ON ADMISSION: ***COUMADIN 3 mg MWF, 2 mg T TH S,S - last dose [**2147-10-7**]
ASA 82 mg daily
amiodarone 200 mg daily - stopped 1 week ago
amlodipine 2.5 mg daily
lasix 20 mg daily
atenolol 50 mg daily
HCTZ 25 mg daily - stopped 1 week ago

ALLERGIES: lisinopril / Iodine

PHYSICAL EXAM: Pulse:82 Resp:18  O2 sat: 100% RA
B/P  Right: 118/77   Left:
Height: 64"    Weight:160

FAMILY HISTORY: Grandfather with DM and MI in his 50's
Father with HTN and CAD

SOCIAL HISTORY: Patient lives alone. She works in Food and Beverage Services as
a manager.
-Tobacco history: denied
-ETOH: occasional
-Illicit drugs: denied 

### Response:
{'Mitral valve disorders,Cardiac complications, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Atrial fibrillation,Other second degree atrioventricular block,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Unspecified glaucoma,Long-term (current) use of anticoagulants'}
