CHIEF COMPLAINT: Palpitations and increasing fatigue

PRESENT ILLNESS: 37 year old gentleman, known to our service (please see H&P from
[**6-20**]) who is originally from [**Country 2784**] and was found to have a
heart murmur on exam 6 years ago. He was found to have mitral
regurgitation which was subsequently followed by serial
echocardiograms by multiple physicians as he moves frequently.
His echocardiogram last year showed moderate to severe mitral
valve prolapse with 3+ mitral regurgitation. A cardiac MRI was
obtained which showed bileaflet mitral valve prolapse with
moderate mitral regurgitation. The LVEF was mildly depressed at
48%. The effective forward LVEF was moderately depressed at 35%.
He is symptomatic with mainly fatigue however he does note
occasional palpitations.

MEDICAL HISTORY: Mitral valve regurgitation s/p mitral valve repair
Past medical history:
- Hypertension
- Non-sustained ventricular tachycardia
- Anxiety
- ? syncopal event [**5-21**]
- + PPD [**2181**], negative CXR

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Lisinopril 30 mg PO DAILY
2. Magnesium Oxide 400 mg PO DAILY
3. Sotalol 80 mg PO BID
Theragran-M premier 1 tab daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 80  Resp: 16  O2 sat: 100%
B/P Left: 114/80
Height: 5'[**96**]"    Weight: 225

FAMILY HISTORY: N0n-contrib for Premature coronary artery disease. Two older
brothers, one with hypertension, the other with no known cardiac
disease. His mother has asthma and his father died of cancer.
There is no family history of sudden cardiac death.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 6 months ago
Lives with: College roommate
Contact: [**Name (NI) **] [**Last Name (NamePattern1) 89423**]               Phone # [**Telephone/Fax (1) 89424**]
Occupation: He is a CEO of a series of call centers called the
VTW Company. This involves a lot of both national and
international travel.
Cigarettes: Smoked no [X] yes [] last cigarette _____ Hx:
Other Tobacco use: None
ETOH: < 1 drink/week [] [**1-16**] drinks/week [X] >8 drinks/week []
Illicit drug use-none
Mitral valve disorders,Anxiety state, unspecified
Mitral valve disorder,Anxiety state NOS
Admission Date:  [**2198-5-21**]              Discharge Date:   [**2198-5-26**]

Date of Birth:  [**2160-7-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Palpitations and increasing fatigue

Major Surgical or Invasive Procedure:
[**2198-5-21**] Mitral valve repair (36mm CG future ring)

History of Present Illness:
37 year old gentleman, known to our service (please see H&P from
[**6-20**]) who is originally from [**Country 2784**] and was found to have a
heart murmur on exam 6 years ago. He was found to have mitral
regurgitation which was subsequently followed by serial
echocardiograms by multiple physicians as he moves frequently.
His echocardiogram last year showed moderate to severe mitral
valve prolapse with 3+ mitral regurgitation. A cardiac MRI was
obtained which showed bileaflet mitral valve prolapse with
moderate mitral regurgitation. The LVEF was mildly depressed at
48%. The effective forward LVEF was moderately depressed at 35%.
He is symptomatic with mainly fatigue however he does note
occasional palpitations.

When we saw him in [**2196**] surgery was recommended but cardiology
decided to postpone surgery and treat his ventricular ectopy in
hopes to improve his LV systolic function and dimensions. Holter
monitor study in [**2197-12-10**] still showed significant amount of
ectopy, and he has persistent symptoms due to this, albeit less
frequent. Recent Echo on [**2198-4-24**] revealed moderate/severe mitral
valve bileaflet prolapse involving all anterior segment and all
posterior scallops with moderate to severe (3+) mitral
regurgitation.

Past Medical History:
Mitral valve regurgitation s/p mitral valve repair
Past medical history:
- Hypertension
- Non-sustained ventricular tachycardia
- Anxiety
- ? syncopal event [**5-21**]
- + PPD [**2181**], negative CXR


Social History:
Race: Caucasian
Last Dental Exam: 6 months ago
Lives with: College roommate
Contact: [**Name (NI) **] [**Last Name (NamePattern1) 89423**]               Phone # [**Telephone/Fax (1) 89424**]
Occupation: He is a CEO of a series of call centers called the
VTW Company. This involves a lot of both national and
international travel.
Cigarettes: Smoked no [X] yes [] last cigarette _____ Hx:
Other Tobacco use: None
ETOH: < 1 drink/week [] [**1-16**] drinks/week [X] >8 drinks/week []
Illicit drug use-none

Family History:
N0n-contrib for Premature coronary artery disease. Two older
brothers, one with hypertension, the other with no known cardiac
disease. His mother has asthma and his father died of cancer.
There is no family history of sudden cardiac death.

Physical Exam:
Pulse: 80  Resp: 16  O2 sat: 100%
B/P Left: 114/80
Height: 5'[**96**]"    Weight: 225

General: Well-developed male in no acute distress
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X]
Neck: Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] Irregular [] Murmur [X] grade 236 late systolic
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X] Edema/Varicosities:
None [X]
Neuro: Grossly intact [X]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit      Right: -   Left: -

Pertinent Results:
[**2198-5-21**] Echo: PRE-BYPASS: No spontaneous echo contrast 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. There is mild regional left
ventricular systolic dysfunction with basal to mid inferior and
inferoseptal hypokinesis. There is mild to moderate global left
ventricular hypokinesis. Overall left ventricular systolic
function is moderately depressed (LVEF= 35-40 %). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic stenosis or aortic
regurgitation. There is moderate/severe posterior leaflet mitral
valve prolapse, worst at P2. The entire anterior leaflet
prolapses as well, but to a lesser degree than the posterior
leaflet. An eccentric, anteriorly directed jet of moderate to
severe (3+) mitral regurgitation is seen. Due to the eccentric
nature of the regurgitant jet, its severity may be significantly
underestimated (Coanda effect). There is no pericardial
effusion. Dr. [**Last Name (STitle) **] was notified in person of the results at time
of surgery.
POST-BYPASS: The patient is AV paced. The patient is on an
epinephrine infusion. Left ventricular function remains
depressed, with an LVEF = 35%. Lateral wall motion remains
unchanged from prebypass. Right ventricular function appears
mildly depressed. There is a mitral annuloplasty ring in place.
Trace mitral regurgitation is seen. There is a mean gradient of
4mmHg across the mitral valve at a cardiac output of 5.6 L/min.
There is no systolic anterior motion of the mitral valve and no
increased LVOT gradient. The aorta is intact post-decannulation.

Brief Hospital Course:
Mr. [**Known lastname **] [**Known lastname 89425**] was a same day admit and brought directly to
the operating room where he underwent a mitral valve repair.
Please see operative note for surgical details. Following
surgery he was transferred to the CVICU for invasive monitoring
in stable condition. Later this day he was weaned from sedation,
awoke neurologically intact and extubated.  Post-operatively his
rhythm was junctional/brady requiring pacing.  Nodal agents were
held.  He subsequently developed atrial fibrillation with slow
ventricular response.  He remained hemodynamically stable.   He
was started on Sotalol and beta-blocker was held.  Rhythm
converted to Sinus.  He was gently diuresed toward the
preoperative weight.  The patient was transferred to the
telemetry floor for further recovery.  Chest tubes and pacing
wires were discontinued without complication.  The patient was
evaluated by the physical therapy service for assistance with
strength and mobility.  By the time of discharge on POD #5 the
patient was ambulating freely, the wound was healing and pain
was controlled with oral analgesics.  The patient was discharged
on POD#5 in good condition with appropriate follow up
instructions.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Lisinopril 30 mg PO DAILY
2. Magnesium Oxide 400 mg PO DAILY
3. Sotalol 80 mg PO BID
Theragran-M premier 1 tab daily

Discharge Medications:
1. Lisinopril 30 mg PO DAILY
hold for SBP<95 and notify HO
RX *lisinopril 20 mg once a day Disp #*60 Tablet Refills:*1
2. Sotalol 80 mg PO BID
RX *sotalol 80 mg once a day Disp #*30 Tablet Refills:*1
3. Acetaminophen 650 mg PO/PR Q4H:PRN temperature >38.0
4. Aspirin EC 81 mg PO DAILY Start: POD #1
RX *aspirin 81 mg once a day Disp #*30 Tablet Refills:*1
5. Furosemide 10 mg PO DAILY Duration: 5 Days
RX *furosemide 20 mg once a day Disp #*5 Tablet Refills:*0
6. HYDROmorphone (Dilaudid) 2-4 mg PO Q3H:PRN pain
RX *hydromorphone 2 mg every four (4) hours Disp #*60 Tablet
Refills:*0
7. Ibuprofen 400 mg PO Q8H:PRN pain
RX *ibuprofen 200 mg every six (6) hours as needed Disp #*120
Tablet Refills:*1
8. Potassium Chloride 10 mEq PO DAILY Duration: 5 Days
RX *potassium chloride 10 mEq once a day Disp #*5 Tablet
Refills:*0
9. Magnesium Oxide 400 mg PO DAILY


Discharge Disposition:
Home With Service

Facility:
VNA Assoc. of [**Hospital3 **]

Discharge Diagnosis:
Mitral valve regurgitation s/p mitral valve repair
Past medical history:
- Hypertension
- Non-sustained ventricular tachycardia
- Anxiety
- ? syncopal event [**5-21**]
- + PPD [**2181**], negative CXR


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
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
Wound check at Cardiac Surgery office: [**2198-6-5**] 10:00 in the
[**Hospital **] medical office building, [**Doctor First Name **], [**Hospital Unit Name **]
Surgeon: Dr. [**Last Name (STitle) **] [**2198-6-28**] at 1:00pm in the [**Hospital **] medical office
building, [**Doctor First Name **], [**Hospital Unit Name **]

Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**2198-6-15**] at 10:20a

Please call to schedule appointments with your
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**3-15**] 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:[**2198-6-5**]
{'Mitral valve disorders,Anxiety state, unspecified'}


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: Palpitations and increasing fatigue

PRESENT ILLNESS: 37 year old gentleman, known to our service (please see H&P from
[**6-20**]) who is originally from [**Country 2784**] and was found to have a
heart murmur on exam 6 years ago. He was found to have mitral
regurgitation which was subsequently followed by serial
echocardiograms by multiple physicians as he moves frequently.
His echocardiogram last year showed moderate to severe mitral
valve prolapse with 3+ mitral regurgitation. A cardiac MRI was
obtained which showed bileaflet mitral valve prolapse with
moderate mitral regurgitation. The LVEF was mildly depressed at
48%. The effective forward LVEF was moderately depressed at 35%.
He is symptomatic with mainly fatigue however he does note
occasional palpitations.

MEDICAL HISTORY: Mitral valve regurgitation s/p mitral valve repair
Past medical history:
- Hypertension
- Non-sustained ventricular tachycardia
- Anxiety
- ? syncopal event [**5-21**]
- + PPD [**2181**], negative CXR

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Lisinopril 30 mg PO DAILY
2. Magnesium Oxide 400 mg PO DAILY
3. Sotalol 80 mg PO BID
Theragran-M premier 1 tab daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 80  Resp: 16  O2 sat: 100%
B/P Left: 114/80
Height: 5'[**96**]"    Weight: 225

FAMILY HISTORY: N0n-contrib for Premature coronary artery disease. Two older
brothers, one with hypertension, the other with no known cardiac
disease. His mother has asthma and his father died of cancer.
There is no family history of sudden cardiac death.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 6 months ago
Lives with: College roommate
Contact: [**Name (NI) **] [**Last Name (NamePattern1) 89423**]               Phone # [**Telephone/Fax (1) 89424**]
Occupation: He is a CEO of a series of call centers called the
VTW Company. This involves a lot of both national and
international travel.
Cigarettes: Smoked no [X] yes [] last cigarette _____ Hx:
Other Tobacco use: None
ETOH: < 1 drink/week [] [**1-16**] drinks/week [X] >8 drinks/week []
Illicit drug use-none 

### Response:
{'Mitral valve disorders,Anxiety state, unspecified'}
