CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: This is a 75 year old female with history of non-ischemic
cardiomyopathy and atrial flutter. She was recently admitted to
[**Hospital3 35813**] Center on [**2130-8-14**] with congestive heart failure
and hypotension. Workup revealed severe mitral regurgitation and
severely depressed left ventricular function with an ejection
fraction of 30%. Her coronary arteries were angiographically
normal. Based on the above results, she was subsequently
transferred to [**Hospital1 18**] for operative care.

MEDICAL HISTORY: Non-ischemic cardiomyopathy, Hypertension, Atrial flutter with
history of failed ablation, s/p PPM/AICD placement, Chronic
anemia, Osteoporosis with multiple lumbar compression fractures,
History of non-Hodgkins lymphoma, Spinal stenosis with chronic
low back pain, History of seizures, History of herpetic
neuralgia, s/p chole, s/p appendectomy

MEDICATION ON ADMISSION: Warfarin - stopped PTA, ASA 325 qd, Coreg 6.25 [**Hospital1 **], Digoxin
0.125 qd, Cozaar 25 qd, Sotalol 160 [**Hospital1 **], Protonix 40 qd,
Spironolactone 12.5 qd, Tegretol 100 [**Hospital1 **], lasix 40 qd, Lexapro
10 qd, Colace, Senna, Oxycodone

ALLERGIES: Penicillins / Ace Inhibitors / Lidoderm / Codeine

PHYSICAL EXAM: Vitals: Temp 99.2, BP 106/50, HR 65 AV paced, R 18, SAT 99% RA
General: Elderly female in no acute distress
HEENT: oropharynx benign, PERRL, sclera anicteric
Neck: suppple, no JVD, no carotid bruits
Chest: lungs clear bilaterally
Heart: regular rate, s1s2, [**2-19**] holosystolic murmur
Abdomen: benign
Ext: warm, no pedal edema
Pulses: palpable distal pulses, no femoral bruits
Neuro: nonfocal

FAMILY HISTORY: Son diagnosed with coronary artery disease in his 40's.

SOCIAL HISTORY: No history of tobacco or ETOH. Lives with sister-in-law.
Congestive heart failure, unspecified,Mitral valve disorders,Atrial fibrillation,Other primary cardiomyopathies,Urinary tract infection, site not specified,Other and unspecified coagulation defects,Unspecified pleural effusion,Fitting and adjustment of automatic implantable cardiac defibrillator,Unspecified essential hypertension,Unspecified deficiency anemia,Personal history of other lymphatic and hematopoietic neoplasms,Osteoporosis, unspecified
CHF NOS,Mitral valve disorder,Atrial fibrillation,Prim cardiomyopathy NEC,Urin tract infection NOS,Coagulat defect NEC/NOS,Pleural effusion NOS,Ftng autmtc dfibrillator,Hypertension NOS,Deficiency anemia NOS,Hx-lymphatic malign NEC,Osteoporosis NOS
Admission Date:  [**2130-8-29**]              Discharge Date:   [**2130-9-7**]

Date of Birth:  [**2055-1-25**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Ace Inhibitors / Lidoderm / Codeine

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2130-8-31**] Mitral valve replacement utilizing [**Street Address(2) 11599**]. [**Male First Name (un) 923**]
porcine valve. Maze procedure utilizing radio frequency
ablation. Ligation of left atrial appendage.

History of Present Illness:
This is a 75 year old female with history of non-ischemic
cardiomyopathy and atrial flutter. She was recently admitted to
[**Hospital3 35813**] Center on [**2130-8-14**] with congestive heart failure
and hypotension. Workup revealed severe mitral regurgitation and
severely depressed left ventricular function with an ejection
fraction of 30%. Her coronary arteries were angiographically
normal. Based on the above results, she was subsequently
transferred to [**Hospital1 18**] for operative care.

Past Medical History:
Non-ischemic cardiomyopathy, Hypertension, Atrial flutter with
history of failed ablation, s/p PPM/AICD placement, Chronic
anemia, Osteoporosis with multiple lumbar compression fractures,
History of non-Hodgkins lymphoma, Spinal stenosis with chronic
low back pain, History of seizures, History of herpetic
neuralgia, s/p chole, s/p appendectomy

Social History:
No history of tobacco or ETOH. Lives with sister-in-law.

Family History:
Son diagnosed with coronary artery disease in his 40's.

Physical Exam:
Vitals: Temp 99.2, BP 106/50, HR 65 AV paced, R 18, SAT 99% RA
General: Elderly female in no acute distress
HEENT: oropharynx benign, PERRL, sclera anicteric
Neck: suppple, no JVD, no carotid bruits
Chest: lungs clear bilaterally
Heart: regular rate, s1s2, [**2-19**] holosystolic murmur
Abdomen: benign
Ext: warm, no pedal edema
Pulses: palpable distal pulses, no femoral bruits
Neuro: nonfocal


Pertinent Results:
[**2130-9-5**] 04:04AM BLOOD WBC-11.8* RBC-3.64*# Hgb-10.6*#
Hct-31.5*# MCV-87 MCH-29.2 MCHC-33.7 RDW-16.8* Plt Ct-112*
[**2130-9-7**] 04:12AM BLOOD PT-15.8* INR(PT)-1.7
[**2130-9-7**] 04:12AM BLOOD K-4.4
[**2130-9-5**] 04:04AM BLOOD Glucose-83 UreaN-16 Creat-0.5 Na-137
K-4.1 Cl-100 HCO3-28 AnGap-13

Brief Hospital Course:
Patient was admitted and underwent further preoperative
evaluation which included a repeat echocardiogram. This was
notable for 3+ mitral regurgitation with moderate to severe
tricuspid regurgitation. The overall left ventricular systolic
function was mildly depressed but compared to previous studies,
her ejection fraction had improved to 50%. There was moderate
pulmonary artery systolic hypertension. Her left atrium was
dilated. She had a normal aortic root and her aortic valves were
mildly thickened with only 1+ aortic insufficiency. Workup was
otherwise unremarkable and she was eventually cleared for
surgery. She remained stable on medical therapy. Antibiotics
were started for her preoperative urinary tract infection -
cutlture grew out E. coli sensitive to Bactrim and Ancef.

On [**8-31**], Dr. [**Last Name (STitle) **] performed a mitral valve
replacement([**Street Address(2) 11599**]. [**Male First Name (un) 923**] porcine valve) and MAZE procedure.
Surgery was uneventful. The intraoperative TEE showed no mitral
regurgitation with an ejection fraction around 35-40%. After the
operation, she was brought to the CSRU in stable condition. She
initially required multiple blood products for an anemia and a
postoperative coagulopathy. She concomitantly experienced a
transient increasing pressor requirement which prompted a TEE
which found no evidence of cardiac tamponade. Over the next 48
hours, she successfully weaned from inotropic support and was
extubated without difficulty. Amiodarone was eventually started
given her history of atrial fibrillation/flutter as well as
Warfarin for her porcine mitral valve replacement. She
maintained stable hemodynamcis and adequate urine output. She
was intermittently transfused with additional packed red blood
cells to maintain hematocrit near 30%.

Postop, she continued to experience a persistent leukocystosis.
All lines were changed and pan cultures were obtained. Her white
count peaked to 25K on POD#3. All cultures remained negative. On
POD#4, she transferred to the SDU. There medical therapy was
optimized. She required additional diuresis. By discharge, chest
x-ray was notable for improving pleural effusions. Amiodarone
was titrated and Warfarin was dosed for a goal INR between 2.0 -
2.5. By discharge, her white count improved to 11K. She remained
afebrile. At discharge, she was tolerating 1L nasal cannula with
oxygen saturations of 95%.


Medications on Admission:
Warfarin - stopped PTA, ASA 325 qd, Coreg 6.25 [**Hospital1 **], Digoxin
0.125 qd, Cozaar 25 qd, Sotalol 160 [**Hospital1 **], Protonix 40 qd,
Spironolactone 12.5 qd, Tegretol 100 [**Hospital1 **], lasix 40 qd, Lexapro
10 qd, Colace, Senna, Oxycodone

Discharge Medications:
1. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO DAILY (Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Warfarin 1 mg Tablet Sig: as directed Tablet PO DAILY
(Daily): [**9-4**] 2 mg
[**9-5**] 3 mg
[**9-6**] 3 mg INR 1.2
[**9-7**] INR 1.7
goal INR [**1-19**].
5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Carbamazepine 100 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO BID (2 times a day).
8. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
9. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily): 400 mg Qd x 1 week then 200 mg QD.
10. Escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours) as needed.
12. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Doctor Last Name 62491**]Rehabilitation

Discharge Diagnosis:
Congestive Heart Failure, Mitral regurgitation, Non-ischemic
cardiomyopathy - s/p porcine MVR and MAZE, Hypertension, History
of Atrial flutter with history of failed ablation, s/p PPM/AICD
placement, Chronic anemia, Osteoporosis with multiple lumbar
compression fractures, History of non-Hodgkins lymphoma, Spinal
stenosis with chronic low back pain, History of seizures,
History of herpetic neuralgia, s/p chole, s/p appendectomy,
Postoperative leukocytosis, Preoperative UTI, Plueral effusions


Discharge Condition:
Good


Discharge Instructions:
Keep wounds clean and dry. OK to shower, no bathing or swimming.
Take all medications as prescribed.
Call for any fever, redness or drainage from wounds.
No lifting more than 10 lbs for at least 10 weeks.

Followup Instructions:
[**Hospital 409**] clinic in 2 weeks
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 62492**] on [**2130-9-21**] @ 2PM
Local cardiologist in 2 weeks
Local PCP [**Last Name (NamePattern4) **] 2 weeks



Completed by:[**2130-9-7**]
{'Congestive heart failure, unspecified,Mitral valve disorders,Atrial fibrillation,Other primary cardiomyopathies,Urinary tract infection, site not specified,Other and unspecified coagulation defects,Unspecified pleural effusion,Fitting and adjustment of automatic implantable cardiac defibrillator,Unspecified essential hypertension,Unspecified deficiency anemia,Personal history of other lymphatic and hematopoietic neoplasms,Osteoporosis, 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: Shortness of breath

PRESENT ILLNESS: This is a 75 year old female with history of non-ischemic
cardiomyopathy and atrial flutter. She was recently admitted to
[**Hospital3 35813**] Center on [**2130-8-14**] with congestive heart failure
and hypotension. Workup revealed severe mitral regurgitation and
severely depressed left ventricular function with an ejection
fraction of 30%. Her coronary arteries were angiographically
normal. Based on the above results, she was subsequently
transferred to [**Hospital1 18**] for operative care.

MEDICAL HISTORY: Non-ischemic cardiomyopathy, Hypertension, Atrial flutter with
history of failed ablation, s/p PPM/AICD placement, Chronic
anemia, Osteoporosis with multiple lumbar compression fractures,
History of non-Hodgkins lymphoma, Spinal stenosis with chronic
low back pain, History of seizures, History of herpetic
neuralgia, s/p chole, s/p appendectomy

MEDICATION ON ADMISSION: Warfarin - stopped PTA, ASA 325 qd, Coreg 6.25 [**Hospital1 **], Digoxin
0.125 qd, Cozaar 25 qd, Sotalol 160 [**Hospital1 **], Protonix 40 qd,
Spironolactone 12.5 qd, Tegretol 100 [**Hospital1 **], lasix 40 qd, Lexapro
10 qd, Colace, Senna, Oxycodone

ALLERGIES: Penicillins / Ace Inhibitors / Lidoderm / Codeine

PHYSICAL EXAM: Vitals: Temp 99.2, BP 106/50, HR 65 AV paced, R 18, SAT 99% RA
General: Elderly female in no acute distress
HEENT: oropharynx benign, PERRL, sclera anicteric
Neck: suppple, no JVD, no carotid bruits
Chest: lungs clear bilaterally
Heart: regular rate, s1s2, [**2-19**] holosystolic murmur
Abdomen: benign
Ext: warm, no pedal edema
Pulses: palpable distal pulses, no femoral bruits
Neuro: nonfocal

FAMILY HISTORY: Son diagnosed with coronary artery disease in his 40's.

SOCIAL HISTORY: No history of tobacco or ETOH. Lives with sister-in-law. 

### Response:
{'Congestive heart failure, unspecified,Mitral valve disorders,Atrial fibrillation,Other primary cardiomyopathies,Urinary tract infection, site not specified,Other and unspecified coagulation defects,Unspecified pleural effusion,Fitting and adjustment of automatic implantable cardiac defibrillator,Unspecified essential hypertension,Unspecified deficiency anemia,Personal history of other lymphatic and hematopoietic neoplasms,Osteoporosis, unspecified'}
