CHIEF COMPLAINT: fever, cough , shortness of breath at home after discharge
[**2174-4-13**].

PRESENT ILLNESS: Mr [**Known lastname 77804**] is a 61yo male s/p MVrepair done on [**2174-4-8**]. He
progressed well from his surgery and was discharged to home with
servives on [**2174-4-13**]. He reports over the past 48-72 hours he
began experiencing a cough with dyspnea. [**5-9**] he became febrile
temp=101 and he vomited x 2. He also reports episodes of
increased heart rate and blood pressure associated with
coughing. Coughing was relieved with robitussin. Dr.[**Name (NI) 27809**]
office was called and Mr [**Known lastname 77804**] was told recommended to go to
the ED.

MEDICAL HISTORY: s/p MVrepair (#30 annuloplasty band [**2174-4-8**]), and gortex neo
band
HTN
GERD
Obesity
post op AFib
high cholesterol

MEDICATION ON ADMISSION: ASA 81(1)
Toprol XL 50(1)
Amiodarone 200(1)
Lasix 40(2)
KCL 10(1)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical exam prior to discharge
VS: T=98.5', 94/57,78 SR, rr:18,Wt.=111.7, 96% R/A
General: A&O x3, NAD
CVS:RRR
Lungs:CTA
ABD: benign
EXT:no C/C/E
sternum stable.

FAMILY HISTORY: NC

SOCIAL HISTORY: Denies tobacco use. Admits to several ETOH drinks with dinner.
Urinary tract infection, site not specified,Unspecified essential hypertension,Pure hypercholesterolemia,Obesity, unspecified,Esophageal reflux,Syncope and collapse
Urin tract infection NOS,Hypertension NOS,Pure hypercholesterolem,Obesity NOS,Esophageal reflux,Syncope and collapse
Admission Date:  [**2174-5-10**]              Discharge Date:   [**2174-5-14**]

Date of Birth:  [**2112-12-28**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
fever, cough , shortness of breath at home after discharge
[**2174-4-13**].

Major Surgical or Invasive Procedure:
s/p MV repair (#30 annuloplasty band) [**2174-4-8**].

History of Present Illness:
Mr [**Known lastname 77804**] is a 61yo male s/p MVrepair done on [**2174-4-8**]. He
progressed well from his surgery and was discharged to home with
servives on [**2174-4-13**]. He reports over the past 48-72 hours he
began experiencing a cough with dyspnea. [**5-9**] he became febrile
temp=101 and he vomited x 2. He also reports episodes of
increased heart rate and blood pressure associated with
coughing. Coughing was relieved with robitussin. Dr.[**Name (NI) 27809**]
office was called and Mr [**Known lastname 77804**] was told recommended to go to
the ED.

Past Medical History:
s/p MVrepair (#30 annuloplasty band [**2174-4-8**]), and gortex neo
band
HTN
GERD
Obesity
post op AFib
high cholesterol

Social History:
Denies tobacco use. Admits to several ETOH drinks with dinner.


Family History:
NC

Physical Exam:
Physical exam prior to discharge
VS: T=98.5', 94/57,78 SR, rr:18,Wt.=111.7, 96% R/A
General: A&O x3, NAD
CVS:RRR
Lungs:CTA
ABD: benign
EXT:no C/C/E
sternum stable.

Pertinent Results:
[**2174-5-13**] 06:00AM BLOOD WBC-5.5 RBC-3.05* Hgb-9.2* Hct-27.1*
MCV-89 MCH-30.0 MCHC-33.8 RDW-14.4 Plt Ct-177
[**2174-5-12**] 02:54AM BLOOD WBC-6.0 RBC-3.18* Hgb-9.4* Hct-28.2*
MCV-89 MCH-29.6 MCHC-33.3 RDW-14.5 Plt Ct-179
[**2174-5-12**] 02:54AM BLOOD Glucose-103 UreaN-18 Creat-1.0 Na-138
K-4.0 Cl-106 HCO3-21* AnGap-15
[**2174-5-11**] 02:12PM BLOOD Glucose-118* UreaN-15 Creat-1.0 Na-138
K-4.3 Cl-106 HCO3-23 AnGap-13

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 77805**]Portable TTE
(Complete) Done [**2174-5-11**] at 12:18:52 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2112-12-28**]
Age (years): 61 M  Hgt (in): 69
BP (mm Hg): 111/74  Wgt (lb): 244
HR (bpm): 78  BSA (m2): 2.25 m2
Indication: Endocarditis.
ICD-9 Codes: 424.0, 424.90, 424.1, 424.2
Test Information
Date/Time: [**2174-5-11**] at 12:18    Interpret MD: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
[**Last Name (NamePattern1) **], MD
Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**Name2 (NI) **] L.
[**Hospital1 **], RDCS
Doppler: Full Doppler and color Doppler Test Location: [**Location 13333**]/[**Hospital Ward Name 121**] 6
Contrast: None Tech Quality: Adequate
Tape #: 2008W000-0:00 Machine: Vivid i-3
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *5.4 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.9 cm  <= 5.2 cm
Right Atrium - Four Chamber Length:  *6.6 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  0.9 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  0.9 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *5.7 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  >= 55%  >= 55%
Aorta - Sinus Level:  *3.9 cm  <= 3.6 cm
Aorta - Ascending:  *3.5 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.2 m/sec  <= 2.0 m/sec
Mitral Valve - E Wave:  1.7 m/sec
Mitral Valve - A Wave:  0.4 m/sec
Mitral Valve - E/A ratio:  4.25
Mitral Valve - E Wave deceleration time:  202 ms  140-250 ms

Findings
LEFT ATRIUM: LA volume markedly increased (>32ml/m2).

RIGHT ATRIUM/INTERATRIAL SEPTUM: Moderately dilated RA.

LEFT VENTRICLE: Normal LV wall thickness. Mildly dilated LV
cavity. Overall normal LVEF (>55%). No resting LVOT gradient.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
Paradoxic septal motion consistent with prior cardiac surgery.

AORTA: Mildly dilated aortic sinus. Focal calcifications in
aortic root. Mildly dilated ascending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mitral
valve annuloplasty ring. Well-seated mitral annular ring with
normal gradient. No mass or vegetation on mitral valve. Mild
mitral annular calcification. No MS. Trivial MR. [Due to
acoustic shadowing, the severity of MR may be significantly
UNDERestimated.]

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR. Indeterminate PA systolic pressure.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

PERICARDIUM: No pericardial effusion.
Conclusions
The left atrial volume is markedly increased (>32ml/m2). The
right atrium is moderately dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity is mildly
dilated. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The aortic root is mildly dilated at the sinus
level. The ascending aorta is mildly dilated. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. A mitral valve annuloplasty ring
is present. The mitral annular ring appears well seated and is
not obstructing flow. No mass or vegetation is seen on the
mitral valve. Trivial mitral regurgitation is seen. [Due to
acoustic shadowing, the severity of mitral regurgitation may be
significantly UNDERestimated.] The pulmonary artery systolic
pressure could not be determined. There is no pericardial
effusion.

IMPRESSION: No obvious vegetation or abscess seen. There is a
small, linear echodensity on the ventricular side of the
anterior mitral valve leaflet. It is probably the synthetic
mitral chord. This appears to be causing some turbulent flow
directed towards the posterior leaflet during systole. There is
trivial mitral regurgitation (may be underestimated due to
shadowing). Overall LV systolic function appears intact.

If clinically suggested, the absence of a vegetation by 2D
echocardiography does not exclude endocarditis.
  Electronically signed by [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2174-5-11**] 16:17

   RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2174-5-11**] 1:57 PM

CHEST (PORTABLE AP)

Reason: ? infiltrate

[**Hospital 93**] MEDICAL CONDITION:
61 year old man with s/p mv repair readmit for fever
REASON FOR THIS EXAMINATION:
? infiltrate
CHEST RADIOGRAPH

INDICATION: Readmission for fever.

FINDINGS: As compared to the previous radiograph of [**2174-5-10**], there is unchanged subtle cardiomegaly. Status post mitral
valve replacement. Unchanged minimal fluid overload, no focal
parenchymal opacity suggestive of pneumonia. No pleural
effusions.

DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]
Approved: WED [**2174-5-11**] 4:42 PM


Brief Hospital Course:
[**5-10**] Mr [**Known lastname 77804**] was admitted for observation and further workup
for fever-cough and dyspnea; likely from volume overload. TTE
performed, blood cultures sent, beta-blocker reduced and
diuresis increased. Antibiotic therapy for a positive UTI was
completed with Bactrim. All remaining cultures were negative. No
futher events of fever and dyspnea. On [**2174-5-13**] Mr [**Known lastname 77804**] was
felt to be fully recovered after adequate diuresis and ABX
therapy for his UTI. He was discharged to home and recommended
to keep followup visits with his PCP, [**Name10 (NameIs) **], and
DrKhabbaz.

Medications on Admission:
ASA 81(1)
Toprol XL 50(1)
Amiodarone 200(1)
Lasix 40(2)
KCL 10(1)


Discharge Medications:
1. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
UTI


Discharge Condition:
Good.


Discharge Instructions:
Return to the emergency room if you develop fever, shortness of
breath,

Followup Instructions:
Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 77806**] 1 week
Already scheduled appointments:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 16827**] Date/Time:[**2174-6-16**] 1:00
Provider:  [**Name10 (NameIs) 27270**] [**Name11 (NameIs) **] TESTING Phone:[**Telephone/Fax (1) 11767**]
Date/Time:[**2174-5-18**] 9:00



Completed by:[**2174-5-16**]
{'Urinary tract infection, site not specified,Unspecified essential hypertension,Pure hypercholesterolemia,Obesity, unspecified,Esophageal reflux,Syncope and collapse'}


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: fever, cough , shortness of breath at home after discharge
[**2174-4-13**].

PRESENT ILLNESS: Mr [**Known lastname 77804**] is a 61yo male s/p MVrepair done on [**2174-4-8**]. He
progressed well from his surgery and was discharged to home with
servives on [**2174-4-13**]. He reports over the past 48-72 hours he
began experiencing a cough with dyspnea. [**5-9**] he became febrile
temp=101 and he vomited x 2. He also reports episodes of
increased heart rate and blood pressure associated with
coughing. Coughing was relieved with robitussin. Dr.[**Name (NI) 27809**]
office was called and Mr [**Known lastname 77804**] was told recommended to go to
the ED.

MEDICAL HISTORY: s/p MVrepair (#30 annuloplasty band [**2174-4-8**]), and gortex neo
band
HTN
GERD
Obesity
post op AFib
high cholesterol

MEDICATION ON ADMISSION: ASA 81(1)
Toprol XL 50(1)
Amiodarone 200(1)
Lasix 40(2)
KCL 10(1)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical exam prior to discharge
VS: T=98.5', 94/57,78 SR, rr:18,Wt.=111.7, 96% R/A
General: A&O x3, NAD
CVS:RRR
Lungs:CTA
ABD: benign
EXT:no C/C/E
sternum stable.

FAMILY HISTORY: NC

SOCIAL HISTORY: Denies tobacco use. Admits to several ETOH drinks with dinner. 

### Response:
{'Urinary tract infection, site not specified,Unspecified essential hypertension,Pure hypercholesterolemia,Obesity, unspecified,Esophageal reflux,Syncope and collapse'}
