CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 75yo woman with past medical history of cardiomyopathy and know
mitral regurgitation admiited for heparinization bridge for
history of Afib. Pre-op MVR

MEDICAL HISTORY: Past Medical History:
Atrial Fibrillation s/p AV node ablation
Breast CA s/p bilat mastectomy
Cardiomyopathy (EF 40-50%)
Hypertension
Mitral Regurgitation
Sarcoid - negative myocardial biopsy [**2116**]
Past Surgical History:
PPM [**2117-11-16**] ([**First Name8 (NamePattern2) **] [**Male First Name (un) 923**])

MEDICATION ON ADMISSION: Actonel 35 QWk
ASA 81 QD
Calcium 600 qd
Coreg 3.125 [**Hospital1 **]
Coumadin 1mg QMon and Fri/2mg rest of week- LAST DOSE [**2121-4-2**]
Digoxin .125 qd
Fish Oil 1000 qd
Lasix 40 QD
Lisinopril 5 QD
MAg Oxide 400 qd
MVI
Potassium Chloride 10mEq qd
Proteinex 40
Zocor 10 QD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 75 VP Resp: 16  O2 sat: 100%-RA
B/P  Right: 128/76   Left:
Height:  5'0"   Weight: 64.2

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Last Dental Exam: 1 wk ago
Lives with:very involved daughters
Occupation: retired
Tobacco: Quit 45pack year history
ETOH:
Mitral valve disorders,Other primary cardiomyopathies,Atrial fibrillation,Unspecified essential hypertension,Sarcoidosis,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Personal history of noncompliance with medical treatment, presenting hazards to health,Personal history of urinary calculi,Long-term (current) use of anticoagulants
Mitral valve disorder,Prim cardiomyopathy NEC,Atrial fibrillation,Hypertension NOS,Sarcoidosis,Hx of breast malignancy,Acq absnce breast/nipple,Hx of past noncompliance,Prsnl hst urnr dsrd calc,Long-term use anticoagul
Admission Date:  [**2121-4-6**]              Discharge Date:   [**2121-4-13**]

Date of Birth:  [**2045-6-19**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2121-4-8**] - Mitral Valve Repair (28mm Annuloplasty Ring)
[**2121-4-7**] - Cardiac Catheterizatin


History of Present Illness:
75yo woman with past medical history of cardiomyopathy and know
mitral regurgitation admiited for heparinization bridge for
history of Afib. Pre-op MVR


Past Medical History:
Past Medical History:
Atrial Fibrillation s/p AV node ablation
Breast CA s/p bilat mastectomy
Cardiomyopathy (EF 40-50%)
Hypertension
Mitral Regurgitation
Sarcoid - negative myocardial biopsy [**2116**]
Past Surgical History:
PPM [**2117-11-16**] ([**First Name8 (NamePattern2) **] [**Male First Name (un) 923**])


Social History:
Last Dental Exam: 1 wk ago
Lives with:very involved daughters
Occupation: retired
Tobacco: Quit 45pack year history
ETOH:


Family History:
non contributory


Physical Exam:
Pulse: 75 VP Resp: 16  O2 sat: 100%-RA
B/P  Right: 128/76   Left:
Height:  5'0"   Weight: 64.2

General:NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur 3/6 SEM
Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x]
Extremities: Warm [x], well-perfused [x]  Edema: trace bilateral
lower extremity edema/ chronic left upper extremity lymphedema
Varicosities: None [x]
Neuro: Grossly intact- nonfocal exam
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  no


Pertinent Results:
[**2121-4-7**] Cardiac Catheterization
1.  Selective coronary angiography of this right-dominant system

demonstrated no angiographically apparent flow-limiting coronary
artery
disease.  The LMCA, LAD, LCx, and RCA all had no
angiographically
apparent flow-limiting disease.
2.  Resting hemodynamics revealed normal left- and right-sided
filling
pressures with an LVEDP of 17 mmHg and an RVEDP of 4 mmHg.
Pulmonary
arterial pressures were normal at 35/15 mmHg.  Mean PCWP was
normal at
15 mmHg.  Cardiac output was decreased at 3.65 L/min with an
index of
2.09 L/min/m2.
3.  Left ventriculography demonstrated [**1-30**]+ moderately severe
mitral
regurgitation.  Ventricular function was decreased at 33-45%.
There was
severe anteroapical and inferoapical hypokinesis.

FINAL DIAGNOSIS:
1.  No angiographically apparent coronary disease.
2.  Moderately severe mitral regurgitation.
3.  Left ventricular dysfuction with EF 33-45% and severe
anterioapical
and inferoapical hypokinesis.
4.  Normal left- and right-sided filling pressures.

[**2121-4-8**] ECHO
Pre Bypass: The left atrium is moderately dilated. No atrial
septal defect is seen by 2D or color Doppler. There is mild
global left ventricular hypokinesis (LVEF = 45 %). Right
ventricular chamber size and free wall motion are normal. There
are three aortic valve leaflets. There is no aortic valve
stenosis. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. There is partial posterior mitral
leaflet flail at P3 with severe prolapse at P1 as well..
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). The tricuspid
valve leaflets are mildly thickened. Wires can be seen entering
the RV and Coronary Sinus consistent with BiV pacer. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] is
seen passing through the atrium and ventricle into the pulmonary
artery.

Post Bypass: The patient is AV paced on epinepherine and
phenylepherine infusions. Left ventricular function remains
unchanged, except prominent septal dyskinesis consistent with
epicardial V pacing. Initial RV dysfunction seen post bypass
improved to baseline over time (suspect coronary air). Tricuspid
regurgitation is severe initially post bypasss, is mild to
moderte by chest closure with improved RV function. The RV wire
and PA catheter are seen as pre bypass. The coronary sinus wire
can not be identified in the sinus. There is an additional thin
structure with a small lucent mass on the end seen just above
the tricuspid valve. It may be associated with the pre-existing
coronary sinus wire (consider migration of the wire into the
RA), but association with the tricuspid valve can not be
excluded. Aortic contours intact. Remaining exam is unchanged.
All findings discussed with surgeons at the time of the exam.


Brief Hospital Course:
Ms. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2121-4-7**] for cardiac
catheterization and surgical management of her mitral valve
disease. Her cardiac catheterization revealed clean coronaries.
She was worked-up in the usual preoperative manner. Heparin was
started as a bridge to surgery as she had previously been on
coumadin for atrial fibrillation. On [**2121-4-8**], she was taken to
the operating room where she underwent a mitral valve repair.
Please see operative note for surgical details. Postoperatively
she was taken to the intensive care unit for monitoring. Over
the next several hours, she awoke neurologically intact and was
extubated without difficulty. She weaned off pressors and was
started on Beta-blocker/Statin/Aspirin, and diuresis. She was
transferred to the floor on POD #1 to begin increasing her
activity level. Physical Therapy was consulted for evaluation of
strength and mobility. Home physical therapy was recommended on
discharge. Many of her preoperative medications were resumed.
She continued to progress and on [**2121-4-13**] she was cleared for
discharge to home with VNA. All follow up appointments were
advised.
Dr. [**Last Name (STitle) 1683**] will resume coumadin management as an outpatient. She
will take 1mg on [**2121-4-14**] and have her blood checked [**2121-4-15**].

Medications on Admission:
Actonel 35 QWk
ASA 81 QD
Calcium 600 qd
Coreg 3.125 [**Hospital1 **]
Coumadin 1mg QMon and Fri/2mg rest of week- LAST DOSE [**2121-4-2**]
Digoxin .125 qd
Fish Oil 1000 qd
Lasix 40 QD
Lisinopril 5 QD
MAg Oxide 400 qd
MVI
Potassium Chloride 10mEq qd
Proteinex 40
Zocor 10 QD

Discharge Medications:
1. carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Coumadin 1 mg Tablet Sig: As instructed by Dr. [**Last Name (STitle) 31149**] for a
goal INR of 2.0-2.5 Tablets PO once a day: Please [**Last Name (un) **] as
instructed by Dr. [**Last Name (STitle) 1683**]. .
Disp:*30 Tablet(s)* Refills:*2*
8. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Fish Oil 1,000 (120-180) mg Capsule Sig: One (1) Capsule PO
once a day.
10. digitek  Sig: One (1) 0.125mg (125mcg)  once a day.
Disp:*30 Tablets* Refills:*2*
11. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
12. lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
13. potassium chloride 10 mEq Tablet Extended Release Sig: One
(1) Tablet Extended Release PO once a day.
Disp:*30 Tablet Extended Release(s)* Refills:*2*
14. magnesium oxide 400 mg Tablet Sig: One (1) Tablet PO once a
day.
15. Actonel 35 mg Tablet Sig: One (1) Tablet PO once a month.


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Hospital Homecare

Discharge Diagnosis:
Atrial Fibrillation s/p AV node ablation
Breast CA s/p bilat mastectomy
Cardiomyopathy (EF 40-50%)
Hypertension
Mitral Regurgitation s/p MV repair
Sarcoid - negative myocardial biopsy [**2116**]


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
1+ 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) Coumadin dosing per Dr. [**Last Name (STitle) 1683**]. Take 1mg on Monday [**4-14**] and
then as instructed by Dr. [**Last Name (STitle) 1683**].
7) You may resume your at home fish oil, multivitamins, Actonel
and magnesium oxide.
8) 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) **] on Thursday [**2121-5-1**] 1:30PM
Cardiologist:Dr. [**Last Name (STitle) 83788**] in 3 weeks. Please call [**Telephone/Fax (1) 8226**]
to schedule appointment.
Wound check appointment [**2121-4-17**] at 11:00AM [**Hospital **] Medical
Buliding [**Hospital Unit Name **]
Please call to schedule appointments with your
Primary Care Dr.[**Last Name (STitle) 1683**] in [**4-1**] weeks [**Telephone/Fax (1) 35326**]

**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 A Fib
Goal INR 2.0-2.5
First draw day after discharge Tuesday [**2121-4-15**]. This may be done
at Dr.[**Name (NI) 10122**] lab or by visiting nurse. You will then be
instructed on what dose to take. You may take 1mg on [**2121-4-14**].
Results to phone [**Telephone/Fax (1) 35326**], Dr. [**Last Name (STitle) 1683**] will continue to
follow- confirmed with [**Doctor First Name 717**]



Completed by:[**2121-4-13**]
{'Mitral valve disorders,Other primary cardiomyopathies,Atrial fibrillation,Unspecified essential hypertension,Sarcoidosis,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Personal history of noncompliance with medical treatment, presenting hazards to health,Personal history of urinary calculi,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: Dyspnea on exertion

PRESENT ILLNESS: 75yo woman with past medical history of cardiomyopathy and know
mitral regurgitation admiited for heparinization bridge for
history of Afib. Pre-op MVR

MEDICAL HISTORY: Past Medical History:
Atrial Fibrillation s/p AV node ablation
Breast CA s/p bilat mastectomy
Cardiomyopathy (EF 40-50%)
Hypertension
Mitral Regurgitation
Sarcoid - negative myocardial biopsy [**2116**]
Past Surgical History:
PPM [**2117-11-16**] ([**First Name8 (NamePattern2) **] [**Male First Name (un) 923**])

MEDICATION ON ADMISSION: Actonel 35 QWk
ASA 81 QD
Calcium 600 qd
Coreg 3.125 [**Hospital1 **]
Coumadin 1mg QMon and Fri/2mg rest of week- LAST DOSE [**2121-4-2**]
Digoxin .125 qd
Fish Oil 1000 qd
Lasix 40 QD
Lisinopril 5 QD
MAg Oxide 400 qd
MVI
Potassium Chloride 10mEq qd
Proteinex 40
Zocor 10 QD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 75 VP Resp: 16  O2 sat: 100%-RA
B/P  Right: 128/76   Left:
Height:  5'0"   Weight: 64.2

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Last Dental Exam: 1 wk ago
Lives with:very involved daughters
Occupation: retired
Tobacco: Quit 45pack year history
ETOH: 

### Response:
{'Mitral valve disorders,Other primary cardiomyopathies,Atrial fibrillation,Unspecified essential hypertension,Sarcoidosis,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Personal history of noncompliance with medical treatment, presenting hazards to health,Personal history of urinary calculi,Long-term (current) use of anticoagulants'}
