CHIEF COMPLAINT: dyspnea on exertion

PRESENT ILLNESS: 68 year old male with history of mitral valve prolapse,
transferred to [**Hospital1 18**] from [**Hospital3 **] with new-onset afib
and
troponin elevation to 0.07. He reports 6-7 days of fatigue, and
[**2-19**] day history of sore throat. Over past several days, has also
had a dull pain in his left shoulder, which typically occurs in
the morning and has resolved with aspirin. He was not having any
dyspnea, though did note dyspnea on exertion earlier today when
walking across the street (usually able to do so w/o
difficulty).
Upon echocardiogram was found to have moderate to severe mitral
regurgitation and is now being referred to cardiac surgery for a
mitral valve replacement.

MEDICAL HISTORY: Mitral valve prolapse
HL
BPH
Constipation
s/p hernia surgery
s/p remote throat surgery (30-40 yrs ago per patient) for speech
problems

MEDICATION ON ADMISSION: Losartan 25mg daily
Tamsulosin 0.4mg daily
Finasteride 5mg HS
MVI daily
Fibercon 625mg HS
Colace 100mg [**Hospital1 **]
Florigen 1 PO BID
Miralax daily
Coumadin 5mg daily for afib****
cephalexin until [**1-9**] for strep throat
Plavix - last dose:none

ALLERGIES: Amoxicillin

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Father had CAD, MI in 60s. No known family history of arrythmias
or sudden death.

SOCIAL HISTORY: Married, lives with wife. Owns small business selling hearing
aids. Denies tobacco or illicit drug use. Has never smokd. No
EtOH.
Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Constipation, unspecified,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Anemia, unspecified
Mitral valve disorder,Crnry athrscl natve vssl,Atrial fibrillation,BPH w/o urinary obs/LUTS,Constipation NOS,Long-term use anticoagul,Hyperlipidemia NEC/NOS,Anemia NOS
Admission Date:  [**2197-1-22**]              Discharge Date:   [**2197-1-28**]

Date of Birth:  [**2128-12-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Amoxicillin

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


Major Surgical or Invasive Procedure:
[**2197-1-26**]
Coronary Artery Bypass Graft x 3 LIMA->LAD, SVG->OM2, SVG->RCA,
Mitral valve Repair


History of Present Illness:
68 year old male with history of mitral valve prolapse,
transferred to [**Hospital1 18**] from [**Hospital3 **] with new-onset afib
and
troponin elevation to 0.07. He reports 6-7 days of fatigue, and
[**2-19**] day history of sore throat. Over past several days, has also
had a dull pain in his left shoulder, which typically occurs in
the morning and has resolved with aspirin. He was not having any
dyspnea, though did note dyspnea on exertion earlier today when
walking across the street (usually able to do so w/o
difficulty).
Upon echocardiogram was found to have moderate to severe mitral
regurgitation and is now being referred to cardiac surgery for a
mitral valve replacement.


Past Medical History:
Mitral valve prolapse
HL
BPH
Constipation
s/p hernia surgery
s/p remote throat surgery (30-40 yrs ago per patient) for speech
problems

Social History:
Married, lives with wife. Owns small business selling hearing
aids. Denies tobacco or illicit drug use. Has never smokd. No
EtOH.


Family History:
Father had CAD, MI in 60s. No known family history of arrythmias
or sudden death.

Physical Exam:
Physical Exam

Pulse:99 Resp:18  O2 sat:99/RA
B/P 135/78
Height:5'1.5"     Weight:57.6 kgs

General:
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 III/VI, systolic
murmur
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: none   Left: none

Pertinent Results:
[**2197-1-26**] 10:00AM BLOOD Hct-23.9*
[**2197-1-26**] 05:45AM BLOOD WBC-9.2 RBC-2.45* Hgb-7.8* Hct-22.2*
MCV-91 MCH-31.9 MCHC-35.2* RDW-13.0 Plt Ct-96*
[**2197-1-22**] 03:00PM BLOOD WBC-6.0 RBC-3.98* Hgb-12.6* Hct-36.6*
MCV-92 MCH-31.7 MCHC-34.4 RDW-12.3 Plt Ct-220
[**2197-1-26**] 05:45AM BLOOD PT-23.1* INR(PT)-2.2*
[**2197-1-22**] 03:00PM BLOOD PT-13.0* PTT-31.4 INR(PT)-1.2*
[**2197-1-26**] 05:45AM BLOOD Glucose-107* UreaN-20 Creat-1.0 Na-133
K-3.7 Cl-99
[**2197-1-22**] 03:00PM BLOOD Glucose-163* UreaN-25* Creat-1.2 Na-136
K-4.2 Cl-102 HCO3-26 AnGap-12


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 91938**] (Complete)
Done [**2197-1-23**] at 9:22:39 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2128-12-14**]
Age (years): 68 M  Hgt (in): 54
BP (mm Hg): 112/50  Wgt (lb): 119
HR (bpm): 69  BSA (m2): 1.39 m2
Indication: Chest pain. Congestive heart failure. Coronary
artery disease. Left ventricular function. Mitral valve disease.
Preoperative assessment. Valvular heart disease.
ICD-9 Codes: 428.0, 402.90, 786.05, 424.0, 424.2
Test Information
Date/Time: [**2197-1-23**] at 09:22    Interpret MD: [**Name6 (MD) 3892**] [**Name8 (MD) 3893**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2012AW-1: Machine: us2
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Four Chamber Length:  *5.7 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  1.1 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.2 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Left Ventricle - Stroke Volume:  36 ml/beat
Left Ventricle - Cardiac Output:  2.46 L/min
Left Ventricle - Cardiac Index:  *1.77  >= 2.0 L/min/M2
Aorta - Annulus:  2.0 cm  <= 3.0 cm
Aorta - Sinus Level:  2.9 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.7 cm  <= 3.0 cm
Aorta - Ascending:  2.8 cm  <= 3.4 cm
Aorta - Arch:  2.0 cm  <= 3.0 cm
Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  1.1 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  5 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  2 mm Hg
Aortic Valve - LVOT VTI:  14
Aortic Valve - LVOT diam:  1.8 cm
Aortic Valve - Valve Area:  *2.0 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Moderate LA enlargement. No spontaneous echo
contrast in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good (>20 cm/s) LAA
ejection velocity.

RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Normal regional LV systolic function. Overall normal LVEF
(>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Normal
descending aorta diameter.

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

MITRAL VALVE: Myxomatous mitral valve leaflets. Moderate/severe
MVP. No MS. Eccentric MR jet. MR vena contracta is >=0.7cm
Severe (4+) MR.

TRICUSPID VALVE: Moderate [2+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Written informed consent was obtained from the
patient. The patient was under general anesthesia throughout the
procedure. No TEE related complications. The patient appears to
be in sinus rhythm. Results were personally reviewed with the MD
caring for the patient. See Conclusions for post-bypass data
Conclusions
PRE-BYPASS: The left atrium is moderately dilated. 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 size is normal. Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is normal (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen. The mitral valve
leaflets are myxomatous. There is moderate/severe anterior
leaflet mitral valve prolapse. An eccentric, posteriorly
directed jet of mitral regurgitation is seen. The mitral
regurgitation vena contracta is >=0.7cm. Severe (4+) mitral
regurgitation is seen. Moderate [2+] tricuspid regurgitation is
seen. There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified
in person of the results prior to incision.

POST-BYPASS: The patient is in sinus rhythm. The patient is on
no inotropes. Biventricular function is unchanged. There is a
mitral annuloplasty ring in place. Trace to mild mitral
regurgitation is seen. There is a peak gradient of 6 mmHg at a
blood pressure of 92/51. Tricuspid regurgitation is mild. The
aorta is intact post-decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2197-1-24**] 12:41


?????? [**2187**] CareGroup IS. All rights reserved.


Brief Hospital Course:
On [**2197-1-23**] Mr. [**Known lastname 91937**] was taken to the operating room and
underwent Coronary artery bypass grafting x 3 (left internal
mammary artery grafted to the left anterior diagnal/ saphenous
vein grafted to Right coronary artery and Obtuse Marginal) with
Dr.[**Last Name (STitle) **]. Cardiopulmonary Bypass Time=114 minutes. Cross Clamp
Time=96 minutes. Please refer to the operative report for
further surgical details. He tolerated the procedure well and
was transferred to the CVICU intubated and sedated requiring
pressor support. He awoke neurologically intact and was
extubated. He weaned off pressor support and was started on
beta-blocker/Statin/ aspirin and diuresis. He had ventricular
ectopy requiring an Amiodarone drip. His postop rhythm went back
to his baseline paroxysmal atrial fibrillation and
anticoagulation was resumed with Coumadin. All lines and drains
were discontinued per protocol. POD#1 he was transferred to the
step down unit for further monitoring and increased activity.
Physical Therapy was consulted for evaluation of strength and
mobility. He received a unit of packed red blood cells for
postoperative anemia likely due to volume resuscitation. His
hematocrit remained stable. The remainder of his hospital course
was essentially uneventful. He was cleared for discharge to home
with services on POD#5. All follow up appointments were advised.


Medications on Admission:
Losartan 25mg daily
Tamsulosin 0.4mg daily
Finasteride 5mg HS
MVI daily
Fibercon 625mg HS
Colace 100mg [**Hospital1 **]
Florigen 1 PO BID
Miralax daily
Coumadin 5mg daily for afib****
cephalexin until [**1-9**] for strep throat
Plavix - last dose:none


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
4. warfarin 1 mg Tablet Sig: as directed  Tablet PO once a day:
indication: afib
goal INR 2.0-2.5.
Disp:*30 Tablet(s)* Refills:*2*
5. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
6. finasteride 5 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
7. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
8. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day: 2
tabs daily for 7 days then on [**2197-2-4**] begin 1 tablet daily until
advised to stop.
Disp:*60 Tablet(s)* Refills:*2*
9. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
11. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
12. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 5
days.
Disp:*5 Tablet(s)* Refills:*0*
13. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO once a day for 5 days.
Disp:*10 Tablet Extended Release(s)* Refills:*0*
14. Outpatient Lab Work
INR check on [**2197-1-30**] and call to Dr. [**Last Name (STitle) 28436**]  [**Telephone/Fax (1) 17503**] for
coumadin dosing ****very senstitve to coumadin******


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Coronary Artery Disease, Mitral Valve prolapse


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with Percocet
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
trace Edema



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**]

**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) **] [**Telephone/Fax (1) 170**] on Date/Time:[**2197-2-22**] 1:15 in
the [**Hospital **] medical office building [**Hospital Unit Name **], [**Doctor First Name **]
WOUND CARE NURSE Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2197-2-2**] 10:00 in
the [**Hospital **] medical office building [**Hospital Unit Name **], [**Doctor First Name **]
Cardiologist: Dr [**Last Name (STitle) 10543**] [**2197-2-21**] at 11:30am

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 28436**] in [**3-23**] weeks [**Telephone/Fax (1) 17503**]

**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 Paroxysmal Atrial
fibrillation
Goal INR 2.0-2.5
First draw [**2197-1-30**]
Results to phone Dr [**Last Name (STitle) 28436**] [**Telephone/Fax (1) 17503**]



Completed by:[**2197-1-28**]
{'Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Constipation, unspecified,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Anemia, 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: dyspnea on exertion

PRESENT ILLNESS: 68 year old male with history of mitral valve prolapse,
transferred to [**Hospital1 18**] from [**Hospital3 **] with new-onset afib
and
troponin elevation to 0.07. He reports 6-7 days of fatigue, and
[**2-19**] day history of sore throat. Over past several days, has also
had a dull pain in his left shoulder, which typically occurs in
the morning and has resolved with aspirin. He was not having any
dyspnea, though did note dyspnea on exertion earlier today when
walking across the street (usually able to do so w/o
difficulty).
Upon echocardiogram was found to have moderate to severe mitral
regurgitation and is now being referred to cardiac surgery for a
mitral valve replacement.

MEDICAL HISTORY: Mitral valve prolapse
HL
BPH
Constipation
s/p hernia surgery
s/p remote throat surgery (30-40 yrs ago per patient) for speech
problems

MEDICATION ON ADMISSION: Losartan 25mg daily
Tamsulosin 0.4mg daily
Finasteride 5mg HS
MVI daily
Fibercon 625mg HS
Colace 100mg [**Hospital1 **]
Florigen 1 PO BID
Miralax daily
Coumadin 5mg daily for afib****
cephalexin until [**1-9**] for strep throat
Plavix - last dose:none

ALLERGIES: Amoxicillin

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Father had CAD, MI in 60s. No known family history of arrythmias
or sudden death.

SOCIAL HISTORY: Married, lives with wife. Owns small business selling hearing
aids. Denies tobacco or illicit drug use. Has never smokd. No
EtOH. 

### Response:
{'Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Constipation, unspecified,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Anemia, unspecified'}
