CHIEF COMPLAINT: New murmur

PRESENT ILLNESS: 51 year old gentleman with newly diagnosed heart murmur.
Echocardiogram notable for aortic insufficiency and a small,
mobile echodensity on the LV side of
the aortic valve measuring 4x4mm in diameter. Referred for AVR.

MEDICAL HISTORY: Aortic valve mass with severe aortic insufficiency
Hypertension
Hyperlipidemia
Gout
Obesity
Psoriasis

MEDICATION ON ADMISSION: Lisinopril 40mg Daily
Allopurinol
Amlodipine 10mg Daily
Amoxicillin 200 mg TID since [**1-16**] (tooth extraction)
Coreg CR 40 mg daily
HCTZ 25 daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:54  Resp:12  O2 sat:97% RA
B/P  Right:134/65    Left:
Height: 5'[**65**]'    Weight:285#

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Occupation: Works in IT at law firm
Lives with: Wife and daughter in [**Name (NI) 13421**]
Tobacco: Never
ETOH: Rare
Aortic valve disorders,Cardiac arrest,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Congenital insufficiency of aortic valve,Other specified conduction disorders,Coronary atherosclerosis of native coronary artery,Syncope and collapse,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Obesity, unspecified,Other psoriasis,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Cardiomegaly
Aortic valve disorder,Cardiac arrest,Acute kidney failure NOS,Surg compl-heart,Cong aorta valv insuffic,Conduction disorder NEC,Crnry athrscl natve vssl,Syncope and collapse,Hypertension NOS,Hyperlipidemia NEC/NOS,Gout NOS,Obesity NOS,Other psoriasis,Abn react-surg proc NEC,Cardiomegaly
Name:  [**Known lastname 13183**],[**Known firstname **] D.                 Unit No:   [**Numeric Identifier 13420**]

Admission Date:  [**2165-1-22**]              Discharge Date:   [**2165-1-29**]

Date of Birth:  [**2112-11-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 741**]
Addendum:
Chief Complaint:
New murmur

Major Surgical or Invasive Procedure:
[**2165-1-22**] cardiac catheterization
[**2165-1-23**] Aortic valve replacement (29mm St. [**Male First Name (un) 744**] porcine) and
removal aortic valve mass
[**2165-1-28**] AICD


History of Present Illness:
51 year old gentleman with newly diagnosed heart murmur.
Echocardiogram notable for aortic insufficiency and a small,
mobile echodensity on the LV side of
the aortic valve measuring 4x4mm in diameter. Referred for AVR.

Past Medical History:
Aortic valve mass with severe aortic insufficiency
Hypertension
Hyperlipidemia
Gout
Obesity
Psoriasis

Social History:
Occupation: Works in IT at law firm
Lives with: Wife and daughter in [**Name (NI) 13421**]
Tobacco: Never
ETOH: Rare

By transesphogeal echo during the surgery the patient had:
There are three aortic valve leaflets. There appears to be a
mass in the aortic sinus distal to the left coronary cusp. There
is a raphe extending from the right coronary cusp to the wall of
the aorta. There is no aortic valve stenosis. Severe (4+) aortic
regurgitation is seen. The aortic regurgitation jet is
eccentric, directed toward the anterior mitral leaflet.
His aortic valve was considered to be a congenitally abnormal
valve.

Additionally during his hospital stay he was noted to have an
acute kidney injury. His creatinine on admission was 1.0, during
the immediate post-operative period it climbed to 1.6 and
quickly resolved to its baseline prior to discharge.

Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) 102**]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2165-2-6**]

Admission Date:  [**2165-1-22**]              Discharge Date:   [**2165-1-29**]

Date of Birth:  [**2112-11-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
New murmur

Major Surgical or Invasive Procedure:
[**2165-1-22**] cardiac catheterization
[**2165-1-23**] Aortic valve replacement (29mm St. [**Male First Name (un) 923**] porcine) and
removal aortic valve mass
[**2165-1-28**] AICD


History of Present Illness:
51 year old gentleman with newly diagnosed heart murmur.
Echocardiogram notable for aortic insufficiency and a small,
mobile echodensity on the LV side of
the aortic valve measuring 4x4mm in diameter. Subsequent blood
cultures were negative. Denies history of fevers, chills and
rigors. Denies chest pain, dyspnea on exertion and orthopnea.
Based upon the above findings, he was referred for possible
aortic valve replacement surgery.

Past Medical History:
Aortic valve mass with severe aortic insufficiency
Hypertension
Hyperlipidemia
Gout
Obesity
Psoriasis


Social History:
Occupation: Works in IT at law firm
Lives with: Wife and daughter in [**Name (NI) 3786**]
Tobacco: Never
ETOH: Rare


Family History:
noncontributory


Physical Exam:
Pulse:54  Resp:12  O2 sat:97% RA
B/P  Right:134/65    Left:
Height: 5'[**65**]'    Weight:285#

General:
Skin: Dry [x] intact [x] + psoriatric lesions
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur IV/VI diastolic murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] small ventral hernia
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None []
Neuro: Grossly intact: No focal deficits
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: B/L transmitted murmur


Pertinent Results:
Admission Labs:
[**2165-1-22**] 09:25AM   PT-11.0 PTT-23.0 INR(PT)-0.9
[**2165-1-22**] 09:25AM   PLT COUNT-198
[**2165-1-22**] 09:25AM   WBC-5.6 RBC-4.72 HGB-13.4* HCT-39.5* MCV-84
MCH-28.4 MCHC-34.0 RDW-14.9
[**2165-1-22**] 09:25AM   %HbA1c-6.2* eAG-131*
[**2165-1-22**] 09:25AM   ALBUMIN-4.0 CALCIUM-9.1 CHOLEST-207*
[**2165-1-22**] 09:25AM   ALT(SGPT)-20 AST(SGOT)-20 CK(CPK)-125 ALK
PHOS-57 AMYLASE-29 TOT BILI-0.7 DIR BILI-0.1 INDIR BIL-0.6
[**2165-1-22**] 09:25AM   GLUCOSE-110* UREA N-26* CREAT-0.9 SODIUM-135
POTASSIUM-4.5 CHLORIDE-102 TOTAL CO2-24 ANION GAP-14
Discharge labs:
[**2165-1-29**] 02:34AM BLOOD WBC-9.3 RBC-3.92* Hgb-10.8* Hct-32.9*
MCV-84 MCH-27.6 MCHC-32.9 RDW-14.1 Plt Ct-246
[**2165-1-27**] 09:11PM BLOOD WBC-8.9 RBC-3.68* Hgb-10.2* Hct-30.6*
MCV-83 MCH-27.6 MCHC-33.2 RDW-14.1 Plt Ct-218
[**2165-1-29**] 02:34AM BLOOD PT-14.6* PTT-24.9 INR(PT)-1.3*
[**2165-1-28**] 02:16AM BLOOD PT-13.9* PTT-26.7 INR(PT)-1.2*
[**2165-1-27**] 05:43AM BLOOD PT-12.9 PTT-24.7 INR(PT)-1.1
[**2165-1-29**] 02:34AM BLOOD Glucose-99 UreaN-18 Creat-1.1 Na-137
K-4.7 Cl-101 HCO3-30 AnGap-11
[**2165-1-27**] 09:11PM BLOOD Glucose-133* UreaN-16 Creat-1.0 Na-136
K-4.3 Cl-100 HCO3-31 AnGap-9
Echo [**2165-1-23**]
Pre-bypass:
The left atrium and right atrium are normal in cavity size. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium or left atrial appendage. No atrial septal defect is
seen by 2D or color Doppler. The left ventricular cavity is
mildly dilated. Overall left ventricular systolic function is
low normal (LVEF 50-55%). Right ventricular chamber size and
free wall motion are normal. The aortic root is moderately
dilated at the sinus level. The ascending aorta is mildly
dilated. The aortic arch is mildly dilated. There are simple
atheroma in the aortic arch. There are complex (>4mm) atheroma
in the descending thoracic aorta. There are three aortic valve
leaflets. There appears to be a mass in the aortic sinus distal
to the left coronary cusp. There is a raphe extending from the
right coronary cusp to the wall of the aorta. There is no aortic
valve stenosis. Severe (4+) aortic regurgitation is seen. The
aortic regurgitation jet is eccentric, directed toward the
anterior mitral leaflet. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is no
pericardial effusion.
Post-bypass:
The patient is receiving no inotropic support post-CPB. There is
a bioprosthetic valve well-seated in the aortic position with
good leaflet excursion. There is no paravalvular or
transvalvular regurgitation. The mean gradient across the
prosthetic valve is 8 mm Hg at a cardiac output of 7.8 L/min.
Biventricular systolic function is preserved and similar to
prebypass function. All other findings are consistent with
pre-bypass findings. The aorta is intact post-decannulation. All
findings were discussed with the surgeon.
echo [**2165-1-28**]
Conclusions
The left and right atrium are moderately dilated. There is
moderate symmetric left ventricular hypertrophy. The left
ventricular cavity size is top normal with abnormal septal
motion (?post op vs. IVCD). Overall left ventricular systolic
function is mildly depressed (LVEF= 40-45 %). Right ventricular
chamber size and free wall motion are normal. The aortic arch is
mildly dilated. A well seated aortic bioprosthesis is seen with
thin/mobile leaflets. The transaortic gradient is slightly
increased (?anemia). No aortic regurgitation is seen. The mitral
valve leaflets are structurally normal. Mild (1+) mitral
regurgitation is seen. There is mild pulmonary artery systolic
hypertension. There is no pericardial effusion.
IMPRESSION: Moderate symmetic left ventricular hypertrophy with
mildly reduced global systolic function. Well seated aortic
valve bioprosthesis with slightly increased gradient. Mild
mitral regurgitation. Pulmonary artery systolic hypertension.
Radiology Report CHEST (PA & LAT) Study Date of [**2165-1-29**] 9:06 AM

Final Report
INDICATION: 52-year-old man, status post dual chamber ICD,
assess lead
placement.
COMPARISON: Chest radiograph from [**2165-1-26**].
PA AND LATERAL CHEST RADIOGRAPHS:
An ICD generator overlies the left pectoralis. The leads are
seen in
appropriate position within the right atrium and right
ventricle. There is no pneumothorax. The sternal wires are
intact. The lung parenchyma shows no focal or diffuse disease.
There is unchanged small left-sided pleural
effusion. The osseous structures are intact.
IMPRESSION: Appropriate ICD lead placement.
The study and the report were reviewed by the staff radiologist.

DR. [**First Name8 (NamePattern2) **] [**Name (STitle) 28398**]
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]


Brief Hospital Course:
Underwent cardiac catheterization and was admitted post
procedure for preoperative testing.  The next day he was brought
to the operating room and underwent aortic valve replacement and
mass removal.  See operative report for further details.  He
received vancomycin for perioperative antibiotics. In summary he
had: Aortic valve replacement with 29-mm St. [**Hospital 923**] Medical Biocor
Epic tissue valve, his bypass time was 87 minutes with a bypass
time of 65 minutes. He tolerated the operation well and was
transferred from the operating room to the cardiac surgery ICU
in stable condition.  In the first twenty four hours he was
weaned from sedation, awoke neurologically intact, and was
extubated without complications.  He remained in the intensive
care unit to monitor his renal function and heart rhythm due to
atrial fibrillation.  He was treated with beta blockers and
amiodarone for atrial fibrillation which continued, so he was
started on coumadin for anticoagulation. He remained
hemodynamically stable and was transferred from the ICU to the
stepdown unit on POD2. Early morning of POD3 [**2165-1-27**] (1:45am)
the patient suffered a ventricular tachycardic cardiac arrest.
He was successfully cardioverted  transferred back to cardiac
surgery ICU for further recovery and started on an amiodarone
drip.  All electrolytes were repleted per protocol  The
following evening he had a 30 beat run of v-tac which converted
to atrial fibrillation spontaneously.  The electrophysiology
service was consulted, he had electrophysiology studies(unable
to induce VT) and AICD was placed on [**2165-1-28**].  The device was
interrogated the following morning.  The patient was cleared by
physical therapy and discharged home with visiting nurses in
good condition on POD 6. He is to followup with Dr [**Last Name (STitle) **] in 6
weeks and with the device clinic in 1 week.

Medications on Admission:
Lisinopril 40mg Daily
Allopurinol
Amlodipine 10mg Daily
Amoxicillin 200 mg TID since [**1-16**] (tooth extraction)
Coreg CR 40 mg daily
HCTZ 25 daily


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
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:*0*
3. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. 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*
5. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 5 days.
Disp:*20 Capsule(s)* Refills:*0*
6. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
Disp:*30 Tablet(s)* Refills:*0*
7. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*0*
9. Outpatient Lab Work
serial PT/INR
dx: atrial fibrillation
goal INR 2-2.5
results to Dr. [**Last Name (STitle) 40570**] [**Telephone/Fax (1) 78480**]
10. Coumadin 2 mg Tablet Sig: as directed Tablet PO once a day:
Target INR 2-2.5

Dosing by Dr. [**Last Name (STitle) 40570**] [**Telephone/Fax (1) 78480**].
.
Disp:*75 Tablet(s)* Refills:*2*
11. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
aortic insufficiency s/p AVR
V-tac arrest [**2165-1-26**], s/p AICD [**2165-1-28**]
aortic valve mass
Post operative atrial fibrillation
Hypertension
hyperlipidemia
obesity
gout
psoriasis


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating steady gait
Sternal pain managed with percocet prn
Sternal and AICD incisions healing well/CDI


Discharge Instructions:
Please shower daily (following 1 week of sponge baths for AICD)
including washing incisions gently with mild soap, no baths or
swimming, and look at your incisions
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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Limit left arm movement x 6 weeks
Keep AICD area dry x 7 days (sponge bath for sternal incision-
no shower)
No driving x 6 months due to v-tac and syncopal episode

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2165-2-21**] 2:00
Please call to schedule appointments
Primary Care: [**First Name9 (NamePattern2) **] [**Last Name (LF) 79420**],[**First Name3 (LF) **] M [**Telephone/Fax (1) 78480**] in [**12-8**] weeks
Cardiologist:Dr.[**Last Name (STitle) **]  in [**12-8**] weeks
Labs: PT/INR for coumadin dosing, goal INR 2.0-2.5 for atrial
fibrillation with first draw [**2165-1-30**] results to Dr. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 40570**]
[**Doctor Last Name **] [**Telephone/Fax (1) 78480**]
Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2165-2-4**]
2:00



Completed by:[**2165-1-29**]
{'Aortic valve disorders,Cardiac arrest,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Congenital insufficiency of aortic valve,Other specified conduction disorders,Coronary atherosclerosis of native coronary artery,Syncope and collapse,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Obesity, unspecified,Other psoriasis,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Cardiomegaly'}


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: New murmur

PRESENT ILLNESS: 51 year old gentleman with newly diagnosed heart murmur.
Echocardiogram notable for aortic insufficiency and a small,
mobile echodensity on the LV side of
the aortic valve measuring 4x4mm in diameter. Referred for AVR.

MEDICAL HISTORY: Aortic valve mass with severe aortic insufficiency
Hypertension
Hyperlipidemia
Gout
Obesity
Psoriasis

MEDICATION ON ADMISSION: Lisinopril 40mg Daily
Allopurinol
Amlodipine 10mg Daily
Amoxicillin 200 mg TID since [**1-16**] (tooth extraction)
Coreg CR 40 mg daily
HCTZ 25 daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:54  Resp:12  O2 sat:97% RA
B/P  Right:134/65    Left:
Height: 5'[**65**]'    Weight:285#

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Occupation: Works in IT at law firm
Lives with: Wife and daughter in [**Name (NI) 13421**]
Tobacco: Never
ETOH: Rare 

### Response:
{'Aortic valve disorders,Cardiac arrest,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Congenital insufficiency of aortic valve,Other specified conduction disorders,Coronary atherosclerosis of native coronary artery,Syncope and collapse,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Obesity, unspecified,Other psoriasis,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Cardiomegaly'}
