CHIEF COMPLAINT: Shortness of breath.

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 62-year-old
woman with known mitral stenosis who complained of shortness
of breath with minimal exertion times five years progressing
over the past several months. She presented to the emergency
room at an outside hospital on [**8-8**] with a complaint
of shortness of breath, cyanosis and palpitations.  She was
found on admission to the emergency room to be in atrial
flutter and was cardioverted with diltiazem drip.  The
patient was then transferred to [**Hospital1 188**] for further evaluation.  The patient had an
echocardiogram done on [**8-11**] that showed an ejection
fraction of 35 to 40 percent with global hypokinesis 1 to 2
plus, aortic regurgitation, severe mitral stenosis with 1 to
2 plus mitral regurgitation and 2 plus tricuspid
regurgitation.  She then had a cardiac catheterization done
on the [**8-12**] that showed mitral valve area of 0.77
cm squared with severe mitral stenosis, moderate pulmonary
hypertension, ejection fraction of 60 percent.

MEDICAL HISTORY: Atrial fibrillation, atrial stenosis,
mitral stenosis, mitral regurgitation, diabetes mellitus,
hypertension, asthma, hypercholesterolemia, status post
permanent pacemaker five years ago, gastroesophageal reflux
disease, sleep apnea, uses BiPAP at home, congestive heart
failure and lupus.

MEDICATION ON ADMISSION: 

ALLERGIES: Lasix, Codeine, Ceclor, Keflex, Penicillin,
Voltaren and tape.

PHYSICAL EXAM: 

FAMILY HISTORY: None.  Mother had a stroke, otherwise
unknown.

SOCIAL HISTORY: Lives in East ________ with her husband.
[**Name (NI) 1139**] - quit approximately two weeks prior to admission and
had smoked for 20 years prior to that.  Alcohol - denies use.
Mitral stenosis,Diseases of tricuspid valve,Atrial flutter,Rheumatic heart failure (congestive),Primary hypercoagulable state,Other and unspecified angina pectoris,Other chronic pulmonary heart diseases,Unspecified essential hypertension
Mitral stenosis,Tricuspid valve disease,Atrial flutter,Rheumatic heart failure,Prim hypercoagulable st,Angina pectoris NEC/NOS,Chr pulmon heart dis NEC,Hypertension NOS
Admission Date: [**2110-8-9**]        Discharge Date: [**2110-8-27**]

Date of Birth:  [**2048-4-3**]        Sex:  F

Service:  CSU


This dictation is done for the cardiothoracic service.

CHIEF COMPLAINT:  Shortness of breath.

HISTORY OF PRESENT ILLNESS:  Mrs. [**Known lastname **] is a 62-year-old
woman with known mitral stenosis who complained of shortness
of breath with minimal exertion times five years progressing
over the past several months. She presented to the emergency
room at an outside hospital on [**8-8**] with a complaint
of shortness of breath, cyanosis and palpitations.  She was
found on admission to the emergency room to be in atrial
flutter and was cardioverted with diltiazem drip.  The
patient was then transferred to [**Hospital1 188**] for further evaluation.  The patient had an
echocardiogram done on [**8-11**] that showed an ejection
fraction of 35 to 40 percent with global hypokinesis 1 to 2
plus, aortic regurgitation, severe mitral stenosis with 1 to
2 plus mitral regurgitation and 2 plus tricuspid
regurgitation.  She then had a cardiac catheterization done
on the [**8-12**] that showed mitral valve area of 0.77
cm squared with severe mitral stenosis, moderate pulmonary
hypertension, ejection fraction of 60 percent.

PAST MEDICAL HISTORY:  Atrial fibrillation, atrial stenosis,
mitral stenosis, mitral regurgitation, diabetes mellitus,
hypertension, asthma, hypercholesterolemia, status post
permanent pacemaker five years ago, gastroesophageal reflux
disease, sleep apnea, uses BiPAP at home, congestive heart
failure and lupus.

ALLERGIES:  Lasix, Codeine, Ceclor, Keflex, Penicillin,
Voltaren and tape.

MEDICATIONS AT HOME:
1. Glyburide 5 q.d.
2. Bumex 2 q.d.
3. Paxil 40 q.d.
4. Protonix 40 q.d.
5. Colchicine 0.6 b.i.d.
6. Synthroid 25 mcg q.d.
7. Aspirin 81 q.d.
8. Nicotine 41 mg topically q.d.
9. Metoprolol 25 b.i.d.
10.      Trazodone 100 q. H.s.
11.      Clonazepam 0.5 q.d.
12.      Coumadin 5 alternating with 2.5 and metformin 500
   b.i.d.


SOCIAL HISTORY:  Lives in East ________ with her husband.
[**Name (NI) 1139**] - quit approximately two weeks prior to admission and
had smoked for 20 years prior to that.  Alcohol - denies use.

FAMILY HISTORY:  None.  Mother had a stroke, otherwise
unknown.

REVIEW OF SYMPTOMS:  General:  Weight is stable.  Poor
appetite.  She takes sleeping pills. Skin:  Positive
pruritus, no lesions.  Head, ears, eyes, nose and throat:
Positive headaches, migraines, wears glasses, positive
sinusitis, epistaxis and rhinorrhea, positive sore throat and
no hoarseness.  Respiratory:  history of asthma, history of
bronchitis, pneumonia about a year ago.  No chronic
obstructive pulmonary disease.  Cardiovascular:  Positive
edema, palpitations, and angina.  History of hypertension and
hypercholesterolemia. Gastrointestinal:  History of abdominal
pain and fatty liver.  History of a liver cyst and
gastroesophageal reflux disease.  Musculoskeletal:  History
of soldier fracture.  No surgery. History of claudication.
History of osteoarthritis.  Heme:  Bruises easily on
Coumadin, currently positive lupus.  Psych:  Positive
depression and positive anxiety.

PHYSICAL EXAMINATION:  Height is 5 feet and 1 inch, weight is
180 pounds. Vital signs:  Temperature is 96.5, heart rate is
68, Respiratory rate is 20, O2 sat is 100 percent on room
air.  In general, sitting up in no acute distress eating
dinner.  Neurological:  Alert and oriented times 3,
appropriate, slow to answer questions, no carotid bruits.
Respiratory: Fine rales bilaterally.  Cardiovascular:
Regular rate and rhythm. S1 and S2 with a 3/6 systolic
ejection murmur loudest at the apex.  Gastrointestinal:
Nontender.  Somewhat firm, positive bowel sounds.
Extremities:  2 plus edema with varicosities bilaterally.
Pulses are 1plus throughout.

LABORATORY DATA:  White blood cell count is 7.6, hematocrit
is 37.8, platelets 237, sodium 138, potassium 4.2, chloride
99, CO2 31, BUN 12, creatinine 0.8, glucose 132, PT 14.7, PTT
30.5, INR is 1.4.

Following the patient's cardiac valuation, she ws seen by the
neurology service after complaining about right arm
paralysis.  Initial CAT scan was negative. She also underwent
carotid duplex which showed no significant lesions in either
the right or the left. Additionally, the patient was seen
prior to the psychiatry service and thought that she had some
mild delirium, however, was not acutely depressed.  Over the
next several days, the patient's neurological and psychiatric
issues were sorted out and ultimately the patient was brought
to the Operating Room on [**8-18**].  Please see the Operating
Room report for full details.

In summary, the patient had a mitral valve replacement
[**11-15**] with a St. [**Male First Name (un) 923**] mechanical valve, tricuspid
valve repair with a number 28 anuloplasty ring and a Mays
procedure.  She tolerated the operation well and was
transferred from the Operating Room to the Cardiothoracic
Intensive Care Unit.  Once in the Cardiothoracic Intensive
Care Unit, the patient's anesthesia was reversed.  Initial
attempts at weaning her from the ventilator were
unsuccessful.  On postoperative day 1, the patient remained
intubated and was hemodynamically stable. Therefore, her
sedatives were again discontinued. She was successfully
weaned from the ventilator and extubated.  Following
extubation, the patient was inconsistently following commands
with a flat affect. The patient was seen by the
electrophysiology service on postoperative day 1 as she was
having periods of ventricular paced rhythm with a rate of
120's via her permanent pacemaker.  However, by the time the
electrophysiologist saw her, she was no longer having these
episodes and no intervention was required. Her amiodarone
dose was adjusted per the recommendations and she is to have
follow up with Dr. [**Last Name (STitle) **].  On postoperative day 2, the
patient was successfully weaned from her __| QA MARKER: 498
|____.  She remained hemodynamically stable throughout this.
Heparin infusion was started to protect her mechanical mitral
valve.  Within the next several days, the patient remained
hemodynamically.  However, neurologically, she fluctuated
between periods of restlessness and lethargy with a flat
affect in a uncooperative manner.  By postoperative day 3,
she was much more alert and cooperative.  Her chest tubes and
temporary pacing wires were removed and she remained
hemodynamically stable.  On postoperative day 4, she was
transferred from the Cardiothoracic Intensive Care Unit Floor
2 for continuing postoperative care and cardiac
rehabilitation.  Once on the floor, the patient continued to
be followed by the neurology and psychiatry services.  She
became more interactive with the staff. She remained
hemodynamically stable throughout this. She was restarted on
Coumadin and maintained on heparin infusion while awaiting a
therapeutic INR.  By postoperative day 8, the patient's INR
had approached therapeutic range. Her heparin infusion ws
discontinued and she was screened for rehabilitation for
potential discharge to rehabilitation for continuing care. On
postoperative day 9, it was decided that the patient was
stable and ready to be discharged when a bed became
available.

At the time of this dictation, the patient's physical
examination is as follows:  Vital signs - temperature 98.3,
heart rate 75 in sinus rhythm, blood pressure is 116/69,
Respiratory rate is 20, O2 sat is 95 percent on room air.
Weight preoperatively was 82 kilograms and at discharge was
77 kilograms.

LABORATORY DATA:  PT is 17.4, PTT 1.9, white blood cell count
is 9, hematocrit 36.3, platelets 334, sodium 141, potassium
3.6, chloride 101, chloride 31, BUN 14, creatinine 0.9,
glucose 86.

PHYSICAL EXAMINATION:  Neurologically, alert and oriented,
moves all extremities, follows commands.  Respiratory :
Clear to auscultation bilaterally.  Cardiovascular:  regular
rate and rhythm, S1 and S2 with clicks.  Sternum is stable.
Incision with steri-strips, open to air, clean and dry.
Abdomen: Soft and nontender and nondistended with positive
bowel sounds.  Extremities: Warm and well perfused with 1
plus edema.

The patient's condition at discharge is good. She is to be
discharged to rehabilitation.

DISCHARGE DIAGNOSIS:
1. Mitral stenosis, status post mitral valve replacement with
   a number 27 St. [**Male First Name (un) 923**] mechanical valve.
2. Tricuspid regurgitation, status post tricuspid valve
   repair with a number 28 anuloplasty ring.
3. Atrial fibrillation, status post Mays procedure.
4. Diabetes mellitus.
5. Hypertension.
6. Asthma.
7. Hypercholesterolemia.
8. Status post permanent pacemaker.

The patient is to have follow up with Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] 2 to 3 weeks
and follow up with Dr. [**Last Name (STitle) **] in four weeks and follow up
with Dr. [**Last Name (STitle) **] in four weeks.

DISCHARGE MEDICATIONS:
1. Colace 100 mg b.i.d.
2. Pantoprazole 40 mg q.d.
3. Bumex 2 mg q.d.
4. Potassium chloride 20 mEq q.d.
5. Captopril 12.5 mg t.i.d.
6. Warfarin as directed to maintain a target INR of 3 to 3.5.
   The patient has received 3 mg for the last 3 days.
7. Paroxetine 30 mg q.d.
8. Amiodarone 200 mg q.d.
9. Levothyroxine 25 mcg q.d.
10.      Colchicine 0.6 mg b.i.d.
11.      Econazole powder p.r.n.
12.      Ibuprofen 400 mg q. 4 to 6 hours p.r.n.

The patient will need an INR check on [**2110-8-28**] for
Coumadin dosing.



                        [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 5897**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2110-8-27**] 13:43:16
T:  [**2110-8-27**] 15:01:23
Job#:  [**Job Number 57787**]


Name:  [**Known lastname 571**], [**Known firstname **]          Unit No:  [**Numeric Identifier 10733**]

Admission Date: [**2110-8-9**]        Discharge Date: [**2110-9-5**]

Date of Birth:  [**2048-4-3**]        Sex:  F

Service:  CSU


ADDENDUM TO PREVIOUS DISCHARGE SUMMARY DATED [**Numeric Identifier 10734**]:  Please
see previous Discharge Summary for full past medical history
and [**Hospital 1325**] hospital course up until [**2110-8-27**]. Patient was
originally scheduled to be discharged to Rehabilitation.
However, before a bed at the rehabilitation facility could
become available the patient progressed sufficiently with
physical therapy to the point where she was deemed safe for
discharge to home.  Subsequently the patient remained in the
hospital for several days awaiting her INR to increase to a
safe level and by postoperative day number 18 her INR had
risen to 2.9 and she was cleared for discharge to home.

CONDITION AT DISCHARGE:  Temperature maximum 97.9, pulse 76,
blood pressure 108/68, respiratory rate 16, room air oxygen
saturation 97 percent.  Neurologically the patient is awake,
alert and oriented times three.  Her examination is nonfocal.
Heart is regular rate and rhythm with a sharp mild click and
no murmur.  Respiratory:  Breath sounds were clear
bilaterally.  Gastrointestinal:  Positive bowel sounds, soft,
nontender, nondistended, tolerating a regular diet.
Extremities:  Lower extremities have bilateral varicosities.
No evidence of edema.  Sternal incision is clean and dry.
There is no erythema or drainage.

Chest x-ray performed on [**9-5**] showed a small right effusion,
was without evidence of infiltrate or pneumothorax.

LABORATORY DATA:  Her PT was 21.4, her INR was 2.9.

Patient is to be discharged to home in stable condition.

DISCHARGE DIAGNOSES:
1. Mitral stenosis, status post mitral valve replacement with
   a [**Street Address(2) 10735**]. [**Male First Name (un) 744**] mechanical valve.
2. Tricuspid regurgitation, status post tricuspid valve
   repair.
3. Atrial fibrillation.
4. Status post Maze procedure.
5. Diabetes mellitus.
6. Hypertension.
7. Asthma.
8. Hypercholesterolemia.
9. Status post VVI permanent pacemaker.
10.      Anxiety.


DISCHARGE MEDICATIONS:
1. Colace 100 mg P.O. B.I.D
2. Protonix 40 mg P.O. once daily.
3. Bumex 2 mg P.O. once daily.
4. Amiodarone 200 mg P.O. once daily.
5. Synthroid 25 mcg P.O. once daily.
6. Colchicine 0.6 mg P.O. B.I.D
7. Ibuprofen 400 mg P.O. q 4 to 6 hours p.r.n.
8. Coumadin.  Patient is to be discharged with alternating
   doses of 7 [**12-20**] and 10 mg of Coumadin.  She is to take 7.5
   mg of Coumadin on [**9-5**].  She is to have her INR checked on
   [**9-6**].  If the INR is within range of 3.0 to 3.5 she is to
   take 10 mg Coumadin on [**9-6**].  She is also to have her INR
   checked on [**9-7**] and again if the INR if sufficient she to
   take 7.5 mg of Coumadin on [**9-7**].  These laboratories will
   be followed by Dr.[**Name (NI) 10736**] house staff with appropriate
   instructions to the Visiting Nurse and patient is to have
   INR drawn on [**9-8**] with results called to her primary care
   physician, [**Last Name (NamePattern4) **].[**Name (NI) 10737**] office.
9. Paxil 40 mg P.O. once daily.
10.      Nicotine transdermal patch 7 mg patch transdermal
   once daily.
11.      Trazodone 25 mg P.O. once daily.
12.      Clonopin 0.5 mg P.O. once daily.
13.      Glyburide 5 mg P.O. once daily.
14.      Glucophage 500 mg P.O. B.I.D
15.      Lisinopril 10 mg P.O. once daily.
16.      Lopressor 12.5 mg P.O. B.I.D

Patient is to follow up with her cardiologist, Dr. [**Last Name (STitle) **], in two
to three weeks.  She is to follow up with her primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 2031**], by phone on [**9-8**] for INR results
and in person in two to three weeks.  She is to follow up
with Dr. [**Last Name (STitle) **] in four weeks.  She is to follow up with Dr.
[**Last Name (STitle) **] from electrophysiology service in four weeks for
evaluation of her pacemaker.  Her Coumadin follow up is as
above.  The INR on [**9-6**] and [**9-7**] will be checked by Dr.[**Name (NI) 10738**] house staff and on [**9-8**] will be checked by Dr.[**Name (NI) 10739**] office.



                        [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 6562**]

Dictated By:[**Last Name (NamePattern4) 7369**]
MEDQUIST36
D:  [**2110-9-5**] 15:20:37
T:  [**2110-9-5**] 17:57:38
Job#:  [**Job Number 10740**]
{'Mitral stenosis,Diseases of tricuspid valve,Atrial flutter,Rheumatic heart failure (congestive),Primary hypercoagulable state,Other and unspecified angina pectoris,Other chronic pulmonary heart diseases,Unspecified essential hypertension'}


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: Mrs. [**Known lastname **] is a 62-year-old
woman with known mitral stenosis who complained of shortness
of breath with minimal exertion times five years progressing
over the past several months. She presented to the emergency
room at an outside hospital on [**8-8**] with a complaint
of shortness of breath, cyanosis and palpitations.  She was
found on admission to the emergency room to be in atrial
flutter and was cardioverted with diltiazem drip.  The
patient was then transferred to [**Hospital1 188**] for further evaluation.  The patient had an
echocardiogram done on [**8-11**] that showed an ejection
fraction of 35 to 40 percent with global hypokinesis 1 to 2
plus, aortic regurgitation, severe mitral stenosis with 1 to
2 plus mitral regurgitation and 2 plus tricuspid
regurgitation.  She then had a cardiac catheterization done
on the [**8-12**] that showed mitral valve area of 0.77
cm squared with severe mitral stenosis, moderate pulmonary
hypertension, ejection fraction of 60 percent.

MEDICAL HISTORY: Atrial fibrillation, atrial stenosis,
mitral stenosis, mitral regurgitation, diabetes mellitus,
hypertension, asthma, hypercholesterolemia, status post
permanent pacemaker five years ago, gastroesophageal reflux
disease, sleep apnea, uses BiPAP at home, congestive heart
failure and lupus.

MEDICATION ON ADMISSION: 

ALLERGIES: Lasix, Codeine, Ceclor, Keflex, Penicillin,
Voltaren and tape.

PHYSICAL EXAM: 

FAMILY HISTORY: None.  Mother had a stroke, otherwise
unknown.

SOCIAL HISTORY: Lives in East ________ with her husband.
[**Name (NI) 1139**] - quit approximately two weeks prior to admission and
had smoked for 20 years prior to that.  Alcohol - denies use. 

### Response:
{'Mitral stenosis,Diseases of tricuspid valve,Atrial flutter,Rheumatic heart failure (congestive),Primary hypercoagulable state,Other and unspecified angina pectoris,Other chronic pulmonary heart diseases,Unspecified essential hypertension'}
