CHIEF COMPLAINT: Severe mitral regurgitation

PRESENT ILLNESS: 54 year old male with known mitral
valve prolapse and mitral regurgitation. Recent stress
echocardiogram showed partial flail posterior leaflet with
severe
mitral regurgitation. Current symptoms include exertional
dyspnea
and chest tightness. Also admits to decreased energy and
exercise
tolerance. Given the above findings, he was referred for
consideration of mitral valve repair.

MEDICAL HISTORY: Past Medical History:
- Mitral Valve Prolapse with significant Mitral Regurg
- Anxiety
- Colonic Polyps

MEDICATION ON ADMISSION: CLONAZEPAM 0.5 prn, VIAGRA 25 prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 72 Resp: 1  O2 sat: 96/RA
B/P  Right: 138/93   Left: 143/91
Height: 5'[**61**]"    Weight: 160 lbs

FAMILY HISTORY: Family History: Father CABG at age 82. Denies premature coronary
artery disease.

SOCIAL HISTORY: Lives with: Girlfriend in [**Name2 (NI) 1110**]
Occupation: Production Manager of theater department at
[**University/College 88005**]: quit [**2161-9-9**], approximate 20-30 PYH
ETOH: occasional wine, no history of abuse
Mitral valve disorders,Anxiety state, unspecified,Benign neoplasm of colon
Mitral valve disorder,Anxiety state NOS,Benign neoplasm lg bowel
Admission Date:  [**2162-2-25**]              Discharge Date:   [**2162-2-28**]

Date of Birth:  [**2107-6-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Severe mitral regurgitation

Major Surgical or Invasive Procedure:
Minimally invasive mitral valve repair using a
right-sided mini thoracotomy and posterior leaflet triangular
resection of P2 with ring annuloplasty using a 30-mm [**Doctor Last Name **]
Physio II ring model number 5200, serial number [**Serial Number 88004**].


History of Present Illness:
54 year old male with known mitral
valve prolapse and mitral regurgitation. Recent stress
echocardiogram showed partial flail posterior leaflet with
severe
mitral regurgitation. Current symptoms include exertional
dyspnea
and chest tightness. Also admits to decreased energy and
exercise
tolerance. Given the above findings, he was referred for
consideration of mitral valve repair.


Past Medical History:
Past Medical History:
- Mitral Valve Prolapse with significant Mitral Regurg
- Anxiety
- Colonic Polyps

Past Surgical History:
- Colonic Polypectomy
- Nasal Polypectomy
- Vasectomy


Social History:
Lives with: Girlfriend in [**Name2 (NI) 1110**]
Occupation: Production Manager of theater department at
[**University/College 88005**]: quit [**2161-9-9**], approximate 20-30 PYH
ETOH: occasional wine, no history of abuse


Family History:
Family History: Father CABG at age 82. Denies premature coronary
artery disease.


Physical Exam:
Pulse: 72 Resp: 1  O2 sat: 96/RA
B/P  Right: 138/93   Left: 143/91
Height: 5'[**61**]"    Weight: 160 lbs

General: no acute distress
Skin: Warm[x] 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 3/6 systolic
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
 [x] no palpable masses
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: Grossly intact

Pulses:
Femoral      Right: +2         Left: +2
DP           Right: +2         Left: +2
PT           [**Name (NI) 167**]: +2         Left: +2
Radial       Right: TR band    Left: +2


Pertinent Results:
[**2162-2-27**] 06:40AM BLOOD

WBC-11.3* RBC-3.25* Hgb-10.3* Hct-29.9* MCV-92 MCH-31.7
MCHC-34.4 RDW-12.8 Plt Ct-132*

[**2162-2-25**] 01:51PM BLOOD

PT-13.7* PTT-44.7* INR(PT)-1.2*

[**2162-2-27**] 06:40AM BLOOD

Glucose-124* UreaN-11 Creat-0.8 Na-138 K-4.2 Cl-103 HCO3-29
AnGap-10

[**2162-2-25**] 1:51 pm MRSA SCREEN      Source: Nasal swab.

MRSA SCREEN (Final [**2162-2-27**]):    No MRSA isolated.

CXR:

FINDINGS:

In comparison with study of [**2-25**], all of the monitoring and
support devices have been removed except for a right IJ sheath.
Specifically, there is no evidence of pneumothorax following
chest tube removal.

ECHO:

PRE-BYPASS: The left atrium is normal in 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. Left ventricular wall thicknesses and cavity
size are normal. There is moderate regional left ventricular
systolic dysfunction with moderate mid anterior, [**Last Name (un) **]-septal
and lateral wall hypokinesis. Apex is hypokinetic. Right
ventricular chamber size and free wall motion are normal. There
are simple atheroma in the descending thoracic aorta. There are
three aortic valve leaflets. The aortic valve leaflets are
mildly thickened (?#). There is no aortic valve stenosis. Mild
(1+) aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is moderate thickening of the mitral
valve chordae. Mild (1+) mitral regurgitation is seen. There is
no pericardial effusion.


Brief Hospital Course:
The patient was brought to the operating room on [**1-25**] where the
patient underwent Minimally invasive mitral valve repair using a
right-sided mini thoracotomy and posterior leaflet triangular
resection of P2 with ring annuloplasty using a 30-mm [**Doctor Last Name **]
Physio II ring model number 5200, serial number [**Serial Number 88004**].

Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.

The patient was transferred to the telemetry floor for further
recovery.  Chest tubes and pacing wires were discontinued
without complication.  The patient was evaluated by the physical
therapy service for assistance with strength and mobility.  By
the time of discharge on POD 4 the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.

The patient was discharged home in good condition with
appropriate follow up instructions.

Pt did have atrial, put on amiodarone converted to NSR, Has been
in NSR x 24 hrs.

Medications on Admission:
CLONAZEPAM 0.5 prn, VIAGRA 25 prn

Discharge Medications:
1. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for 4 weeks for 4 weeks.
Disp:*120 Tablet(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:*2*
3. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 30 days.
Disp:*60 Tablet(s)* Refills:*0*
4. oxycodone-acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
5. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400 mg po bid x 7 days, then 200 mg po bid x 7 days,
then 200 mg po qd untill f/u .
Disp:*120 Tablet(s)* Refills:*2*
6. furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
7. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO Q12H (every 12 hours)
for 7 days.
Disp:*14 Tablet, ER Particles/Crystals(s)* Refills:*0*
8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
9. oxycodone 5 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for
10 days.
Disp:*30 Tablet(s)* Refills:*0*
10. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
Severe mitral regurgitation
anxiety


Discharge Condition:
DISCHARGE CONDITION:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
DISCHARGE INSTRUCTIONS:
Please shower daily 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 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**
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge


Followup Instructions:
Dr[**Name (NI) 9379**] office has been notified to make you an
appointment, they should be calling you early next week. If you
do not hear from their office, please call and make an
appointment.

Name: [**Name8 (MD) 914**], M.D., [**Doctor First Name **] C.
Division:Cardiac Surgery
Organization:[**Hospital1 18**]
Office Location:W/LMOB 2A
Patient Phone:([**Telephone/Fax (1) 1504**]

Dr[**Name (NI) 79913**] office has been notified to make you an appointment,
they should be calling you early next week. If you do not hear
from their office, please call and make an appointment.

Name: [**Last Name (LF) **], [**First Name3 (LF) **] S
Department:cardiology
Office Location:[**Location (un) **]
Office Phone:([**Telephone/Fax (1) 66291**]

You should make an appointment with your PCP 2-4 weeks, please
call his office and schedule this.

Name: [**Last Name (LF) 3453**],[**First Name3 (LF) **] C
Location: [**Location (un) 2274**] [**University/College **]
Address: [**Hospital1 3470**], [**University/College **],[**Numeric Identifier 3471**]
Phone: [**Telephone/Fax (1) 3472**]

you have an appointment for a wound check [**3-10**] at 1015,
please show up at [**Hospital Ward Name **] 6 at this time.



Completed by:[**2162-2-28**]
{'Mitral valve disorders,Anxiety state, unspecified,Benign neoplasm of colon'}


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: Severe mitral regurgitation

PRESENT ILLNESS: 54 year old male with known mitral
valve prolapse and mitral regurgitation. Recent stress
echocardiogram showed partial flail posterior leaflet with
severe
mitral regurgitation. Current symptoms include exertional
dyspnea
and chest tightness. Also admits to decreased energy and
exercise
tolerance. Given the above findings, he was referred for
consideration of mitral valve repair.

MEDICAL HISTORY: Past Medical History:
- Mitral Valve Prolapse with significant Mitral Regurg
- Anxiety
- Colonic Polyps

MEDICATION ON ADMISSION: CLONAZEPAM 0.5 prn, VIAGRA 25 prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 72 Resp: 1  O2 sat: 96/RA
B/P  Right: 138/93   Left: 143/91
Height: 5'[**61**]"    Weight: 160 lbs

FAMILY HISTORY: Family History: Father CABG at age 82. Denies premature coronary
artery disease.

SOCIAL HISTORY: Lives with: Girlfriend in [**Name2 (NI) 1110**]
Occupation: Production Manager of theater department at
[**University/College 88005**]: quit [**2161-9-9**], approximate 20-30 PYH
ETOH: occasional wine, no history of abuse 

### Response:
{'Mitral valve disorders,Anxiety state, unspecified,Benign neoplasm of colon'}
