CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 82 year old female with known mitral regurgitation who
has been experiencing worsening shortness of breath and
orthopnea. She is followed closely by Dr. [**Last Name (STitle) 5017**] who has been
adjusting her diuretic therapy. Despite medical therapy, she
continues to experience heart failure symptoms. She was seen in
clinic by Dr. [**Last Name (STitle) **] on [**2127-6-12**] and now presents for
preadmission testing in preparation for surgery.

MEDICAL HISTORY: Chronic Diastolic Congestive Heart Failure/Mitral Regurgitation
Questionable History of Myocardial Infarction [**2125-1-22**]
Hypertension
Obesity
Osteoarthritis, Left Knee - requires Cortisone shots
Polymyositis
Gout
Small Splenic Aneurysm
Hiatal Hernia
Cataracts
Hypothyroidism

MEDICATION ON ADMISSION: Lasix 40 qd
Levothyroxine 25 qd
Lisinopril 10 qd
Metoprolol Succ 25 qd
Pepcid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Family History: Brother - heart attack at age 49

SOCIAL HISTORY: Occupation: Retired Waitress
Last Dental Exam : Full dentures
Lives with: Husband
[**Name (NI) 1139**]: never
ETOH: never
Mitral valve disorders,Chronic diastolic heart failure,Polymyositis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Obesity, unspecified,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Gout, unspecified,Unspecified acquired hypothyroidism
Mitral valve disorder,Chr diastolic hrt fail,Polymyositis,Crnry athrscl natve vssl,Hypertension NOS,Obesity NOS,Loc osteoarth NOS-l/leg,Gout NOS,Hypothyroidism NOS
Admission Date:  [**2127-7-21**]              Discharge Date:   [**2127-7-26**]

Date of Birth:  [**2044-8-2**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
Coronary artery bypass x1(Left internal mammary artery grafted
to left anterior descending artery)/Mitral Valve repair (#28mm
CG annuloplasty ring)-[**2127-7-21**]


History of Present Illness:
82 year old female with known mitral regurgitation who
has been experiencing worsening shortness of breath and
orthopnea. She is followed closely by Dr. [**Last Name (STitle) 5017**] who has been
adjusting her diuretic therapy. Despite medical therapy, she
continues to experience heart failure symptoms. She was seen in
clinic by Dr. [**Last Name (STitle) **] on [**2127-6-12**] and now presents for
preadmission testing in preparation for surgery.

Past Medical History:
Chronic Diastolic Congestive Heart Failure/Mitral Regurgitation
Questionable History of Myocardial Infarction [**2125-1-22**]
Hypertension
Obesity
Osteoarthritis, Left Knee - requires Cortisone shots
Polymyositis
Gout
Small Splenic Aneurysm
Hiatal Hernia
Cataracts
Hypothyroidism

Social History:
Occupation: Retired Waitress
Last Dental Exam : Full dentures
Lives with: Husband
[**Name (NI) 1139**]: never
ETOH: never


Family History:
Family History: Brother - heart attack at age 49


Physical Exam:
Physical Exam

Pulse:  92 Resp: 16  O2 sat: 95%
B/P  Right:  142/80  Left: 135/85
Height: 65"    Weight: 180

General: Elderly obese female in no acute distress
Skin: Dry [x] intact [x], No C/C
HEENT: PERRLA, EOMI, NCAT, OP Benign, Edentulous
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [**3-28**] holosytolc murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema - trace
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: 2  Left: 2


Pertinent Results:
[**2127-7-22**] 03:00AM BLOOD WBC-15.6* RBC-3.70* Hgb-11.0* Hct-33.2*
MCV-90 MCH-29.7 MCHC-33.2 RDW-13.4 Plt Ct-148*
[**2127-7-21**] 03:25PM BLOOD WBC-15.9*# RBC-3.60* Hgb-10.4*# Hct-30.6*
MCV-85 MCH-29.0 MCHC-34.1 RDW-13.9 Plt Ct-156
[**2127-7-21**] 03:25PM BLOOD PT-15.2* PTT-38.2* INR(PT)-1.3*
[**2127-7-21**] 02:07PM BLOOD PT-16.4* PTT-36.6* INR(PT)-1.5*
[**2127-7-23**] 05:25AM BLOOD WBC-13.2* RBC-3.28* Hgb-9.7* Hct-29.7*
MCV-91 MCH-29.5 MCHC-32.5 RDW-13.6 Plt Ct-118*
[**2127-7-21**] 03:25PM BLOOD PT-15.2* PTT-38.2* INR(PT)-1.3*
[**2127-7-23**] 05:25AM BLOOD Glucose-104 UreaN-29* Creat-1.2* Na-139
K-4.8 Cl-107 HCO3-21* AnGap-16
[**2127-7-25**] 05:30AM BLOOD UreaN-21* Creat-0.8 K-3.9

pre-CPB: 82 yr old female w/ pmhx of htn and CAD whose
intraoperative echocardiogram showed normal left ventricular
function with an EF> 55% and no evidence of abnormal wall
motion. There was severe mitral regurgitation with myxomatous
degeneration of both leaflets and partail flail. The vena
contracta was > 7 mm.
Multiplanar reconstructions were generated and confirmed on an
independent workstation.

LEFT ATRIUM: Dilated LA. No mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good
(>20 cm/s) LAA ejection velocity.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA. A catheter or pacing wire is seen
in the RA and extending into the RV. No ASD by 2D or color
Doppler.

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness and cavity
size. 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. Simple atheroma in descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (?#). Trace
AR.

MITRAL VALVE: Myxomatous mitral valve leaflets. Partial mitral
leaflet flail. MR vena contracta is >=0.7cm Severe (4+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.


PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. A TEE was performed in the location listed above. I
certify I was present in compliance with HCFA regulations. The
patient was monitored by a nurse [**First Name (Titles) **] [**Last Name (Titles) 9833**] throughout the
procedure. The patient was under general anesthesia throughout
the procedure. The patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.
post-CPB: patient was weaned from bypass with 1 mcg/kg/min of
phenylehrine. There was no evidence of new regional wall motion
abnormalities and EF was > 55%. A well seated mitral
annuloplasty ring was seen with interrogation via Doppler
revealing minimal residual regurgitation in the settinag of a
mean gradient of 4 mm Hg. All findings discussed with surgeons
at the time of the exam.
Conclusions
The left atrium is dilated. No mass/thrombus is seen in 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. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. There are simple atheroma in
the descending thoracic aorta. Trace aortic regurgitation is
seen. The mitral valve leaflets are myxomatous. There is partial
mitral leaflet flail. The mitral regurgitation vena contracta is
>=0.7cm. Severe (4+) mitral regurgitation is seen. There is no
pericardial effusion.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2127-7-23**] 12:32


?????? [**2121**] CareGroup IS. All rights reserved.


Brief Hospital Course:
[**7-21**] Ms.[**Known lastname **] was taken to the operating room and underwent
coronary artery bypass grafting x1(left internal mammary artery
grafted to the left anterior descending artery)/Mitral Valve
repair (#28mm CG annuloplasty ring). Cross clamp time = 56
minutes. Cardiopulmonary Bypass time= 74 minutes. Please refer
to Dr[**Last Name (STitle) **] operative report for further details. She was
transferred in critical but stable condition to the CVICU. She
awoke neurologically intact and was extubated without
difficulty. All lines and drains were discontinued in a timely
fashion. Beta-blocker and diuretic was initiated. She continued
to progress and was transferred to the step down unit on POD#1
for further monitoring. Physical therapy was consulted and
evaluated the patient.  Ms.[**Known lastname **] postoperative course was
essentially uneventful. She continued to progress and was
cleared by Dr.[**Last Name (STitle) **] for discharge to rehab on POD #5.  All
follow up appointments were advised.

Medications on Admission:
Lasix 40 qd
Levothyroxine 25 qd
Lisinopril 10 qd
Metoprolol Succ 25 qd
Pepcid


Discharge Medications:
1. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
4. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
8. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
9. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
10. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q4H (every 4 hours) as
needed for wheezing.
11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day). Tablet(s)
12. Furosemide 80 mg Tablet Sig: One (1) Tablet PO twice a day.
Tablet(s)
13. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day. Tab
Sust.Rel. Particle/Crystal(s)


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 5016**] [**Doctor Last Name 1495**] Raphaels TCU - [**Location (un) 7661**]

Discharge Diagnosis:
Coronary artery disease/Mitral Regurgitation


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

Dr [**Last Name (STitle) **],[**First Name3 (LF) **] H. [**Telephone/Fax (1) 5424**] in 1 week, please call for
appointment
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])





Completed by:[**2127-7-26**]
{'Mitral valve disorders,Chronic diastolic heart failure,Polymyositis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Obesity, unspecified,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Gout, unspecified,Unspecified acquired hypothyroidism'}


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: 82 year old female with known mitral regurgitation who
has been experiencing worsening shortness of breath and
orthopnea. She is followed closely by Dr. [**Last Name (STitle) 5017**] who has been
adjusting her diuretic therapy. Despite medical therapy, she
continues to experience heart failure symptoms. She was seen in
clinic by Dr. [**Last Name (STitle) **] on [**2127-6-12**] and now presents for
preadmission testing in preparation for surgery.

MEDICAL HISTORY: Chronic Diastolic Congestive Heart Failure/Mitral Regurgitation
Questionable History of Myocardial Infarction [**2125-1-22**]
Hypertension
Obesity
Osteoarthritis, Left Knee - requires Cortisone shots
Polymyositis
Gout
Small Splenic Aneurysm
Hiatal Hernia
Cataracts
Hypothyroidism

MEDICATION ON ADMISSION: Lasix 40 qd
Levothyroxine 25 qd
Lisinopril 10 qd
Metoprolol Succ 25 qd
Pepcid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Family History: Brother - heart attack at age 49

SOCIAL HISTORY: Occupation: Retired Waitress
Last Dental Exam : Full dentures
Lives with: Husband
[**Name (NI) 1139**]: never
ETOH: never 

### Response:
{'Mitral valve disorders,Chronic diastolic heart failure,Polymyositis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Obesity, unspecified,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Gout, unspecified,Unspecified acquired hypothyroidism'}
