CHIEF COMPLAINT: intraventricular mass

PRESENT ILLNESS: This 80 year old female with no significant cardiac history was
found to have a 1.2 x 0.7cm mobile mass of the left ventricle.
The mass was noted to be attached to the papillary muscle. She
has no signs or symptoms of endocarditis and it does not appear
to be a thrombus or malignancy. She has had no signs of
emboliztion. She was referred for surgical evaluation regarding
removal of the mass in [**Month (only) 205**] and returns now for excision.

MEDICAL HISTORY: Hypertension
Carotid Artery Stenosis
Hypercholesterolemia
Osteopenia
noninsulin dependent Diabetes Mellitus
Renal Insufficiency (baseline Cr 1.9)Psoriasis - patient denies
Hypothyroidism
Irritable Bowel Syndrome Polylmyalgia Rheumatica
Gout
Proteiuria
Diabetic Neuropathy
Skin Cancer
s/p Cataract surgery
s/p Tonsilectomy

MEDICATION ON ADMISSION: ATENOLOL -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth once a day
DOXAZOSIN -  (Prescribed by Other Provider) - 2 mg Tablet - 1
Tablet(s) by mouth once a day
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth twice a day
LEVOTHYROXINE -  (Prescribed by Other Provider) - 75 mcg Tablet
- 1 Tablet(s) by mouth once a day
METFORMIN -  (Prescribed by Other Provider) - 500 mg Tablet - 1
Tablet(s) by mouth twice a day
PREDNISONE -  (Prescribed by Other Provider) - 1 mg Tablet - 3
Tablet(s) by mouth once a day
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day

ALLERGIES: Norvasc / lisinopril

PHYSICAL EXAM: Pulse: 63 Resp: 16 O2 sat: 99%
B/P   Right: 178/70   Left: 181/76
Height: 5'1"   Weight: 136lb

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 1 month ago
Lives with: Wife
Contact: [**Name (NI) 4906**]              Phone #
Occupation: Retired
Cigarettes: Smoked no [] yes [x] last cigarette _1992 Hx: vague
historian
Other Tobacco use: denies
ETOH: < 1 drink/week [] [**1-23**] drinks/week [] >8 drinks/week []
Illicit drug use: denies
Endocardial fibroelastosis,Delirium due to conditions classified elsewhere,Polyneuropathy in diabetes,Atrial fibrillation,Polymyalgia rheumatica,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Disorder of bone and cartilage, unspecified,Unspecified disorder of kidney and ureter,Gout, unspecified,Personal history of other malignant neoplasm of skin,Personal history of tobacco use
Endocard fibroelastosis,Delirium d/t other cond,Neuropathy in diabetes,Atrial fibrillation,Polymyalgia rheumatica,DMII neuro nt st uncntrl,Anemia NOS,Hypertension NOS,Hypothyroidism NOS,Pure hypercholesterolem,Bone & cartilage dis NOS,Renal & ureteral dis NOS,Gout NOS,Hx-skin malignancy NEC,History of tobacco use
Admission Date:  [**2158-8-8**]              Discharge Date:   [**2158-8-13**]

Date of Birth:  [**2077-9-4**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Norvasc / lisinopril

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
intraventricular mass

Major Surgical or Invasive Procedure:
[**2158-8-8**] Excision of cardiac mass

History of Present Illness:
This 80 year old female with no significant cardiac history was
found to have a 1.2 x 0.7cm mobile mass of the left ventricle.
The mass was noted to be attached to the papillary muscle. She
has no signs or symptoms of endocarditis and it does not appear
to be a thrombus or malignancy. She has had no signs of
emboliztion. She was referred for surgical evaluation regarding
removal of the mass in [**Month (only) 205**] and returns now for excision.

Past Medical History:
Hypertension
Carotid Artery Stenosis
Hypercholesterolemia
Osteopenia
noninsulin dependent Diabetes Mellitus
Renal Insufficiency (baseline Cr 1.9)Psoriasis - patient denies
Hypothyroidism
Irritable Bowel Syndrome Polylmyalgia Rheumatica
Gout
Proteiuria
Diabetic Neuropathy
Skin Cancer
s/p Cataract surgery
s/p Tonsilectomy

Social History:
Race: Caucasian
Last Dental Exam: 1 month ago
Lives with: Wife
Contact: [**Name (NI) 4906**]              Phone #
Occupation: Retired
Cigarettes: Smoked no [] yes [x] last cigarette _1992 Hx: vague
historian
Other Tobacco use: denies
ETOH: < 1 drink/week [] [**1-23**] drinks/week [] >8 drinks/week []
Illicit drug use: denies

Family History:
No premature coronary artery disease

Physical Exam:
Pulse: 63 Resp: 16 O2 sat: 99%
B/P   Right: 178/70   Left: 181/76
Height: 5'1"   Weight: 136lb

General: Well-developed elderly female in no acute distress
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 [**12-22**]
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X] Edema [-] Many
erythematous and actinic keratosis lesions on bilateral LE
Varicosities: None [X]
Neuro: Grossly intact [X]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: 1+  Left: 1+
Radial       Right: 2+  Left: 2+

Carotid Bruit     Right: -   Left: -

Pertinent Results:
[**2158-8-12**] 05:20AM BLOOD WBC-11.3* RBC-2.96* Hgb-8.5* Hct-24.9*
MCV-84 MCH-28.9 MCHC-34.3 RDW-15.7* Plt Ct-176
[**2158-8-11**] 06:01AM BLOOD WBC-14.0* RBC-3.13* Hgb-9.1* Hct-26.2*
MCV-84 MCH-29.1 MCHC-34.8 RDW-16.1* Plt Ct-147*
[**2158-8-13**] 06:11AM BLOOD Na-139 K-4.3 Cl-101
[**2158-8-12**] 05:20AM BLOOD Glucose-85 UreaN-25* Creat-0.9 Na-138
K-4.0 Cl-100 HCO3-30 AnGap-12

[**Known lastname 13613**],[**Known firstname **] [**Medical Record Number 88845**] F  80  [**2077-9-4**]

Cardiology Report ECG Study Date of [**2158-8-10**]  10:58:52 PM


Atrial fibrillation with a rapid ventricular response. Left
bundle-branch
block. Compared to the previous tracing of [**2158-8-9**] atrial
fibrillation has
replaced atrial pacing.

PRE-BYPASS: The left atrium is mildly dilated. No spontaneous
echo contrast or thrombus is seen in the body of the left atrium
or left atrial appendage. No spontaneous echo contrast or
thrombus is seen in the body of the right atrium or the right
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%). A moderate sized thrombus/mass is seen in the left
ventricle attached ro th eposter-medial papillary muscle. The
thrombus/mass is mobile and pedunculated. Right ventricular
chamber size and free wall motion are normal. There are simple
atheroma in the aortic root. There are simple atheroma in the
descending thoracic aorta. There are three aortic valve
leaflets. The aortic valve leaflets are moderately thickened.
There is no aortic valve stenosis. No aortic regurgitation is
seen. The mitral valve leaflets are moderately thickened. There
is severe mitral annular calcification. There is moderate
thickening of the mitral valve chordae. Physiologic mitral
regurgitation is seen (within normal limits). There is no
pericardial effusion.

POST CPB:
1. Preserved [**Hospital1 **]-ventrivcular systolic function
2. Mitral valve and aortic valve structure and function is
normal.
3. No LV mass or thrombus is seen in the cavity.
4. Intact aorta
CXR
right IJ catheter in place that extends to about the junction
with the
superior vena cava. Continued bibasilar opacification consistent
with
atelectasis and effusion in a patient following CABG procedure.
No evidence
of pneumothorax.



Brief Hospital Course:
80yr old female found to have 1.2x0/7cm2 mobile mass of the left
ventricle. The mass was noted to be attached to the papillary
muscle she was referred for surgical evaluation.  On [**8-8**] she
underwent excision/removal of mobile mass which was attached to
posteropmedial aspect of papillary muscle and trabeculations.
The surgery was preformed by Dr. [**Last Name (STitle) **]. Her OR course was
uneventful.She arrived from the unit intubated on propofol.  She
was very hypertensive in attempting to wean and extubate and
required cardene. She was initially  a-paced for sinus brady.
Eventually she weaned and extubated by POD#1. She was found to
be mildly confused but moving all extremities. She was
discharged to the floor on POD#1. Her first and second night she
was confused and required haldol and pain med was minimized. The
confusion resolved and she was seen by PT/OT who recommended
rehab placement. On the floor she was again bradycardic and
required a-pacing. She developed  rapid a-fib and POD#2 and was
loaded with IV amiodarone and transitioned to a low oral dose
due to her bradycardia. She remains in SR with brief epsiodes of
a-fib, her BP is stable and is tolerating low dose betablocker
and amiodarone. She was started on coumadin 2mg for past three
days and her INR is not yet therapeutic, INR goal 2-2.5. Her
chest tubes and pacing wires were removed without incident. She
has a rise in her white count, a repeat UA C&S was sent that was
negative and her WBC normalized. She is diabetic and was
resarted on oral [**Doctor Last Name 360**] ,but still requires lantus and slidng
scale. She was restrted on preop dose of prednisone. She
continues to be above her dry weight, her renal function
remained normal and she continues on low dose diuretic therapy.
Of note the cardiac mass was found to be a fibroelastoma. she
was ready for discharge to [**Location (un) 54752**]@[**Hospital 88846**] [**Hospital **] rehab.
Follow-up appointments were not arranged at the time of
discharge but the office will call with f/u dates.

Medications on Admission:
ATENOLOL -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth once a day
DOXAZOSIN -  (Prescribed by Other Provider) - 2 mg Tablet - 1
Tablet(s) by mouth once a day
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth twice a day
LEVOTHYROXINE -  (Prescribed by Other Provider) - 75 mcg Tablet
- 1 Tablet(s) by mouth once a day
METFORMIN -  (Prescribed by Other Provider) - 500 mg Tablet - 1
Tablet(s) by mouth twice a day
PREDNISONE -  (Prescribed by Other Provider) - 1 mg Tablet - 3
Tablet(s) by mouth once a day
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day

Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth once a day
FERROUS FUMARATE [IRON] -  (Prescribed by Other Provider) - 55
mg (18 mg) Tablet Extended Release - 1 Tablet(s) by mouth twice
a day

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. prednisone 1 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
6. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain/temp.
7. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
8. tramadol 50 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain.
Disp:*30 Tablet(s)* Refills:*1*
9. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
11. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO BID (2 times a day).
12. amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day): continue for 1 week then decrease to 200mg daily for one
week then dc.
13. doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
14. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
15. warfarin 2 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for
1 doses: check daily INR.
16. metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
17. ferrous sulfate 325 mg (65 mg iron) Capsule, Extended
Release Sig: One (1) Capsule, Extended Release PO once a day.
18. insulin glargine 100 unit/mL Solution Sig: One (1) 10 units
Subcutaneous once a day.
19. Novolog
Novolog sliding scale ACHS, see attached handout


Discharge Disposition:
Extended Care

Facility:
[**Hospital 54752**] Rehab & Skilled Nursing Center - [**Hospital1 1559**]

Discharge Diagnosis:
Cardiac mass
s/p excision of mass
polymyalgia rheumatica
hypertension
hypothyroidism
noninsulin dependent diabetes mellitus
Carotid Artery Stenosis
Hypercholesterolemia
Osteopenia
Renal Insufficiency (baseline Cr 1.9)

Irritable Bowel Syndrome
Gout
Proteinuria
Diabetic Neuropathy
Skin Cancer
s/p Cataract surgery
s/p Tonsilectomy


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with tylenol only
Incisions:
Sternal - healing well, no erythema or drainage
Edema minimal 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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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) 88847**]) Offic to call and make appt
Cardiologist: Dr. [**First Name (STitle) 1075**] Office to call and make appt

Please call to schedule appointments with:
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 8036**]in [**3-21**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2158-8-13**]
{'Endocardial fibroelastosis,Delirium due to conditions classified elsewhere,Polyneuropathy in diabetes,Atrial fibrillation,Polymyalgia rheumatica,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Disorder of bone and cartilage, unspecified,Unspecified disorder of kidney and ureter,Gout, unspecified,Personal history of other malignant neoplasm of skin,Personal history of tobacco use'}


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: intraventricular mass

PRESENT ILLNESS: This 80 year old female with no significant cardiac history was
found to have a 1.2 x 0.7cm mobile mass of the left ventricle.
The mass was noted to be attached to the papillary muscle. She
has no signs or symptoms of endocarditis and it does not appear
to be a thrombus or malignancy. She has had no signs of
emboliztion. She was referred for surgical evaluation regarding
removal of the mass in [**Month (only) 205**] and returns now for excision.

MEDICAL HISTORY: Hypertension
Carotid Artery Stenosis
Hypercholesterolemia
Osteopenia
noninsulin dependent Diabetes Mellitus
Renal Insufficiency (baseline Cr 1.9)Psoriasis - patient denies
Hypothyroidism
Irritable Bowel Syndrome Polylmyalgia Rheumatica
Gout
Proteiuria
Diabetic Neuropathy
Skin Cancer
s/p Cataract surgery
s/p Tonsilectomy

MEDICATION ON ADMISSION: ATENOLOL -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth once a day
DOXAZOSIN -  (Prescribed by Other Provider) - 2 mg Tablet - 1
Tablet(s) by mouth once a day
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth twice a day
LEVOTHYROXINE -  (Prescribed by Other Provider) - 75 mcg Tablet
- 1 Tablet(s) by mouth once a day
METFORMIN -  (Prescribed by Other Provider) - 500 mg Tablet - 1
Tablet(s) by mouth twice a day
PREDNISONE -  (Prescribed by Other Provider) - 1 mg Tablet - 3
Tablet(s) by mouth once a day
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day

ALLERGIES: Norvasc / lisinopril

PHYSICAL EXAM: Pulse: 63 Resp: 16 O2 sat: 99%
B/P   Right: 178/70   Left: 181/76
Height: 5'1"   Weight: 136lb

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 1 month ago
Lives with: Wife
Contact: [**Name (NI) 4906**]              Phone #
Occupation: Retired
Cigarettes: Smoked no [] yes [x] last cigarette _1992 Hx: vague
historian
Other Tobacco use: denies
ETOH: < 1 drink/week [] [**1-23**] drinks/week [] >8 drinks/week []
Illicit drug use: denies 

### Response:
{'Endocardial fibroelastosis,Delirium due to conditions classified elsewhere,Polyneuropathy in diabetes,Atrial fibrillation,Polymyalgia rheumatica,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Disorder of bone and cartilage, unspecified,Unspecified disorder of kidney and ureter,Gout, unspecified,Personal history of other malignant neoplasm of skin,Personal history of tobacco use'}
