CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 75 year old female with history of mitral regurgitation and
chronic atrial fibrillation. Serial echocardiograms have shown
worsening mitral regurgitation and mitral valve prolapse and
increased pulmonary hypertension. In preparation for mitral
valve surgery, she underwent cardiac catheterization which
revealed no significant coronary artery disease. She is referred
for mitral valve repair/replacement.  She is admitted today for
PAT and heparin after a coumadin washout.

MEDICAL HISTORY: Mitral valve regurgitation s/p mitral valve replacement
Chronic Diastolic Congestive heart failure
Mitral Valve Prolapse with Regurgitation
Atrial Fibrillation - Coumadin for roughly 1 year
Hypertension
Dyslipidemia
Diabetes Mellitus Type II
Asbestosis
Anemia h/o 1 blood transfusion
Gastroesophageal reflux disease
Depression
Varicose veins
Osteoporosis
remote history of pneumonia
Past Surgical History:
D+C in distant past
Colonoscopy with polypectomy

MEDICATION ON ADMISSION: ***Coumadin 2mg daily*** followed by Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] dose [**2110-2-5**]
Celebrex 200mg po daily
Metformin 500mg po daily
Paroxetine 20mg po daily
Hyzaar 100mg po daily
Omeprazole 20mg po daily
Atenolol 50mg po daily
Lescol 80mg po daily
Actonel q week (Wednesday)
Furosemide 20mg po daily

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Pulse: 63 sr  Resp: 22  O2 sat: 97% RA
B/P  Right: 118/56   Left:
Height: 65"     Weight: 174

FAMILY HISTORY: Son died of PE/Mother died of CAD at age 61/Father died of CAD
in early 80's/Brother died of cancer at age 59

SOCIAL HISTORY: Lives with: Son who is bipolar in [**Location (un) 701**], MA.
Occupation: Retired
Tobacco: Never but is exposed to significant second hand smoke.
ETOH: Very rare
Mitral valve disorders,Rupture of chordae tendineae,Acute kidney failure, unspecified,Chronic diastolic heart failure,Mobitz (type) II atrioventricular block,Atrial fibrillation,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Asbestosis,Esophageal reflux,Depressive disorder, not elsewhere classified,Asymptomatic varicose veins,Osteoporosis, unspecified,Long-term (current) use of anticoagulants,Anemia, unspecified
Mitral valve disorder,Chordae tendinae rupture,Acute kidney failure NOS,Chr diastolic hrt fail,Atrioven block-mobitz ii,Atrial fibrillation,Chr pulmon heart dis NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Asbestosis,Esophageal reflux,Depressive disorder NEC,Asympt varicose veins,Osteoporosis NOS,Long-term use anticoagul,Anemia NOS
Admission Date:  [**2110-2-9**]              Discharge Date:   [**2110-2-19**]

Date of Birth:  [**2034-8-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2110-2-11**] Mitral valve replacement
[**2110-2-17**] permanent pacemaker insertion


History of Present Illness:
75 year old female with history of mitral regurgitation and
chronic atrial fibrillation. Serial echocardiograms have shown
worsening mitral regurgitation and mitral valve prolapse and
increased pulmonary hypertension. In preparation for mitral
valve surgery, she underwent cardiac catheterization which
revealed no significant coronary artery disease. She is referred
for mitral valve repair/replacement.  She is admitted today for
PAT and heparin after a coumadin washout.

Past Medical History:
Mitral valve regurgitation s/p mitral valve replacement
Chronic Diastolic Congestive heart failure
Mitral Valve Prolapse with Regurgitation
Atrial Fibrillation - Coumadin for roughly 1 year
Hypertension
Dyslipidemia
Diabetes Mellitus Type II
Asbestosis
Anemia h/o 1 blood transfusion
Gastroesophageal reflux disease
Depression
Varicose veins
Osteoporosis
remote history of pneumonia
Past Surgical History:
D+C in distant past
Colonoscopy with polypectomy

Social History:
Lives with: Son who is bipolar in [**Location (un) 701**], MA.
Occupation: Retired
Tobacco: Never but is exposed to significant second hand smoke.
ETOH: Very rare

Family History:
Son died of PE/Mother died of CAD at age 61/Father died of CAD
in early 80's/Brother died of cancer at age 59

Physical Exam:
Pulse: 63 sr  Resp: 22  O2 sat: 97% RA
B/P  Right: 118/56   Left:
Height: 65"     Weight: 174

General: WDWN mildly anxious
Skin: Warm, dry and intact. No lesions or rashes noted.
HEENT: NCAT, PERRL [X] EOMI [X], sclera anicteric
Full dentures.
Neck:  Supple [X] Full ROM [X] No JVD
Chest: Lungs clear bilaterally [X]
Heart: Irregular rate and rhythm, III/VI holosystolic murmur
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  Trace-1+ LE Edema.
Bowing on LE at knees. Arthritic nodules on hands.
Varicosities: Grossly varicosed bilaterally. Thighs worse then
lower legs.
Neuro: Grossly intact, No focal deficts
Pulses:
Femoral      Right:2+   Left:2+
DP           Right:1+   Left:1+
PT           [**Name (NI) 167**]:1+   Left:1+
Radial       Right:2+   Left:2+

Carotids: cardiac murmur is transmitted

Pertinent Results:
[**2110-2-19**] 07:40AM BLOOD Hct-32.2*
[**2110-2-18**] 05:45AM BLOOD WBC-7.7 RBC-3.67* Hgb-10.5* Hct-30.8*
MCV-84 MCH-28.6 MCHC-34.0 RDW-14.4 Plt Ct-182
[**2110-2-9**] 02:45PM BLOOD WBC-6.0 RBC-3.78* Hgb-11.0* Hct-32.3*
MCV-85 MCH-29.0 MCHC-33.9 RDW-14.7 Plt Ct-218
[**2110-2-19**] 07:40AM BLOOD PT-17.2* PTT-27.0 INR(PT)-1.5*
[**2110-2-18**] 05:45AM BLOOD Plt Ct-182
[**2110-2-17**] 06:21AM BLOOD PT-13.8* PTT-24.7 INR(PT)-1.2*
[**2110-2-18**] 05:45AM BLOOD Glucose-88 UreaN-25* Creat-1.1 Na-140
K-4.3 Cl-102 HCO3-29 AnGap-13
[**2110-2-9**] 02:45PM BLOOD Glucose-123* UreaN-49* Creat-1.4* Na-140
K-4.0 Cl-103 HCO3-27 AnGap-14
[**2110-2-9**] 02:45PM BLOOD %HbA1c-6.4* eAG-137*

[**Known lastname **],[**Known firstname **] [**Medical Record Number 97001**] F  75  [**2034-8-16**]

Radiology Report CHEST (PA & LAT) Study Date of [**2110-2-18**] 9:26 AM



[**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG CSRU [**2110-2-18**] 9:26 AM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 97002**]
Reason: lead placement



[**Hospital 93**] MEDICAL CONDITION:
   75 year old woman with heart block s/p dual chamber PM.
Assess lead placement
REASON FOR THIS EXAMINATION:
   lead placement



Final Report
HISTORY: Pacemaker placement.

FINDINGS: In comparison with study of [**2-14**], there has been
placement of a
pacemaker device with leads extending to the right atrium and
apex of the
right ventricle. No evidence of pneumothorax. Other than
somewhat better
lung volumes, there is little change in the appearance of the
heart and lungs.

DR. [**First Name11 (Name Pattern1) 1569**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 11006**]
Approved: TUE [**2110-2-18**] 11:19 AM

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 97003**] (Complete)
Done [**2110-2-11**] at 9:37:12 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2034-8-16**]
Age (years): 75 F  Hgt (in): 64
BP (mm Hg): 112/58  Wgt (lb): 174
HR (bpm): 71  BSA (m2): 1.85 m2
Indication: Atrial fibrillation. Mitral valve disease.
ICD-9 Codes: 786.05, 424.0
Test Information
Date/Time: [**2110-2-11**] at 09:37    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW001-0:00 Machine: IE33
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *8.0 cm  <= 4.0 cm
Aortic Valve - Peak Velocity:  1.6 m/sec  <= 2.0 m/sec

Findings
LEFT ATRIUM: Marked LA enlargement. No spontaneous echo contrast
or thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Normal
interatrial septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Overall normal LVEF (>55%). [Intrinsic LV
systolic function likely depressed given the severity of
valvular regurgitation.]

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Focal
calcifications in aortic root. Normal ascending aorta diameter.
Normal aortic arch diameter. Normal descending aorta diameter.
Simple atheroma in descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Myxomatous mitral valve leaflets. Eccentric MR
jet. Severe (4+) MR. [**Name13 (STitle) 15110**] to the eccentric MR jet, its severity
may be underestimated (Coanda effect).

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild to
moderate [[**12-7**]+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

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. The patient was under general anesthesia throughout
the procedure. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
Pre-bypass:
The left atrium is markedly dilated. 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.
Overall left ventricular systolic function is normal (LVEF>55%).
[Intrinsic left ventricular systolic function is likely more
depressed given the severity of valvular regurgitation.]
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. The mitral
valve leaflets are myxomatous. An eccentric, posteriorly
directed jet of Severe (4+) mitral regurgitation is seen. Due to
the eccentric nature of the regurgitant jet, its severity may be
significantly underestimated (Coanda effect). The 3D views of
the mitral valve show a flail A3 portion of the anterior
leaflet.
There is no pericardial effusion.

Post-bypass:
The patient is not receiving inotropic support post-CPB.
There is a well-seated bioprosthetic valve in the mitral
position with good leaflet excursion. There is no paravalvular
regurgitation. There is a very small jet of transvalvular
regurgitation. The mean pressure gradient across the valve is 4
mm Hg at a cardiac output of 3.5 L/min.
Left ventricular systolic function post-MVR is mildly depressed
(LVEF 45%).
All other findings are consistent with pre-bypass findings.
The aorta is intact post-decannulation.
All findings were discussed with the surgeon intraoperatively.

  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2110-2-12**] 12:23




Brief Hospital Course:
She was admitted on [**2110-2-9**] for intravenous heparin to bridge
from coumadin prior to surgery.  On [**2110-2-11**] she was brought to
the operating room where she underwent a mitral valve
replacement. Please see operative report for surgical details.
Following surgery she was transferred to the CVICU for invasive
monitoring in stable condition. Within 24 hours she was weaned
from sedation, awoke neurologically intact and extubated. She
was noted to have av block post operatively but hemodynamically
stable, on [**2-13**] EP was consulted for evaluation.  Baseline cr
1.4 with peak increase post operatively 1.6, medications
adjusted.  She continued in AV block and remained in intensive
care due to rhythm.  On [**2-17**] she was taken for permanent
pacemaker insertion.  She continued to progress, was transferred
to the floor and was ready for discharge to rehab on post
operative day 8 and 2.

Medications on Admission:
***Coumadin 2mg daily*** followed by Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] dose [**2110-2-5**]
Celebrex 200mg po daily
Metformin 500mg po daily
Paroxetine 20mg po daily
Hyzaar 100mg po daily
Omeprazole 20mg po daily
Atenolol 50mg po daily
Lescol 80mg po daily
Actonel q week (Wednesday)
Furosemide 20mg po daily

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
2. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
6. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Metformin 500 mg Tablet Extended Rel 24 hr Sig: One (1)
Tablet Extended Rel 24 hr PO DAILY (Daily).
8. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
9. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours) for 5 doses.
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once : please
give 2mg on [**2-20**] and check INR [**2-21**] for further dosing .
12. Outpatient Lab Work
Labs: PT/INR for coumadin dosing with goal INR 2.0-2.5 for
atrial fibrillation - first draw [**2-21**] please draw at least twice
a week and as needed - received 2mg [**2-17**], 5mg [**2-18**], 2mg [**2-19**] INR
1.5
13. Lescol 40 mg Capsule Sig: Two (2) Capsule PO once a day.
14. Losartan 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Last Name (un) **] Center - [**Location (un) 701**]

Discharge Diagnosis:
Mitral valve regurgitation s/p mitral valve replacement
AV block and tachy-brady syndrome s/p permanent pacemaker
Atrial Fibrillation
Hypertension
Dyslipidemia
Diabetes Mellitus Type II
Asbestosis
Anemia
Gastroesophageal reflux disease
Depression
Varicose veins
Osteoporosis
remote history of pneumonia
Colonoscopy with polypectomy


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with assistance
Sternal pain managed with ultram prn


Discharge Instructions:
For first week no shower due to pacemaker insertion site -
should be able to shower after device clinic visit, please bath
daily until able to shower daily including washing incisions
gently with mild soap, no baths or swimming, and look at your
incisions - left subclavian (pacemaker insertion site) do not
wash until after seen in device clinic
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
Left arm keep elbow at or below shoulder level for 6 weeks due
to pacemaker insertion
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

Followup Instructions:
DEVICE CLINIC Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2110-2-25**] 10:00
[**Name6 (MD) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2110-3-20**] 1:00

Please call to schedule appointments
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**12-7**] weeks
Cardiologist Dr. [**Last Name (NamePattern4) 40823**] [**Last Name (NamePattern1) **] in [**12-7**] weeks

Labs: PT/INR for coumadin dosing with goal INR 2.0-2.5 for
atrial fibrillation - first draw [**2-21**] please draw at least twice
a week and as needed - received 2mg [**2-17**], 5mg [**2-18**], 2mg [**2-19**] INR
1.5



Completed by:[**2110-2-19**]
{'Mitral valve disorders,Rupture of chordae tendineae,Acute kidney failure, unspecified,Chronic diastolic heart failure,Mobitz (type) II atrioventricular block,Atrial fibrillation,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Asbestosis,Esophageal reflux,Depressive disorder, not elsewhere classified,Asymptomatic varicose veins,Osteoporosis, unspecified,Long-term (current) use of anticoagulants,Anemia, unspecified'}


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: Dyspnea on exertion

PRESENT ILLNESS: 75 year old female with history of mitral regurgitation and
chronic atrial fibrillation. Serial echocardiograms have shown
worsening mitral regurgitation and mitral valve prolapse and
increased pulmonary hypertension. In preparation for mitral
valve surgery, she underwent cardiac catheterization which
revealed no significant coronary artery disease. She is referred
for mitral valve repair/replacement.  She is admitted today for
PAT and heparin after a coumadin washout.

MEDICAL HISTORY: Mitral valve regurgitation s/p mitral valve replacement
Chronic Diastolic Congestive heart failure
Mitral Valve Prolapse with Regurgitation
Atrial Fibrillation - Coumadin for roughly 1 year
Hypertension
Dyslipidemia
Diabetes Mellitus Type II
Asbestosis
Anemia h/o 1 blood transfusion
Gastroesophageal reflux disease
Depression
Varicose veins
Osteoporosis
remote history of pneumonia
Past Surgical History:
D+C in distant past
Colonoscopy with polypectomy

MEDICATION ON ADMISSION: ***Coumadin 2mg daily*** followed by Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] dose [**2110-2-5**]
Celebrex 200mg po daily
Metformin 500mg po daily
Paroxetine 20mg po daily
Hyzaar 100mg po daily
Omeprazole 20mg po daily
Atenolol 50mg po daily
Lescol 80mg po daily
Actonel q week (Wednesday)
Furosemide 20mg po daily

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Pulse: 63 sr  Resp: 22  O2 sat: 97% RA
B/P  Right: 118/56   Left:
Height: 65"     Weight: 174

FAMILY HISTORY: Son died of PE/Mother died of CAD at age 61/Father died of CAD
in early 80's/Brother died of cancer at age 59

SOCIAL HISTORY: Lives with: Son who is bipolar in [**Location (un) 701**], MA.
Occupation: Retired
Tobacco: Never but is exposed to significant second hand smoke.
ETOH: Very rare 

### Response:
{'Mitral valve disorders,Rupture of chordae tendineae,Acute kidney failure, unspecified,Chronic diastolic heart failure,Mobitz (type) II atrioventricular block,Atrial fibrillation,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Asbestosis,Esophageal reflux,Depressive disorder, not elsewhere classified,Asymptomatic varicose veins,Osteoporosis, unspecified,Long-term (current) use of anticoagulants,Anemia, unspecified'}
