CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This is a 63 y.o woman with past medical history significant
only for hypertension who presents with a 4 month history of
periodic chest pain. Note that the history was limited by
language and cultural barriers. The patient reports that she has
been having a "tightening" chest pain that comes and goes over
the past several months. This pain radiated up her neck and down
her right arm, and significantly worsened yesterday night,
waking her up from sleep. Her symptoms were concerning enough
that they came to the emergency room today, where a CTA of the
chest was performed to rule out dissection. The CTA found that
the patient had an extremely large left atrial myxoma that
occupied nearly the entire left atrium, measuring 3.7 x 3.3 cm
on CT. A bedside TTE performed by the cardiology fellow showed
the same mass but normal ejection fraction. She was evaluated by
CT surgery in the ED with potential plan for excision next week,
but with optimization and pre-op workup to be performed by
cardiology. She was admitted to the CCU for close observation.

MEDICAL HISTORY: hypertension
h/o sinusitis
hysterectomy for "fibroids"

MEDICATION ON ADMISSION: amlodipine 5mg qdaily
hydrochlorthiazide 25mg qdaily
fludrocortisone nasal spray

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T=97.4 BP=152/93 HR=108 RR=18 O2 sat=97% on RA
GENERAL: WDWN woman in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Originally from [**Country 2045**], moved here in [**2177**]. Works at [**Hospital1 18**] in
housekeeping.
-Tobacco history: none
-ETOH: none
-Illicit drugs: none
Benign neoplasm of heart,Unspecified essential hypertension
Benign neoplasm heart,Hypertension NOS
Admission Date:  [**2197-2-17**]              Discharge Date:   [**2197-2-27**]

Date of Birth:  [**2134-1-7**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2197-2-22**] Resection of left atrial mass with repair of inter
atrial septum with dacron patch

History of Present Illness:
This is a 63 y.o woman with past medical history significant
only for hypertension who presents with a 4 month history of
periodic chest pain. Note that the history was limited by
language and cultural barriers. The patient reports that she has
been having a "tightening" chest pain that comes and goes over
the past several months. This pain radiated up her neck and down
her right arm, and significantly worsened yesterday night,
waking her up from sleep. Her symptoms were concerning enough
that they came to the emergency room today, where a CTA of the
chest was performed to rule out dissection. The CTA found that
the patient had an extremely large left atrial myxoma that
occupied nearly the entire left atrium, measuring 3.7 x 3.3 cm
on CT. A bedside TTE performed by the cardiology fellow showed
the same mass but normal ejection fraction. She was evaluated by
CT surgery in the ED with potential plan for excision next week,
but with optimization and pre-op workup to be performed by
cardiology. She was admitted to the CCU for close observation.

Past Medical History:
hypertension
h/o sinusitis
hysterectomy for "fibroids"

Social History:
Originally from [**Country 2045**], moved here in [**2177**]. Works at [**Hospital1 18**] in
housekeeping.
-Tobacco history: none
-ETOH: none
-Illicit drugs: none

Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
VS: T=97.4 BP=152/93 HR=108 RR=18 O2 sat=97% on RA
GENERAL: WDWN woman in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 5 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, ND. Mild RUQ tenderness.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Radial and DP pulses 2+ bilaterally.
Neuro: anxious, but answers questions appropriately. CN II-XII
intact. Strength 5/5 in biceps, triceps, deltoids, hip flexors,
plantar and dorsiflexors of ankles bilaterally. Downgoing
babinski. Sensation grossly intact bilaterally.

Pertinent Results:
[**2197-2-22**] Echo: Pre-Bypass: The left atrium is mildly dilated. A
mass is seen in the body of the left atrium. The mass was
approximately 3.5 x 3 cm. The mass was attached to the
interatrial septum by a short stalk. During diastole the mass
did have movement toward the mitral valve without evidence of
significant obstruction to left ventricular inflow. The mass was
heterogenous with smooth edges. No spontaneous echo contrast is
seen in the left atrial appendage. The right atrium is dilated.
A patent foramen ovale is present. A left-to-right shunt across
the interatrial septum is seen at rest. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). The right ventricle displays normal free wall
contractility. Interventricular septal motion is normal. The
diameters of aorta at the sinus, ascending and arch levels are
normal. There are simple atheroma in the ascending aorta. There
are simple atheroma in the aortic arch. There are simple
atheroma in the aortic arch. There are simple atheroma in the
descending thoracic aorta. The aortic valve leaflets (3) are
mildly thickened. There is no aortic valve stenosis. No
significant aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened.Trace to mild (1+) mitral
regurgitation is seen. There is no pericardial effusion.  Dr.
[**Last Name (STitle) **] was notified in person of the results on [**2197-2-22**] at
1030. Post-Bypass: The patient is being A-paced without
inotropic support. Overall biventricular systolic function is
unchanged from prebypass period. The left atrial mass is now
absent. A patch has been applied to the interatrial septum.
There is no evidence of left to right shunt across the
interatrial septum. Mitral regurgitation is improved
post-bypass, now with trace mitral regurgitation. The thoracic
aorta is intact post-decannulation. Findings have been discussed
in person with Dr. [**Last Name (STitle) **].
[**2197-2-20**] Cardiac cath: 1. Normal coronary arteries with evidence
of microvascular dysfunction. 2. Diastolic hypertension.
[**2197-2-17**] Chest CT: 1. Left atrial lesion measuring up to 3.8 cm
with apparent thin attachment to the interatrial septum, most
likely an atrial myxoma. Differential considerations include an
intraatrial thrombus. Correlation with echocardiography and
cardiac MR is recommended. 2. No pulmonary embolism or acute
aortic syndrome. 3. Two 2-mm pulmonary nodules. In the absence
of risk factors (ie. smoking, malignancy), there is no further
followup necessary. If there are risk factors, then a 12-month
followup chest CT [**First Name8 (NamePattern2) **] [**Last Name (un) 8773**] guidelines is recommended.
[**2197-2-26**] 10:00AM BLOOD WBC-13.1* RBC-3.54* Hgb-10.1* Hct-29.5*
MCV-83 MCH-28.5 MCHC-34.3 RDW-14.0 Plt Ct-316#
[**2197-2-17**] 01:30PM BLOOD WBC-7.7 RBC-5.04 Hgb-13.5 Hct-41.3 MCV-82
MCH-26.8* MCHC-32.6 RDW-13.3 Plt Ct-213
[**2197-2-22**] 12:54PM BLOOD PT-13.4 PTT-33.3 INR(PT)-1.1
[**2197-2-26**] 10:00AM BLOOD Glucose-124* UreaN-10 Creat-0.6 K-4.3
[**2197-2-17**] 01:30PM BLOOD Glucose-92 UreaN-9 Creat-0.6 Na-137 K-3.8
Cl-100 HCO3-28 AnGap-13

Brief Hospital Course:
[**2197-2-22**] Ms.[**Known lastname **] was taken to the operating room and underwent
resection of left atrial mass and repair of intra-atrial septum
(dacron patch). Cardiopulmonary bypass time=49 minutes. Cross
clamp time=37 minutes. Please refer to the operative report for
further details. She tolerated the procedure well and was
transferred to the CVICU intubated, sedated, in critical but
stable condition. She awoke neurologically intact and was
extubated without difficulty. All lines and drains were
discontinued in a timely fashion. Beta-Blocker/Asa/Statin/and
diuresis was initiated. She was transferred to the step down
unit for further monitoring. Physical therapy was consulted for
strength and mobility evaluation. Pathology revealed the mass
was an atrial myxoma with large fibrin thrombus. She continued
to slowly progress and was cleared for discharge to home with
VNA on POD# 5. All follow up appointments were advised.


Medications on Admission:
amlodipine 5mg qdaily
hydrochlorthiazide 25mg qdaily
fludrocortisone nasal spray

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. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*2*
4. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
Disp:*1 * Refills:*0*
5. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
6. Potassium Chloride 10 mEq Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO Q12H (every 12 hours) for 5
days.
Disp:*10 Tablet Sustained Release(s)* Refills:*0*
7. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
8. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain: **Please take with FOOD.
Disp:*45 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Left atrial mass s/p resection
Past medical history:
hypertension
h/o sinusitis
hysterectomy for "fibroids"

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with percocet prn

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 until follow up with
surgeon
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

Followup Instructions:
Recommended Follow-up:Please call to schedule appointments
Surgeon Dr. [**Last Name (STitle) **] on([**Telephone/Fax (1) 170**]) on [**2197-3-30**] at 1:15PM
Primary Care Dr. [**Last Name (STitle) **] [**12-31**] weeks
Cardiologist Dr. [**Last Name (STitle) 6512**] in [**12-31**] weeks
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will



Completed by:[**2197-2-27**]
{'Benign neoplasm of heart,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: Chest pain

PRESENT ILLNESS: This is a 63 y.o woman with past medical history significant
only for hypertension who presents with a 4 month history of
periodic chest pain. Note that the history was limited by
language and cultural barriers. The patient reports that she has
been having a "tightening" chest pain that comes and goes over
the past several months. This pain radiated up her neck and down
her right arm, and significantly worsened yesterday night,
waking her up from sleep. Her symptoms were concerning enough
that they came to the emergency room today, where a CTA of the
chest was performed to rule out dissection. The CTA found that
the patient had an extremely large left atrial myxoma that
occupied nearly the entire left atrium, measuring 3.7 x 3.3 cm
on CT. A bedside TTE performed by the cardiology fellow showed
the same mass but normal ejection fraction. She was evaluated by
CT surgery in the ED with potential plan for excision next week,
but with optimization and pre-op workup to be performed by
cardiology. She was admitted to the CCU for close observation.

MEDICAL HISTORY: hypertension
h/o sinusitis
hysterectomy for "fibroids"

MEDICATION ON ADMISSION: amlodipine 5mg qdaily
hydrochlorthiazide 25mg qdaily
fludrocortisone nasal spray

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T=97.4 BP=152/93 HR=108 RR=18 O2 sat=97% on RA
GENERAL: WDWN woman in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Originally from [**Country 2045**], moved here in [**2177**]. Works at [**Hospital1 18**] in
housekeeping.
-Tobacco history: none
-ETOH: none
-Illicit drugs: none 

### Response:
{'Benign neoplasm of heart,Unspecified essential hypertension'}
