CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 81 y/o male with h/o congestive heart failure with multiple
admissions in past. Most recent in [**1-30**]. Admits to occassional
dyspnea on exertion. Presented with echo findings or severe MR
with an EF 25-30% and cardiac cath findings of single vessel
coronary artery disease (60% LAD).

MEDICAL HISTORY: Congestive Heart Failure, Hypertension, Hypecholesterolemia,
Peripheral Vascular Disease, Chronic Renal Insufficiency, h/o
Pumonary Embolism, Anemia, Benign Prostatic Hypertrophy s/p
TURP, Gastroesophageal Reflux Disease, SIADH, Pancreatic cysts,
h/o Skin cancer s/p removal, Varicose veins s/p RLE stripping,
s/p cataract surgery, s/p tonsillectomy, s/p lipoma/mass removal
left thigh

MEDICATION ON ADMISSION: Coumadin 2mg qd, Lipitor 20mg qd, Lasix 40mg qd, Coreg 12.5mg
qd, Avodart 0.5mg qd, Aspirin 81mg qd, Colace 100mg qd,
TRazadone 25mg qhs, Spiriva, Urecholine, Kcl, Lisinopril 10mg
qd, Metamucil, Ondavsetron

ALLERGIES: Maxzide

PHYSICAL EXAM: 80 12 118/60 6'2" 155#
Gen: WD/WN male in NAD
Skin: W/D intact
HEENT: EOMI, PERRL, NC/AT, OP benign
Neck: Supple, FROM, -JVD, -Bruit
Chest: CTAB -w/r/r
Heart: RRR w/ [**1-1**] murmur
Abd: Soft NT/ND, +BS
Ext: Warm, well-perfused, -edema, left thigh scar, bilat
varicosities R>L
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: No premature CAD.

SOCIAL HISTORY: Quit smoking 40 yrs ago. Occ. ETOH.
Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Chronic combined systolic and diastolic heart failure,Atrial fibrillation,Retention of urine, unspecified,Chronic kidney disease, unspecified,Personal history of venous thrombosis and embolism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Esophageal reflux,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Peripheral vascular disease, unspecified
Crnry athrscl natve vssl,Mitral valve disorder,Chr syst/diastl hrt fail,Atrial fibrillation,Retention urine NOS,Chronic kidney dis NOS,Hx-ven thrombosis/embols,Hy kid NOS w cr kid I-IV,Pure hypercholesterolem,Long-term use anticoagul,Esophageal reflux,BPH w urinary obs/LUTS,Periph vascular dis NOS
Admission Date:  [**2109-7-6**]              Discharge Date:   [**2109-7-15**]

Date of Birth:  [**2027-7-22**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Maxzide

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2109-7-8**] Coronary Artery Bypass Graft x 1 (Lima to LAD), Mitral
Valve Replacement (30mm Band)

History of Present Illness:
81 y/o male with h/o congestive heart failure with multiple
admissions in past. Most recent in [**1-30**]. Admits to occassional
dyspnea on exertion. Presented with echo findings or severe MR
with an EF 25-30% and cardiac cath findings of single vessel
coronary artery disease (60% LAD).

Past Medical History:
Congestive Heart Failure, Hypertension, Hypecholesterolemia,
Peripheral Vascular Disease, Chronic Renal Insufficiency, h/o
Pumonary Embolism, Anemia, Benign Prostatic Hypertrophy s/p
TURP, Gastroesophageal Reflux Disease, SIADH, Pancreatic cysts,
h/o Skin cancer s/p removal, Varicose veins s/p RLE stripping,
s/p cataract surgery, s/p tonsillectomy, s/p lipoma/mass removal
left thigh

Social History:
Quit smoking 40 yrs ago. Occ. ETOH.

Family History:
No premature CAD.

Physical Exam:
80 12 118/60 6'2" 155#
Gen: WD/WN male in NAD
Skin: W/D intact
HEENT: EOMI, PERRL, NC/AT, OP benign
Neck: Supple, FROM, -JVD, -Bruit
Chest: CTAB -w/r/r
Heart: RRR w/ [**1-1**] murmur
Abd: Soft NT/ND, +BS
Ext: Warm, well-perfused, -edema, left thigh scar, bilat
varicosities R>L
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2109-7-15**] 06:30AM BLOOD WBC-8.0 RBC-2.97* Hgb-9.7* Hct-28.0*
MCV-94 MCH-32.6* MCHC-34.6 RDW-15.1 Plt Ct-217#
[**2109-7-6**] 03:51PM BLOOD WBC-8.0 RBC-3.32* Hgb-11.0* Hct-31.8*
MCV-96 MCH-33.3* MCHC-34.7 RDW-16.0* Plt Ct-244
[**2109-7-15**] 06:30AM BLOOD Plt Ct-217#
[**2109-7-15**] 06:30AM BLOOD PT-24.9* PTT-34.5 INR(PT)-2.5*
[**2109-7-6**] 03:51PM BLOOD Plt Ct-244
[**2109-7-6**] 03:51PM BLOOD PT-13.1 PTT-24.4 INR(PT)-1.1
[**2109-7-15**] 06:30AM BLOOD Glucose-92 UreaN-34* Creat-1.4* Na-130*
K-4.6 Cl-97 HCO3-28 AnGap-10
[**2109-7-6**] 03:51PM BLOOD Glucose-77 UreaN-35* Creat-1.2 Na-136
K-5.4* Cl-101 HCO3-30 AnGap-10
[**2109-7-6**] 03:51PM BLOOD ALT-20 AST-24 LD(LDH)-159 AlkPhos-82
Amylase-69 TotBili-0.3
[**2109-7-15**] 06:30AM BLOOD Calcium-7.8* Phos-3.5 Mg-2.4
[**2109-7-6**] 03:51PM BLOOD TSH-1.2

RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2109-7-15**] 10:05 AM

CHEST (PA & LAT)

Reason: evaluate effusion

[**Hospital 93**] MEDICAL CONDITION:
81 year old man s/p mvr/cabg
REASON FOR THIS EXAMINATION:
evaluate effusion
REASON FOR EXAMINATION: Followup of a patient after mitral valve
replacement and CABG.

Portable AP chest radiograph was compared to [**2109-7-10**].

The cardiac size is mildly enlarged but stable. The
post-sternotomy wires are unchanged. The calcified aortic arch
is again noted. There is no congestive heart failure or new
consolidations. Fibronodular opacities in both apices, left
significantly more than right are unchanged and most likely
represent previous granulomatous exposure.

Small bilateral pleural effusion is grossly unchanged. There is
no pneumothorax.

IMPRESSION: No significant change.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**]
DR. [**First Name8 (NamePattern2) **] [**Doctor Last Name **]
Approved: TUE [**2109-7-16**] 1:51 PM

Cardiology Report ECG Study Date of [**2109-7-14**]  8:40:00 AM


Atrial fibrillation with a controlled ventricular response.
Right axis
deviation. Probable rate dependent left bundle-branch block.
Compared to
prior tracing of [**2109-7-11**] two QRS morphologies are now seen,
possibly secondary
to a rate-related phenomenon. There are no other diagnostic
interim changes.


Read by: [**Last Name (LF) **],[**First Name3 (LF) **] V.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
65 0 110 424/432 0 35 -15

Cardiology Report ECHO Study Date of [**2109-7-8**]



PATIENT/TEST INFORMATION:
Indication: coronary artery disease; mitral regurgitation
Height: (in) 72
Weight (lb): 163
BSA (m2): 1.95 m2
BP (mm Hg): 120/70
HR (bpm): 73
Status: Inpatient
Date/Time: [**2109-7-8**] at 10:04
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007AW01-:
Test Location: Anesthesia West OR cardiac
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name (STitle) 412**] [**Last Name (Prefixes) 413**]

MEASUREMENTS:
Left Atrium - Four Chamber Length: *5.4 cm (nl <= 5.2 cm)
Left Ventricle - Septal Wall Thickness: *1.2 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Inferolateral Thickness: *1.2 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: *6.5 cm (nl <= 5.6 cm)
Left Ventricle - Ejection Fraction: 25% to 30% (nl >=55%)
Aorta - Valve Level: *3.7 cm (nl <= 3.6 cm)
Aorta - Ascending: *3.9 cm (nl <= 3.4 cm)
Aortic Valve - Peak Velocity: 1.0 m/sec (nl <= 2.0 m/sec)

INTERPRETATION:

Findings:

LEFT ATRIUM: Mild LA enlargement. Mild spontaneous echo contrast
in the LAA.
No thrombus in the LAA.

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

LEFT VENTRICLE: Normal LV wall thickness. Moderately dilated LV
cavity.
Severely depressed LVEF.

LV WALL MOTION: Regional LV wall motion abnormalities include:
mid
anteroseptal - hypo; septal apex - hypo;

RIGHT VENTRICLE: Normal RV chamber size. Mild global RV free
wall hypokinesis.

AORTA: Mildly dilated ascending aorta. Focal calcifications in
ascending
aorta. Complex (>4mm) atheroma in the descending thoracic aorta.


AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Mild to
moderate ([**11-27**]+) AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP.
Mild mitral
annular calcification. Moderate to severe (3+) MR.

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with
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. No TEE
related
complications. The TEE probe was passed with assistance from the

anesthesioology staff using a laryngoscope. The patient was
under general
anesthesia throughout the procedure. The patient appears to be
in sinus
the patient.

Conclusions:
PRE-BYPASS:
1. The left atrium is mildly dilated. Mild spontaneous echo
contrast is
present in the left atrial appendage. No thrombus is seen in the
left atrial
appendage.
2. No atrial septal defect is seen by 2D or color Doppler.
3. Left ventricular wall thicknesses are normal. The left
ventricular cavity
is moderately dilated. Overall left ventricular systolic
function is globally
severely depressed (LVEF= 35 %) with focalities in mid and
apical septal wall.
4. Right ventricular chamber size is normal. There is mild
global right
ventricular free wall hypokinesis.
5. The ascending aorta is mildly dilated. There are complex
(>4mm) atheroma in
the descending thoracic aorta.
6. The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is
not present. Mild to moderate ([**11-27**]+) aortic regurgitation is
seen.
7. The mitral valve leaflets are mildly thickened. There is no
mitral valve
prolapse. Moderate to severe (3+) mitral regurgitation is seen.
There is a
mild posterior leaflet restriction.
8. There is no pericardial effusion.

Post-bypass:

LVEF 20% on milrinone and epinephrine.
RV function is similar to pre CPB.
There is no residual mitral regurgitation or mitral stenosis.
There is a ring
in the mitral position, stable and functioning well.
Mild to moderate AI.
Aortic contour is intact

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD on [**2109-7-9**]
14:26.
[**Location (un) **] PHYSICIAN:







Brief Hospital Course:
Mr. [**Known lastname 71362**] was admitted a couple days prior to surgery
secondary to being on Coumadin and requiring pre-operative
work-up. He discontinued his Coumadin approximately 5 days prior
to admission and was started on Heparin on day of admission.
During his pre-operative period he was worked-up in the usual
manner. On [**7-8**] he was brought to the operating room where he
underwent a coronary artery bypass graft x 1 and mitral valve
repair. Please see operative report for surgical details.
Following surgery he was transferred to the CSRU for invasive
monitoring in stable condition. Within 24 hours he was weaned
from sedation awoke neurologically intact and extubated. Chest
tubes were removed on post-op day one and he was weaned from all
Inotropes. Amiodarone was given d/t ectopy/AV block. He was
started on beta blockers and diuretics and gently diuresed
towards his pre-op weight. Later on this day he was transferred
to the SDU for further care. He worked with physical therapy and
was ready for discharge home with services on POD 7.

Medications on Admission:
Coumadin 2mg qd, Lipitor 20mg qd, Lasix 40mg qd, Coreg 12.5mg
qd, Avodart 0.5mg qd, Aspirin 81mg qd, Colace 100mg qd,
TRazadone 25mg qhs, Spiriva, Urecholine, Kcl, Lisinopril 10mg
qd, Metamucil, Ondavsetron

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*30 Capsule(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:*0*
3. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
5. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
6. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*qs Cap(s)* Refills:*0*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*0*
9. Avodart 0.5 mg Capsule Sig: One (1) Capsule PO once a day.
Disp:*15 Capsule(s)* Refills:*0*
10. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO once a day:
please take 3mg [**7-15**] and [**7-16**] - please have INR checked [**7-17**] for
further dosing .
Disp:*90 Tablet(s)* Refills:*0*
11. Outpatient [**Name (NI) **] Work
PT/INR for coumadin dosing goal INR 2-2.5
Results to Dr [**Last Name (STitle) 37742**] office # [**Telephone/Fax (1) 23083**]
Please check Mon-Wed-Fri
12. Metamucil Smooth Texture     Packet Sig: One (1)  PO once a
day.
Disp:*30 packets* Refills:*0*
13. Urecholine 25 mg Tablet Sig: One (1) Tablet PO four times a
day.
Disp:*120 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Coronary Artery Disease, Mitral Regurgitation s/p Coronary
Artery Bypass Graft x 1, Mitral Valve Replacement
PMH: Congestive Heart Failure, Hypertension,
Hypecholesterolemia, Peripheral Vascular Disease, Chronic Renal
Insufficiency, h/o Pumonary Embolism, Anemia, Benign Prostatic
Hypertrophy s/p TURP, Gastroesophageal Reflux Disease, SIADH,
Pancreatic cysts, h/o Skin cancer s/p removal, Varicose veins
s/p RLE stripping, s/p cataract surgery, s/p tonsillectomy, s/p
lipoma/mass removal left thigh


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**]

[**Last Name (NamePattern4) 2138**]p Instructions:
Please call to schedule all appointments
Dr. [**Last Name (Prefixes) **] in 4 weeks [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) **] in [**12-29**] weeks
Dr. [**Last Name (STitle) 37742**] in 1 week [**Telephone/Fax (1) 23083**]
Wound check please schedule with RN [**Telephone/Fax (1) 3633**]\nLab: PT/INR
for coumadin dosing goal INR 2-2.5
Results to Dr [**Last Name (STitle) 37742**] office # [**Telephone/Fax (1) 23083**]
Please check Mon-Wed-Fri



Completed by:[**2109-7-16**]
{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Chronic combined systolic and diastolic heart failure,Atrial fibrillation,Retention of urine, unspecified,Chronic kidney disease, unspecified,Personal history of venous thrombosis and embolism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Esophageal reflux,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Peripheral vascular disease, 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: 81 y/o male with h/o congestive heart failure with multiple
admissions in past. Most recent in [**1-30**]. Admits to occassional
dyspnea on exertion. Presented with echo findings or severe MR
with an EF 25-30% and cardiac cath findings of single vessel
coronary artery disease (60% LAD).

MEDICAL HISTORY: Congestive Heart Failure, Hypertension, Hypecholesterolemia,
Peripheral Vascular Disease, Chronic Renal Insufficiency, h/o
Pumonary Embolism, Anemia, Benign Prostatic Hypertrophy s/p
TURP, Gastroesophageal Reflux Disease, SIADH, Pancreatic cysts,
h/o Skin cancer s/p removal, Varicose veins s/p RLE stripping,
s/p cataract surgery, s/p tonsillectomy, s/p lipoma/mass removal
left thigh

MEDICATION ON ADMISSION: Coumadin 2mg qd, Lipitor 20mg qd, Lasix 40mg qd, Coreg 12.5mg
qd, Avodart 0.5mg qd, Aspirin 81mg qd, Colace 100mg qd,
TRazadone 25mg qhs, Spiriva, Urecholine, Kcl, Lisinopril 10mg
qd, Metamucil, Ondavsetron

ALLERGIES: Maxzide

PHYSICAL EXAM: 80 12 118/60 6'2" 155#
Gen: WD/WN male in NAD
Skin: W/D intact
HEENT: EOMI, PERRL, NC/AT, OP benign
Neck: Supple, FROM, -JVD, -Bruit
Chest: CTAB -w/r/r
Heart: RRR w/ [**1-1**] murmur
Abd: Soft NT/ND, +BS
Ext: Warm, well-perfused, -edema, left thigh scar, bilat
varicosities R>L
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: No premature CAD.

SOCIAL HISTORY: Quit smoking 40 yrs ago. Occ. ETOH. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Chronic combined systolic and diastolic heart failure,Atrial fibrillation,Retention of urine, unspecified,Chronic kidney disease, unspecified,Personal history of venous thrombosis and embolism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Esophageal reflux,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Peripheral vascular disease, unspecified'}
