CHIEF COMPLAINT: DOE

PRESENT ILLNESS: 73 yo female with recent admission for CHF at OSH. Workup
revealed severe MR [**First Name (Titles) **] [**Last Name (Titles) **]. HTN. Cath [**11-14**] showed 85% PDA
lesion,LAD 20-30%, LVEDP 76 and PAP 87/30. Echo revealed EF 55%
[**Doctor Last Name **], severe [**Doctor Last Name **]. HTN, moderate to severe MR.Referred for
surgical evaluation.

MEDICAL HISTORY: MR/CAD/TR
[**Doctor Last Name **]. HTN
COPD ( home O2 at night)
A fib
GERD
chronic diastolic CHF
elev. lipids
HTN
NIDDM
obesity

MEDICATION ON ADMISSION: digoxin 0.25 mg daily
lasix 60 mg daily
cozaar 100 mg daily
ASA 81 mg daily
evista 60 mg daily
prilosec 20 mg daily
pravachol 80 mg daily
toprol XL 100 mg qAM, 50 mg qPM
coumadin daily
spiriva one puff daily
asmanex one puff [**Hospital1 **]
tramadol 50 mg [**Hospital1 **]
glipizide 2.5 mg daily
prednisone on occasion for COPD flare( most recently 6 weeks
ago)

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: HR 74   RR 24  right 150/70    left 160/70
5'6"   238#

FAMILY HISTORY: non-contrib.

SOCIAL HISTORY: not employed
quit smoking 20 years ago, but smoked 1 ppd for many years
less than 1 drink per week
lives alone
Mitral valve disorders,Chronic diastolic heart failure,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other chronic pulmonary heart diseases,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Obesity, unspecified,Anemia, unspecified
Mitral valve disorder,Chr diastolic hrt fail,Urin tract infection NOS,Hyposmolality,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Chr pulmon heart dis NEC,Chr airway obstruct NEC,Atrial fibrillation,Pure hypercholesterolem,Obesity NOS,Anemia NOS
Admission Date:  [**2118-1-8**]              Discharge Date:   [**2118-1-15**]

Date of Birth:  [**2044-7-10**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Iodine; Iodine Containing

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
DOE

Major Surgical or Invasive Procedure:
s/p Mitral valve repair (28mm [**Company **] CG Future annuloplasty
ring) and coronary artery bypass graft x1 (SVG>PDA) [**1-11**]


History of Present Illness:
73 yo female with recent admission for CHF at OSH. Workup
revealed severe MR [**First Name (Titles) **] [**Last Name (Titles) **]. HTN. Cath [**11-14**] showed 85% PDA
lesion,LAD 20-30%, LVEDP 76 and PAP 87/30. Echo revealed EF 55%
[**Doctor Last Name **], severe [**Doctor Last Name **]. HTN, moderate to severe MR.Referred for
surgical evaluation.

Past Medical History:
MR/CAD/TR
[**Doctor Last Name **]. HTN
COPD ( home O2 at night)
A fib
GERD
chronic diastolic CHF
elev. lipids
HTN
NIDDM
obesity

PSH: back surgs. x3
kidney stone [**Doctor First Name **] 20 yrs. ago
TAH 40 years ago


Social History:
not employed
quit smoking 20 years ago, but smoked 1 ppd for many years
less than 1 drink per week
lives alone

Family History:
non-contrib.

Physical Exam:
HR 74   RR 24  right 150/70    left 160/70
5'6"   238#

somewhat SOB
skin/HEENT unremarkable
neck supple. full ROM, no carotid bruits appreciated
CTAB
irregular with holosystolic murmur
soft, NT, ND, obese, + BS
warm, well-perfused, no peripheral edema or varicosities noted
eccchymosis right groin s/p recent cath, no hematoma
2+ bil. fems/radials
1+ bil. DP/PTs

Pertinent Results:
[**2118-1-14**] 07:10AM BLOOD WBC-11.2* RBC-3.07* Hgb-9.5* Hct-29.5*
MCV-96 MCH-30.8 MCHC-32.1 RDW-16.3* Plt Ct-140*
[**2118-1-14**] 07:10AM BLOOD PT-14.3* INR(PT)-1.2*
[**2118-1-14**] 07:10AM BLOOD Plt Ct-140*
[**2118-1-14**] 07:10AM BLOOD Glucose-108* UreaN-22* Creat-0.9 Na-136
K-4.4 Cl-98 HCO3-29 AnGap-13
[**2118-1-12**] 12:01AM BLOOD ALT-16 AST-47* AlkPhos-42 Amylase-26
TotBili-0.4
[**2118-1-14**] 07:10AM BLOOD Mg-2.1
[**2118-1-8**] 07:00PM BLOOD %HbA1c-6.2*

RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2118-1-13**] 8:22 AM

CHEST (PORTABLE AP)

Reason: ? effusion

[**Hospital 93**] MEDICAL CONDITION:
73 year old woman with
REASON FOR THIS EXAMINATION:
? effusion
HISTORY: 73-year-old female, evaluate for effusion.

COMPARISON: [**2118-1-11**].

PORTABLE UPRIGHT CHEST, ONE VIEW: There is interval removal of
endotracheal tube. Multiple chest tubes are unchanged. Right
internal jugular central venous catheter with tip in upper SVC.
Cardiac silhouette is enlarged, unchanged. Mediastinal and hilar
contours are unchanged. Since prior study, there is resolved
pulmonary edema with lung fields grossly clear. No large
effusion is identified.

IMPRESSION: Interval improvement with resolution of pulmonary
edema. No obvious pleural effusion identified.

jr
The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
DR. [**First Name (STitle) 3901**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3902**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: FRI [**2118-1-14**] 4:33 PM

Conclusions
PRE-BYPASS:
1. The left atrium is moderately dilated. No thrombus is seen in
the left atrial appendage. The right atrium is moderately
dilated. A patent foramen ovale is present. A left-to-right
shunt across the interatrial septum is seen at rest.
2. Overall left ventricular systolic function is low normal
(LVEF 50-55%). [Intrinsic left ventricular systolic function is
likely more depressed given the severity of valvular
regurgitation.]
3. The right ventricular cavity is mildly dilated. There is mild
global right ventricular free wall hypokinesis.
4. There are simple atheroma in the aortic arch. There are
simple atheroma in the descending thoracic aorta.
5. There are three aortic valve leaflets. There is mild aortic
valve stenosis (area 1.2-1.9cm2). No aortic regurgitation is
seen.
6. The mitral valve leaflets are mildly thickened. Moderate to
severe (3+) mitral regurgitation is seen.
7. There is a trivial/physiologic pericardial effusion.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine,
epinephrine, and was being A paced.

1. A mitral annuloplasty ring is seen well seated. Trace MR is
noted. A mean gradient of [**4-11**] mm of Hg is obtained. MVA is
estimated to be around 2.0 cm2.
2. RV systolic function was initially moderate-severely
depressed. Subsequent improvement was seen to mild hypokinesis.
3. LV function was preserved.
4. Aorta is intact post decannulation.
5. Other findings are unchanged
I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 928**] [**Name8 (MD) 929**], MD, MD,
Interpreting physician [**Last Name (NamePattern4) **] [**2118-1-12**] 08:38


?????? [**2113**]




Brief Hospital Course:
Admitted [**1-8**] and started on IV heparin while she was off
coumadin (LD [**1-3**]).Treated for a UTI over the weekend with
cipro. Underwent MV repair/cabg x1 with Dr. [**Last Name (STitle) 1290**] on [**1-11**].
Transferred to the CVICU in stable condition on propofol,
epinephrine, and phenylephrine drips.Extubated that night and
drips weaned slowly with gentle diuresis. Pul. home meds also
restarted. Chest tubes removed and transferred to the floor on
POD #2. Pacing wires removed on POD #3 and coumadin restarted
for chronic A fib. Cleared for discharge to home with services
on POD #4.Pt. is to make all followup appts. as per discharge
instructions.

[**Name8 (MD) 14777**] NP[**MD Number(3) **] with [**Doctor First Name 717**] at Dr[**Name (NI) 16071**] office and he will
continue to follow her coumadin dosing, doses and INR results
faxed to office #[**Telephone/Fax (1) 31080**].

Medications on Admission:
digoxin 0.25 mg daily
lasix 60 mg daily
cozaar 100 mg daily
ASA 81 mg daily
evista 60 mg daily
prilosec 20 mg daily
pravachol 80 mg daily
toprol XL 100 mg qAM, 50 mg qPM
coumadin daily
spiriva one puff daily
asmanex one puff [**Hospital1 **]
tramadol 50 mg [**Hospital1 **]
glipizide 2.5 mg daily
prednisone on occasion for COPD flare( most recently 6 weeks
ago)

Discharge Medications:
1. Asmanex Twisthaler 220 mcg (120 doses) Aerosol Powdr Breath
Activated Sig: One (1)  Inhalation once a day.
Disp:*qs qs* Refills:*2*
2. Raloxifene 60 mg Tablet Sig: One (1) Tablet PO daily ().
Disp:*30 Tablet(s)* Refills:*0*
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Disp:*30 Tablet(s)* Refills:*0*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. Furosemide 80 mg Tablet Sig: One (1) Tablet PO twice a day:
please take twice a day for 1 week then decrease to once a day
until you follow up with Dr [**First Name (STitle) 1075**].
Disp:*60 Tablet(s)* Refills:*0*
6. 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*
7. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
8. Pravachol 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
9. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
10. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*qs Cap(s)* Refills:*2*
11. Coumadin 3 mg Tablet Sig: One (1) Tablet PO once a day:
please take 3mg sunday and have INR check ed monday for further
dosing by Dr [**First Name (STitle) 1075**].
Disp:*30 Tablet(s)* Refills:*2*
12. Glipizide 5 mg Tab,Sust Rel Osmotic Push 24hr Sig: One (1)
Tab,Sust Rel Osmotic Push 24hr PO DAILY (Daily).
Disp:*30 Tab,Sust Rel Osmotic Push 24hr(s)* Refills:*0*
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*0*
14. Cozaar 25 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 11485**] VNA

Discharge Diagnosis:
Mitral regurgitation s/p MV repair
Coronary artery disease s/p CABG
Atrial fibrillation
Pulmonary hypertension
elevated cholesterol
Hypertension
Diabetes mellitus
COPD
chronic diastolic CHF
obesity

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**]
PT/INR for coumadin dosing mon-wed-fri with results to Dr [**First Name (STitle) 1075**]
office #([**Telephone/Fax (1) 20259**] for atrial fibrillation with goal 2-2.5

[**Last Name (NamePattern4) 2138**]p Instructions:
Please call to schedule all appointments
Dr [**Last Name (Prefixes) **] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr [**First Name (STitle) **] in 1 week ([**Telephone/Fax (1) 60170**])
Dr [**First Name (STitle) 1075**] in [**3-13**] weeks  ([**Telephone/Fax (1) 6256**])
Wound check appointment [**Hospital1 **] heart center ([**Telephone/Fax (2) 20259**] -
please schedule for thrusday with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 2 weeks
PT/INR for coumadin dosing mon-wed-fri with results to Dr [**First Name (STitle) 1075**]
office #([**Telephone/Fax (1) 20259**] for atrial fibrillation with goal 2-2.5



Completed by:[**2118-2-3**]
{'Mitral valve disorders,Chronic diastolic heart failure,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other chronic pulmonary heart diseases,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Obesity, unspecified,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: DOE

PRESENT ILLNESS: 73 yo female with recent admission for CHF at OSH. Workup
revealed severe MR [**First Name (Titles) **] [**Last Name (Titles) **]. HTN. Cath [**11-14**] showed 85% PDA
lesion,LAD 20-30%, LVEDP 76 and PAP 87/30. Echo revealed EF 55%
[**Doctor Last Name **], severe [**Doctor Last Name **]. HTN, moderate to severe MR.Referred for
surgical evaluation.

MEDICAL HISTORY: MR/CAD/TR
[**Doctor Last Name **]. HTN
COPD ( home O2 at night)
A fib
GERD
chronic diastolic CHF
elev. lipids
HTN
NIDDM
obesity

MEDICATION ON ADMISSION: digoxin 0.25 mg daily
lasix 60 mg daily
cozaar 100 mg daily
ASA 81 mg daily
evista 60 mg daily
prilosec 20 mg daily
pravachol 80 mg daily
toprol XL 100 mg qAM, 50 mg qPM
coumadin daily
spiriva one puff daily
asmanex one puff [**Hospital1 **]
tramadol 50 mg [**Hospital1 **]
glipizide 2.5 mg daily
prednisone on occasion for COPD flare( most recently 6 weeks
ago)

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: HR 74   RR 24  right 150/70    left 160/70
5'6"   238#

FAMILY HISTORY: non-contrib.

SOCIAL HISTORY: not employed
quit smoking 20 years ago, but smoked 1 ppd for many years
less than 1 drink per week
lives alone 

### Response:
{'Mitral valve disorders,Chronic diastolic heart failure,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other chronic pulmonary heart diseases,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Obesity, unspecified,Anemia, unspecified'}
