CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 58038**] is a 61-year-old man
who was found to have a systolic click on physical exam in
[**2139**]. He was asymptomatic for many years. In a visit to his
cardiologist in [**2154**] the patient was noted to have AFib with
an echo showing mitral valve prolapse. In [**2157-6-28**], the
patient developed a progressive cough, and in [**Month (only) 216**] he
developed progressive shortness of breath and CHF.

MEDICAL HISTORY: Significant for mitral regurgitation,
atrial fibrillation, basal cell CA of the chest, lactose
intolerance, allergic rhinitis.

MEDICATION ON ADMISSION: Include Lasix 80 mg q.a.m. and 40
mg q.p.m., lisinopril 10 mg daily, Toprol-XL 100 mg b.i.d.,
warfarin 5 mg daily (with the last dose being taken on [**4-11**]).

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father with CAD with a MI in early 30s.

SOCIAL HISTORY: He lives with his wife in [**Name (NI) 86**]. He is a
retired physician. [**Name10 (NameIs) 4273**] tobacco use. Alcohol use is limited
to 2 glasses of wine per day.
Mitral valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Urinary tract infection, site not specified,Other chronic pulmonary heart diseases
Mitral valve disorder,CHF NOS,Atrial fibrillation,Urin tract infection NOS,Chr pulmon heart dis NEC
Unit No:  [**Numeric Identifier 58037**]
Admission Date: [**2158-4-13**]
Discharge Date: [**2158-4-27**]
Date of Birth:  [**2097-2-1**]
Sex:  M
Service:  CSU


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 58038**] is a 61-year-old man
who was found to have a systolic click on physical exam in
[**2139**]. He was asymptomatic for many years. In a visit to his
cardiologist in [**2154**] the patient was noted to have AFib with
an echo showing mitral valve prolapse. In [**2157-6-28**], the
patient developed a progressive cough, and in [**Month (only) 216**] he
developed progressive shortness of breath and CHF.

He was referred to CT surgery for evaluation for MVR. At that
time, a cardiac cath done in [**2158-2-28**] supported a
diagnosis of severe mitral regurgitation and found no
coronary artery disease. He was admitted to [**Hospital1 **] [**Hospital1 **] [**First Name (Titles) **]
[**4-13**] for management of his congestive heart failure as
well as evaluation for transplant.  The patient's cath done
on the [**4-11**] showed 4+ MR, with an EF of
50%, with severe pulmonary hypertension, mild MS, and no
coronary artery disease. An echo done on [**2158-2-11**]
showed an EF of 60%, with partial mitral valve flail and
thickening of the mitral valve chordae, 3+ MR with no mitral
stenosis, 2+ TR with a dilated right and left atrium, and
severe pulmonary systolic hypertension.

PAST MEDICAL HISTORY:  Significant for mitral regurgitation,
atrial fibrillation, basal cell CA of the chest, lactose
intolerance, allergic rhinitis.

PAST SURGICAL HISTORY:  Significant for anal fissure repair
approximately 20 years ago.

ALLERGIES:  The patient states no known drug allergies.

MEDICATIONS ON ADMISSION:  Include Lasix 80 mg q.a.m. and 40
mg q.p.m., lisinopril 10 mg daily, Toprol-XL 100 mg b.i.d.,
warfarin 5 mg daily (with the last dose being taken on [**4-11**]).

SOCIAL HISTORY:  He lives with his wife in [**Name (NI) 86**]. He is a
retired physician. [**Name10 (NameIs) 4273**] tobacco use. Alcohol use is limited
to 2 glasses of wine per day.

FAMILY HISTORY:  Father with CAD with a MI in early 30s.

REVIEW OF SYMPTOMS:  Significant for a history of congestive
heart failure, 3-pillow orthopnea, history of anxiety and
panic attacks.

PHYSICAL EXAMINATION PRIOR TO ADMISSION:  Includes a height
of 5 feet 10.5 inches and weight of 159 pounds. Vital signs
with a temperature of 96.4, heart rate of 98, blood pressure
of 128/73, respiratory rate of 18, and O2 saturation of 94%
on room air. In general, in no acute distress.
Neurologically, alert and oriented x 3. Moves all
extremities. Follows commands. Respiratory is clear to
auscultation bilaterally. Cardiovascular with a regular rate
and rhythm, S1 and S2, with a [**5-3**] murmur. The abdomen is
soft, nontender, and nondistended with normal active bowel
sounds. The extremities are warm and well perfused with trace
edema bilaterally. The pulses are 1+ throughout. The neck is
supple with no carotid bruits, and JVD sitting bolt upright.

RADIOLOGIC STUDIES:  A cardiac MR done on the [**4-5**]
showed a forward left ventricular EF of 17% with posterior
mitral valve prolapse, partial flailed leaflets, severe MR,
severe biatrial enlargement.

HOSPITAL COURSE:  As stated, initially the patient was
admitted preoperatively for management of his congestive
heart failure as well as a transplant workup. He spent
several days in the hospital preoperatively being diuresed.
He was subsequently found to have a UTI which was treated
with Levaquin. He was ultimately transferred to the CCU for
milrinone, Nipride, and Natrecor infusions. Ultimately, on
the [**4-21**], he was brought to the operating room for
mitral valve repair plus or minus replacement. Please see the
OR report for full details. In summary, the patient underwent
a mitral valve repair with a 30-mm [**Doctor Last Name 405**] annuloplasty band
and a quadrangular resection of the posterior leaflet. His
bypass time was 77 minutes with a cross-clamp time of 52
minutes.

He tolerated the operation and was transferred from the
operating room to the cardiothoracic intensive care unit. At
the time of transfer, the patient was in a sinus rhythm at 80
beats per minute with a mean arterial pressure of 68 and a
CVP of 11. He had milrinone at 0.5 mcg/kg/min, Levophed at
0.15 mcg/kg/min, dobutamine at 5 mcg/kg/min, and propofol at
20 mcg/kg/min. The patient did well in the immediate
postoperative period. However, given the severity of his CHF
preoperatively it was decided to keep the patient sedated and
ventilated throughout the night of surgery.

On postoperative day 1, he continued to be hemodynamically
stable and well oxygenated. His milrinone was weaned. His
sedation was also weaned, and the patient was successfully
extubated early in the morning of postoperative day 1.
Additionally, the patient's Levophed infusion was weaned to
off, and he was noted to have transient periods of atrial
fibrillation. On postoperative day 2, the patient continued
to progress well.  His milrinone was weaned to off. His Swan-
Ganz catheter was removed following the discontinuation of
his milrinone. His mediastinal chest tubes were removed, and
the patient was started on active diuresis. On postoperative
day 3, the patient was started on an ACE inhibitor as well as
beta blockers, and anticoagulation was started given the
patient's history of atrial fibrillation. Additionally, the
patient was transferred to the floor for continued
postoperative care and cardiac rehabilitation.

Once on the floor, the patient's activity level was increased
with the assistance of the nursing staff as well as physical
therapy. He had an otherwise uneventful hospital course. On
postoperative day 5, his pleural chest tubes were removed. On
postoperative day 6, it was decided that the patient was
stable and ready to be discharged to home.

At the time of this dictation, the patient's physical exam is
as follows. Temperature of 98, heart rate of 93, atrial
fibrillation, blood pressure of 130/70, respiratory rate of
18, and O2 saturation of 99% on room air. Weight
preoperatively of 72 kilograms; at discharge 70.9 kilograms.
On physical exam, neurologically alert and oriented x 3.
Moves all extremities. Follows commands. A nonfocal exam.
Pulmonary reveals clear to auscultation bilaterally. Cardiac
with an irregularly irregular S1 and S2. The sternum is
stable. Incision with Steri-Strips without drainage or
erythema. The abdomen is soft, nontender, and nondistended
with normal active bowel sounds. The extremities are warm and
well perfused with no edema.

Lab data with a white count of 6.8, hematocrit of 35.7,
platelets 136. Sodium of 137, potassium of 4.4, chloride of
103, CO2 of 30, BUN of 11, creatinine of 0.7, glucose of 84.
INR on the day of discharge is 1.3.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE DISPOSITION:  He is to be discharged to home with
VNA.

DI[**Last Name (STitle) 408**]E FOLLOWUP:  He is to have followup in the wound
clinic in 2 weeks, followup with Dr. [**Last Name (STitle) 12167**] in 2 to 3 weeks,
and followup with Dr. [**Last Name (Prefixes) **] in 4 weeks.

DISCHARGE DIAGNOSES:
1. Status post mitral valve repair with #30 [**Doctor Last Name 405**]
   annuloplasty band and quadrangular resection of the
   posterior leaflet.
2. Atrial fibrillation.
3. Basal cell carcinoma of the chest.
4. Lactose intolerance.
5. Allergic rhinitis.
6. Status post rectal fissure repair.


MEDICATIONS ON DISCHARGE:
1. Colace 100 mg b.i.d..
2. Aspirin 81 mg daily.
3. Percocet 5/325 1 to 2 tablets q.4-6h. as needed.
4. Potassium chloride 20 mEq daily x 10 days.
5. Warfarin 5 mg daily on the day of discharge. The patient
   to have an INR check on the day after discharge by the
   visiting nurses with the results called to Dr. [**Last Name (STitle) 12167**].
   The patient is to follow Dr.[**Name (NI) 21923**] recommendations
   from that point for continued Coumadin dosing.
6. Lopressor XL 50 mg daily.
7.
   Lisinopril 10 mg daily.
8. Lasix 20 mg daily x 10 days.




                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2158-4-27**] 15:33:37
T:  [**2158-4-27**] 16:46:51
Job#:  [**Job Number 58039**]
{'Mitral valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Urinary tract infection, site not specified,Other chronic pulmonary heart diseases'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname 58038**] is a 61-year-old man
who was found to have a systolic click on physical exam in
[**2139**]. He was asymptomatic for many years. In a visit to his
cardiologist in [**2154**] the patient was noted to have AFib with
an echo showing mitral valve prolapse. In [**2157-6-28**], the
patient developed a progressive cough, and in [**Month (only) 216**] he
developed progressive shortness of breath and CHF.

MEDICAL HISTORY: Significant for mitral regurgitation,
atrial fibrillation, basal cell CA of the chest, lactose
intolerance, allergic rhinitis.

MEDICATION ON ADMISSION: Include Lasix 80 mg q.a.m. and 40
mg q.p.m., lisinopril 10 mg daily, Toprol-XL 100 mg b.i.d.,
warfarin 5 mg daily (with the last dose being taken on [**4-11**]).

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father with CAD with a MI in early 30s.

SOCIAL HISTORY: He lives with his wife in [**Name (NI) 86**]. He is a
retired physician. [**Name10 (NameIs) 4273**] tobacco use. Alcohol use is limited
to 2 glasses of wine per day. 

### Response:
{'Mitral valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Urinary tract infection, site not specified,Other chronic pulmonary heart diseases'}
