CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: This 84-year-old patient with known mitral regurgitation has
been regularly followed by serial echocardiograms.  He has had
an increase in shortness of breath symptoms and a recent echo
demonstrated moderate to severe regurgitation with preserved
left ventricular function. He is now electively admitted for
mitral valve repair or replacement.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
COPD
Fibromyalgia
BPH
Skin Cancer
Nephrolithiasis
s/p TURP

MEDICATION ON ADMISSION: ASA 81 QD
Methyldopa 500 TID
Captopril 50 QD
HCTZ 25mg QD
Benicar 20 QD
Prednisone 2.5mg QOD
Albuterol
Azmacort
Vitamins

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse 76  BP 124/88
GEN: WDWN in NAD
SKIN: Telagectiasis noted
HEENT: NCAT, PERRL, OP benign
LUNGS: Clear
HEART: RRR, III/VI systolic murmur
ABD: Benign
EXT: Warm, no edema.
NEURO: Nonfocal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired. Lives with wife. Quit smoking 40 years ago and drinks 1
drink per week.
Mitral valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Bladder neck obstruction,Atherosclerosis of aorta,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant melanoma of skin,Anemia, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use
Mitral valve disorder,Surg compl-heart,Atrial fibrillation,Chr airway obstruct NEC,Bladder neck obstruction,Aortic atherosclerosis,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx-malig skin melanoma,Anemia NOS,BPH w/o urinary obs/LUTS,History of tobacco use
Admission Date:  [**2149-5-13**]              Discharge Date:   [**2149-5-23**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2149-5-13**] - MVR (31 mm [**Last Name (un) 66915**] Pericardial Tissue)


History of Present Illness:
This 84-year-old patient with known mitral regurgitation has
been regularly followed by serial echocardiograms.  He has had
an increase in shortness of breath symptoms and a recent echo
demonstrated moderate to severe regurgitation with preserved
left ventricular function. He is now electively admitted for
mitral valve repair or replacement.


Past Medical History:
Hypertension
Hyperlipidemia
COPD
Fibromyalgia
BPH
Skin Cancer
Nephrolithiasis
s/p TURP

Social History:
Retired. Lives with wife. Quit smoking 40 years ago and drinks 1
drink per week.

Family History:
Non-contributory

Physical Exam:
Pulse 76  BP 124/88
GEN: WDWN in NAD
SKIN: Telagectiasis noted
HEENT: NCAT, PERRL, OP benign
LUNGS: Clear
HEART: RRR, III/VI systolic murmur
ABD: Benign
EXT: Warm, no edema.
NEURO: Nonfocal

Pertinent Results:
[**2149-5-13**] ECHO
Pre bypass: The left atrium is moderately dilated. No
mass/thrombus is seen in the left atrium or left atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler. There is mild symmetric left ventricular hypertrophy.
The left ventricular cavity size is normal. Regional left
ventricular wall motion is normal. [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. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion. There is no
aortic valve stenosis. There is mild tricuspid reguritation and
mild pulmonic insufficiency. Mild (1+) aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. There is
moderate/severe mitral valve prolapse with 3+ (moderate to
severe) mitral reguritation. There is partial mitral leaflet
flail involving the posterior leaflet. There is a
trivial/physiologic pericardial effusion. The ascending aorta is
poorly seen. There is some
suggestion of calcifcation of the distal portion of the
ascending aorta. The aortic arch is poorly seen with some simple
plaque and calcification. There is calcification of the
descending aorta with simple atheroma.

Post bypass: Pt is paced (atrial) and on phenylepherine
infusion. LV function is perserved EF >55%, no wall motion
abnormalities. #31 ce bioprostheis in the mitral position. Trace
central MR, no MS, no obvious perivalvular leaks. Aortic
contours preserved. Remaining exam unchanged. Findings discussed
with surgeons at time of surgery.

[**2149-5-20**] CXR
Slightly improved but persistent small loculated right pleural
effusion and small left pleural effusion.

[**2149-5-23**] 05:56AM BLOOD Hct-30.4*
[**2149-5-18**] 05:10AM BLOOD WBC-12.1* RBC-3.85* Hgb-11.3* Hct-33.1*
MCV-86 MCH-29.4 MCHC-34.1 RDW-15.0 Plt Ct-153
[**2149-5-23**] 05:56AM BLOOD PT-29.8* INR(PT)-3.1*
[**2149-5-22**] 05:45AM BLOOD PT-29.3* INR(PT)-3.1*
[**2149-5-23**] 05:56AM BLOOD UreaN-38* Creat-1.2 K-4.6

[**Last Name (NamePattern4) 4125**]ospital Course:
Mr. [**Known lastname 174**] was admitted to the [**Hospital1 18**] on [**2149-5-13**] for elective
surgical management of his mitral valve disease. He was taken to
the operating room where he underwent a mitral valve replacement
using a 31mm pericardial tissue valve. Postoperatively he was
taken to the cardiac surgical intensive cacre unit for
monitoring. On postoperative day one, he awoke neurologically
intact and was extubated. He developed atrial fibrillation for
which amiodarone was started. He was transfused with a unit of
packed red blood cells for postoperative anemia. He was gently
diuresed towards his preoperative weight. On postoperative day
four, he was transferred to the step down floor for further
recovery. The physical therapy service was consulted for
assistance with his postoperative strength and mobility. His
pulmonary staus continued to improve, however he benefits fro
aggressive pulmonary toilet. Mr. [**Known lastname 174**] developed urinary
retention for which a foley catheter was reinserted and flomax
was started. He again failed a void trial and was seen by
urology who preformed a cystoscopy and inserted a foley. The
cystoscopy revealed bladder neck contractures for which he needs
to follow up with a urologist. Given the amount of urethral
instrumentation and his recent valve surgery he was placed on
levofloxacin for one week. As Mr. [**Known lastname 174**] continue dto have
paroxysmal atrial fibrillation, coumadin was started for
anticoagulation on [**5-19**]. His doses of coumadin were 3-3-2.5-0-1.
His INR the day of discharge was 3.1. An echocariogram was
rechecked which showed a normal ef and good valvular function.
Mr. [**Known lastname 174**] continued to make steady progress and was discharged
on postoperative day 10. He will follow-up with Dr. [**Last Name (Prefixes) **],
his cardiologist, Dr. [**Last Name (STitle) 7047**], and his primary care physician.

Medications on Admission:
ASA 81 QD
Methyldopa 500 TID
Captopril 50 QD
HCTZ 25mg QD
Benicar 20 QD
Prednisone 2.5mg QOD
Albuterol
Azmacort
Vitamins

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet 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. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
7. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 7 days: for 1 week, then 200 mg daily until d/c'd by
Dr. [**Last Name (STitle) 7047**].
9. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
10. Prednisone 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Methyldopa 250 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours).
12. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO DAILY (Daily).
13. Ipratropium Bromide 0.02 % Solution Sig: Two (2) puffs
Inhalation Q6H (every 6 hours) as needed.
14. Warfarin 1 mg Tablet Sig: One (1) Tablet PO once a day for 1
days: 1 mg then check INR.  Dose for target INR of 2.0-2.5.
Disp:*0 Tablet(s)* Refills:*0*
15. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q4H (every 4 hours).
16. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q4H (every 4 hours).
17. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
18. Furosemide 80 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
19. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 1 weeks.


Discharge Disposition:
Extended Care

Facility:
Life Care of [**Location (un) 5165**]

Discharge Diagnosis:
MR (s/p MVR)
HTN
COPD
BPH


Discharge Condition:
good


Discharge Instructions:
may shower, no bathing or swimming for 1 month
no creams lotions or powders to any incisions
no lifting > 10# in 10 weeks

[**Last Name (NamePattern4) 2138**]p Instructions:
with Dr. [**Last Name (STitle) 7047**] in [**2-14**] weeks
with Dr. [**Last Name (Prefixes) **] in 4 weeks
Local urologist after discharge
Primary care doctor 2 weeks



Completed by:[**2149-5-23**]
{'Mitral valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Bladder neck obstruction,Atherosclerosis of aorta,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant melanoma of skin,Anemia, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use'}


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: Shortness of breath

PRESENT ILLNESS: This 84-year-old patient with known mitral regurgitation has
been regularly followed by serial echocardiograms.  He has had
an increase in shortness of breath symptoms and a recent echo
demonstrated moderate to severe regurgitation with preserved
left ventricular function. He is now electively admitted for
mitral valve repair or replacement.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
COPD
Fibromyalgia
BPH
Skin Cancer
Nephrolithiasis
s/p TURP

MEDICATION ON ADMISSION: ASA 81 QD
Methyldopa 500 TID
Captopril 50 QD
HCTZ 25mg QD
Benicar 20 QD
Prednisone 2.5mg QOD
Albuterol
Azmacort
Vitamins

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse 76  BP 124/88
GEN: WDWN in NAD
SKIN: Telagectiasis noted
HEENT: NCAT, PERRL, OP benign
LUNGS: Clear
HEART: RRR, III/VI systolic murmur
ABD: Benign
EXT: Warm, no edema.
NEURO: Nonfocal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired. Lives with wife. Quit smoking 40 years ago and drinks 1
drink per week. 

### Response:
{'Mitral valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Bladder neck obstruction,Atherosclerosis of aorta,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant melanoma of skin,Anemia, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use'}
