CHIEF COMPLAINT: increasing dyspnea

PRESENT ILLNESS: 51 yo female with severe MR and increasing dyspnea referred
pre-op for cath prior to valve surgery. Followed with serial
echos, and most recent in [**4-23**] showed worsening MR since [**2180**],
as well as severe pulm. HTN. She also has had intermittent chest
pain with exertion. Cath in [**Month (only) 116**] showed normal coronaries, 4+ MR,
and EF >55%.Referred to Dr. [**Last Name (STitle) 1290**] for surgical
repair/replacement.

MEDICAL HISTORY: MVP/MR
[**First Name (Titles) **] [**Last Name (Titles) 2182**]
right benign breast lumpectomy
osteopenia
s/p ectopic pregnancy 20 yrs. ago
thrombosed left femoral pseudoaneurysm

MEDICATION ON ADMISSION: prozac 20 mg daily
trazadone 50 mg daily
albuterol MDI prn
fosamax 70 mg q Monday

ALLERGIES: Percocet / Codeine

PHYSICAL EXAM: NAD, WD,WN
NC/AT, PERRLA, EOMI, OP benign
complete dentures
neck supple, full ROM, no lymphadenopathy or thyromegaly
carotids 2+ Bilat. without bruits
CTAB
RRR  3/6 holosystolic murmur
+ BS, soft, NT, ND, no masses or HSM
no c/c/e, 2+ bilat. peripheral pulses
non-focal neuro exam

FAMILY HISTORY: ? CAD (unclear)

SOCIAL HISTORY: 30 pack yea history- quit 3 1/2 years ago
lives with her 2 children
divorced
[**1-21**] glasses wine/week
Mitral valve disorders,Peripheral vascular complications, not elsewhere classified,Arterial embolism and thrombosis of lower extremity,Chronic airway obstruction, not elsewhere classified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Mitral valve disorder,Surg comp-peri vasc syst,Lower extremity embolism,Chr airway obstruct NEC,Abn react-artif implant
Admission Date:  [**2185-6-7**]              Discharge Date:   [**2185-6-14**]

Date of Birth:  [**2134-4-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Percocet / Codeine

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

Major Surgical or Invasive Procedure:
[**2185-6-7**] Minimally Invasive Mitral Valve Replacement utilizing a
[**Street Address(2) 56457**]. [**Male First Name (un) 923**] mechanical valve


History of Present Illness:
51 yo female with severe MR and increasing dyspnea referred
pre-op for cath prior to valve surgery. Followed with serial
echos, and most recent in [**4-23**] showed worsening MR since [**2180**],
as well as severe pulm. HTN. She also has had intermittent chest
pain with exertion. Cath in [**Month (only) 116**] showed normal coronaries, 4+ MR,
and EF >55%.Referred to Dr. [**Last Name (STitle) 1290**] for surgical
repair/replacement.

Past Medical History:
MVP/MR
[**First Name (Titles) **] [**Last Name (Titles) 2182**]
right benign breast lumpectomy
osteopenia
s/p ectopic pregnancy 20 yrs. ago
thrombosed left femoral pseudoaneurysm

Social History:
30 pack yea history- quit 3 1/2 years ago
lives with her 2 children
divorced
[**1-21**] glasses wine/week

Family History:
? CAD (unclear)

Physical Exam:
NAD, WD,WN
NC/AT, PERRLA, EOMI, OP benign
complete dentures
neck supple, full ROM, no lymphadenopathy or thyromegaly
carotids 2+ Bilat. without bruits
CTAB
RRR  3/6 holosystolic murmur
+ BS, soft, NT, ND, no masses or HSM
no c/c/e, 2+ bilat. peripheral pulses
non-focal neuro exam


Pertinent Results:
[**2185-6-13**] 06:00AM BLOOD WBC-8.1 RBC-3.46* Hgb-11.1* Hct-32.4*
MCV-94 MCH-32.0 MCHC-34.2 RDW-13.6 Plt Ct-292#
[**2185-6-14**] 07:00AM BLOOD PT-23.6* INR(PT)-2.4*
[**2185-6-13**] 06:00AM BLOOD Plt Ct-292#
[**2185-6-13**] 06:00AM BLOOD Glucose-94 UreaN-13 Creat-0.7 Na-139
K-4.3 Cl-101 HCO3-31 AnGap-11
[**2185-6-13**] 06:00AM BLOOD Calcium-9.1 Phos-4.2# Mg-1.7

REPORT


INDICATION: 51-year-old post-mitral valve replacement with right
leg
weakness.

TECHNIQUE: Multiplanar T1- and T2-weighted images of the brain
without IV
contrast including axial FLAIR, gradient echo, and
diffusion-weighted
sequences. MR angiogram of the brain with 3D time-of-flight and
multiplanar
reformatted images.

No prior studies.

MRI OF THE BRAIN WITHOUT IV CONTRAST: Numerous areas of focal
increased T2
and FLAIR signal intensity are seen within the white matter of
both cerebral
hemispheres as well as in the periventricular white matter
surrounding both
lateral ventricles. Numerous focal rounded areas of
susceptibility artifact
are also seen within the cortex and subcortical white matter of
both cerebral
hemispheres. Some of these may represent flow-related artifact.
There is no
restricted diffusion. No structural brain abnormality is seen on
T1-weighted
images. Ventricles and sulci are normal in appearance.

MR ANGIOGRAM: Normal signal intensity is seen within both
vertebral, both
internal carotid, the basilar, and circle of [**Location (un) 431**] arteries and
branch
vessels. There is a dominant left anteroinferior cerebellar
artery. No flow-
limiting stenosis or area of aneurysmal dilation is seen.

IMPRESSION:

1. MRI [**Location (un) 4059**] small vessel ischemic changes.

2. Areas of susceptibility on gradient echo images may represent
early
amyloid angiopathy or sequela from prior small emboli.

3. MR [**First Name (Titles) 20827**] [**Last Name (Titles) 4059**] no flow-limiting stenosis or
aneurysmal
dilation.

Findings were communicated with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20286**] on the morning of [**6-14**], [**2184**].



THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name (STitle) 7853**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]

DR. [**First Name (STitle) 23303**] [**Doctor Last Name **]


Approved: WED [**2185-6-15**] 5:23 PM
Procedure Date:[**2185-6-14**]

FINAL REPORT


HISTORY: Effusion.

PA and lateral radiographs of the chest demonstrate interval
removal of the
two right jugular central venous catheters seen on [**2185-6-8**].
Prosthetic
cardiac valve is unchanged. There is widening of the
acromioclavicular joint
and probable resection of distal right clavicle. There is no
pneumothorax.
The lungs are clear. Trachea is midline. There is a small
right-sided
pleural effusion.

IMPRESSION:

Interval removal of right jugular central venous catheters. No
pneumothorax.

Resolution of previously described congestive heart failure.
Small persistent
right pleural effusion.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 6892**]


Approved: [**Doctor First Name **] [**2185-6-23**] 8:02 AM
Procedure Date:[**2185-6-11**]

FINAL REPORT


INDICATION: Status post mitral valve replacement, evaluate for
right groin
hematoma.

FINDINGS: Grayscale and Doppler son[**Name (NI) 1417**] of the right groin
were performed.
Common femoral vein and artery appear unremarkable without
evidence of fistula
or pseudoaneurysm. No fluid collections are identified.
Ultrasound over
the patient's area of pain in the right thigh area [**Name (NI) 4059**]
patent vessels
without evidence of abnormal fluid collection.

IMPRESSION: No evidence of right groin hematoma, fistula or
pseudoaneurysm.



THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]


Approved: SAT [**2185-6-11**] 11:13 AM
Procedure Date:[**2185-6-10**]

Conclusions
PRE-BYPASS:
1) No atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thickness, cavity size, and systolic function
are normal (LVEF>55%).

2) Right ventricular chamber size and free wall motion are
normal. The ascending, transverse and descending thoracic aorta
are normal in diameter and free of atherosclerotic plaque.

3) The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation.

4) there is a long anterior mitral leaflet with a probable
myxomatous appearance. The posterior leaflet is small or
retracted. There is an eccentric regurgitant jet with reversal
in pumonary veins c/w severe mitral regurgitation.
C-[**Month (only) **] distance is 3.0cm. Mitral annulus is 3.7cm.

Post-Bypass (1):
A prosthetic ring is seen in mitral annulus stable in position.
Preserved biventricular systolic function. Aortic contour is
well preserved. There is a mitral regurgitant jet, eccentric
seen well in MVLAX view c/w a moderate or atleast a mild to
moderate regurgitation.

Post-Bypass (2):
A mechanical prosthetic valve is seen in the mitral position,
stable inpositon and both the leaflets are opening and closing
well. Peak transmital gradient is 5mm of Hg and a mean of 3mm of
Hg (immediate post-bypass).
Preserved biventricular systolic function. Aortic contour is
well preserved. Trivial MR and no AI.
I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician





Brief Hospital Course:
Admitted on [**6-7**] and underwent minimally invasive mitral valve
replacement with a mechanical valve. Transferred to the CSRU in
stable condition on titrated phenylephrine and propofol drips.
On nipride and insulin drips on POD #1, and did not extubate
until later in the day. Chest tubes removed that evening and pt.
c/o pain and paresthesia of right inner thigh. Coumadin started
that evening,all drips off, and transferred to the floor on POD
#2 to begin to increase her activity level. Gentle diuresis and
beta blockade started and heparin continued until INR
therapeutic. Neurology consult obtained for right thigh pain on
POD #3. Vascular service also consulted and CT scanning /US
completed for the femoral neuropathy. All exams negative for
hematoma or fluid collection.Neurontin started per neurology and
follow up encouraged with neurology clinic post-discharge.Right
leg pain improved on discharge day with dilaudid. Coumadin
dosing and INR follow up to be done by Dr. [**Last Name (STitle) 30197**]. First blood
draw to be done [**6-16**].

Medications on Admission:
prozac 20 mg daily
trazadone 50 mg daily
albuterol MDI prn
fosamax 70 mg q Monday

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 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:*100 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
3. Fluoxetine 10 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
Disp:*60 Capsule(s)* Refills:*0*
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
5. Ibuprofen 400 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours) for 10 days.
Disp:*42 Tablet(s)* Refills:*0*
6. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal DAILY (Daily).
Disp:*30 Patch 24HR(s)* Refills:*2*
7. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every [**3-24**]
hours as needed.
Disp:*60 Tablet(s)* Refills:*0*
8. Gabapentin 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day): Increase to 100-100-200 in 5 days.
Disp:*90 Capsule(s)* Refills:*2*
9. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO ONCE (Once) for 1
doses: Check INR [**2185-6-16**] with results faxed to Dr. [**Last Name (STitle) 56458**]
office.
Disp:*60 Tablet(s)* Refills:*0*
10. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Mitral Regurgitation - s/p Minimally Invasive Mitral Valve
Replacement([**Street Address(2) 56457**]. [**Male First Name (un) 923**] mechanical valve), Postop
Right Leg Neuropathic Pain, Chronic Obstructive Pulmonary
Disease, Left Femoral Pseudoaneurysm with Thrombosis, Prior
Right Breast Lumpectomy, Osteopenia


Discharge Condition:
Good


Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. Call with fever, redness or drainage from incision or
weigh gain more than 2 pounds in one day or five in one week.
No driving until follow up woth surgeon.


Followup Instructions:
Dr. [**Last Name (STitle) 1290**] in [**3-23**] weeks - call for appt
Dr. [**Last Name (STitle) **] in [**1-21**] weeks - call for appt
Dr. [**Last Name (STitle) 30197**] in [**1-21**] weeks - call for appt
Dr. [**First Name (STitle) **] (Neurology) [**Telephone/Fax (1) 541**]
Dr. [**Last Name (STitle) 30197**] will adjust Warfarin as outpatient. VNA should fax
results to [**Telephone/Fax (1) 19981**]. Please check INR [**2185-6-16**]. Patient will
eventually will have blood drawn at [**Hospital1 **] [**Location (un) 620**] lab when VNA
services have expired.



Completed by:[**2185-7-4**]
{'Mitral valve disorders,Peripheral vascular complications, not elsewhere classified,Arterial embolism and thrombosis of lower extremity,Chronic airway obstruction, not elsewhere classified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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: increasing dyspnea

PRESENT ILLNESS: 51 yo female with severe MR and increasing dyspnea referred
pre-op for cath prior to valve surgery. Followed with serial
echos, and most recent in [**4-23**] showed worsening MR since [**2180**],
as well as severe pulm. HTN. She also has had intermittent chest
pain with exertion. Cath in [**Month (only) 116**] showed normal coronaries, 4+ MR,
and EF >55%.Referred to Dr. [**Last Name (STitle) 1290**] for surgical
repair/replacement.

MEDICAL HISTORY: MVP/MR
[**First Name (Titles) **] [**Last Name (Titles) 2182**]
right benign breast lumpectomy
osteopenia
s/p ectopic pregnancy 20 yrs. ago
thrombosed left femoral pseudoaneurysm

MEDICATION ON ADMISSION: prozac 20 mg daily
trazadone 50 mg daily
albuterol MDI prn
fosamax 70 mg q Monday

ALLERGIES: Percocet / Codeine

PHYSICAL EXAM: NAD, WD,WN
NC/AT, PERRLA, EOMI, OP benign
complete dentures
neck supple, full ROM, no lymphadenopathy or thyromegaly
carotids 2+ Bilat. without bruits
CTAB
RRR  3/6 holosystolic murmur
+ BS, soft, NT, ND, no masses or HSM
no c/c/e, 2+ bilat. peripheral pulses
non-focal neuro exam

FAMILY HISTORY: ? CAD (unclear)

SOCIAL HISTORY: 30 pack yea history- quit 3 1/2 years ago
lives with her 2 children
divorced
[**1-21**] glasses wine/week 

### Response:
{'Mitral valve disorders,Peripheral vascular complications, not elsewhere classified,Arterial embolism and thrombosis of lower extremity,Chronic airway obstruction, not elsewhere classified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
