CHIEF COMPLAINT: Decreased excercise tolerance

PRESENT ILLNESS: Mrs. [**Known lastname 94278**] is a 62-year-old female
with recurrent episodes of pulmonary edema and heart failure,
who was known to have moderate to severe mitral regurgitation
on multiple evaluations, including cardiac MRI, left
ventriculography, and transesophageal echocardiogram. She had
increasing left ventricular and left atrial dimensions. She
has also had multiple recurrent episodes of paroxysmal atrial
fibrillation and is on treatment with flecainide and
anticoagulation. Her left atrial measured around 7 cm in 1
dimension. She is presenting for repair of her mitral valve
and an attempt at ablation of her atrial arrhythmia with a
modified left-sided maze procedure. Cath [**5-3**] showed no
siginificant coronary disease.

MEDICAL HISTORY: Sleep Apnea
Hypothyroid
Depression
GERD
PAF
HTN
Dyslipidemia
MR

MEDICATION ON ADMISSION: Coumadin
Aspirin 325mg QD
Norvasc 5mg QD
Flecanide 200mg [**Hospital1 **]
Synthyroid 100mcg QD
Ativan
Protonix 40mg QD

ALLERGIES: Nifedipine / Clonidine / Prazosin / Nitroquick / Lopressor

PHYSICAL EXAM: 40 SB   17   123/69  65"  260

FAMILY HISTORY: Fathger with 2 MI's starting at age 60.

SOCIAL HISTORY: Engineer. Lives with husband. [**Name (NI) 4084**] smoked and does not drink.
Mitral valve disorders,Atrial fibrillation,Congestive heart failure, unspecified,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Unspecified acquired hypothyroidism
Mitral valve disorder,Atrial fibrillation,CHF NOS,Obstructive sleep apnea,Hyperlipidemia NEC/NOS,Hypertension NOS,Esophageal reflux,Hypothyroidism NOS
Admission Date:  [**2153-5-15**]              Discharge Date:   [**2153-5-29**]

Date of Birth:  [**2090-9-28**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Nifedipine / Clonidine / Prazosin / Nitroquick / Lopressor

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Decreased excercise tolerance

Major Surgical or Invasive Procedure:
[**2153-5-15**] - Mitral Valve Repair (30mm CE Physio Ring), MAZE, Left
Atrial Appendage Ligation.
[**2153-5-23**] dual chamber pacemaker placement

History of Present Illness:
Mrs. [**Known lastname 94278**] is a 62-year-old female
with recurrent episodes of pulmonary edema and heart failure,
who was known to have moderate to severe mitral regurgitation
on multiple evaluations, including cardiac MRI, left
ventriculography, and transesophageal echocardiogram. She had
increasing left ventricular and left atrial dimensions. She
has also had multiple recurrent episodes of paroxysmal atrial
fibrillation and is on treatment with flecainide and
anticoagulation. Her left atrial measured around 7 cm in 1
dimension. She is presenting for repair of her mitral valve
and an attempt at ablation of her atrial arrhythmia with a
modified left-sided maze procedure. Cath [**5-3**] showed no
siginificant coronary disease.


Past Medical History:
Sleep Apnea
Hypothyroid
Depression
GERD
PAF
HTN
Dyslipidemia
MR


Social History:
Engineer. Lives with husband. [**Name (NI) 4084**] smoked and does not drink.

Family History:
Fathger with 2 MI's starting at age 60.

Physical Exam:
40 SB   17   123/69  65"  260

GEN: NAD
SKIN: Bilateral LE stasis changes
HEENT: Unremarkable
LUNGS: Clear
HEART: RRR, Nl S1-S2
ABD: Obese, soft, NT, ND, NABS
EXT: 1+ LE edema
NEURO: Nonfocal

Pertinent Results:
[**2153-5-15**] ECHO
The left atrium is elongated. The right atrium is moderately
dilated. There is mild symmetric left ventricular hypertrophy.
The left ventricular cavity is moderately dilated. Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is normal (LVEF>55%). Tissue Doppler imaging
suggests a normal left ventricular filling pressure
(PCWP<12mmHg). Right ventricular chamber size and free wall
motion are normal. The ascending aorta is mildly dilated. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. The mitral valve
leaflets are mildly thickened. There is no mitral valve
prolapse. Mild to moderate ([**2-6**]+) mitral regurgitation is seen.
There is an anterior space which most likely represents a fat
pad.

IMPRESSION: Mild symmetric left ventricular hypertrophy with
dilated left
ventricular cavity and preserved biventricular systolic
function. Mild to
moderate mitral regurgitation.

[**2153-5-29**] 06:30AM BLOOD WBC-9.6 RBC-3.55* Hgb-10.1* Hct-31.9*
MCV-90 MCH-28.5 MCHC-31.6 RDW-15.1 Plt Ct-475*
[**2153-5-29**] 06:30AM BLOOD Plt Ct-475*
[**2153-5-29**] 06:30AM BLOOD PT-20.9* INR(PT)-2.0*
[**2153-5-29**] 06:30AM BLOOD Glucose-99 UreaN-14 Creat-1.0 Na-142
K-4.3 Cl-98 HCO3-38* AnGap-10
[**2153-5-29**] 06:30AM BLOOD ALT-47* AST-35 LD(LDH)-190 Amylase-23
TotBili-0.4
[**2153-5-29**] 06:30AM BLOOD Lipase-19
[**2153-5-29**] 06:30AM BLOOD Albumin-3.5 Mg-2.5

RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2153-5-28**] 2:17 PM

CHEST (PA & LAT)

Reason: evaluation lll ? atelectasis

[**Hospital 93**] MEDICAL CONDITION:
62 year old woman s/p MVrepair, MAZE with LAA ligation now dual
chamber pacemaker placement
REASON FOR THIS EXAMINATION:
evaluation lll ? atelectasis
2 VIEW CHEST [**2153-5-28**]:

COMPARISON: [**2153-5-24**].

INDICATION: Evaluate left lower lobe.

Permanent pacemaker remains in standard position with leads in
the right atrium and right ventricle. Heart is enlarged but
stable in size. Improving left lower lobe opacity is noted with
residual patchy and linear areas of atelectasis remaining. 2
foci of discoid atelectasis are present in the right upper and
mid lung regions adjacent to an area of fluid within the minor
fissure. Small pleural effusions are present bilaterally but
have decreased in size.

There has been prior median sternotomy and mitral valve
replacement.

IMPRESSION: Improving left lower lobe atelectasis and decreasing
small pleural effusions.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]
Approved: MON [**2153-5-28**] 5:49 PM





Brief Hospital Course:
Mrs. [**Known lastname 94278**] was admitted to the [**Hospital1 18**] on [**2153-5-15**] in
prepartion for mitral valve surgery. She was started on heparin
as she had stopped her coumadin 4 days prior. A transesophageal
echocardiogram was obtained which showed 2+ MR, 1+ TR and a
normal ejection fraction. On [**2153-5-17**], Mrs. [**Known lastname 94278**]  was
taken to the operating room where she underwent a mitral valve
repair with a ring, a MAZE procedure and a left atrial appendage
ligation. Postoperatively she was taken to the intensive care
unit for monitoring. By postoperative day one, Ms. [**Known lastname 94278**]
had awoke neurologically intact and was extubated. The
electrophysiology service was consulted for evaluation of his
junctional rhythm. Flecanide was held. Later on postoperative
day one, Ms. [**Known lastname 94278**] was transferred to the step down unit
for further recovery. Gentle diuresis was initiated. She
developed rapid atrial fibrillation which was not responsive to
calcium channel blockers and beta blockade. Given her history of
heart block and current rapid atrial fibrillation, she was
transferred back to the intensive care unit for monitoring.
Flecanide was resumed and she converted back into a junctional
rhythm. She had a few runs of nonsustained ventricular
tachycardia along with pauses. Heparin was started for
anticoagulation given she continued to fluctuate between atrial
fibrillation and a junctional rhythm.

On [**2153-5-21**], Ms. [**Known lastname 94278**] was transferred back to the step
down unit for further recovery. The electrophysiology service
continued to follow her and suspected a pacemaker would likely
be needed for her sinus node dysunction. Given her continued
rapid atrial fibrillation alternating with junctional
bradycardia, a dual chamber permenant pacemaker was placed on
[**2153-5-23**]. Her epicardial pacing wires were removed after a normal
interoggation of her pacemaker was obtained. She worked with
physical therapy daily to help increase her strength and
mobility. When her INR was within therapeutic range on coumadin,
her heparin was discontinued. She continued to make steady
progress and was discharged to home with VNA and home oxygen on
[**2153-5-29**]. She will follow-up with Dr. [**Last Name (STitle) **], her cardiologist
and her primary care physician as an outpatient. Her coumadin
management will resume with the [**Hospital 18**] [**Hospital3 **] as
an outpatient.

Medications on Admission:
Coumadin
Aspirin 325mg QD
Norvasc 5mg QD
Flecanide 200mg [**Hospital1 **]
Synthyroid 100mcg QD
Ativan
Protonix 40mg QD


Discharge Medications:
1. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for SOB/wheeze.
Disp:*qs qs* Refills:*0*
5. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO DAILY (Daily).
Disp:*60 Capsule, Sustained Release(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. Warfarin 1 mg Tablet Sig: Dose for goal INR of 2.0-2.5
Tablets PO DAILY (Daily): Goal INR 2.0-2.5 for Atrial
Fibrillation.
Disp:*30 Tablet(s)* Refills:*0*
8. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q2H (every 2
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
9. Flecainide 50 mg Tablet Sig: Four (4) Tablet PO Q12H (every
12 hours).
Disp:*320 Tablet(s)* Refills:*0*
10. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*0*
11. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
12. Warfarin 5 mg Tablet Sig: goal INR 2-2.5  Tablets PO once a
day: dosing based on INR goal 2-2.5 .
Disp:*60 Tablet(s)* Refills:*0*
13. coumadin
please take 6mg coumadin [**5-29**] and [**5-30**] with INR check [**5-31**] -
results to coumadin clinic for further dosing
14. Outpatient [**Name (NI) **] Work
PT/INR Goal INR is 2.0-2.5. Please have blood drawn (PT/INR)
[**2153-5-31**] with results sent to the [**Hospital 18**] [**Hospital3 **].
phone [**Telephone/Fax (1) 2173**]
15. Oxygen-Air Delivery Systems     Device Sig: Two (2) liters
Miscellaneous continuous: for portability pulse dose system .
Disp:*qs qs* Refills:*0*
16. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
Disp:*30 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
s/p MVrepair/ MAZE/ ligation left atrial appendage
Sleep Apnea
PAF
Hypothyroid
Depression
GERD
HTN
PAF
Tachy/brady syndrome


Discharge Condition:
Stable


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
4) No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. No bathing or swimming
for 1 month. Use sunscreen on incision if exposed to sun.
5)No lifting greater then 10 pounds for 10 weeks.
6)No driving for 1 month.
7)Coumadin dosing to be managed by the [**Hospital1 18**] coumadin clinc as
per preoperatively. Goal INR is 2.0-2.5. Please have blood drawn
(PT/INR) [**2153-5-30**] with results sent to the [**Hospital1 18**] [**Hospital 3052**]. phone [**Telephone/Fax (1) 2173**]

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with [**First Name4 (NamePattern1) 402**] [**Last Name (NamePattern1) 7173**] NP in 2 weeks. [**Telephone/Fax (1) 285**]
Follow-up with Dr. [**Last Name (STitle) 2427**] in [**3-11**] weeks. [**Telephone/Fax (1) 250**]
PT/INR blood work on [**2153-5-31**] to coumadin clinic Goal INR is
2.0-2.5. [**Hospital 18**] [**Hospital3 **]. phone [**Telephone/Fax (1) 2173**]
Please call all providers for appointments.

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. Phone:[**Telephone/Fax (1) 285**]
Date/Time:[**2153-9-11**] 1:40



Completed by:[**2153-6-7**]
{'Mitral valve disorders,Atrial fibrillation,Congestive heart failure, unspecified,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Unspecified acquired hypothyroidism'}


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: Decreased excercise tolerance

PRESENT ILLNESS: Mrs. [**Known lastname 94278**] is a 62-year-old female
with recurrent episodes of pulmonary edema and heart failure,
who was known to have moderate to severe mitral regurgitation
on multiple evaluations, including cardiac MRI, left
ventriculography, and transesophageal echocardiogram. She had
increasing left ventricular and left atrial dimensions. She
has also had multiple recurrent episodes of paroxysmal atrial
fibrillation and is on treatment with flecainide and
anticoagulation. Her left atrial measured around 7 cm in 1
dimension. She is presenting for repair of her mitral valve
and an attempt at ablation of her atrial arrhythmia with a
modified left-sided maze procedure. Cath [**5-3**] showed no
siginificant coronary disease.

MEDICAL HISTORY: Sleep Apnea
Hypothyroid
Depression
GERD
PAF
HTN
Dyslipidemia
MR

MEDICATION ON ADMISSION: Coumadin
Aspirin 325mg QD
Norvasc 5mg QD
Flecanide 200mg [**Hospital1 **]
Synthyroid 100mcg QD
Ativan
Protonix 40mg QD

ALLERGIES: Nifedipine / Clonidine / Prazosin / Nitroquick / Lopressor

PHYSICAL EXAM: 40 SB   17   123/69  65"  260

FAMILY HISTORY: Fathger with 2 MI's starting at age 60.

SOCIAL HISTORY: Engineer. Lives with husband. [**Name (NI) 4084**] smoked and does not drink. 

### Response:
{'Mitral valve disorders,Atrial fibrillation,Congestive heart failure, unspecified,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Unspecified acquired hypothyroidism'}
