CHIEF COMPLAINT: Increasing DOE

PRESENT ILLNESS: 67 year old gentleman who developed shortness of breath and a
new
heart murmur roughly one year ago. A stress test was performed
which did not show ischemia however the echocardiogram revealed
mitral regurgitation. A repeat echocardiogram was peformed this
[**Month (only) 205**] which showed posterior leaflet prolapse with associated
severe mitral regurgitation. Mild left ventricular hypertrophy
was noted as well as pulmonary vein reversal. Given the severity
of his disease, he was referred for surgical evaluation. He is
symptomatic with fatigue, occasional lightheadedness, dyspnea on
exertion and some mild exertional chest heaviness.

MEDICAL HISTORY: Hyperlipidemia
Hypertension
Mitral regurgitation
Depression
Skin Cancer (Basal/Melanoma)
Past Pilonidal cyst
GERD
Past Surgical History:
Neck lift
Right ankle pin
Excision of pilonidal cyst
Skin cancer execisions
Biteral knee arthroscopies

MEDICATION ON ADMISSION: omeprazole 20 mg daily
simvastatin 20 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: Family History:no Premature coronary artery disease
Sister with MR.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Every 6 months, dental clearance obtained
Lives with: Wife/child in [**Hospital1 **]
Occupation:retired teacher
Cigarettes: Smoked no [] yes [x] 1ppd x 20yrs last cigarette 5
years ago Hx: 20 pack year history
Other Tobacco use:denies
ETOH: < 1 drink/week [X]  [**12-31**] drinks/week [] >8 drinks/week []
Illicit drug use-none
Mitral valve disorders,Rupture of chordae tendineae,Acidosis,Atrial fibrillation,Esophageal reflux,Unspecified essential hypertension,Cardiac rhythm regulators causing adverse effects in therapeutic use,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Personal history of other malignant neoplasm of skin,Other postprocedural status
Mitral valve disorder,Chordae tendinae rupture,Acidosis,Atrial fibrillation,Esophageal reflux,Hypertension NOS,Adv eff card rhyth regul,Hyperlipidemia NEC/NOS,Depressive disorder NEC,Hx-skin malignancy NEC,Post-proc states NEC
Admission Date:  [**2154-7-26**]              Discharge Date:   [**2154-7-30**]

Date of Birth:  [**2086-9-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Increasing DOE


Major Surgical or Invasive Procedure:
s/p Mitral Valve repair (Gortex neo cord/#30 physio 2 ring) on
[**2154-7-26**]


History of Present Illness:
67 year old gentleman who developed shortness of breath and a
new
heart murmur roughly one year ago. A stress test was performed
which did not show ischemia however the echocardiogram revealed
mitral regurgitation. A repeat echocardiogram was peformed this
[**Month (only) 205**] which showed posterior leaflet prolapse with associated
severe mitral regurgitation. Mild left ventricular hypertrophy
was noted as well as pulmonary vein reversal. Given the severity
of his disease, he was referred for surgical evaluation. He is
symptomatic with fatigue, occasional lightheadedness, dyspnea on
exertion and some mild exertional chest heaviness.


Past Medical History:
Hyperlipidemia
Hypertension
Mitral regurgitation
Depression
Skin Cancer (Basal/Melanoma)
Past Pilonidal cyst
GERD
Past Surgical History:
Neck lift
Right ankle pin
Excision of pilonidal cyst
Skin cancer execisions
Biteral knee arthroscopies


Social History:
Race: Caucasian
Last Dental Exam: Every 6 months, dental clearance obtained
Lives with: Wife/child in [**Hospital1 **]
Occupation:retired teacher
Cigarettes: Smoked no [] yes [x] 1ppd x 20yrs last cigarette 5
years ago Hx: 20 pack year history
Other Tobacco use:denies
ETOH: < 1 drink/week [X]  [**12-31**] drinks/week [] >8 drinks/week []
Illicit drug use-none


Family History:
Family History:no Premature coronary artery disease
Sister with MR.


Physical Exam:
Admission Physical Exam

Pulse: 54  Resp: 16 O2 sat: 100%
B/P  Right: 124/87    Left: 126/88
Height: 66"    Weight:183

General: WDWN in NAD
Skin: Warm, Dry and intact. Some well healed surgical scars
HEENT: NCAT, PERRLA, EOMI, Sclera anicteric, no carotid bruits
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] III/VI systolic murmur best heard along left
sternal border
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  Edema [X] _____
Varicosities: None [X]
Neuro: Grossly intact [X]
Pulses:
Femoral      Right:2   Left:2
DP           Right:2   Left:2
PT           [**Name (NI) 167**]:2   Left:2
Radial       Right:2   Left:2

Carotid Bruit   Transmitted vs. bruit


Pertinent Results:
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.5 cm  0.6 - 1.1 cm
Left Ventricle - Diastolic Dimension:  5.3 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  3.9 cm
Left Ventricle - Fractional Shortening:  *0.26  >= 0.29
Aorta - Sinus Level:  3.4 cm  <= 3.6 cm
Aorta - Ascending:  2.8 cm  <= 3.4 cm
Findings
Multiplanar reconstructions were generated and confirmed on an
independent workstation.
LEFT ATRIUM: Good (>20 cm/s) LAA ejection velocity.
RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.
LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
global systolic function (LVEF>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: No atheroma in ascending aorta. Normal aortic arch
diameter. Simple atheroma in descending aorta.
AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets (3). No AS. Trace AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets.
Moderate/severe MVP. Torn mitral chordae. [**Male First Name (un) **] of the mitral
chordae (normal variant). No resting LVOT gradient. Severe (4+)
MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets.
PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized.
No PS. Physiologic PR.
PERICARDIUM: No pericardial effusion.
Conclusions
PREBYPASS:
No atrial septal defect is seen by 2D or color Doppler.
Left ventricular wall thickness, cavity size, and global
systolic function are normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. The aortic valve leaflets
(3) are mildly thickened. There is no aortic valve stenosis.
Trace aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. There is
moderate/severe P3 leaflet mitral valve prolapse. Torn mitral
chordae are present. Severe (4+) mitral regurgitation is seen.
There is no pericardial effusion.
POSTBYPASS:
The patient is on a low dose phenyleprine infusion.
Biventricular function is preserved.
There is a well-seated Mitral Annuloplasty ring noted. There is
no mitral stenosis or regurgitation. There is no periprosthesis
leak detected.
The previously noted trace aortic regurgitation is unchanged.
The aorta remains intact post decannulation.

[**2154-7-30**] 05:30AM BLOOD WBC-8.3 RBC-3.34* Hgb-11.0* Hct-30.8*
MCV-92 MCH-33.1* MCHC-35.8* RDW-12.4 Plt Ct-206#
[**2154-7-28**] 04:45AM BLOOD WBC-11.6* RBC-3.52* Hgb-11.6* Hct-32.2*
MCV-92 MCH-32.8* MCHC-35.9* RDW-12.1 Plt Ct-129*
[**2154-7-30**] 05:30AM BLOOD PT-27.1* INR(PT)-2.6*
[**2154-7-29**] 11:05AM BLOOD PT-21.4* INR(PT)-2.0*
[**2154-7-26**] 12:04PM BLOOD PT-14.4* PTT-36.5* INR(PT)-1.2*
[**2154-7-30**] 05:30AM BLOOD Glucose-96 UreaN-15 Creat-0.8 Na-141
K-4.3 Cl-107 HCO3-25 AnGap-13
[**2154-7-29**] 06:50AM BLOOD Glucose-130* UreaN-19 Na-138 K-4.1 Cl-105
HCO3-27 AnGap-10
[**2154-7-28**] 10:05AM BLOOD Na-131* K-5.0 Cl-98

Brief Hospital Course:
On [**2154-7-26**] Mr.[**Known lastname 7749**] was taken to the operating room and underwent
Mitral Valve repair (Gortex neo cord/#30 physio 2 ring) with Dr.
[**Last Name (STitle) **]. Please see operative report for further surgical
details. He tolerated the procedure well and was transferred to
the CVICU intubated and sedated. He awoke neurologically intact
and was extubated without difficulty. He weaned off pressor
support and was started on Beta-blocker/Statin/Aspirin and
diuresed to his preoperative weight. All lines and drains were
discontinued per protocol. He continued to progress and on POD#1
he was transferred to the step down unit for further monitoring.
Physical Therapy was consulted for evaluation of strength and
mobility. He did go into a rate controlled atrial fibrillation
on POD 2 and Amiodarone was not started due to heart rate in the
50-60's.  Coumadin was started on 9.4 and the patient was given
5 mg/1 mg/0.5 mg for INR goal 2.0-2.5.  INR on [**7-29**] was 2.0->2.6
on [**7-30**].  Amiodarone was started on [**7-30**] with patient remaining in
atrial fibrillation heart rate 80's and fully anticoagulated.
Amiodarone weaning to be determined by cardiologist Dr [**Last Name (STitle) **]. The
remainder of his hospital course was essentially uneventful. He
was cleared for discharge to home on POD 4 with VNA services.
All follow up appointments were advised.


Medications on Admission:
omeprazole 20 mg daily
simvastatin 20 mg daily


Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. furosemide 20 mg Tablet Sig: One (1) Tablet PO every
twenty-four(24) hours for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
3. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day for 7 days.
Disp:*7 Tablet, ER Particles/Crystals(s)* Refills:*0*
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. 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:*2*
6. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
7. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
8. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*1*
9. warfarin 1 mg Tablet Sig: One (1) Tablet PO every
twenty-four(24) hours: Take as directed for INR goal 2.0-2.5.
On [**7-30**] take o.5 mg Coumadin dose.
Disp:*60 Tablet(s)* Refills:*0*
10. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for PAIN OR FEVER .
11. paroxetine HCl 10 mg Tablet Sig: One (1) Tablet PO every
twenty-four(24) hours. Tablet(s)
12. amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 30 days: Continue as directed by cardiologist.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Mitral Regurgitation s/p Mitral Valve repair (Gortex neo
cord/#30 physio 2 ring) on [**2154-7-26**]
Secondary:
Hyperlipidemia
Hypertension
Depression
Skin Cancer (Basal/Melanoma)
Past Pilonidal cyst
GERD


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Edema


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr.[**Last Name (STitle) **] #[**Telephone/Fax (1) 170**] on [**8-28**] at 1:45pm

Cardiologist: Dr.[**Last Name (STitle) **] [**Name (STitle) **] [**Telephone/Fax (1) 4475**] on [**8-20**] at 11:30 AM

Please call to schedule appointments with your
Primary Care Dr. [**First Name (STitle) **] in [**11-25**] weeks [**Telephone/Fax (1) 17503**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication Atrial Fibrillation
Goal INR 2.0-2.5
Take Coumadin 0.5 mg on [**2154-7-30**]
First draw [**2154-7-31**]
Results to phone [**Telephone/Fax (1) 4475**]
Fax: [**Telephone/Fax (1) 29683**]



Completed by:[**2154-7-30**]
{'Mitral valve disorders,Rupture of chordae tendineae,Acidosis,Atrial fibrillation,Esophageal reflux,Unspecified essential hypertension,Cardiac rhythm regulators causing adverse effects in therapeutic use,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Personal history of other malignant neoplasm of skin,Other postprocedural status'}


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 DOE

PRESENT ILLNESS: 67 year old gentleman who developed shortness of breath and a
new
heart murmur roughly one year ago. A stress test was performed
which did not show ischemia however the echocardiogram revealed
mitral regurgitation. A repeat echocardiogram was peformed this
[**Month (only) 205**] which showed posterior leaflet prolapse with associated
severe mitral regurgitation. Mild left ventricular hypertrophy
was noted as well as pulmonary vein reversal. Given the severity
of his disease, he was referred for surgical evaluation. He is
symptomatic with fatigue, occasional lightheadedness, dyspnea on
exertion and some mild exertional chest heaviness.

MEDICAL HISTORY: Hyperlipidemia
Hypertension
Mitral regurgitation
Depression
Skin Cancer (Basal/Melanoma)
Past Pilonidal cyst
GERD
Past Surgical History:
Neck lift
Right ankle pin
Excision of pilonidal cyst
Skin cancer execisions
Biteral knee arthroscopies

MEDICATION ON ADMISSION: omeprazole 20 mg daily
simvastatin 20 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: Family History:no Premature coronary artery disease
Sister with MR.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Every 6 months, dental clearance obtained
Lives with: Wife/child in [**Hospital1 **]
Occupation:retired teacher
Cigarettes: Smoked no [] yes [x] 1ppd x 20yrs last cigarette 5
years ago Hx: 20 pack year history
Other Tobacco use:denies
ETOH: < 1 drink/week [X]  [**12-31**] drinks/week [] >8 drinks/week []
Illicit drug use-none 

### Response:
{'Mitral valve disorders,Rupture of chordae tendineae,Acidosis,Atrial fibrillation,Esophageal reflux,Unspecified essential hypertension,Cardiac rhythm regulators causing adverse effects in therapeutic use,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Personal history of other malignant neoplasm of skin,Other postprocedural status'}
