CHIEF COMPLAINT: mitral regurgitation

PRESENT ILLNESS: This  55 year old male with known murmur for many years has been
followed by his cardiologist for approximately 6-7 years for
mitral valve prolapse. He has undergone several echocardiograms
with the most recent showing moderate to severe mitral
regurgitation, bileaflet prolapse and mild LV enlargement. In
addition, he has been noticing slowly worsening dyspnea on
exertion. He now presents for surgical repair after having
undergone preoperative workup.

MEDICAL HISTORY: Myxomatous mitral valve prolapse
Mitral regurgitation
Gastroesophageal reflux disease

MEDICATION ON ADMISSION: MVI daily
Aspirin 81 mg daily
Omeprazole 20 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 55 Resp: 18 O2 sat: 98%
B/P  Right: 141/70   Left: 123/83
Height: 5'[**05**]"    Weight: 180 lbs

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: last dental visit on Monday [**2106-5-10**]
Lives with: Wife
Occupation: Supervisor at group home
Tobacco: Never
ETOH: Denies
Mitral valve disorders,Ostium secundum type atrial septal defect,Esophageal reflux,Other iatrogenic hypotension,Anemia, unspecified
Mitral valve disorder,Secundum atrial sept def,Esophageal reflux,Iatrogenc hypotnsion NEC,Anemia NOS
Admission Date:  [**2106-5-25**]              Discharge Date:   [**2106-5-29**]

Date of Birth:  [**2050-10-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
mitral regurgitation

Major Surgical or Invasive Procedure:
[**2106-5-25**] mitral valve repair (30 mm CE Physio II Ring)/patent
foramen ovale closure


History of Present Illness:
This  55 year old male with known murmur for many years has been
followed by his cardiologist for approximately 6-7 years for
mitral valve prolapse. He has undergone several echocardiograms
with the most recent showing moderate to severe mitral
regurgitation, bileaflet prolapse and mild LV enlargement. In
addition, he has been noticing slowly worsening dyspnea on
exertion. He now presents for surgical repair after having
undergone preoperative workup.

Past Medical History:
Myxomatous mitral valve prolapse
Mitral regurgitation
Gastroesophageal reflux disease


Social History:
Race: Caucasian
Last Dental Exam: last dental visit on Monday [**2106-5-10**]
Lives with: Wife
Occupation: Supervisor at group home
Tobacco: Never
ETOH: Denies


Family History:
non-contributory


Physical Exam:
Pulse: 55 Resp: 18 O2 sat: 98%
B/P  Right: 141/70   Left: 123/83
Height: 5'[**05**]"    Weight: 180 lbs

General: Well-developed male in no acute distress
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X]
Neck: Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] Irregular [] soft systolic ejection Murmur [**2-7**];
with radiation to left carotid area
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X] Edema: none
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     Right: -   Left: very soft bruit from cardiac
murmur


Pertinent Results:
[**2106-5-25**] TEE
Pre-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage.
A patent foramen ovale is present. A left-to-right shunt across
the interatrial septum is seen at rest.
Overall left ventricular systolic function is normal (LVEF>55%).

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.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis. Trace aortic
regurgitation is seen.
The mitral valve leaflets are moderately thickened. The mitral
valve leaflets are myxomatous. Moderate to severe (3+) mitral
regurgitation is seen.
There is no pericardial effusion.
Post-CPB:
The patient is A-Paced, on no inotropes.
There is a mitral ring repair with a trace of MR, residual mean
gradient of 3 mmHg.
The anterior leaflet is redundant and may pose a risk of [**Male First Name (un) **].
None evident in OR.
RV systolic fxn preserved.
LV systolic fxn is mildly depressed with inferior HK.
No flow seen through Foramen Ovale.
Trace AI. Aorta intact.

[**2106-5-28**] 06:25AM BLOOD WBC-10.3 RBC-2.53* Hgb-7.7* Hct-22.7*
MCV-90 MCH-30.6 MCHC-34.1 RDW-13.3 Plt Ct-102*
[**2106-5-28**] 06:25AM BLOOD Glucose-108* UreaN-17 Creat-0.8 Na-139
K-4.5 Cl-101 HCO3-32 AnGap-11

Brief Hospital Course:
Mr. [**Known lastname 89414**] was admitted to the hospital and brought to the
operating room on [**2106-5-25**] where he underwent a mitral repair (30
mm CE Physio II Ring) and patent foramen ovale closure. Overall
the patient tolerated the procedure well and post-operatively
was transferred to the CVICU in stable condition for recovery
and invasive monitoring.

He initially had high chest tube drainage and received multiple
products for correction of a coagulopathy. POD 1 found the
patient extubated, alert and oriented and breathing comfortably.
 He did have a vagal event where he lost consciousness for
approximately 10 seconds with transfer from chair to bed on post
operative day 1. The patient was neurologically intact and
hemodynamically stable. Neosynephrine was weaned off post
operative day 2 with a stable blood pressure. Beta blocker was
initiated and the patient was gently diuresed toward his
preoperative weight.  The patient was transferred to the
telemetry floor for further recovery.  Chest tubes and pacing
wires were discontinued without complication.

He was anemic to 24 and on [**5-28**] his hematocrit was 22.7  He felt
well and declined transfusion. The patient was evaluated by the
Physical Therapy service for assistance with strength and
mobility.  By the time of discharge on POD four the patient was
ambulating freely, the wound was healing and pain was controlled
with oral analgesics.

The patient was discharged on post-operative day four to home
with visiting nursing in good condition with appropriate follow
up instructions.

Medications on Admission:
MVI daily
Aspirin 81 mg daily
Omeprazole 20 mg daily


Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain/fever.
4. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
Disp:*7 Tablet(s)* Refills:*2*
8. 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:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
mitral regurgitation
s/p mitral valve repair,closure of patent foramen ovale
gastroesophageal reflux disease
patent foramen ovale


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
 Edema;none


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 [**6-17**] at 1:45pm
cardiology: Dr. [**Last Name (STitle) **] on [**6-26**] at 10am

Please call to schedule appointments with:
Primary Care: Dr. [**Last Name (STitle) 11487**] in [**3-9**] weeks ([**Telephone/Fax (1) 8506**])

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




Completed by:[**2106-5-29**]
{'Mitral valve disorders,Ostium secundum type atrial septal defect,Esophageal reflux,Other iatrogenic hypotension,Anemia, unspecified'}


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: mitral regurgitation

PRESENT ILLNESS: This  55 year old male with known murmur for many years has been
followed by his cardiologist for approximately 6-7 years for
mitral valve prolapse. He has undergone several echocardiograms
with the most recent showing moderate to severe mitral
regurgitation, bileaflet prolapse and mild LV enlargement. In
addition, he has been noticing slowly worsening dyspnea on
exertion. He now presents for surgical repair after having
undergone preoperative workup.

MEDICAL HISTORY: Myxomatous mitral valve prolapse
Mitral regurgitation
Gastroesophageal reflux disease

MEDICATION ON ADMISSION: MVI daily
Aspirin 81 mg daily
Omeprazole 20 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 55 Resp: 18 O2 sat: 98%
B/P  Right: 141/70   Left: 123/83
Height: 5'[**05**]"    Weight: 180 lbs

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: last dental visit on Monday [**2106-5-10**]
Lives with: Wife
Occupation: Supervisor at group home
Tobacco: Never
ETOH: Denies 

### Response:
{'Mitral valve disorders,Ostium secundum type atrial septal defect,Esophageal reflux,Other iatrogenic hypotension,Anemia, unspecified'}
