CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 63 y/o male with recent episode of s. viridans endocarditis in
[**2148-10-5**]. Since that time he has completed a course of IV
antibiotics and extensive dental work. Follow-up echo showed
severe mitral regurgitation and he has also developed atrial
fibrillation. He conitnues to have dyspnea on exertion and
shortness of breath along with 2 pillow orthopnea.

MEDICAL HISTORY: Mitral Regurgitation, Patent Foramen Ovale, Atrial Fibrillation,
Endocarditis, Congestive Heart Failure, Chronic Obstructive
Pulmonary Disease, Asthma, Gout, Anxiety, s/p cataract surgery

MEDICATION ON ADMISSION: Warfarin, Verapamil, Lisinopril, [**Doctor First Name **], Ambien, Advair,
Albuterol, Singulair, Spiriva

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 90 5'7" 102kg
Gen: Well-appearing male in NAD
Skin: W/D intact
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: Irreg-reg rhythm
Abd: Soft, NT, ND +BS
Ext: Warm, well-perfused, minimal edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking in [**10/2148**] after 2ppd x 50yrs. Denies ETOH use.
Coronary atherosclerosis of native coronary artery,Chronic diastolic heart failure,Chronic obstructive asthma, unspecified,Mitral valve disorders,Ostium secundum type atrial septal defect,Atrial fibrillation,Gout, unspecified
Crnry athrscl natve vssl,Chr diastolic hrt fail,Chronic obst asthma NOS,Mitral valve disorder,Secundum atrial sept def,Atrial fibrillation,Gout NOS
Admission Date:  [**2149-1-13**]              Discharge Date:   [**2149-1-22**]

Date of Birth:  [**2085-5-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 1283**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2149-1-13**] Coronary Artery Bypass Graft x 2 (LIMA to LAD, SVG to
Diag), Mitral Valve Replacement with On-X Conform-X Mechanical
Valve, PFO Closure, MAZE procedure, Left atrial appendage
ligation

History of Present Illness:
63 y/o male with recent episode of s. viridans endocarditis in
[**2148-10-5**]. Since that time he has completed a course of IV
antibiotics and extensive dental work. Follow-up echo showed
severe mitral regurgitation and he has also developed atrial
fibrillation. He conitnues to have dyspnea on exertion and
shortness of breath along with 2 pillow orthopnea.

Past Medical History:
Mitral Regurgitation, Patent Foramen Ovale, Atrial Fibrillation,
Endocarditis, Congestive Heart Failure, Chronic Obstructive
Pulmonary Disease, Asthma, Gout, Anxiety, s/p cataract surgery

Social History:
Quit smoking in [**10/2148**] after 2ppd x 50yrs. Denies ETOH use.

Family History:
Non-contributory

Physical Exam:
VS: 90 5'7" 102kg
Gen: Well-appearing male in NAD
Skin: W/D intact
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: Irreg-reg rhythm
Abd: Soft, NT, ND +BS
Ext: Warm, well-perfused, minimal edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**1-16**] Echo: PRE-CPB:1. The left atrium is moderately dilated. No
thrombus is seen in the left atrial appendage. 2. A patent
foramen ovale is present. A left-to-right shunt across the
interatrial septum is seen at rest. 3. There is mild symmetric
left ventricular hypertrophy. The left ventricular cavity size
is top normal/borderline dilated. Overall left ventricular
systolic function is mildly depressed (LVEF= 40 %). [Intrinsic
left ventricular systolic function is likely more depressed
given the severity of valvular regurgitation.] 4. Right
ventricular chamber size and free wall motion are normal. Right
ventricular systolic function is normal.
5. The ascending, transverse and descending thoracic aorta are
normal in diameter and free of atherosclerotic plaque.. The
ascending aorta is mildly dilated. There are simple atheroma in
the ascending aorta. There are simple atheroma in the aortic
arch. There are simple atheroma in the descending thoracic
aorta. 6. There are three aortic valve leaflets. The aortic
valve leaflets are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen. 7. The mitral valve
leaflets are moderately thickened. There is partial mitral
leaflet flail seen of the P2 leaflet. The mitral valve leaflets
do not fully coapt. No mass or vegetation is seen on the mitral
valve. Torn mitral chordae are present. The mitral regurgitation
vena contracta is >=0.7cm. Severe (4+) mitral regurgitation is
seen. POST-CPB: On infusions of milrinone, epi, neo. Well-seated
mechanical valve in the mitral position. Normal washing jets.
Gradient of 9 mmHg at CCO of 7.0 liters/min. Difficult to assess
LV function due to poor windows. Trivial residual PFO remains
post closure. Aortic contour is normal post decannulation.

Brief Hospital Course:
Mr. [**Known lastname **] was a same day admit after undergoing all
pre-operative work-up as an out-patient. On day of admission he
was brought directly to the operating room where he underwent a
coronary artery bypass graft x 2, mitral valve replacement, MAZE
procedure, PFO closure, and left atrial appendage ligation.
Please see operative report for surgical details. Following
surgery he was transferred to the CVICU for invasive monitoring
in stable condition. On post-operative day one he was weaned
from sedation, awoke neurologically intact and extubated. On
post-op day 2 his chest tubes were removed. Amiodarone was
restarted. On post-op day three beta blockers and diuretics were
started and he was gently diuresed towards his pre-op weight.
Coumadin was also initiated with a Heparin bridge until
patient's INR was at a therapeutic level. His epicardial pacing
wires were removed and he was transferred to the step down
floor. He did well postoperatively, awaited therapeutic INR and
was ready for discharge home with PT on POD #9.
Spoke with Dr. [**Last Name (STitle) **] who agreed to follow his coumadin.


Medications on Admission:
Warfarin, Verapamil, Lisinopril, [**Doctor First Name **], Ambien, Advair,
Albuterol, Singulair, Spiriva

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
2. 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:*1*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*1*
4. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*30 Cap(s)* Refills:*1*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
7. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
8. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 Disk with Device(s)* Refills:*0*
10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
11. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours).
Disp:*qs 1 month* Refills:*0*
12. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
13. Coumadin 2.5 mg Tablet Sig: Three (3) Tablet PO at bedtime:
Check INR [**1-24**] with results to Dr. [**Last Name (STitle) **].
Disp:*90 Tablet(s)* Refills:*0*
14. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
15. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7
days.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
Coronary Artery Disease, Mitral Regurgitation, Patent Foramen
Ovale, Atrial Fibrillation s/p Coronary Artery Bypass Graft x 2,
Mitral Valve Replacement, PFO Closure, MAZE procedure
PMH: Endocarditis, Congestive Heart Failure, Chronic Obstructive
Pulmonary Disease, Asthma, Gout, Anxiety, s/p cataract surgery

Discharge Condition:
Good

Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
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. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Call with any questions or concerns.
8) Coumadin to be followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. INR to be checked


[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) **] in [**3-9**] weeks
Dr. [**Last Name (STitle) **] in [**2-6**] weeks


Completed by:[**2149-1-22**]
{'Coronary atherosclerosis of native coronary artery,Chronic diastolic heart failure,Chronic obstructive asthma, unspecified,Mitral valve disorders,Ostium secundum type atrial septal defect,Atrial fibrillation,Gout, 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: Dyspnea on exertion

PRESENT ILLNESS: 63 y/o male with recent episode of s. viridans endocarditis in
[**2148-10-5**]. Since that time he has completed a course of IV
antibiotics and extensive dental work. Follow-up echo showed
severe mitral regurgitation and he has also developed atrial
fibrillation. He conitnues to have dyspnea on exertion and
shortness of breath along with 2 pillow orthopnea.

MEDICAL HISTORY: Mitral Regurgitation, Patent Foramen Ovale, Atrial Fibrillation,
Endocarditis, Congestive Heart Failure, Chronic Obstructive
Pulmonary Disease, Asthma, Gout, Anxiety, s/p cataract surgery

MEDICATION ON ADMISSION: Warfarin, Verapamil, Lisinopril, [**Doctor First Name **], Ambien, Advair,
Albuterol, Singulair, Spiriva

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 90 5'7" 102kg
Gen: Well-appearing male in NAD
Skin: W/D intact
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: Irreg-reg rhythm
Abd: Soft, NT, ND +BS
Ext: Warm, well-perfused, minimal edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking in [**10/2148**] after 2ppd x 50yrs. Denies ETOH use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic diastolic heart failure,Chronic obstructive asthma, unspecified,Mitral valve disorders,Ostium secundum type atrial septal defect,Atrial fibrillation,Gout, unspecified'}
