CHIEF COMPLAINT: History of mitral valve prolapse

PRESENT ILLNESS: The patient is a 38-year-old man who presents with increasing
shortness of breath and ventricular dysfunction. He has known
severe mitral regurgitation.
Catheterization showed normal ejection fraction and normal
coronary arteries but a reduced effective forward ejection
fraction.  It was elected to proceed with mitral valve repair
replacement.

MEDICAL HISTORY: Asthma
Migraines
HTN
right femoral hernia

MEDICATION ON ADMISSION: Norvasc 5mg QD
Excedrin PRN

ALLERGIES: Penicillins

PHYSICAL EXAM: 62 Reg 131/79 99% RA sat
GEN: NAD
NEURO: A+Ox3, MAE, follows commands
HEENT: PERRL, EOMI, Anicteric sclera, MMM, OP Benign, 2+
carotids with radiated murmur
LUNGS: CTA
HEART: RRR, IV/VI SEM
ABD: Benign
EXT: Warm, no C/C/E, no varicosities, well perfused.

FAMILY HISTORY: Father with COPD/HTN died at age 68

SOCIAL HISTORY: Married living with wife and 2 children. Works as a painter.
Mitral valve disorders,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Ventricular fibrillation,Unspecified essential hypertension,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus
Mitral valve disorder,CHF NOS,Surg compl-heart,Ventricular fibrillation,Hypertension NOS,Migrne unsp wo ntrc mgrn
Admission Date:  [**2127-5-6**]              Discharge Date:   [**2127-5-10**]

Date of Birth:  [**2087-5-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
History of mitral valve prolapse

Major Surgical or Invasive Procedure:
[**2127-5-7**] - MV repair(29mm Duran Ancore Band)
[**2127-5-6**] - Cardiac Catheterization

History of Present Illness:
The patient is a 38-year-old man who presents with increasing
shortness of breath and ventricular dysfunction. He has known
severe mitral regurgitation.
Catheterization showed normal ejection fraction and normal
coronary arteries but a reduced effective forward ejection
fraction.  It was elected to proceed with mitral valve repair
replacement.


Past Medical History:
Asthma
Migraines
HTN
right femoral hernia

Social History:
Married living with wife and 2 children. Works as a painter.

Family History:
Father with COPD/HTN died at age 68

Physical Exam:
62 Reg 131/79 99% RA sat
GEN: NAD
NEURO: A+Ox3, MAE, follows commands
HEENT: PERRL, EOMI, Anicteric sclera, MMM, OP Benign, 2+
carotids with radiated murmur
LUNGS: CTA
HEART: RRR, IV/VI SEM
ABD: Benign
EXT: Warm, no C/C/E, no varicosities, well perfused.

Pertinent Results:
[**2127-5-6**] 10:00AM   PLT COUNT-237
[**2127-5-6**] 10:00AM   WBC-8.5 RBC-5.03 HGB-15.4 HCT-43.8 MCV-87
MCH-30.6 MCHC-35.2* RDW-12.9
[**2127-5-6**] 10:00AM   ALT(SGPT)-15 AST(SGOT)-17 ALK PHOS-60
AMYLASE-21 TOT BILI-0.5 DIR BILI-0.1 INDIR BIL-0.4
[**2127-5-6**] 10:00AM   GLUCOSE-156* UREA N-18 CREAT-1.0 SODIUM-139
POTASSIUM-4.0 CHLORIDE-104 TOTAL CO2-27 ANION GAP-12
[**2127-5-6**] 10:59PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2127-5-10**] 05:15AM BLOOD WBC-10.1 RBC-2.69* Hgb-8.4* Hct-23.8*
MCV-89 MCH-31.4 MCHC-35.4* RDW-13.1 Plt Ct-108*
[**2127-5-10**] 05:15AM BLOOD Glucose-116* UreaN-14 Creat-0.9 Na-141
K-3.7 Cl-103 HCO3-31 AnGap-11

[**2127-5-9**] CXR
Small bilateral pleural effusions. Increased basilar opacities,
consistent with atelectasis, less likely a pneumonia.

[**2127-5-6**] Cardiac Cath
1. Selective coronary angiography of this right dominant system
revealed
no evidence of obstructive coronary artery disease.  The left
main
coronary artery is without angiographic evidence of obstructive
coronary
artery disease.  The left anterior descending coronary artery is
without
angiographic evidence of obstructive coronary artery disease in
the
proximal, mid, or distal LAD.  The left circumflex coronary
artery is
without angiographic evidence of obstructive coronary artery
disease in
the proximal, mid, or distal vessel.  The right coronary artery
is the
dominant vessel.  There is no angiographic evidence of
obstructive
coronary artery disease in the proximal, mid, or distal RCA.
2. Left ventriculography revealed normal left ventricular
systolic
function.  Contrast calculated LVEF = 60%.  There was 4+ mitral
regurgitation.
3. Right heart catheterization revealed normal right and left
sided
filling pressures.

[**2127-5-6**] ECHO
Pre Bypass:
1. The left atrium is moderately dilated. No atrial septal
defect or patent foramen ovale is seen by 2D, color Doppler or
saline contrast with maneuvers.
2. The coronary sinus is large, but injection of agitated saline
in the left arm supports normal drainage pattern (no suggestion
of presistent left svc).
3. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is top normal/borderline dilated.
Regional left ventricular wall motion is normal. Overall left
ventricular systolic function is normal (LVEF>55%).
[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.
5.There are simple atheroma in the aortic arch and the
descending thoracic aorta.
6.The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. There is no aortic valve stenosis. Trace
aortic regurgitation is seen.
7.The mitral valve leaflets are moderately thickened. The mitral
valve
leaflets are myxomatous. The mitral valve leaflets are
elongated. There is
severe mitral valve prolapse of the posterior leaflet. There is
mitral anular calcification. Also noted is heavy calcification
of a portion of the cordae attaching to the posterior leaflet.
The [**Doctor Last Name **]/PL ratio is > 1 and the Csept distance measures 2.7 cm.
8. There is no pericardial effusion.

POST -BYPASS: Pt is receiving an infusion of phenylephrine
1. No mitral valve prolapse is seen. Mitral ring appears to be
in good
position. No MR is detected. The posterior leaflet has been
extensively
resected. The leaflets are co-apting well.
2. Aorta and interatrial septum are intact
3. Other findings are unchanged


Brief Hospital Course:
Mr. [**Known lastname 31385**] was admitted to the [**Hospital1 18**] on [**2127-5-6**] for a cardiac
catheterization and elective surgical management of his mitral
valve prolapse. His cardiac catheterization revealed normal
coronary arteries, 4+ mitral regurgitation and a left
ventricular ejection fraction of 60%. Mr. [**Known lastname 31385**] was worked-up
in the usual preoperative manner and found to be ready for
surgery. On [**2127-5-7**], Mr. [**Known lastname 31385**] was taken to the operating
room where he underwent a mitral valve repair utilizing a 29mm
duran ancore band. Please se operative note for specific
details. Postoperatively he was taken to the cardiac surgical
intensive care unit for monitoring. By postoperative day one,
Mr. [**Known lastname 31385**] was awake, extubated and neurologically intact. He
was then transferred to the cardiac surgical step down unit for
further recovery. He was gently diuresed towards his
preoperative weight. The physical therapy service was consulted
for assistance with his postoperative strength and mobility.
Beta blockade, aspirin and a statin were resumed. Mr. [**Known lastname 31385**]
continued to make steady progress and was discharged home on
postoperative day three. He will follow-up with Dr. [**Last Name (STitle) **], his
cardiologist and his primary care physician as an outpatient. On
discharge, his wound was clean, dry and intact and his vital
signs were stable.

Medications on Admission:
Norvasc 5mg QD
Excedrin PRN

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
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:*2*
3. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q2H (every 2
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain: Take with food.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Mitral regurgitation


Discharge Condition:
Good


Discharge Instructions:
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs for 3 months.
Shower daily, let water flow over wounds, pat dry with a towel.
Call our office for sternal drainage, temp>101.5

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) **] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) **] for 4 weeks.



Completed by:[**2127-6-11**]
{'Mitral valve disorders,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Ventricular fibrillation,Unspecified essential hypertension,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}


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: History of mitral valve prolapse

PRESENT ILLNESS: The patient is a 38-year-old man who presents with increasing
shortness of breath and ventricular dysfunction. He has known
severe mitral regurgitation.
Catheterization showed normal ejection fraction and normal
coronary arteries but a reduced effective forward ejection
fraction.  It was elected to proceed with mitral valve repair
replacement.

MEDICAL HISTORY: Asthma
Migraines
HTN
right femoral hernia

MEDICATION ON ADMISSION: Norvasc 5mg QD
Excedrin PRN

ALLERGIES: Penicillins

PHYSICAL EXAM: 62 Reg 131/79 99% RA sat
GEN: NAD
NEURO: A+Ox3, MAE, follows commands
HEENT: PERRL, EOMI, Anicteric sclera, MMM, OP Benign, 2+
carotids with radiated murmur
LUNGS: CTA
HEART: RRR, IV/VI SEM
ABD: Benign
EXT: Warm, no C/C/E, no varicosities, well perfused.

FAMILY HISTORY: Father with COPD/HTN died at age 68

SOCIAL HISTORY: Married living with wife and 2 children. Works as a painter. 

### Response:
{'Mitral valve disorders,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Ventricular fibrillation,Unspecified essential hypertension,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}
