CHIEF COMPLAINT: ascites and LE edema

PRESENT ILLNESS: 62 yo female initially seen in early [**Month (only) 216**] for evaluation of
MR/TR in the setting of LE edema and ascites. Echo in [**2123-6-25**]
revealed 4+ MR, 3+ TR, 1+ AI, and dilated main PA and RA.
Referred to Dr. [**Last Name (STitle) 1290**] for surgery. This was delayed pending
preoperative workup as well as the pt's concerns regarding
probable need for blood transfusions.Preop workup complete
during an admission in late [**Month (only) 216**] that included cath, PICC
placement for IV access,as well as treatment for a UTI. Her INR
did not ever completely normalize given continuing hepatic
issues. PICC was removed prior to this admission. Returns now
for surgery.

MEDICAL HISTORY: NIDDM
chronic AFib
ascites
prolactinoma
childhood polio
hypothyroidism (Hashimoto's thyroiditis)
sleep apnea
CHF
pulm. HTN
left breast CA/mastectomy
peripheral neuropathy
left shoulder fx
left foot fx
PSH: right partial thyroidectomy
right breast lumpectomy
TAH/BSO

MEDICATION ON ADMISSION: Liothyronine 400 mcg daily
JANUVIA 50 mg daily
Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr twice
daily
Bumetanide 4 mg twice daily
Spironolactone 25 mg twice daily
Vicodin 5-500 mg One Tablet PO every 6-8 hours as needed for
pain.

ALLERGIES: Morphine / Preservative / Amoxicillin / Ciprofloxacin

PHYSICAL EXAM: NAD
56.7 kg  65"  95.5 T   98% RA sat.  73 A fib  110/70   RR 22
alert and oriented x3
MAE [**5-29**] BUE, [**4-29**] BLE
old abd scar healed
EOMI   PERRLA
neck supple, with full ROM, no carotid bruits
CTAB posteriorly
Irregular   2/6 systolic murmur
abd soft, NT, distended, + BS, ascites
extrems warm, well-perfused
1+ bil. DP/PT/radials
2+ bil. fems

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 4 drinks per week
Mitral valve disorders,Acute kidney failure with lesion of tubular necrosis,Pneumonia, organism unspecified,Intestinal infection due to Clostridium difficile,Other and unspecified coagulation defects,Diseases of tricuspid valve,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of breast
Mitral valve disorder,Ac kidny fail, tubr necr,Pneumonia, organism NOS,Int inf clstrdium dfcile,Coagulat defect NEC/NOS,Tricuspid valve disease,Atrial fibrillation,Iatrogenc hypotnsion NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Hx of breast malignancy
Admission Date:  [**2123-10-4**]              Discharge Date:   [**2123-11-1**]

Date of Birth:  [**2060-9-23**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Morphine / Preservative / Amoxicillin / Ciprofloxacin

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
ascites and LE edema

Major Surgical or Invasive Procedure:
[**2123-10-5**]  MV repair/TV repair/ right atrial thrombectomy with RAA
ligation (28 mm [**Company 1543**] CG Future Mitral ring/ 34 mm CE MC3
tricuspid ring)

History of Present Illness:
62 yo female initially seen in early [**Month (only) 216**] for evaluation of
MR/TR in the setting of LE edema and ascites. Echo in [**2123-6-25**]
revealed 4+ MR, 3+ TR, 1+ AI, and dilated main PA and RA.
Referred to Dr. [**Last Name (STitle) 1290**] for surgery. This was delayed pending
preoperative workup as well as the pt's concerns regarding
probable need for blood transfusions.Preop workup complete
during an admission in late [**Month (only) 216**] that included cath, PICC
placement for IV access,as well as treatment for a UTI. Her INR
did not ever completely normalize given continuing hepatic
issues. PICC was removed prior to this admission. Returns now
for surgery.

Past Medical History:
NIDDM
chronic AFib
ascites
prolactinoma
childhood polio
hypothyroidism (Hashimoto's thyroiditis)
sleep apnea
CHF
pulm. HTN
left breast CA/mastectomy
peripheral neuropathy
left shoulder fx
left foot fx
PSH: right partial thyroidectomy
right breast lumpectomy
TAH/BSO


Social History:
4 drinks per week


Family History:
Noncontributory

Physical Exam:
NAD
56.7 kg  65"  95.5 T   98% RA sat.  73 A fib  110/70   RR 22
alert and oriented x3
MAE [**5-29**] BUE, [**4-29**] BLE
old abd scar healed
EOMI   PERRLA
neck supple, with full ROM, no carotid bruits
CTAB posteriorly
Irregular   2/6 systolic murmur
abd soft, NT, distended, + BS, ascites
extrems warm, well-perfused
1+ bil. DP/PT/radials
2+ bil. fems


Pertinent Results:
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname 5269**] [**Last Name (NamePattern1) **]       [**Hospital1 18**] [**Numeric Identifier 11319**]TTE (Complete)
Done [**2123-10-4**] at 5:04:26 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Last Name (Prefixes) 413**], [**First Name3 (LF) 412**]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2060-9-23**]
Age (years): 63 F  Hgt (in): 65
BP (mm Hg): 92/60  Wgt (lb): 116
HR (bpm): 78  BSA (m2): 1.57 m2
Indication: Left ventricular function. Preoperative assessment.
Valvular heart disease.
ICD-9 Codes: V43.3, 424.1, 424.0, 424.2
Test Information
Date/Time: [**2123-10-4**] at 17:04    Interpret MD: [**Name6 (MD) **] [**Name8 (MD) 4082**], MD
Test Type: TTE (Complete) Son[**Name (NI) 930**]: [**First Name11 (Name Pattern1) 11320**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **], RDCS

Doppler: Full Doppler and color Doppler Test Location: West Echo
Lab
Contrast: None Tech Quality: Adequate
Tape #: 2007W037-0:00 Machine: Vivid [**8-1**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.3 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.1 cm  <= 5.2 cm
Right Atrium - Four Chamber Length:  *6.5 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  3.6 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  >= 60%  >= 55%
Aorta - Sinus Level:  2.8 cm  <= 3.6 cm
Aorta - Ascending:  2.6 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.5 m/sec  <= 2.0 m/sec
Aortic Valve - Pressure Half Time:  424 ms
Mitral Valve - E Wave:  1.0 m/sec
TR Gradient (+ RA = PASP):  14 mm Hg  <= 25 mm Hg
Pulmonic Valve - Peak Velocity:  0.7 m/sec  <= 1.5 m/sec

Findings
This study was compared to the prior study of [**2123-9-23**].
LEFT ATRIUM: Moderate LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Moderately dilated RA. Normal
IVC diameter (1.5-2.5cm) with <50% decrease during respiration
(estimated RAP 11-15mmHg).

LEFT VENTRICLE: Normal LV wall thickness, cavity size and
regional/global systolic function (LVEF >55%). [Intrinsic LV
systolic function likely depressed given the severity of
valvular regurgitation.]

RIGHT VENTRICLE: Moderately dilated RV cavity. Normal RV
systolic function. [Intrinsic RV systolic function likely more
depressed given the severity of TR]. Abnormal diastolic septal
motion/position consistent with RV volume overload.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Mild (1+) AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Eccentric
MR jet. Moderate (2+) MR.

TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets.
Tricuspid leaflets do not fully coapt. Severe [4+] TR. Normal PA
systolic pressure.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with physiologic PR.

PERICARDIUM: Trivial/physiologic pericardial effusion.

GENERAL COMMENTS: The rhythm appears to be atrial fibrillation.
Ascites.
Conclusions
The left and right atrium are moderately dilated. The estimated
right atrial pressure is 11-15mmHg.There is mild symmetric left
ventricular hypertrophy with normal cavity size and
regional/global systolic function (LVEF >55%) [Intrinsic left
ventricular systolic function is likely more depressed given the
severity of mitral regurgitation.] Right ventricular chamber
size is moderately increased with normal free wall motion.
[Intrinsic right ventricular systolic function is likely more
depressed given the severity of tricuspid regurgitation.] There
is abnormal diastolic septal motion/position consistent with
right ventricular volume overload. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. Mild
(1+) aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. An eccentric, anteriorly directed jet of
moderate (2+) mitral regurgitation is seen. The tricuspid valve
leaflets are mildly thickened and fail to fully coapt. Severe
[4+] tricuspid regurgitation is seen. The estimated pulmonary
artery systolic pressure is high normal. There is a
trivial/physiologic pericardial effusion.

Compared with the prior study (images reviewed) of [**2123-9-23**],
the findings are similar (TR was also severe on the prior
study).
Electronically signed by [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4083**], MD, Interpreting
physician

RADIOLOGY   Preliminary Report

CHEST (PORTABLE AP)  [**2123-10-23**] 7:25 AM

CHEST (PORTABLE AP)

Reason: placement of dophoff tube confirmation

[**Hospital 93**] MEDICAL CONDITION:
63 year old woman s/p MV repair/TV repair now s/p tracheostomy
REASON FOR THIS EXAMINATION:
placement of dophoff tube confirmation
HISTORY: Dobbhoff tube placement.

Single portable radiograph of the chest demonstrates no change
in the support lines when compared with [**2123-10-21**]. Right-sided
pleural effusion persists and is unchanged. There may be slight
interval improvement in the previously seen left-sided pleural
effusion. Bibasilar atelectasis persists. No pneumothorax is
identified. Trachea is midline. Cardiomediastinal contours are
unchanged.

IMPRESSION:

Slight interval improvement in left-sided pleural effusion,
otherwise no change.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 6892**]






?????? [**2119**]

Brief Hospital Course:
Admitted [**10-4**] and underwent surgery on [**10-5**] with Dr. [**Last Name (STitle) 1290**].
Please refer to the operative note for details. Transferred to
the CVICU on epinephrine, propofol and nitroglycerin drips.
Epinephrine weaned off due to VTach. Extubated that night, but
reintubated the following afternoon for increasing acidosis and
mental status changes. Renal consult also done for decreasing
urine output.Echo also done with no significant findings. EP
service also consulted for her chronic Afib management.
Extubated again on the morning of [**10-9**], but reintubated again a
few hours later for resp. failure.
  She was noted to have ventilator associated pneumonia on [**10-11**].
 She was treated with vancomycin, levofloxacin, and meropenem.
She was followed by the Renal service for continued renal
failure.  On [**10-14**], she was noted to be positive for Clostridium
difficile toxin in her stool, and she was treated with Flagyl.
At this point, she was on Vancomycin and Flagyl.  She was unable
to wean from the ventilator and underwent a tracheostomy on
[**2123-10-21**].
  Throughout her course, he bilirubin counts had risen steadily.
 She was initiated on hemodialysis.  She was maintained
supportively, but with no signs of improvement.  She was
unresponsive to painful stimuli, and an EEG demonstrated
encephalopathy.  She was given lactulose and rifaximin with th
eintent of clearing any hepatic encephalopathy.
  She was evaluated by the renal service, hepatology service and
the transplant surgery service.  All felt that her condition was
critical and likely irreversible.  Her family was [**Name (NI) 653**], and
met with social work, hepatology, and the on-call intensivist.
The decision was made to change her code status to Comfort
Measures.
  A fentayl drip was initiated and her pressors were withdrawn
at 6:45 PM, [**11-1**].  Her blood pressure declined, and her heart
rhythm degenerated to ventricular tachycardia, fibrillation, and
then asystole.  She was pronounced at 7:54 PM, [**2123-11-1**].  The
family requested tha a post-mortem be performed.

Medications on Admission:
Liothyronine 400 mcg daily
JANUVIA 50 mg daily
Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr twice
daily
Bumetanide 4 mg twice daily
Spironolactone 25 mg twice daily
Vicodin 5-500 mg One Tablet PO every 6-8 hours as needed for
pain.


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Cardiac failure


Discharge Condition:
Deceased


Discharge Instructions:
none

Followup Instructions:
None
{'Mitral valve disorders,Acute kidney failure with lesion of tubular necrosis,Pneumonia, organism unspecified,Intestinal infection due to Clostridium difficile,Other and unspecified coagulation defects,Diseases of tricuspid valve,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}


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: ascites and LE edema

PRESENT ILLNESS: 62 yo female initially seen in early [**Month (only) 216**] for evaluation of
MR/TR in the setting of LE edema and ascites. Echo in [**2123-6-25**]
revealed 4+ MR, 3+ TR, 1+ AI, and dilated main PA and RA.
Referred to Dr. [**Last Name (STitle) 1290**] for surgery. This was delayed pending
preoperative workup as well as the pt's concerns regarding
probable need for blood transfusions.Preop workup complete
during an admission in late [**Month (only) 216**] that included cath, PICC
placement for IV access,as well as treatment for a UTI. Her INR
did not ever completely normalize given continuing hepatic
issues. PICC was removed prior to this admission. Returns now
for surgery.

MEDICAL HISTORY: NIDDM
chronic AFib
ascites
prolactinoma
childhood polio
hypothyroidism (Hashimoto's thyroiditis)
sleep apnea
CHF
pulm. HTN
left breast CA/mastectomy
peripheral neuropathy
left shoulder fx
left foot fx
PSH: right partial thyroidectomy
right breast lumpectomy
TAH/BSO

MEDICATION ON ADMISSION: Liothyronine 400 mcg daily
JANUVIA 50 mg daily
Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr twice
daily
Bumetanide 4 mg twice daily
Spironolactone 25 mg twice daily
Vicodin 5-500 mg One Tablet PO every 6-8 hours as needed for
pain.

ALLERGIES: Morphine / Preservative / Amoxicillin / Ciprofloxacin

PHYSICAL EXAM: NAD
56.7 kg  65"  95.5 T   98% RA sat.  73 A fib  110/70   RR 22
alert and oriented x3
MAE [**5-29**] BUE, [**4-29**] BLE
old abd scar healed
EOMI   PERRLA
neck supple, with full ROM, no carotid bruits
CTAB posteriorly
Irregular   2/6 systolic murmur
abd soft, NT, distended, + BS, ascites
extrems warm, well-perfused
1+ bil. DP/PT/radials
2+ bil. fems

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 4 drinks per week 

### Response:
{'Mitral valve disorders,Acute kidney failure with lesion of tubular necrosis,Pneumonia, organism unspecified,Intestinal infection due to Clostridium difficile,Other and unspecified coagulation defects,Diseases of tricuspid valve,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}
