CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This 52 year old white male was visiting the US from [**Country **]
presented with three days of intermittent chest pain,weakness
and fatigue. An echocardiogram in the ED revealed a partially
flail posterior mitral leaflet with 2+ regurgitation. Cardiac
surgery was consulted for evaluation of surgical correction.

MEDICAL HISTORY: Hyperlipidemia
Hypothyroid
s/p thyroid cancer and surgical removal

MEDICATION ON ADMISSION: 1. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO daily
except fridays.
3. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO QFRI
(every Friday).
4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:108 Resp:16  O2 sat:100/RA
B/P  165/88
Height:     Weight:184#

FAMILY HISTORY: Mother died at age 62 of CAD, father died of alzheimers. Brother
recently had a stroke.

SOCIAL HISTORY: He lives in [**Country **] with his wife, and works as an accountant. He
is visiting his son.
-Tobacco history: quit 30 yrs ago (smoked 1ppd/5 yrs)
-ETOH: 12 drinks/wk
-Illicit drugs: none
Coronary atherosclerosis of native coronary artery,Rupture of chordae tendineae,Intermediate coronary syndrome,Paralytic ileus,Mitral valve disorders,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of thyroid,Postsurgical hypothyroidism
Crnry athrscl natve vssl,Chordae tendinae rupture,Intermed coronary synd,Paralytic ileus,Mitral valve disorder,Hyperlipidemia NEC/NOS,Hx of thyroid malignancy,Postsurgical hypothyroid
Name:  [**Known lastname 14361**],[**Known firstname 14362**]                Unit No:   [**Numeric Identifier 14363**]

Admission Date:  [**2132-7-28**]              Discharge Date:   [**2132-8-5**]

Date of Birth:  [**2079-11-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1543**]
Addendum:
Please note, the partial flail mitral valve leaflet was caused
by ruptured chordae tendineae.

Discharge Disposition:
Home With Service

Facility:
Hotel Recovery

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2132-9-15**]

Admission Date:  [**2132-7-28**]              Discharge Date:   [**2132-8-5**]

Date of Birth:  [**2079-11-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Mitral valve repair (26 [**Doctor Last Name **] Ring- SN893344,Model 5200),
Ligation left atrial appendage, Coronary artery bypass graft
x1(Saphenous vein graft to obtuse marginal) [**2132-7-30**]

History of Present Illness:
This 52 year old white male was visiting the US from [**Country **]
presented with three days of intermittent chest pain,weakness
and fatigue. An echocardiogram in the ED revealed a partially
flail posterior mitral leaflet with 2+ regurgitation. Cardiac
surgery was consulted for evaluation of surgical correction.

Past Medical History:
Hyperlipidemia
Hypothyroid
s/p thyroid cancer and surgical removal

Social History:
He lives in [**Country **] with his wife, and works as an accountant. He
is visiting his son.
-Tobacco history: quit 30 yrs ago (smoked 1ppd/5 yrs)
-ETOH: 12 drinks/wk
-Illicit drugs: none

Family History:
Mother died at age 62 of CAD, father died of alzheimers. Brother
recently had a stroke.

Physical Exam:
Pulse:108 Resp:16  O2 sat:100/RA
B/P  165/88
Height:     Weight:184#

Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck: Supple [x- throidectomy scar] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [x] grade _3/6 heard across
precordium, loudest at left axilla
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema [] _____
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: radiating   Left: Radiating

Pertinent Results:
INTRAOP TEE: [**2132-7-30**] PRE-BYPASS: No spontaneous echo contrast is
seen in the body of the left atrium or left atrial appendage.
There is bowing of the interatrial septum suggesting increased
left atrial pressures. The interatrial septum does not appear
aneurysmal. 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 aortic arch. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion. There is no aortic valve stenosis. No aortic
regurgitation is seen. There is partial P2 mitral leaflet flail.
An eccentric, anterior directed jet of moderate to severe (3+)
mitral regurgitation is seen. Due to the eccentric nature of the
regurgitant jet, its severity may be significantly
underestimated (Coanda effect). The C-[**Month (only) **] distance is 2.9 cm,
with a [**Doctor Last Name **]/PL ratio of 1.7. There is a trivial/physiologic
pericardial effusion.
POST-BYPASS: The patient is status post mitral valve repair.
There is a well-positioned annuloplasty ring in the mitral
position. No mitral regurgitation or paravalvular leak is seen.
There is no mitral stenosis with a mean gradient of less than 5
mmHg. Biventricular function is unchanged. There is trace aortic
regurgitation. There is no evidence of systolic anterior motion
of the mitral valve or left ventricular outflow tract
obstruction ([**Male First Name (un) **]/LVOTO). The ascending aorta, aortic arch, and
descending thoracic aorta are intact.

CXR: [**2132-8-3**]: Cardiac silhouette is within normal limits. A
valve replacement is seen.  There is a small left-sided pleural
effusion. There is some atelectasis at the lung bases, which is
stable since the previous study. No pneumothoraces are seen.
There are no signs for overt pulmonary edema.

[**2132-7-28**] 07:25PM BLOOD WBC-9.5 RBC-4.74 Hgb-14.8 Hct-40.8 MCV-86
MCH-31.2 MCHC-36.3* RDW-13.0 Plt Ct-304
[**2132-8-4**] 07:00AM BLOOD WBC-9.0 RBC-2.89* Hgb-9.0* Hct-25.7*
MCV-89 MCH-31.0 MCHC-34.9 RDW-13.4 Plt Ct-460*
[**2132-7-28**] 07:25PM BLOOD PT-12.6 PTT-23.7 INR(PT)-1.1
[**2132-7-30**] 03:27PM BLOOD PT-15.2* PTT-35.3* INR(PT)-1.3*
[**2132-7-28**] 07:25PM BLOOD Glucose-107* UreaN-18 Creat-1.0 Na-138
K-5.9* Cl-103 HCO3-26 AnGap-15
[**2132-8-4**] 07:00AM BLOOD Glucose-137* UreaN-21* Creat-0.8 Na-137
K-4.3 Cl-99 HCO3-32 AnGap-10
[**2132-7-29**] 07:15AM BLOOD Phos-3.8 Mg-2.2
[**2132-8-2**] 07:15AM BLOOD Calcium-8.6 Phos-2.7 Mg-2.0

Brief Hospital Course:
Mr. [**Known lastname 90917**] presented to the ED the day prior to planned surgery
with pain. Enzymes were negative and on [**7-30**] he was taken to the
Operating Room and underwent a Mitral valve repair and Coronary
artery bypass grafting x 1. CARDIOPULMONARY BYPASS TIME:120
minutes. CROSSCLAMP TIME: 93 minutes. He tolerated the procedure
well and was transferred to the CVICU, intubated and sedated in
critical but stable condition. He was weaned from low dose Neo
Synephrine, awoke neurologically intact and was extubated the
night of surgery. All lines and drains were discontinued per
protocol. He was started on Beta blockers/Aspirin/Statin,
diuresed and transferred to the floor on POD #1. Physical
Therapy was consulted to evaluate mobility and strength. Of note
his rhythm was in a first degree AV block/accelerated
junctional, continued on low dose beta blockers (this was
present on day of discharge as well). Stable HCT 24 and was
started on iron. He continued to progress and the remainder of
his hospital course was essentially uneventful. He was cleared
for discharge to home with VNA services on post-op day six with
the appropriate medications and follow-up appointments.

Medications on Admission:
1. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO daily
except fridays.
3. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO QFRI
(every Friday).
4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
6. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. mupirocin 2 % Ointment Sig: One (1) application Topical twice
a day for 5 days: Please apply to your nose twice daily for 5
days, starting [**2132-7-26**].
8. temazepam 7.5 mg Capsule Sig: One (1) Capsule PO Once, the
night before your surgery for 1 days.

Discharge Medications:
1. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain for 4 weeks.
Disp:*50 Tablet(s)* Refills:*0*
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever or pain.
Disp:*40 Tablet(s)* Refills:*0*
3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
Disp:*30 Tablet(s)* Refills:*2*
4. 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*
5. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO Q FRIDAY
().
Disp:*5 Tablet(s)* Refills:*2*
6. ferrous sulfate 300  mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily): take with OJ.
Disp:*30 Tablet(s)* Refills:*2*
7. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Senna-S 8.6-50 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
10. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
11. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO
three times a day.
Disp:*90 Tablet(s)* Refills:*2*
12. levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO PO daily
except Fridays.
Disp:*30 Tablet(s)* Refills:*2*
13. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
Hotel Recovery

Discharge Diagnosis:
Coronary Artery disease s/p Coronary artery bypass graft x 1
Mitral regurgitation s/p Mitral Valve Repair
Past medical history:
Hyperlipidemia
h/o thyroid cancer s/p thyroidectomy

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
Leg Right- healing well, no erythema or drainage.
Edema: [**12-16**]+

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**]
**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) 914**] ([**Telephone/Fax (1) 170**]) on [**2132-9-2**] at 2pm in the
[**Hospital Unit Name 91090**] [**Last Name (NamePattern1) **], [**Hospital Unit Name **]
Echocardiogram and CXR prior to office visit - [**2132-8-19**] at 11AM
Phone:[**Telephone/Fax (1) 62**], Clinical center [**Location (un) 470**]

Cardiologist: Dr. [**Last Name (STitle) **] to arrange. Office will contact you
with appointment date and time.

Please call to schedule appointments with: Primary Care doctor
in [**Country **] on return.

**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:[**2132-8-5**]
{'Coronary atherosclerosis of native coronary artery,Rupture of chordae tendineae,Intermediate coronary syndrome,Paralytic ileus,Mitral valve disorders,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of thyroid,Postsurgical hypothyroidism'}


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: Chest pain

PRESENT ILLNESS: This 52 year old white male was visiting the US from [**Country **]
presented with three days of intermittent chest pain,weakness
and fatigue. An echocardiogram in the ED revealed a partially
flail posterior mitral leaflet with 2+ regurgitation. Cardiac
surgery was consulted for evaluation of surgical correction.

MEDICAL HISTORY: Hyperlipidemia
Hypothyroid
s/p thyroid cancer and surgical removal

MEDICATION ON ADMISSION: 1. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO daily
except fridays.
3. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO QFRI
(every Friday).
4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:108 Resp:16  O2 sat:100/RA
B/P  165/88
Height:     Weight:184#

FAMILY HISTORY: Mother died at age 62 of CAD, father died of alzheimers. Brother
recently had a stroke.

SOCIAL HISTORY: He lives in [**Country **] with his wife, and works as an accountant. He
is visiting his son.
-Tobacco history: quit 30 yrs ago (smoked 1ppd/5 yrs)
-ETOH: 12 drinks/wk
-Illicit drugs: none 

### Response:
{'Coronary atherosclerosis of native coronary artery,Rupture of chordae tendineae,Intermediate coronary syndrome,Paralytic ileus,Mitral valve disorders,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of thyroid,Postsurgical hypothyroidism'}
