CHIEF COMPLAINT: syncope

PRESENT ILLNESS: 27 yo male with history of rhabdomyosarcoma s/p XRT, chemo and
surgery at age 5. Has been in remission since then. Syncope
resulted in recent cath. This revealed hemodynamics consistent
with constrictive pericarditis.

MEDICAL HISTORY: - Rhabdomyosarcoma age 5 s/p surgery and XRT x 2 yrs, in
remission
- h/o CMP with biventricular dysfunction
- h/o syncope first in [**2098**] when crouching under a tree, [**11-28**]
had second syncopal episode after running up 3 flights of
stairs, third event again in [**11-28**] after doing jumping jacks
- URI's in the past
- Palpitations in the past
- bony spurs
- GERD

MEDICATION ON ADMISSION: carvedilol 6.25 mg [**Hospital1 **]
enalapril 5 mg daily
ASA 81 mg daily
albuterol prn
MVI daily
lasix 20 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 5'9"  136#
HR 72  RR 16  left BP 106/72
NAD
skin unremarkable
EOMI, PERRL, NC/AT, OP benign
neck supple with full ROM, , no JVD
CTAB, with right chest wall defect and muscle atrophy
soft, NT, ND, + BS
warm, well-perfused, no edema or varicosities
neuro grossly intact, alert and oriented x3, MAE, non-focal
2+ bil fem/DP/PT/radials, no carotid bruits

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. Maternal grandfather with heart disease.
Paternal grandfather with MI.

SOCIAL HISTORY: Grad student studying psychology, has a girlfriend, family
involved. No smoking, etoh, drugs.
Constrictive pericarditis,Other primary cardiomyopathies,Mitral valve disorders,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of other sites,Esophageal reflux
Constrictiv pericarditis,Prim cardiomyopathy NEC,Mitral valve disorder,Hx of irradiation,Hx of malignancy NEC,Esophageal reflux
Admission Date:  [**2109-4-29**]              Discharge Date:   [**2109-5-6**]

Date of Birth:  [**2082-1-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
syncope

Major Surgical or Invasive Procedure:
pericardectomy [**2109-4-29**]


History of Present Illness:
27 yo male with history of rhabdomyosarcoma s/p XRT, chemo and
surgery at age 5. Has been in remission since then. Syncope
resulted in recent cath. This revealed hemodynamics consistent
with constrictive pericarditis.

Past Medical History:
- Rhabdomyosarcoma age 5 s/p surgery and XRT x 2 yrs, in
remission
- h/o CMP with biventricular dysfunction
- h/o syncope first in [**2098**] when crouching under a tree, [**11-28**]
had second syncopal episode after running up 3 flights of
stairs, third event again in [**11-28**] after doing jumping jacks
- URI's in the past
- Palpitations in the past
- bony spurs
- GERD


Social History:
Grad student studying psychology, has a girlfriend, family
involved. No smoking, etoh, drugs.


Family History:
There is no family history of premature coronary artery disease
or sudden death. Maternal grandfather with heart disease.
Paternal grandfather with MI.

Physical Exam:
5'9"  136#
HR 72  RR 16  left BP 106/72
NAD
skin unremarkable
EOMI, PERRL, NC/AT, OP benign
neck supple with full ROM, , no JVD
CTAB, with right chest wall defect and muscle atrophy
soft, NT, ND, + BS
warm, well-perfused, no edema or varicosities
neuro grossly intact, alert and oriented x3, MAE, non-focal
2+ bil fem/DP/PT/radials, no carotid bruits

Pertinent Results:
[**2109-5-6**] 06:50AM BLOOD WBC-10.1 RBC-4.84 Hgb-15.2 Hct-45.9
MCV-95 MCH-31.3 MCHC-33.0 RDW-15.0 Plt Ct-389
[**2109-5-6**] 06:50AM BLOOD PT-14.4* PTT-27.3 INR(PT)-1.3*
[**2109-5-6**] 06:50AM BLOOD Plt Ct-389
[**2109-5-6**] 06:50AM BLOOD Glucose-99 UreaN-26* Creat-0.9 Na-133
K-4.8 Cl-93* HCO3-32 AnGap-13
[**2109-4-29**] 12:03PM BLOOD ALT-26 AST-44* AlkPhos-238* TotBili-1.3
DirBili-0.5* IndBili-0.8

Cardiology Report ECHO Study Date of [**2109-5-3**]



PATIENT/TEST INFORMATION:
Indication: Left ventricular function. Right ventricular
function. S/p pericardiectomy.
Height: (in) 69
Weight (lb): 137
BSA (m2): 1.76 m2
BP (mm Hg): 96/46
HR (bpm): 111
Status: Inpatient
Date/Time: [**2109-5-3**] at 12:09
Test: Portable TTE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007W028-0:35
Test Location: West Other
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name (STitle) **] [**Name (STitle) **]

MEASUREMENTS:
Left Atrium - Long Axis Dimension: 3.6 cm (nl <= 4.0 cm)
Left Ventricle - Septal Wall Thickness: 0.7 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: 0.7 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 4.5 cm (nl <= 5.6 cm)
Left Ventricle - Ejection Fraction: 25% to 30% (nl >=55%)
Aorta - Valve Level: 2.5 cm (nl <= 3.6 cm)
Aorta - Descending Thoracic: 1.7 cm (nl <= 2.5 cm)
Mitral Valve - E Wave: 0.7 m/sec
Mitral Valve - A Wave: 0.3 m/sec
Mitral Valve - E/A Ratio: 2.33
Mitral Valve - E Wave Deceleration Time: 118 msec
TR Gradient (+ RA = PASP): *40 to 46 mm Hg (nl <= 25 mm Hg)

INTERPRETATION:

Findings:

This study was compared to the prior study of [**2109-5-1**].


LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

LEFT VENTRICLE: Normal LV wall thicknesses and cavity size.
False LV tendon
(normal variant). Severely depressed LVEF.

RIGHT VENTRICLE: Moderately dilated RV cavity. Severe global RV
free wall
hypokinesis. [Intrinsic RV systolic function likely more
depressed given the
severity of TR]. Abnormal septal motion/position consistent with
RV
pressure/volume overload.

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

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR. No
MVP.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Moderate [2+]
TR. Moderate
PA systolic hypertension.

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

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Resting tachycardia (HR>100bpm).

Conclusions:
The left atrium is normal in size. Left ventricular wall
thicknesses and
cavity size are normal. Overall left ventricular systolic
function is severely
depressed. The right ventricular cavity is moderately dilated
with severe
global free wall hypokinesis. [Intrinsic right ventricular
systolic function
is likely more depressed given the severity of tricuspid
regurgitation.] There
is abnormal septal motion/position consistent with right
ventricular
pressure/volume overload. The aortic valve leaflets (3) appear
structurally
normal with good leaflet excursion and no aortic regurgitation.
The mitral
valve appears structurally normal with trivial mitral
regurgitation. There is
no mitral valve prolapse. Moderate [2+] tricuspid regurgitation
is seen. There
is moderate pulmonary artery systolic hypertension. There is no
pericardial
effusion. The pericardium may be thickened.

Compared with the prior study (images reviewed) of [**2109-5-1**],
findings are
similar (The LVEF was likley overestimated on the prior study).


Electronically signed by [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4083**], MD on [**2109-5-3**]
15:35.
[**Location (un) **] PHYSICIAN: [**Name10 (NameIs) **],[**First Name3 (LF) **] J.



([**Numeric Identifier 59273**])

RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2109-5-6**] 10:34 AM

CHEST (PORTABLE AP)

Reason: r/o ptx

[**Hospital 93**] MEDICAL CONDITION:
27 year old man with s/p Pericardiectomy and ct removal
REASON FOR THIS EXAMINATION:
r/o ptx
AP CHEST 10:51 A.M. [**5-6**]

HISTORY: Pericardiectomy and chest tube removal.

IMPRESSION: PA and lateral chest compared to [**4-23**] through [**4-30**]:

Since [**4-30**] following removal of bilateral pleural and midline
drains small right pneumothorax with apical and basolateral
components has increased slightly, small left apical
pneumothorax is stable. Bilateral hilar enlargement is stable
and diffuse mild interstitial pulmonary abnormality is
unchanged. Overall diameter of the cardiac silhouette is top
normal and along with borderline distention of the azygos vein,
unchanged since preoperative study on [**2109-4-23**] prior to
sternotomy.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: MON [**2109-5-6**] 3:07 PM








Brief Hospital Course:
Admitted [**4-29**] and underwent pericardectomy with Dr. [**First Name (STitle) **].
Transferred to the CSRU in stable condition on epinephrine and
propofol drips. Extubated the next day and levophed drip
required for pressor support. Echo repeat and epinephrine and
milrinone weaned off on POD #3.Beta blockade titrated and
natrecor started and then discontinued on POD #4. Transferred to
the floor on POD #6. Chest tubes removed on POD #7. He had a
repeat CXR and was cleared for discharge to home with services
on POD #7. Pt. is to make all follow-up appts. as per discharge
instructions.

Medications on Admission:
carvedilol 6.25 mg [**Hospital1 **]
enalapril 5 mg daily
ASA 81 mg daily
albuterol prn
MVI daily
lasix 20 mg daily


Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
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. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Enalapril Maleate 5 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
s/p Pericardectomy
PMH: CMP w/biventricular dysfx, Rhabomyosarcoma s/p chemo/rads,
URI's, Bone spurs, Syncope, GERD


Discharge Condition:
good


Discharge Instructions:
keep wounds clean and dry. OK to shower, no bathing or swimming.
take all medications as prescribed
call for any fever, redness or drainage from wounds

Followup Instructions:
wound clinic in 2 weeks
Dr [**Last Name (STitle) 7772**] in 4 weeks, pt to call for appt [**Telephone/Fax (1) 1504**]
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. Phone:[**Telephone/Fax (1) 285**]
Date/Time:[**2109-6-5**] 12:20
Provider: [**Name10 (NameIs) **],[**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 2788**] INTERNAL MEDICINE (NHB)
Date/Time:[**2109-5-10**] 9:00


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2109-5-8**]
{'Constrictive pericarditis,Other primary cardiomyopathies,Mitral valve disorders,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of other sites,Esophageal reflux'}


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: syncope

PRESENT ILLNESS: 27 yo male with history of rhabdomyosarcoma s/p XRT, chemo and
surgery at age 5. Has been in remission since then. Syncope
resulted in recent cath. This revealed hemodynamics consistent
with constrictive pericarditis.

MEDICAL HISTORY: - Rhabdomyosarcoma age 5 s/p surgery and XRT x 2 yrs, in
remission
- h/o CMP with biventricular dysfunction
- h/o syncope first in [**2098**] when crouching under a tree, [**11-28**]
had second syncopal episode after running up 3 flights of
stairs, third event again in [**11-28**] after doing jumping jacks
- URI's in the past
- Palpitations in the past
- bony spurs
- GERD

MEDICATION ON ADMISSION: carvedilol 6.25 mg [**Hospital1 **]
enalapril 5 mg daily
ASA 81 mg daily
albuterol prn
MVI daily
lasix 20 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 5'9"  136#
HR 72  RR 16  left BP 106/72
NAD
skin unremarkable
EOMI, PERRL, NC/AT, OP benign
neck supple with full ROM, , no JVD
CTAB, with right chest wall defect and muscle atrophy
soft, NT, ND, + BS
warm, well-perfused, no edema or varicosities
neuro grossly intact, alert and oriented x3, MAE, non-focal
2+ bil fem/DP/PT/radials, no carotid bruits

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. Maternal grandfather with heart disease.
Paternal grandfather with MI.

SOCIAL HISTORY: Grad student studying psychology, has a girlfriend, family
involved. No smoking, etoh, drugs. 

### Response:
{'Constrictive pericarditis,Other primary cardiomyopathies,Mitral valve disorders,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of other sites,Esophageal reflux'}
