CHIEF COMPLAINT: SOB and fatigue

PRESENT ILLNESS: This is a 66 year old male with known MVP/MR. [**First Name (Titles) 23278**]
[**Last Name (Titles) 98326**] have shown worsening MR. Currently experiencing
CHF symptoms..worsening shortness of breath, dyspnea on
exertion,
increasing fatigue and intermittent lower extremity edema.
Denies
chest pain, orthopnea and PND.

MEDICAL HISTORY: Mitral valve prolapse, Paroxysmal atrial fibrillation, HTN,
hypercholesterolemia, OSA, GERD, Asthma, Depression,
Hypothyroid, Prodtatism, Essential Tremor , chronic diastolic
heart failure

MEDICATION ON ADMISSION: Primidone 250mg daily, Piroxicam 10
mg daily, Diltiazem 240 mg daily, Lipitor 40 mg daily,
Omeprazole 20 mg daily, Levoxyl 200 mcg daily, Cozaar 50 mg
daily, Remeron 15 mg daily, Fluoxetine 20 mg daily, Flomax 0.8
mg daily, Ventolin as needed, Aspirin 81 mg daily, Symbicort
twice daily, and Vitamin D and B12.

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Penicillins

PHYSICAL EXAM: Physical Exam
Pulse: 76 Resp: 14 O2 sat: 97%RA
B/P  Right:    Left: 139/88
Height:  72inches   Weight: 104kg
General: middle aged male in no acute distress
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [**1-31**] holosystolic murmur
Abdomen: Soft [x] non-distended [x] non-tender x bowel sounds +
[x]
Extremities: Warm [x], well-perfused [x]  Edema - trace
Varicosities: None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right: 2   Left: 2
DP           Right: 1 Left: 1
PT           [**Name (NI) 167**]: 1   Left: 1
Radial       Right: 2  Left: 2
Carotid Bruit        Right: none    Left: none

FAMILY HISTORY: no history of premature cardiac disease.

SOCIAL HISTORY: Lives with wife. [**11-29**] year here and [**11-29**] year in [**State 108**].
Tobacco- 10 pk year. quit 25 yrs ago.
ETOH-rare
Mitral valve disorders,Rupture of chordae tendineae,Chronic diastolic heart failure,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Esophageal reflux
Mitral valve disorder,Chordae tendinae rupture,Chr diastolic hrt fail,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem,Hypothyroidism NOS,Esophageal reflux
Admission Date:  [**2149-5-14**]              Discharge Date:   [**2149-5-20**]

Date of Birth:  [**2082-12-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamide Antibiotics) / Penicillins

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
SOB and fatigue

Major Surgical or Invasive Procedure:
Mitral valve repair (32 [**Company **] ring);MAZE;Left atrial
appendage ligation [**2149-5-14**]


History of Present Illness:
This is a 66 year old male with known MVP/MR. [**First Name (Titles) 23278**]
[**Last Name (Titles) 98326**] have shown worsening MR. Currently experiencing
CHF symptoms..worsening shortness of breath, dyspnea on
exertion,
increasing fatigue and intermittent lower extremity edema.
Denies
chest pain, orthopnea and PND.


Past Medical History:
Mitral valve prolapse, Paroxysmal atrial fibrillation, HTN,
hypercholesterolemia, OSA, GERD, Asthma, Depression,
Hypothyroid, Prodtatism, Essential Tremor , chronic diastolic
heart failure

Social History:
Lives with wife. [**11-29**] year here and [**11-29**] year in [**State 108**].
Tobacco- 10 pk year. quit 25 yrs ago.
ETOH-rare

Family History:
no history of premature cardiac disease.

Physical Exam:
Physical Exam
Pulse: 76 Resp: 14 O2 sat: 97%RA
B/P  Right:    Left: 139/88
Height:  72inches   Weight: 104kg
General: middle aged male in no acute distress
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [**1-31**] holosystolic murmur
Abdomen: Soft [x] non-distended [x] non-tender x bowel sounds +
[x]
Extremities: Warm [x], well-perfused [x]  Edema - trace
Varicosities: None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right: 2   Left: 2
DP           Right: 1 Left: 1
PT           [**Name (NI) 167**]: 1   Left: 1
Radial       Right: 2  Left: 2
Carotid Bruit        Right: none    Left: none


Pertinent Results:
Conclusions
PRE-BYPASS:
The left atrium is dilated. No spontaneous echo contrast or
thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler.
Left ventricular wall thicknesses and cavity size are normal.
Overall left ventricular systolic function is low normal (LVEF
50-55%). The remaining left ventricular segments contract
normally.
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. Trace aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. There is
moderate/severe mitral valve prolapse. Torn mitral chordae are
present. An eccentric, anteriorly 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). There is a trivial/physiologic
pericardial effusion.
Dr. [**Last Name (STitle) 914**] was notified in person of the results on [**Known lastname **]
at 10AM before CPB.

POST-BYPASS:
Normal RV systolic function.
Mild global LV systolic dysfunction (LVEF 45%)
There is no residual MR>
There is a prosthesis in the mitral position, well seated and
functioning well.
The mean mitral gradient is 2 mm of Hg.
Thoracic aorta is intact.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2149-5-14**] 14:16

HISTORY: Postoperative cardiac surgery.

FINDINGS: In comparison with the study of [**5-15**], there has been
some clearing
of the left retrocardiac opacification. Bibasilar atelectasis
with small
bilateral effusions persist in this patient with intact midline
sternal
sutures and a prosthetic valve.

DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**]
Approved: MON [**2149-5-19**] 4:30 PM

  Imaging Lab




?????? [**2142**] CareGroup IS. All rights reserved.


Brief Hospital Course:
Mr [**Known lastname **] was admitted to [**Hospital1 18**] and taken to the OR on
[**2149-5-14**] for mitral valve repair, MAZE and LAAA ligation. See
operative for details. Post operatively he was taken to the
CVICU intubated, sedated and on amiodarone and propofol drips.
Pt was weaned from the ventilator and extubated on POD#0.
Betablockers and diuresis was started on POD#1. Mr. [**Known lastname **]
was in atrial fibrillation and developed conversion pauses
requiring temporary pacing with epicardial wires. A cardiology
consult was obtained. A permanent pacer was indicated at this
time. Betablockers were held then resumed at low dose on POD#4.
Low dose betablocker was tolerated. He converted to NSR.
Coumadin therapy was initiated. Diuresis was ongoing. Chest
tubes and temporary pacing wires were removed per protocol. Pt
was evaluated by physical therapy and cleared for discharge to
home on POD#6.
Dr. [**Last Name (STitle) 98327**] his PCP will [**Name9 (PRE) 86284**] his coumadin management-
confirmed with [**Doctor First Name **] from Dr.[**Name (NI) 98328**] office.Target INR
2.0-2.5.

Medications on Admission:
Primidone 250mg daily, Piroxicam 10
mg daily, Diltiazem 240 mg daily, Lipitor 40 mg daily,
Omeprazole 20 mg daily, Levoxyl 200 mcg daily, Cozaar 50 mg
daily, Remeron 15 mg daily, Fluoxetine 20 mg daily, Flomax 0.8
mg daily, Ventolin as needed, Aspirin 81 mg daily, Symbicort
twice daily, and Vitamin D and B12.


Discharge Medications:
1. 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*
2. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*1*
3. Levothyroxine 100 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
4. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*1*
5. Piroxicam 10 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*1*
6. Primidone 250 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
7. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
8. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*1*
9. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*1*
10. Losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
11. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 inhaler* Refills:*2*
12. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours) as needed for wheezing.
Disp:*1 IH* Refills:*1*
13. Outpatient Lab Work
Next INR draw on [**5-21**] and results called to Dr. [**Last Name (STitle) 20561**]
[**Telephone/Fax (1) 26190**] or fax [**Telephone/Fax (1) 19900**].
INR draws should be at least [**12-31**] week until INR stable.
Goal INR 2.0-2.5 for afib
14. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
15. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
16. Coumadin 2.5 mg Tablet Sig: Three (3) Tablet PO once a day
for 2 days: Take as directed by Dr. [**Last Name (STitle) 20561**] for INR of [**12-30**].5.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Mitral valve prolapse, Paroxysmal atrial fibrillation,
Hypertension, hypercholesterolemia, OSA, GERD, Asthma,
Depression, Hypothyroid, Prodtatism, Essential Tremor


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month, and while taking
narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Have your INR checked on [**2149-5-21**] and resiluts called to Dr. [**Name (NI) 98329**] office [**Telephone/Fax (1) 26190**] or faxed [**Telephone/Fax (1) 19900**]. (confirmed
with [**Doctor First Name **] at Dr.[**Name (NI) 98328**] office)
 Your Goal INR is 2.0-2.5 for afib.


Followup Instructions:
please call and schedule the following appointments
Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr.  [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20561**] in 1 week  ([**Telephone/Fax (1) 26190**])
Dr.  [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7047**] (cardiologist) in [**12-31**] weeks and upon return
to [**State 108**] make appointmemt with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].
[**Doctor Last Name **] of Hearts monitor follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**]

Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2149-5-20**]

Name:  [**Known lastname **],[**Known firstname 1937**]              Unit No:   [**Numeric Identifier 15586**]

Admission Date:  [**2149-5-14**]              Discharge Date:   [**2149-5-20**]

Date of Birth:  [**2082-12-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamide Antibiotics) / Penicillins

Attending:[**First Name3 (LF) 1543**]
Addendum:
Pt. was discharged on Lasix 40 mg. PO BID for 7 days.  He will
also take Potassium Chloride 10 meq PO daily for 7 days.

Discharge Disposition:
Home With Service

Facility:
[**Hospital1 328**] VNA

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

Completed by:[**2149-5-20**]
{'Mitral valve disorders,Rupture of chordae tendineae,Chronic diastolic heart failure,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,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: SOB and fatigue

PRESENT ILLNESS: This is a 66 year old male with known MVP/MR. [**First Name (Titles) 23278**]
[**Last Name (Titles) 98326**] have shown worsening MR. Currently experiencing
CHF symptoms..worsening shortness of breath, dyspnea on
exertion,
increasing fatigue and intermittent lower extremity edema.
Denies
chest pain, orthopnea and PND.

MEDICAL HISTORY: Mitral valve prolapse, Paroxysmal atrial fibrillation, HTN,
hypercholesterolemia, OSA, GERD, Asthma, Depression,
Hypothyroid, Prodtatism, Essential Tremor , chronic diastolic
heart failure

MEDICATION ON ADMISSION: Primidone 250mg daily, Piroxicam 10
mg daily, Diltiazem 240 mg daily, Lipitor 40 mg daily,
Omeprazole 20 mg daily, Levoxyl 200 mcg daily, Cozaar 50 mg
daily, Remeron 15 mg daily, Fluoxetine 20 mg daily, Flomax 0.8
mg daily, Ventolin as needed, Aspirin 81 mg daily, Symbicort
twice daily, and Vitamin D and B12.

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Penicillins

PHYSICAL EXAM: Physical Exam
Pulse: 76 Resp: 14 O2 sat: 97%RA
B/P  Right:    Left: 139/88
Height:  72inches   Weight: 104kg
General: middle aged male in no acute distress
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [**1-31**] holosystolic murmur
Abdomen: Soft [x] non-distended [x] non-tender x bowel sounds +
[x]
Extremities: Warm [x], well-perfused [x]  Edema - trace
Varicosities: None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right: 2   Left: 2
DP           Right: 1 Left: 1
PT           [**Name (NI) 167**]: 1   Left: 1
Radial       Right: 2  Left: 2
Carotid Bruit        Right: none    Left: none

FAMILY HISTORY: no history of premature cardiac disease.

SOCIAL HISTORY: Lives with wife. [**11-29**] year here and [**11-29**] year in [**State 108**].
Tobacco- 10 pk year. quit 25 yrs ago.
ETOH-rare 

### Response:
{'Mitral valve disorders,Rupture of chordae tendineae,Chronic diastolic heart failure,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Esophageal reflux'}
