CHIEF COMPLAINT: mitral valve endocarditis

PRESENT ILLNESS: This 54 year old female was seen originally in [**10-16**] for mitral
valve endocarditis (strep oralis). She was treated with
intravenous antibiotics, however, was readmitted [**2184-12-14**] in
congestive heart failure. At that time, she was diuresed and
surgical planning began. She completed her antibiotics
(penicillin) on [**2185-1-3**] and her PICC line was removed. She
presents today for surgical management of her mitral and
tricuspid valve disease.

MEDICAL HISTORY: Iron Deficiency Anemia
s/p Cesarean Section
Endocarditis
pulmonary hypertension
h/o congestive heart failure
h/o Cervical osteomyelitis
h/o Septic arthritis
h/o Splenic and renal spetic emboli
s/p Vein stripping surgery

MEDICATION ON ADMISSION: Atorvastatin 20', lopressor 25", lasix 40', KCL, PCN G completed

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
T 96.7  BP 112/75      P 61    R12  wt 160lbs
Gen: well appearing, NAD
Heent:anicteric, op clear
Neck:supple, no LAD
Lungs: CTAB, no crackles
CV: RRR nl S1 and S2  III/VI holosystolic murmur
Abd:soft, NT, ND, +BS
Ext: no edema
Neuro:nonfocal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Remote tobacco as a teenager. Denies ETOH. Employed at Target.
Mitral valve disorders,Ostium secundum type atrial septal defect,Diseases of tricuspid valve,Chronic passive congestion of liver,Personal history of venous thrombosis and embolism
Mitral valve disorder,Secundum atrial sept def,Tricuspid valve disease,Chr passiv congest liver,Hx-ven thrombosis/embols
Admission Date:  [**2185-1-14**]              Discharge Date:   [**2185-1-18**]

Date of Birth:  [**2130-12-26**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
mitral valve endocarditis

Major Surgical or Invasive Procedure:
Mitral valve replacement(31-mm [**Company 1543**] Mosaic mitral valve
bioprosthesis),Tricuspid valvuloplasty(28-mm [**Doctor Last Name **] MC3
valvuloplasty ring),Closure of patent foramen ovale. [**2185-1-14**]


History of Present Illness:
This 54 year old female was seen originally in [**10-16**] for mitral
valve endocarditis (strep oralis). She was treated with
intravenous antibiotics, however, was readmitted [**2184-12-14**] in
congestive heart failure. At that time, she was diuresed and
surgical planning began. She completed her antibiotics
(penicillin) on [**2185-1-3**] and her PICC line was removed. She
presents today for surgical management of her mitral and
tricuspid valve disease.

Past Medical History:
Iron Deficiency Anemia
s/p Cesarean Section
Endocarditis
pulmonary hypertension
h/o congestive heart failure
h/o Cervical osteomyelitis
h/o Septic arthritis
h/o Splenic and renal spetic emboli
s/p Vein stripping surgery

Social History:
Remote tobacco as a teenager. Denies ETOH. Employed at Target.


Family History:
Non-contributory

Physical Exam:
Admission:
T 96.7  BP 112/75      P 61    R12  wt 160lbs
Gen: well appearing, NAD
Heent:anicteric, op clear
Neck:supple, no LAD
Lungs: CTAB, no crackles
CV: RRR nl S1 and S2  III/VI holosystolic murmur
Abd:soft, NT, ND, +BS
Ext: no edema
Neuro:nonfocal


Pertinent Results:
[**2185-1-14**] ECHO
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.
Left ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%).
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present.
The mitral valve is abnormal. There is a torn anterior leaflet
at the A2 and all regurgitation is seen through this tear. There
is a moderate-sized vegetation on the mitral valve. Severe (4+)
mitral regurgitation is seen.
The tricuspid valve does not appear to have any vegetations and
there is Moderate to severe [3+] tricuspid regurgitation is seen
with dilated IVC (28mm) and no change in diameter with
respiration seen. There is flow reversal in the hepatic vein as
well. There is severe pulmonary artery systolic hypertension.
There is a small pericardial effusion.
Dr. [**Last Name (STitle) 914**] was notified in person of the results on [**Known firstname **]
[**Known lastname 12130**] at 8AM.
[**2185-1-17**] 06:52AM BLOOD WBC-5.2 RBC-2.88* Hgb-8.6* Hct-26.3*
MCV-92 MCH-29.9 MCHC-32.7 RDW-17.7* Plt Ct-155
[**2185-1-17**] 06:52AM BLOOD Glucose-94 UreaN-25* Creat-0.9 Na-134
K-4.0 Cl-97 HCO3-26 AnGap-15

Brief Hospital Course:
Ms. [**Known lastname 12130**] was admitted to the [**Hospital1 18**] on [**2185-1-14**] for surgical
management of her valve disease. She was taken directly to the
operating room where she underwent mitral valve replacement
using a porcine prosthesis, tricuspid valve repair, PFO clsoure
and ligation of the left atrial appendage. Please see operative
note for details. Postoperatively she was taken to the intensive
care unit for monitoring. She weaned from bypass on Epinephrine,
vasopressin, neo synephrine and Propofol. She later awoke
neurologically intact and was extubated. Pressors were weaned
off and she remained hemodynamically stable.

Aspirin, lipitor and beta blockade were resumed. On
postoperative day one, she was transferred to the step down unit
for for further recovery. She was gently diuresed towards her
preoperative weight. The physical therapy service was consulted
for assistance with her postoperative strength and mobility.
Benadryl was given for a rash she had prior to admission with
good relief.

Operative cultures were negative for aerobic growth and
perioperative cephalosporins were discontinued on the fourth
postoperative day. She continued to make steady progress and was
discharged home on POD 4.

Arrangements for follow up, post discharge instructions and
medications were discussed with the patient prior to discharge.

Medications on Admission:
Atorvastatin 20', lopressor 25", lasix 40', KCL, PCN G completed

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
3. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain for 2 weeks.
Disp:*50 Tablet(s)* Refills:*0*
7. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
s/p mitral valve replacement, tricuspid annuloplasty, closure of
patent foramen ovale, ligation of left atrial appendage
mitral valve Endocarditis
h/0 congestive heart failure
Pulmonary hypertension
iron deficiency anemia
patent foramen ovale
h/o Septic arthritis
h/o splenic septic emboli
h/o renal septic emboli


Discharge Condition:
Good


Discharge Instructions:
report any redness of, or drainage from incisions
Report any fever greater then 100.5.
Report any weight gain of 2 pounds in 24 hours or 5 pounds in 1
week.
No lotions, creams or powders to incisions
Shower daily, no bathing or swimming.
No lifting greater then 10 pounds for 10 weeks from date of
surgery.
No driving for 1 month and off all narcotics.
take all medications as directed


Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 914**] in 1 month. ([**Telephone/Fax (1) 1504**]
Please follow-up with Dr. [**Last Name (STitle) **] in [**1-11**] weeks.
Please follow-up with primary care physician [**Last Name (NamePattern4) **] [**1-12**] weeks.
Call all providers for appointments.



Completed by:[**2185-1-18**]
{'Mitral valve disorders,Ostium secundum type atrial septal defect,Diseases of tricuspid valve,Chronic passive congestion of liver,Personal history of venous thrombosis and embolism'}


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: mitral valve endocarditis

PRESENT ILLNESS: This 54 year old female was seen originally in [**10-16**] for mitral
valve endocarditis (strep oralis). She was treated with
intravenous antibiotics, however, was readmitted [**2184-12-14**] in
congestive heart failure. At that time, she was diuresed and
surgical planning began. She completed her antibiotics
(penicillin) on [**2185-1-3**] and her PICC line was removed. She
presents today for surgical management of her mitral and
tricuspid valve disease.

MEDICAL HISTORY: Iron Deficiency Anemia
s/p Cesarean Section
Endocarditis
pulmonary hypertension
h/o congestive heart failure
h/o Cervical osteomyelitis
h/o Septic arthritis
h/o Splenic and renal spetic emboli
s/p Vein stripping surgery

MEDICATION ON ADMISSION: Atorvastatin 20', lopressor 25", lasix 40', KCL, PCN G completed

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
T 96.7  BP 112/75      P 61    R12  wt 160lbs
Gen: well appearing, NAD
Heent:anicteric, op clear
Neck:supple, no LAD
Lungs: CTAB, no crackles
CV: RRR nl S1 and S2  III/VI holosystolic murmur
Abd:soft, NT, ND, +BS
Ext: no edema
Neuro:nonfocal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Remote tobacco as a teenager. Denies ETOH. Employed at Target. 

### Response:
{'Mitral valve disorders,Ostium secundum type atrial septal defect,Diseases of tricuspid valve,Chronic passive congestion of liver,Personal history of venous thrombosis and embolism'}
