CHIEF COMPLAINT: Flu-like symptoms

PRESENT ILLNESS: Mrs. [**Known lastname 12130**] is a 53 year old female who presented to [**Hospital 40796**] with flu-like symptoms for the last several
weeks. This included fevers, cough, sinus congestion, poor
appetite, fatigue along with intermittent neck/back pain and
shortness of breath. During evaluation, she was noted to have a
heart murmur. Echocardiogram was notable for mitral valve
vegetation with 3-4+ mitral regurgitation. She was stablized on
medical therapy and urgently transferred to the [**Hospital1 18**] for
cardiac surgical evaluation and treatment.

MEDICAL HISTORY: Iron Deficiency Anemia
Prior Cesarean Section

MEDICATION ON ADMISSION: No medications at home

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: At discharge:
VS: 98.6, 111/83, 95SR, 20, 100%RA
Gen: NAD
HEENT: NCAT, EOMI
Neck: with c-collar
Chest: CTAB
Heart: RRR, 3/6 systolic murmur
Abd:NABS, soft, non-tender, non-distended
Ext: trace edema b/l LEs
Neuro:grossly intact

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Remote tobacco as a teenager. Denies ETOH. Employed at Target.
Acute and subacute bacterial endocarditis,Ostium secundum type atrial septal defect,Unspecified osteomyelitis, other specified sites,Septic arterial embolism,Vascular disorders of kidney,Bacteremia,Mitral valve disorders,Unspecified essential hypertension,Hypotension, unspecified,Other symptoms involving respiratory system and chest,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified
Ac/subac bact endocard,Secundum atrial sept def,Osteomyelit NOS-oth site,Septic arterial embolism,Renal vascular disorder,Bacteremia,Mitral valve disorder,Hypertension NOS,Hypotension NOS,Resp sys/chest symp NEC,Streptococcus unspecf
Admission Date:  [**2184-10-13**]              Discharge Date:   [**2184-10-20**]

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:
Flu-like symptoms

Major Surgical or Invasive Procedure:
[**2184-10-14**] Transesophageal Echocardiogram

History of Present Illness:
Mrs. [**Known lastname 12130**] is a 53 year old female who presented to [**Hospital 40796**] with flu-like symptoms for the last several
weeks. This included fevers, cough, sinus congestion, poor
appetite, fatigue along with intermittent neck/back pain and
shortness of breath. During evaluation, she was noted to have a
heart murmur. Echocardiogram was notable for mitral valve
vegetation with 3-4+ mitral regurgitation. She was stablized on
medical therapy and urgently transferred to the [**Hospital1 18**] for
cardiac surgical evaluation and treatment.

Past Medical History:
Iron Deficiency Anemia
Prior Cesarean Section

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

Family History:
Non-contributory

Physical Exam:
At discharge:
VS: 98.6, 111/83, 95SR, 20, 100%RA
Gen: NAD
HEENT: NCAT, EOMI
Neck: with c-collar
Chest: CTAB
Heart: RRR, 3/6 systolic murmur
Abd:NABS, soft, non-tender, non-distended
Ext: trace edema b/l LEs
Neuro:grossly intact




Pertinent Results:
[**2184-10-13**] 03:55PM BLOOD WBC-13.7* RBC-3.07* Hgb-10.0* Hct-28.6*
MCV-93 MCH-32.7* MCHC-35.1* RDW-13.9 Plt Ct-404
[**2184-10-13**] 08:51PM BLOOD PT-16.7* PTT-26.3 INR(PT)-1.5*
[**2184-10-13**] 03:55PM BLOOD Glucose-176* UreaN-8 Creat-0.7 Na-130*
K-2.8* Cl-91* HCO3-30 AnGap-12
[**2184-10-13**] 03:55PM BLOOD ALT-28 AST-26 CK(CPK)-17* AlkPhos-82
Amylase-38 TotBili-0.8
[**2184-10-13**] 03:55PM BLOOD cTropnT-0.07*
[**2184-10-13**] 03:55PM BLOOD Albumin-2.9* Calcium-7.8* Phos-1.7*
Mg-1.6
[**2184-10-19**] 04:07AM BLOOD WBC-7.7 RBC-2.86* Hgb-9.1* Hct-26.6*
MCV-93 MCH-32.0 MCHC-34.3 RDW-14.1 Plt Ct-464*
[**2184-10-20**] 05:22AM BLOOD Glucose-94 UreaN-8 Creat-0.5 Na-133 K-3.3

[**Known lastname **],[**Known firstname **] [**Age over 90 102812**] F  53  [**2130-12-26**]

Radiology Report MR [**Name13 (STitle) **] W& W/O CONTRAST Study Date of
[**2184-10-15**] 8:50 PM


[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] CSRU [**2184-10-15**] SCHED
MR [**Name13 (STitle) **] W& W/O CONTRAST; MR [**Name13 (STitle) **] W &W/O CONTRAST; MR
[**Name13 (STitle) 6452**] W & W/O CONTRAST   Clip # [**Clip Number (Radiology) 102813**]
Reason: assess for abcess/septic source. Please include
cervical/tho
Contrast: MAGNEVIST



[**Hospital 93**] MEDICAL CONDITION:
   53 year old woman mitral valve endocarditis/bacteremia
REASON FOR THIS EXAMINATION:
   assess for abcess/septic source. Please include
cervical/thoracic and lumbar
   spine
CONTRAINDICATIONS FOR IV CONTRAST:
   None.



Provisional Findings Impression: AFSN SAT [**2184-10-16**] 5:49 PM
PFI: Findings are suggestive of discitis and osteomyelitis at
C5-6 level. No
epidural abscess. Fluid within the right facet joint at L3-4
level with small
hyperintense cystic areas posterior to the facet joint could be
due to
degenerative change and a synovial cyst but early septic
arthritis of the
joint could have similar appearance. Focused followup MRI
studies of cervical
and lumbar spine are recommended as clinically appropriate.


Preliminary Report !! PFI !!
PFI: Findings are suggestive of discitis and osteomyelitis at
C5-6 level. No
epidural abscess. Fluid within the right facet joint at L3-4
level with small
hyperintense cystic areas posterior to the facet joint could be
due to
degenerative change and a synovial cyst but early septic
arthritis of the
joint could have similar appearance. Focused followup MRI
studies of cervical
and lumbar spine are recommended as clinically appropriate.

DR. [**First Name (STitle) 3905**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3906**]
PFI entered: SAT [**2184-10-16**] 5:49 PM

  Imaging Lab

[**Known lastname **],[**Known firstname **] [**Age over 90 102812**] F  53  [**2130-12-26**]

Cardiology Report C.CATH Study Date of [**2184-10-15**]


*** Not Signed Out ***

BRIEF HISTORY:   53 year old female with mitral valve
endocarditis
requiring surgical replacement.  She is referred for a
pre-operative
cardiac catheterization.

INDICATIONS FOR CATHETERIZATION:
Coronary artery disease.

PROCEDURE:
Right Heart Catheterization: was performed by percutaneous entry
of the
right femoral vein, using a 7 French pulmonary wedge pressure
catheter,
advanced to the PCW position through an 8 French introducing
sheath.
Cardiac output was measured by the Fick method.
Left Heart Catheterization: was performed by percutaneous entry
of the
right femoral artery, using a 5 French left [**Last Name (un) 2699**] catheter,
advanced
to the ascending aorta through a 5 French introducing sheath.
Coronary Angiography: was performed in multiple projections
using a 5
French JL5 and a 5 French  [**Doctor Last Name **]-1 catheter, with manual contrast
injections.
Conscious Sedation:  was provided with appropriate monitoring
performed by
a member of the nursing staff.

HEMODYNAMICS RESULTS BODY SURFACE AREA:  1.76 m2
  HEMOGLOBIN: 9.2 gms %
  FICK
**PRESSURES
RIGHT ATRIUM {a/v/m} 13/11/7
RIGHT VENTRICLE {s/ed} 39/11
PULMONARY ARTERY {s/d/m} 39/23/31
PULMONARY WEDGE {a/v/m} 28/26/21
AORTA {s/d/m} 92/69/81
**CARDIAC OUTPUT
HEART RATE {beats/min} 95
RHYTHM N
O2 CONS. IND {ml/min/m2} 125
A-V O2 DIFFERENCE {ml/ltr} 39
CARD. OP/IND FICK {l/mn/m2} 5.6/3.2
**RESISTANCES
SYSTEMIC VASC. RESISTANCE 1057
PULMONARY VASC. RESISTANCE 143
  FICK
**% SATURATION DATA (FL)
SVC LOW 62, 61
RA MID 60, 60
IVC HIGH 63, 58
RV MID 58, 58
PA MAIN 59, 59
AO 92, 89

OTHER HEMODYNAMIC DATA:      The oxygen consumption was assumed.




**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**RIGHT CORONARY
1) PROXIMAL RCA   NORMAL
2) MID RCA   NORMAL
2A) ACUTE MARGINAL   NORMAL
3) DISTAL RCA   NORMAL
4) R-PDA   NORMAL
4A) R-POST-LAT   NORMAL
4B) R-LV   NORMAL

**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**LEFT CORONARY
5) LEFT MAIN   NORMAL
6) PROXIMAL LAD   NORMAL
6A) SEPTAL-1   NORMAL
7) MID-LAD   NORMAL
8) DISTAL LAD   NORMAL
9) DIAGONAL-1   NORMAL
10) DIAGONAL-2   NORMAL
12) PROXIMAL CX   NORMAL
13) MID CX   NORMAL
13A) DISTAL CX   NORMAL
14) OBTUSE MARGINAL-1   NORMAL
15) OBTUSE MARGINAL-2   NORMAL
16) OBTUSE MARGINAL-3   NORMAL
17A) POSTERIOR LV   NORMAL


TECHNICAL FACTORS:
Total time (Lidocaine to test complete) = 42 minutes.
Arterial time = 18 minutes.
Fluoro time = 7.5 minutes.
Contrast injected:
          Non-ionic low osmolar (isovue, optiray...), vol 50 ml
Premedications:
          Valium 5 mg P.O.
          ASA 325 mg P.O.
Anesthesia:
          1% Lidocaine subq.
Anticoagulation:
Other medication:
          Fentanyl 25 mcg
          Midazolam 0.5mg
          Heparin 10ml IA
Cardiac Cath Supplies Used:
          - ALLEGIANCE, CUSTOM STERILE PACK
          - [**Company **], LEFT HEART KIT
          - [**Company **], RIGHT HEART KIT
          5FR [**Company **], MULTIPACK
          - [**Company **], PULMONARY WEDGE PRESSURE CATHETER


COMMENTS:
1. Selective coronary angiography of this right dominant system
revealed
no evidence of significant obstructive disease. The LMCA was
short and
widely patent. The LAD had mild luminal irregularities and a
major D3
branch. The LCx was patent and supplies a small OM1, atrial
branch,
large OM2, modest OM3, and tortuous LPL; there was a modest
distal AV
groove LCx beyond the LPP. The RCA had a high anterior origin
and was
patent, with a tortuous rPDA.
2. Resting hemodynamics mildly elevated right heart filling
pressures
with a mean RA of 7mmHg and moderately elevated left heart
filling
pressure with a mean PCWP of 21mmHg.  There was mild pulmonary
artery
hypertension with a PASP of 39mmHg.  The cardiac index was
preserved at
3.2l/min/m2.
3. Left ventriculography was deferred in the setting mitral
valve
endocarditis.
4. A shunt run revealed no oxymetric evidence of significant
intracardiac shunting in either direction.

FINAL DIAGNOSIS:
1. Coronary arteries are free of angiographically significant
disease.
2. Moderately elevated left heart filling pressures.
3. No evidence of intracardiac shunt.

ATTENDING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**First Name8 (NamePattern2) **] [**Doctor Last Name **]
REFERRING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) 177**] [**Name Initial (NameIs) **].
  [**Last Name (LF) **],[**First Name3 (LF) **] D.
CARDIOLOGY FELLOW: [**Last Name (LF) **],[**First Name3 (LF) **] M.
ATTENDING STAFF: [**Last Name (LF) **],[**First Name3 (LF) **] [**First Name8 (NamePattern2) **] [**Doctor Last Name **]


([**Numeric Identifier 102814**])




Brief Hospital Course:
Mrs. [**Known lastname 12130**] was admitted to the cardiac surgical service. She
underwent TEE which revealed large vegetation on the mitral
anterior leaflet with perforation, along with severe mitral
regurgitation. The TEE was also notable for PFO with left to
right flow. She remained on intravenous antibiotics(Gentamicin
and Vancomycin). The ID service was consulted to assist in the
management of antimicrobial therapy.
Additionally, the patient made note of decreased visual acuity
in the left eye.  Ophthalmology was consulted and ruled out
bacterial endophthalmitis.  Antibiotics were changed to
penicillin G according to sensitivities from outside hospital.
The patient noted severe neck stiffness, and MRI was ordered
which revealed C5-C6 osteomyelitis without abscess.
Neurosurgery was consulted, and while surgery is not indicated
at this point, the recommendation is to wear a hard cervical
collar for 6-8 weeks.  The patient made good progress with the
initiation of treatment, and was discharged home on hospital day
8 with extensive discharge and follow-up instructions.  She will
return for mitral valve repair/replacement with Dr. [**Last Name (STitle) 914**] in
approximately 6 weeks.

Medications on Admission:
No medications at home

Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Acyclovir 200 mg Capsule Sig: One (1) Capsule PO 5X/DAY (5
Times a Day) as needed for HSV for 13 doses.
Disp:*13 Capsule(s)* Refills:*0*
7. Acyclovir 5 % Ointment Sig: One (1) Appl Topical ASDIR (AS
DIRECTED) as needed for HSV.
Disp:*qs * Refills:*0*
8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily).
Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
10. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: One (1) ML
Intravenous PRN (as needed) as needed for line flush.
Disp:*qs ML(s)* Refills:*0*
11. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: One (1) ML
Intravenous PRN (as needed) as needed for line flush.
Disp:*qs ML(s)* Refills:*0*
12. Penicillin G Potassium 4 million units IV Q4H


Discharge Disposition:
Home With Service

Facility:
home solutions

Discharge Diagnosis:
Mitral Valve Endocarditis
Mitral Valve Regurgitation
Patent Foramen Ovale


Discharge Condition:
Good


Discharge Instructions:
1)  Monitor wounds for signs of infection.
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
7) Call with any questions or concerns.

Followup Instructions:
1) Dr. [**Last Name (STitle) 914**] in 4 weeks, will need an echo beforehand. call
for appt
2) Dr. [**Last Name (STitle) 4922**] in [**1-11**] weeks, call for appt
3) Weekly labs (ESR, CRP, CBC, BUN/Cre, LFTs) must be faxed to
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] from Infectious Disease at ([**Telephone/Fax (1) 16411**]
4) Follow up with Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 74432**] in [**Hospital **] clinic @ number above
5) Need an MRI at end of antibiotic course in [**5-16**] weeks
6) Please see a dentist in the next 1-2 weeks to evaluate your
teeth pre-operatively so that if there are any teeth that need
to be pulled, you have a long course of antibiotics remaining to
cover and potential bacteria that gets into your bloodstream



Completed by:[**2184-10-20**]
{'Acute and subacute bacterial endocarditis,Ostium secundum type atrial septal defect,Unspecified osteomyelitis, other specified sites,Septic arterial embolism,Vascular disorders of kidney,Bacteremia,Mitral valve disorders,Unspecified essential hypertension,Hypotension, unspecified,Other symptoms involving respiratory system and chest,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified'}


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: Flu-like symptoms

PRESENT ILLNESS: Mrs. [**Known lastname 12130**] is a 53 year old female who presented to [**Hospital 40796**] with flu-like symptoms for the last several
weeks. This included fevers, cough, sinus congestion, poor
appetite, fatigue along with intermittent neck/back pain and
shortness of breath. During evaluation, she was noted to have a
heart murmur. Echocardiogram was notable for mitral valve
vegetation with 3-4+ mitral regurgitation. She was stablized on
medical therapy and urgently transferred to the [**Hospital1 18**] for
cardiac surgical evaluation and treatment.

MEDICAL HISTORY: Iron Deficiency Anemia
Prior Cesarean Section

MEDICATION ON ADMISSION: No medications at home

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: At discharge:
VS: 98.6, 111/83, 95SR, 20, 100%RA
Gen: NAD
HEENT: NCAT, EOMI
Neck: with c-collar
Chest: CTAB
Heart: RRR, 3/6 systolic murmur
Abd:NABS, soft, non-tender, non-distended
Ext: trace edema b/l LEs
Neuro:grossly intact

FAMILY HISTORY: Non-contributory

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

### Response:
{'Acute and subacute bacterial endocarditis,Ostium secundum type atrial septal defect,Unspecified osteomyelitis, other specified sites,Septic arterial embolism,Vascular disorders of kidney,Bacteremia,Mitral valve disorders,Unspecified essential hypertension,Hypotension, unspecified,Other symptoms involving respiratory system and chest,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified'}
