CHIEF COMPLAINT: DOE

PRESENT ILLNESS: 69 yo male with history of RHD/Afib, found to have valvular
stenosis in [**2146**].Recently experiencing DOE and had a recent
admission for lung biopsy for BOOP. Coumadin was recently
stopped and he had a CVA in [**3-16**].Recent echo showed severe
MR/MS/AS.

MEDICAL HISTORY: rheumatic heart disease
A fib
MR/MS/AS
depresseion
CVA
interstitial lung disease
prior amiodarone toxicity
BOOP
depression
OA
elev. chol.
BPH
PNA
pneumothorax
hypothyroidism
diverticulosis
GERD

MEDICATION ON ADMISSION: lasix 10 mg daily
Kcl 20 mEq daily
aldactone 25 mg daily
digoxin 0.25 mg daily
levothyroxine 75 mcg daily
verapamil 180 mg daily
celexa 20 mg [**Hospital1 **]
risperdal 0.25 mg [**Hospital1 **]
Ca++ 500 mg  + D  [**Hospital1 **]
coumadin 4 mg M,W,F (LD [**4-24**])
coumadin 3 mg T, [**Last Name (un) **], SAT, SUN
prednisone 5mg (LD [**5-21**])
claritin 10 mg daily
ASA 81 mg daily
MVI daily
pravachol 40 mg daily
selenium 200 mg daily
prilosec 20 mg daily

ALLERGIES: Niacin / Lopressor

PHYSICAL EXAM: 98 T  104/53   HR 80  RR 18  96% RA sat
alert and oriented x3, moments of short term memory loss evident
[**Last Name (un) **], EOMI, 2+ carotids, no bruits, no JVD
4/6 SEM, no r/g
right basilar faint inspiratory wheezes
abd benign
trace pretibial edema, no c/c
5'8"    155#

FAMILY HISTORY: father died at 49

SOCIAL HISTORY: retired
lives with wife
social ETOH
quit 30 years ago, 35 pack/yr hx
Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Atrial fibrillation,Depressive disorder, not elsewhere classified,Postinflammatory pulmonary fibrosis,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of tobacco use,Personal history of venous thrombosis and embolism,Late effects of cerebrovascular disease, cognitive deficits
Mitr/aortic mult involv,Rheumatic heart failure,Atrial fibrillation,Depressive disorder NEC,Postinflam pulm fibrosis,Osteoarthros NOS-unspec,Hypothyroidism NOS,Esophageal reflux,History of tobacco use,Hx-ven thrombosis/embols,Late ef CV dis-cognf def
Admission Date:  [**2154-5-27**]              Discharge Date:   [**2154-6-3**]

Date of Birth:  [**2085-3-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Niacin / Lopressor

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

Major Surgical or Invasive Procedure:
 [**2154-5-29**] AVR (23mm CE Magna porcine)/ MVR ([**Street Address(2) 12523**]. [**Male First Name (un) 923**]
porcine valve)/ Maze procedure/ligation left atrial appendage


History of Present Illness:
69 yo male with history of RHD/Afib, found to have valvular
stenosis in [**2146**].Recently experiencing DOE and had a recent
admission for lung biopsy for BOOP. Coumadin was recently
stopped and he had a CVA in [**3-16**].Recent echo showed severe
MR/MS/AS.

Past Medical History:
rheumatic heart disease
A fib
MR/MS/AS
depresseion
CVA
interstitial lung disease
prior amiodarone toxicity
BOOP
depression
OA
elev. chol.
BPH
PNA
pneumothorax
hypothyroidism
diverticulosis
GERD


Social History:
retired
lives with wife
social ETOH
quit 30 years ago, 35 pack/yr hx

Family History:
father died at 49

Physical Exam:
98 T  104/53   HR 80  RR 18  96% RA sat
alert and oriented x3, moments of short term memory loss evident
[**Last Name (un) **], EOMI, 2+ carotids, no bruits, no JVD
4/6 SEM, no r/g
right basilar faint inspiratory wheezes
abd benign
trace pretibial edema, no c/c
5'8"    155#

Pertinent Results:
[**2154-5-31**] 06:00AM BLOOD WBC-11.9* RBC-3.14* Hgb-9.9* Hct-28.7*
MCV-91 MCH-31.6 MCHC-34.7 RDW-15.0 Plt Ct-145*
[**2154-5-31**] 06:00AM BLOOD Glucose-95 UreaN-10 Creat-0.8 Na-135
K-3.7 Cl-98 HCO3-29 AnGap-12
[**2154-5-27**] 05:29PM BLOOD %HbA1c-6.1*


PRE CPB The left atrium is moderately dilated. The left atrium
is elongated. Mild spontaneous echo contrast is seen in the body
of the left atrium. Moderate to severe spontaneous echo contrast
is present in the left atrial appendage. The left atrial
appendage emptying velocity is depressed (<0.2m/s). No
definitive thrombus is seen in the left atrial appendage. 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. The descending thoracic aorta is mildly
dilated. There are simple atheroma in the descending thoracic
aorta. There are three aortic valve leaflets. The aortic valve
leaflets are moderately thickened. There is moderate to severe
aortic valve stenosis (area 1.0cm2). Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are moderately
thickened. The mitral valve shows characteristic rheumatic
deformity. There is moderate to severe valvular mitral stenosis
(area 1.0 cm2). Mild to moderate ([**1-9**]+) mitral regurgitation is
seen. The tricuspid valve leaflets are mildly thickened. There
is mild tricuspid regurgitation. There is a trivial/physiologic
pericardial effusion. Dr. [**Last Name (STitle) 914**] was notified in person of the
results in the operating room at the time of the study.

POST CPB Patient is being atrially paced. Normal biventricular
systolic function. Bioprosthesis in the mitral position is
oriented towards the left ventricular outflow tract but is well
seated. Leaflet motion is normal. There is trace valvular mitral
regurgitation. The maximum pressure gradient across the mitral
valve is 13 mm Hg with a mean pressure gradient of 4 mm Hg at a
cardiac output of 6.5 l/m. There is a bioprosthesis located in
the aortic position. It is not well seen but it does appear well
seated with normal leaflet function. There is at least trace
valvular aortic regurgitation but shadowing and poor echo
windows prevent full assessment of the regurgitation. The
maximum pressure gradient across the aortic valve is 14 mm Hg.
The left atrial appendage has been resected. The thoracic aorta
appears intact.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD, Interpreting physician
[**Last Name (NamePattern4) **] [**2154-5-29**] 14:26



Brief Hospital Course:
Admitte [**5-27**] for IV heparin bridge off coumadin. PAT w/u
completed. Underwent surgery [**5-29**] with Dr. [**Last Name (STitle) 914**]. Transferred
to the CVICU in stable condition on titrated propofol and
phenylephrine drips. Extubated that evening. Beta blockade
titrated and transferred to the floor on POD #1. Chest tubes and
pacing wires removed on POD #2. Coumadin restarted on POD #2.
CXR stable post CT removal. Pt consult / pt cleared for home.
Diuresis continued. This was carried on. On Dc INR is 1.2. Pt is
a chronic afibber. Dr [**First Name (STitle) **] will follow in the usual manner.
Coumadin has been discussed thouroughly with the patient. he
agrres with the paln.

Medications on Admission:
lasix 10 mg daily
Kcl 20 mEq daily
aldactone 25 mg daily
digoxin 0.25 mg daily
levothyroxine 75 mcg daily
verapamil 180 mg daily
celexa 20 mg [**Hospital1 **]
risperdal 0.25 mg [**Hospital1 **]
Ca++ 500 mg  + D  [**Hospital1 **]
coumadin 4 mg M,W,F (LD [**4-24**])
coumadin 3 mg T, [**Last Name (un) **], SAT, SUN
prednisone 5mg (LD [**5-21**])
claritin 10 mg daily
ASA 81 mg daily
MVI daily
pravachol 40 mg daily
selenium 200 mg daily
prilosec 20 mg daily


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
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. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO 3X/WEEK
(MO,WE,FR).
Disp:*180 Tablet(s)* Refills:*2*
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
5. Pravastatin 20 mg Tablet Sig: Two (2) 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. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
9. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO 4X/WEEK
([**Doctor First Name **],TU,TH,SA).
Disp:*360 Tablet(s)* Refills:*2*
10. Citalopram 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
11. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
Disp:*30 Suppository(s)* Refills:*0*
12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain: prn.
Disp:*30 Tablet(s)* Refills:*0*
13. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO BID (2 times a
day) for 7 days.
Disp:*0 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
14. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
15. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO Q 8H
(Every 8 Hours).
Disp:*90 Tablet(s)* Refills:*2*
16. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
17. Lasix 20 mg Tablet Sig: [**1-9**] tab Tablet PO once a day: start
after you complete the 40 mg daily dose.
Disp:*15 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] care

Discharge Diagnosis:
AS/MR s/p AVR/MVR/ Maze/ligation LAA
interstitial lung disease
rheumatic heart disease
A fib
CVA
BOOP/amiodarone toxicity
s/p thoracoscopic wedge resecton [**2-15**]
depression
OA
elev. chol.
BPH
PNA
pneumothorax [**1-15**]
hypothyroidism
diverticulosis
GERD


Discharge Condition:
stable


Discharge Instructions:
shower daily and pat incisions dry
no lotions, creams, or powders on any incision
no driving for one month
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 100, redness or drainage
You came in on coumadin, have your INR followed in the usual
manner.

Followup Instructions:
see Dr. [**Last Name (STitle) 914**] in [**2-10**] weeks [**Telephone/Fax (1) 170**]
see Dr. [**Last Name (STitle) 55499**] in 4 weeks

INR:

See Dr. [**Last Name (STitle) 78476**] [**Name (STitle) 13434**] on DC. Your coumadin has not
changed.Keep on the same dose. Go to the lab you go to in
[**Location (un) **] and have your INR drawn NLT [**6-5**]. You are already tied
into the lab. Just in case I aven gven you a prescription for
INR draw. Take this withyou. I hav also set up VNA to draw your
INR. For some reason they cqnnot do,it is your responibiity to
have your INR drawn.



Completed by:[**2154-6-2**]
{'Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Atrial fibrillation,Depressive disorder, not elsewhere classified,Postinflammatory pulmonary fibrosis,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of tobacco use,Personal history of venous thrombosis and embolism,Late effects of cerebrovascular disease, cognitive deficits'}


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: DOE

PRESENT ILLNESS: 69 yo male with history of RHD/Afib, found to have valvular
stenosis in [**2146**].Recently experiencing DOE and had a recent
admission for lung biopsy for BOOP. Coumadin was recently
stopped and he had a CVA in [**3-16**].Recent echo showed severe
MR/MS/AS.

MEDICAL HISTORY: rheumatic heart disease
A fib
MR/MS/AS
depresseion
CVA
interstitial lung disease
prior amiodarone toxicity
BOOP
depression
OA
elev. chol.
BPH
PNA
pneumothorax
hypothyroidism
diverticulosis
GERD

MEDICATION ON ADMISSION: lasix 10 mg daily
Kcl 20 mEq daily
aldactone 25 mg daily
digoxin 0.25 mg daily
levothyroxine 75 mcg daily
verapamil 180 mg daily
celexa 20 mg [**Hospital1 **]
risperdal 0.25 mg [**Hospital1 **]
Ca++ 500 mg  + D  [**Hospital1 **]
coumadin 4 mg M,W,F (LD [**4-24**])
coumadin 3 mg T, [**Last Name (un) **], SAT, SUN
prednisone 5mg (LD [**5-21**])
claritin 10 mg daily
ASA 81 mg daily
MVI daily
pravachol 40 mg daily
selenium 200 mg daily
prilosec 20 mg daily

ALLERGIES: Niacin / Lopressor

PHYSICAL EXAM: 98 T  104/53   HR 80  RR 18  96% RA sat
alert and oriented x3, moments of short term memory loss evident
[**Last Name (un) **], EOMI, 2+ carotids, no bruits, no JVD
4/6 SEM, no r/g
right basilar faint inspiratory wheezes
abd benign
trace pretibial edema, no c/c
5'8"    155#

FAMILY HISTORY: father died at 49

SOCIAL HISTORY: retired
lives with wife
social ETOH
quit 30 years ago, 35 pack/yr hx 

### Response:
{'Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Atrial fibrillation,Depressive disorder, not elsewhere classified,Postinflammatory pulmonary fibrosis,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of tobacco use,Personal history of venous thrombosis and embolism,Late effects of cerebrovascular disease, cognitive deficits'}
