CHIEF COMPLAINT: congestive heart failure

PRESENT ILLNESS: This 69 year old white  male has a history of progressive
exercise intolerance over the summer, culminating in the onset
of a dry cough and dyspnea on exertion the week prior to
admisssion. While vacationing in the south he noted the dyspnea
while golfing.  He returned home because of this and went to
[**Hospital **] hospital and was found in heart failure.  He was
transferred here for an ICU bed on Lasix.  He ruled out for a
myocardial infaction and was diuresed with improvement of
symptoms. Echocardiography revealed a flail posterior mitral
leaflet.

MEDICAL HISTORY: abdominal aortic aneursym (3.8cm)
chronic prostatitis
h/o Lyme disease
hyperlipidemia
benign prostatic hypertrophy

MEDICATION ON ADMISSION: Simvistatin 40mg/D
Bactrim DS [**1-7**] tab/D
Omeprazole 20mg/D
Tobradex Ophth gtt
MVI
Glucosamine
Alprazolam 0.5mg HS prn
Lasix gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Discharge:
awake and alert. [**Last Name (un) **] complaints
lungs- essentially clear.
cor- SR, crisp heart sounds
Exts- trace edema pretibially.
wounds- clean and dry. sternum stable
Wt: 96.4kg (v.96.5 preop)

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: nonsmoker
rare ETOH
lives with his wife.
Is a retired electrical engineer
Mitral valve disorders,Acute diastolic heart failure,Atrial flutter,Unspecified pleural effusion,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified glaucoma,Chronic prostatitis
Mitral valve disorder,Ac diastolic hrt failure,Atrial flutter,Pleural effusion NOS,BPH w/o urinary obs/LUTS,Abdom aortic aneurysm,Hyperlipidemia NEC/NOS,Esophageal reflux,Glaucoma NOS,Chronic prostatitis
Admission Date:  [**2185-10-24**]              Discharge Date:   [**2185-10-31**]

Date of Birth:  [**2116-8-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
congestive heart failure

Major Surgical or Invasive Procedure:
Mitral Valve Replacement(29mm St. [**Male First Name (un) 923**] Epic porcine)
right and left heart catheterization, coronary angiogram


History of Present Illness:
This 69 year old white  male has a history of progressive
exercise intolerance over the summer, culminating in the onset
of a dry cough and dyspnea on exertion the week prior to
admisssion. While vacationing in the south he noted the dyspnea
while golfing.  He returned home because of this and went to
[**Hospital **] hospital and was found in heart failure.  He was
transferred here for an ICU bed on Lasix.  He ruled out for a
myocardial infaction and was diuresed with improvement of
symptoms. Echocardiography revealed a flail posterior mitral
leaflet.

Catheterization was done which revealed no obstructive coronary
disease. Right sided pressures were 44/10/18 in the RV, RA mean
13 and PA 49/24/37. There was biventricular diastloic
dysfunction.  Ech cardiography had shown the LVEF to be 55%.

He was referrred for valve surgery.


Past Medical History:
abdominal aortic aneursym (3.8cm)
chronic prostatitis
h/o Lyme disease
hyperlipidemia
benign prostatic hypertrophy


Social History:
nonsmoker
rare ETOH
lives with his wife.
Is a retired electrical engineer

Family History:
noncontributory


Physical Exam:
Discharge:
awake and alert. [**Last Name (un) **] complaints
lungs- essentially clear.
cor- SR, crisp heart sounds
Exts- trace edema pretibially.
wounds- clean and dry. sternum stable
Wt: 96.4kg (v.96.5 preop)

Pertinent Results:
[**2185-10-31**] 05:30AM BLOOD WBC-11.2* RBC-2.87* Hgb-9.5* Hct-27.0*
MCV-94 MCH-32.9* MCHC-35.0 RDW-15.6* Plt Ct-307
[**2185-10-31**] 05:30AM BLOOD Plt Ct-307
[**2185-10-31**] 05:30AM BLOOD PT-14.6* INR(PT)-1.3*
[**2185-10-31**] 05:30AM BLOOD UreaN-24* Creat-1.1 Na-134 K-3.6 Cl-95*
HCO3-35* AnGap-8
[**2185-10-31**] 05:30AM BLOOD PT-14.6* INR(PT)-1.3*
[**2185-10-30**] 05:50AM BLOOD PT-13.9* INR(PT)-1.2*
[**2185-10-29**] 07:25AM BLOOD PT-13.6* INR(PT)-1.2*
[**2185-10-31**] 05:30AM BLOOD Mg-2.0

Brief Hospital Course:
Following admission he continued diuresis and improved
symptomatically. Cardiac surgical evaluation was completed.
Carotid ultrasound revealed 40-59% [**Doctor First Name 3098**] and 60-69% [**Country **] lesions
as seen on recent outpatient exam according to the patient.
Cardiac catheterization was performed which revealed mild
pulmonary hypertension and no obstructive coronary disease.  He
was prepared for surgery.

On [**10-26**] he went to the operating room where attempts to
repair the flail leaflet were unsuccessful.  A mitral valve
replacement was done with a 29mm St. [**Male First Name (un) 923**] Epic porcine valve.
(See operative note for details.)  He weaned from bypass on
phenylephrine and propofol, in sinus rhythm. Vancomycin was
given perioperatively due to his inhouse status.

He weaned from pressors and the ventilator easily.  CTs were
removed as were pacing wires according to protocol.  He was
transferred to the floor and beta blockade and diuretics were
begun.  He had a brief episode of atrial fibrillation after
transfer, which responded to Amiodarone with restoration of
sinus rhythm.

While he was at his preoperative weight at discharge, he was
admitted in failure and positive fluid balance. He as well has
bilateral pleural effusions on CXR. These, coupled with his
pitting peripheral edema, led to the decision to discharge him
home on diuretics.  He will continue Coumadin for now, given his
episode of atrial fibrillation.  This can be discontinued in the
future if sinus rhythm persists.

Arrangements have been made for Dr. [**Last Name (STitle) 5435**] to control his
anticoagulation, with a target INR of [**2-5**].5. Medications  and
instructions were discussed with him and his wife prior to
discharge.  Home Oxygen has been arranged also as he desaturates
still with exertion.  This also should wean as he diuresis.

He is to receive 5 mg of Coumadin today and 5 mg [**11-1**], with an
INR to be checked on [**11-2**] and check with his doctor for
instructions.

Medications on Admission:
Simvistatin 40mg/D
Bactrim DS [**1-7**] tab/D
Omeprazole 20mg/D
Tobradex Ophth gtt
MVI
Glucosamine
Alprazolam 0.5mg HS prn
Lasix gtt

Discharge Medications:
1. Influen Tr-Split [**2185**] Vac (PF) 45 mcg/0.5 mL Syringe Sig: One
(1) ML Intramuscular ASDIR (AS DIRECTED).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 2 weeks.
Disp:*60 Tablet(s)* Refills:*0*
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Tobramycin-Dexamethasone 0.3-0.1 % Drops, Suspension Sig: One
(1) Drop Ophthalmic [**Hospital1 **] (2 times a day).
Disp:*1 1* Refills:*2*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 2 weeks.
Disp:*28 Capsule(s)* Refills:*0*
7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours).
Disp:*60 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*
8. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
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:*2*
10. Warfarin 1 mg Tablet Sig: as directed Tablet PO DAILY
(Daily) as needed for afib.
Disp:*100 Tablet(s)* Refills:*2*
11. Alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)) as needed.
Disp:*30 Tablet(s)* Refills:*2*
12. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**1-5**] Sprays Nasal
QID (4 times a day) as needed.
13. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
14. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
15. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
16. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
17. Warfarin 1 mg Tablet Sig: as directed Tablet PO once a day:
INR goal 2-2.5.
Disp:*100 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] Area VNA

Discharge Diagnosis:
Mitral regurgitation
s/p mitral valve replacement (29mm St. [**Male First Name (un) 923**] Porcine)
chronic prostatitis
h/o Lyme disease
abdominal aortic aneurysm
Benign prostatic hypertrophy
hyperlipidemia
Glaucoma


Discharge Condition:
good


Discharge Instructions:
no driving for 4 weeks and off all narcotics
no lifting more than 10 pounds for 10 weeks
shower daily, no baths or swimming
no lotions, creams or powders to incisions
report any drainage from, or redness of incisions
report any temperature greater than 100.5
report any weight gain more than 2 pounds a day or 5 pounds a
week
take all medications as directed

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr. [**First Name8 (NamePattern2) 1692**] [**Last Name (NamePattern1) 5435**] in [**1-5**] weeks
Dr. [**Last Name (STitle) **] in 2 weeks
Please call for appointments



Completed by:[**2185-10-31**]
{'Mitral valve disorders,Acute diastolic heart failure,Atrial flutter,Unspecified pleural effusion,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified glaucoma,Chronic prostatitis'}


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: congestive heart failure

PRESENT ILLNESS: This 69 year old white  male has a history of progressive
exercise intolerance over the summer, culminating in the onset
of a dry cough and dyspnea on exertion the week prior to
admisssion. While vacationing in the south he noted the dyspnea
while golfing.  He returned home because of this and went to
[**Hospital **] hospital and was found in heart failure.  He was
transferred here for an ICU bed on Lasix.  He ruled out for a
myocardial infaction and was diuresed with improvement of
symptoms. Echocardiography revealed a flail posterior mitral
leaflet.

MEDICAL HISTORY: abdominal aortic aneursym (3.8cm)
chronic prostatitis
h/o Lyme disease
hyperlipidemia
benign prostatic hypertrophy

MEDICATION ON ADMISSION: Simvistatin 40mg/D
Bactrim DS [**1-7**] tab/D
Omeprazole 20mg/D
Tobradex Ophth gtt
MVI
Glucosamine
Alprazolam 0.5mg HS prn
Lasix gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Discharge:
awake and alert. [**Last Name (un) **] complaints
lungs- essentially clear.
cor- SR, crisp heart sounds
Exts- trace edema pretibially.
wounds- clean and dry. sternum stable
Wt: 96.4kg (v.96.5 preop)

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: nonsmoker
rare ETOH
lives with his wife.
Is a retired electrical engineer 

### Response:
{'Mitral valve disorders,Acute diastolic heart failure,Atrial flutter,Unspecified pleural effusion,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified glaucoma,Chronic prostatitis'}
