CHIEF COMPLAINT: Asymptomatic

PRESENT ILLNESS: 60 year old gentleman with known mitral valve prolapse for the
past 30 years which has been followed by serial echocardiograms.
His most recent echocardiogram revealed moderate to severe
bileaflet prolpase with now blunted pulmonary inflows and a
slight decrease in his left ventricular function. Given the
progression of his disease, he has now been referred for
surgical
evaluation.
Cardiac Catheterization: Date:8/17/1/11     Place:[**Hospital1 18**]
Normal Coronaries

MEDICAL HISTORY: Past Medical History:
Mitral valve proplapse
Hypertension
Hyperlipidemia
Impingement syndrome
Basal cell carcinoma
Tremor in hands
De Quarvain's disease
Colonic adenoma
Recent pneumonia
Past Surgical History:
Nevi excisions
Left inguinal hernia

MEDICATION ON ADMISSION: Zocor 40mg daily
Inderal LA 160mg daily
Primidone 250mg take twice daily as needed for tremor
Amoxicillin prophylaxis

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 63 SR    Resp: 16  O2 sat: 99%
B/P  Right: 123/76   Left: 119/80
Height: 66"    Weight: 160

FAMILY HISTORY: Father with 2 prior CABG's first at age 60. He passed away
following his second CABG. Uncle with fatal MI at age 60

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Every 6 months
Lives with: Alone
Occupation: Retired
Contact: [**Name (NI) 11320**] [**Name (NI) 41297**] (sister)phone# [**Telephone/Fax (1) 89340**]
Tobacco: Never
ETOH: 1 drink per week socially
Mitral valve disorders,Unspecified essential hypertension,Radial styloid tenosynovitis,Personal history of other malignant neoplasm of skin,Other affections of shoulder region, not elsewhere classified
Mitral valve disorder,Hypertension NOS,Radial styloid tenosynov,Hx-skin malignancy NEC,Shoulder region dis NEC
Admission Date:  [**2155-9-9**]              Discharge Date:   [**2155-9-14**]

Date of Birth:  [**2094-7-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Asymptomatic

Major Surgical or Invasive Procedure:
[**2155-9-9**]
MV Repair/P2 resection with 36 mm Annuloplasty Ring


History of Present Illness:
60 year old gentleman with known mitral valve prolapse for the
past 30 years which has been followed by serial echocardiograms.
His most recent echocardiogram revealed moderate to severe
bileaflet prolpase with now blunted pulmonary inflows and a
slight decrease in his left ventricular function. Given the
progression of his disease, he has now been referred for
surgical
evaluation.
Cardiac Catheterization: Date:8/17/1/11     Place:[**Hospital1 18**]
Normal Coronaries


Past Medical History:
Past Medical History:
Mitral valve proplapse
Hypertension
Hyperlipidemia
Impingement syndrome
Basal cell carcinoma
Tremor in hands
De Quarvain's disease
Colonic adenoma
Recent pneumonia
Past Surgical History:
Nevi excisions
Left inguinal hernia


Social History:
Race: Caucasian
Last Dental Exam: Every 6 months
Lives with: Alone
Occupation: Retired
Contact: [**Name (NI) 11320**] [**Name (NI) 41297**] (sister)phone# [**Telephone/Fax (1) 89340**]
Tobacco: Never
ETOH: 1 drink per week socially


Family History:
Father with 2 prior CABG's first at age 60. He passed away
following his second CABG. Uncle with fatal MI at age 60


Physical Exam:
Pulse: 63 SR    Resp: 16  O2 sat: 99%
B/P  Right: 123/76   Left: 119/80
Height: 66"    Weight: 160

General: WDWN in NAD
Skin: Warm, Dry and intact. No C/C/E
HEENT: NACT, PERRLA, EOMI, sclera anciteric. OP benign.
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR, III/VI mid late systolic murmur
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X] No Edema
Varicosities: None [X]
Neuro: Grossly intact
Pulses:
Femoral      Right:2   Left:2
DP           Right:2   Left:2
PT           [**Name (NI) 167**]:2   Left:2
Radial       Right:2   Left:2

Carotid Bruit        Right: None    Left: None


Pertinent Results:
[**2155-9-9**] TTE
LEFT ATRIUM: No spontaneous echo contrast or thrombus in the
body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good (>20 cm/s) LAA ejection velocity.
RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.
LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
global systolic function (LVEF>55%). Normal LV wall thickness.
Normal LV cavity size.
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal aortic diameter at the sinus level. No atheroma in
ascending aorta. No atheroma in aortic arch. Simple atheroma in
descending aorta.
AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.
MITRAL VALVE: Severely thickened/deformed mitral valve leaflets.
Myxomatous mitral valve leaflets. Moderate/severe MVP. No MS.
The MR vena contracta is <0.3cm. Eccentric MR jet. Severe (4+)
MR.
TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. Mild
[1+] TR.
PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized.
No PS. Physiologic PR.
PERICARDIUM: No pericardial effusion.
Conclusions
PREBYASS:
1. No spontaneous echo contrast or thrombus is seen in the body
of the left atrium or left atrial appendage.
2. No atrial septal defect is seen by 2D or color Doppler.
3. Left ventricular wall thickness, cavity size, and global
systolic function are normal (LVEF>55%).Though EF may be
overestimated due to the severity of the Mitral Regurgitation.
4. Right ventricular chamber size and free wall motion are
normal.
5. There are simple atheroma in the descending thoracic aorta.
6. The aortic valve leaflets (3) are mildly thickened. There is
no aortic valve stenosis. No aortic regurgitation is seen.
7. The mitral valve leaflets are severely thickened/deformed.
The mitral valve leaflets are myxomatous. There is
moderate/severe anterior & posterior leaflet mitral valve
prolapse. An eccentric, anteriorly directed jet of Severe (4+)
mitral regurgitation is seen. Dilated mitral annulus measured at
4.3cm.
8. The tricuspid valve leaflets are mildly thickened.
9. There is no pericardial effusion.
POSTBYPASS:
1.The patient is AV paced on low dose phenylephrine infusion.
2. There is a mitral annuloplasty ring in place. There was no
stenosis noted.
3.There is [**1-5**]+ MR noted post annuloplasty.
4. There is moderate to severe [**Male First Name (un) **] noted on 2D, color doppler &
3D images. The findings were unchanged despite fluid challenges,
phenylephrine challenges, or administration of beta blockers.
5. There is mild LVOTobstruction with gradients not exceeding
15-20mmHg.



[**2155-9-13**] 07:35AM BLOOD WBC-5.6 RBC-2.94* Hgb-10.0* Hct-27.3*
MCV-93 MCH-33.9* MCHC-36.5* RDW-13.0 Plt Ct-159
[**2155-9-13**] 07:35AM BLOOD WBC-5.6 RBC-2.94* Hgb-10.0* Hct-27.3*
MCV-93 MCH-33.9* MCHC-36.5* RDW-13.0 Plt Ct-159
[**2155-9-9**] 10:45AM BLOOD WBC-3.8* RBC-2.70*# Hgb-9.0*# Hct-25.3*#
MCV-94 MCH-33.2* MCHC-35.4* RDW-12.8 Plt Ct-63*#
[**2155-9-13**] 07:35AM BLOOD Glucose-99 UreaN-8 Creat-0.6 Na-140 K-4.3
Cl-104 HCO3-29 AnGap-11
[**2155-9-9**] 12:40PM BLOOD UreaN-13 Creat-0.6 Na-140 K-4.0 Cl-108
HCO3-23 AnGap-13

Brief Hospital Course:
Mr.[**Known lastname 89341**] was admitted to the hospital and brought to the
operating room on [**2155-9-9**] where the patient underwent a mitral
valve repair/P2 resection with a 36 mm annuloplasty ring with
dr.[**Last Name (STitle) **].  See operative note for full details. Overall the
patient tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring. POD 1 found the patient extubated, alert
and oriented and breathing comfortably.  He was neurologically
intact and hemodynamically stable on no inotropic or vasopressor
support.  Beta blocker was initiated with goal heart rate
60-70's (moderate [**Male First Name (un) **] with higher heart rates seen on TEE
intraop). The patient was gently diuresed toward the
preoperative weight. Mr.[**Known lastname 89341**] continued to progress and was
transferred to the telemetry floor for further recovery on POD
1. Chest tubes and pacing wires were discontinued without
complication. The patient was evaluated by the physical therapy
service for assistance with strength and mobility.  By the time
of discharge on POD# 4 he was ambulating freely, the wound was
healing and pain was controlled with oral analgesics.  The
patient was discharged to home in good condition, with VNA and
follow up instructions advised.

Medications on Admission:
Zocor 40mg daily
Inderal LA 160mg daily
Primidone 250mg take twice daily as needed for tremor
Amoxicillin prophylaxis


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. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
5. primidone 250 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for tremors.
Disp:*60 Tablet(s)* Refills:*0*
6. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Mitral Regurgitation


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with Dilaudid
Incisions:
Sternal - healing well, no erythema or drainage
Leg Edema


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments

Surgeon: Dr [**Last Name (STitle) **] on [**10-15**] at 1:00pm.
Cardiologist - Dr. [**First Name (STitle) **] [**Name (STitle) **] in [**Hospital1 392**] office on [**10-6**]
at 1:00pm

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) **] in [**4-8**] weeks [**Telephone/Fax (1) 68410**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**




Completed by:[**2155-9-13**]

Name:  [**Known lastname 14158**],[**Known firstname 7937**]                 Unit No:   [**Numeric Identifier 14159**]

Admission Date:  [**2155-9-9**]              Discharge Date:   [**2155-9-14**]

Date of Birth:  [**2094-7-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 741**]
Addendum:
The patient remained hospitalized overnight.  His Lopressor
frequency was increased, and he was kept in-house 24hours for
blood pressure and heart rate/rhythm monitoring.  He tolerated
medication changes without difficulty.  He was discharged home
with VNA on POD 5.

Discharge Disposition:
Home With Service

Facility:
[**Hospital 136**] Homecare

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2155-9-14**]

Admission Date:  [**2155-9-19**]              Discharge Date:   [**2155-9-20**]

Date of Birth:  [**2094-7-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
tachycardia/dizziness

Major Surgical or Invasive Procedure:
none


History of Present Illness:
61yo male s/p mitral valve repair on
[**9-9**] found to have significant [**Male First Name (un) **] on intraop echo. Office
recieved a call from visiting nurse stating he was tachycardic
and hypotensive. Patient states he is sometimes dizzy when he
stands. In ED his HR was 100-110 with a BP of 107/56. He denies
dizziness at this time. Admitted from ER for further eval and
mgmt.


Past Medical History:
Past Medical History:
Mitral valve proplapse s/p MV repair [**2155-9-9**]
Hypertension
Hyperlipidemia
Impingement syndrome
Basal cell carcinoma
Tremor in hands
De Quarvain's disease
Colonic adenoma
Recent pneumonia
Past Surgical History:
Nevi excisions
Left inguinal hernia


Social History:
Race: Caucasian
Last Dental Exam: Every 6 months
Lives with: Alone
Occupation: Retired
Contact: [**Name (NI) 11320**] [**Name (NI) 41297**] (sister)phone# [**Telephone/Fax (1) 89340**]
Tobacco: Never
ETOH: 1 drink per week socially


Family History:
Father with 2 prior CABG's first at age 60. He passed away
following his second CABG. Uncle with fatal MI at age 60


Physical Exam:
Pulse: 104 ST   Resp: 16  O2 sat: 99% RA
B/P  Right: 104/56   Left:
Height: 66"    Weight: 143

General: NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Sternum stable incision healing well, no eryhtema or drainage
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]   +BS [x]
Extremities: Warm [x], well-perfused [x]  Edema: none
Varicosities: None [x]
Neuro: Grossly intact [x]


Pertinent Results:
[**2155-9-19**] 08:20PM   GLUCOSE-83 UREA N-10 CREAT-0.7 SODIUM-140
POTASSIUM-4.4 CHLORIDE-101 TOTAL CO2-30 ANION GAP-13
[**2155-9-19**] 08:20PM   estGFR-Using this
[**2155-9-19**] 08:20PM   cTropnT-0.02*
[**2155-9-19**] 08:20PM URINE  HOURS-RANDOM
[**2155-9-19**] 08:20PM URINE  GR HOLD-HOLD
[**2155-9-19**] 08:20PM   WBC-6.2 RBC-3.70*# HGB-12.0* HCT-34.5*#
MCV-93 MCH-32.4* MCHC-34.8 RDW-13.9
[**2155-9-19**] 08:20PM   NEUTS-68.7 LYMPHS-23.7 MONOS-5.0 EOS-1.9
BASOS-0.7
[**2155-9-19**] 08:20PM   PLT COUNT-349#
[**2155-9-19**] 08:20PM   PT-13.5* PTT-24.0 INR(PT)-1.2*
[**2155-9-19**] 08:20PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.005
[**2155-9-19**] 08:20PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0
LEUK-NEG

Brief Hospital Course:
Admitted from ER on evening of [**9-19**] for IV fluids and tighter HR
control given [**Male First Name (un) **] on postop echo. He was restarted on home
inderal with improvement in tremors and metoprolol was held.
Meds were adjusted and fluids were encouraged. CXR unremarkable.
He continued to make good progress and was cleared for discharge
to home with VNA on HD # 1. All f/u appts were advised.

Medications on Admission:
1. docusate sodium 100 mg [**Hospital1 **]
2. ranitidine HCl 150 mg [**Hospital1 **]
3. aspirin 81 mg DAILY
4. simvastatin 40 mg DAILY
5. primidone 250 mg [**Hospital1 **]
6. hydromorphone 2 mg  1-2 Tablets PO Q3H as needed for pain.
7. metoprolol tartrate 50 mg [**Hospital1 **]


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 DAILY
(Daily) for 2 weeks.
3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. primidone 250 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. propranolol 40 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
Disp:*120 Tablet(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
/p tachycardia and relative hypotension
Mitral valve proplapse/regurgitation s/p MV repair [**2155-9-9**]
Hypertension
Hyperlipidemia
Impingement syndrome
Basal cell carcinoma
Tremor in hands
De Quarvain's disease
Colonic adenoma
Recent pneumonia


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Edema -none


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments:
Surgeon: Dr [**Last Name (STitle) **] on [**10-15**] at 1:00pm.
Cardiologist - Dr. [**First Name (STitle) **] [**Name (STitle) **] in [**Hospital1 392**] office on [**10-6**]
at 1:00pm

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) **] in [**4-8**] weeks [**Telephone/Fax (1) 68410**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2155-9-20**]

Admission Date:  [**2155-9-22**]              Discharge Date:   [**2155-9-24**]

Date of Birth:  [**2094-7-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Rapid Atrial Fibrillation, hypotension


Major Surgical or Invasive Procedure:
Cardioversion [**2155-9-22**]


History of Present Illness:
61yo male s/p mitral valve repair on [**9-9**] found to have
significant [**Male First Name (un) **] on intraop echo. Office recieved a call from
visiting nurse stating he was tachycardic and hypotensive.
Patient states he is sometimes dizzy when he stands. In ED his
HR
was 100-110 with a BP of 107/56. He denies dizziness at this
time. Admitted from ER for further eval and  mgmt.He was
hydrated
and discharged [**9-20**].  At 0300m today he felt palpitations and
had
HR 150-> ED. In ED BP 80s, mentating, however. DCSCV x1 w/ 100
joules to SR w/ BP 113 systolic.


Past Medical History:
Past Medical History:
Mitral valve proplapse s/p MV repair [**2155-9-9**]
Hypertension
Hyperlipidemia
Impingement syndrome
Basal cell carcinoma
Tremor in hands
De Quarvain's disease
Colonic adenoma
Recent pneumonia
Past Surgical History:
Nevi excisions
Left inguinal hernia


Social History:
Race: Caucasian
Last Dental Exam: Every 6 months
Lives with: Alone
Occupation: Retired
Contact: [**Name (NI) 11320**] [**Name (NI) 41297**] (sister)phone# [**Telephone/Fax (1) 89340**]
Tobacco: Never
ETOH: 1 drink per week socially


Family History:
Father with 2 prior CABG's first at age 60. He passed away
following his second CABG. Uncle with fatal MI at age 60


Physical Exam:
Pulse: Resp:16  O2 sat: 98
B/P  Right:113/70(after cardioversion)
Height:     Weight:

General: NAD
Skin: Dry [] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]  +BS [x]
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: Grossly intact [x]


Pertinent Results:
Admission:
[**2155-9-22**] 10:15AM   PT-13.3 PTT-25.7 INR(PT)-1.1
[**2155-9-22**] 10:15AM   GLUCOSE-110* UREA N-14 CREAT-0.8 SODIUM-139
POTASSIUM-4.5 CHLORIDE-103 TOTAL CO2-26 ANION GAP-15
[**2155-9-22**] 10:25AM   PLT COUNT-338
[**2155-9-22**] 10:25AM   NEUTS-82.7* LYMPHS-12.2* MONOS-3.6 EOS-1.0
BASOS-0.5
[**2155-9-22**] 10:25AM   WBC-7.8# RBC-2.95* HGB-9.5* HCT-27.7* MCV-94
MCH-32.1* MCHC-34.1 RDW-13.3

[**2155-9-24**] 05:40AM BLOOD WBC-6.1 RBC-3.20* Hgb-10.2* Hct-29.1*
MCV-91 MCH-31.8 MCHC-34.8 RDW-15.6* Plt Ct-276
[**2155-9-24**] 05:40AM BLOOD PT-16.6* INR(PT)-1.5*
[**2155-9-23**] 05:46AM BLOOD PT-13.8* INR(PT)-1.2*
[**2155-9-24**] 05:40AM BLOOD Glucose-89 UreaN-11 Creat-0.6 Na-139
K-4.1 Cl-106 HCO3-27 AnGap-10

Brief Hospital Course:
Mr [**Known lastname 89341**] was seen and cardioverted in the emergency room.
Following cardioversion he was admitted to cardiac surgery
service and started on Amiodarone and Warfarin.
He spent the next several days readjusting his antiarrhythmics
and titrating his anticoagulation.  He did receive blood for
anemia with hematocrit 24%.  Hematocrit rose appropriately.  He
was discharged to home with VNA services on hospital day 3.  Dr.
[**Last Name (STitle) **] will follow his anti-coagulation.  All follow-up
appointments are advised.

Medications on Admission:
Medications at home:1. aspirin 81 mg Tablet DAILY (Daily).
2. ranitidine HCl 150 mg DAILY
3. simvastatin 40 mg DAILY
4. primidone 250 mg [**Hospital1 **] (2 times a day).
5. propranolol 40 mg [**Hospital1 **]


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
3. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
4. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. warfarin 2.5 mg Tablet Sig: One (1) Tablet PO once a day: Dr.
[**Last Name (STitle) **] to manage for goal INR 2-2.5, dx: afib.
Disp:*30 Tablet(s)* Refills:*2*
6. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x 1 week, then 400mg daily x 1 week, then
200mg daily.
Disp:*90 Tablet(s)* Refills:*2*
7. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Outpatient Lab Work
Labs: PT/INR for Coumadin ?????? indication -Atrial Fibrillation
Goal INR 2.0-2.5
First draw -day after discharge, [**2155-9-25**]
Results to phone [**Telephone/Fax (1) 89342**], Dr. [**Last Name (STitle) **]
9. primidone 250 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
[**2155-9-21**] readmitted with Atrial fibrillation -s/p cardioversion
[**2155-9-9**] MVRepair(36 [**Doctor Last Name **] ring)
PMHX: Mitral valve proplapse, Hypertension, Hyperlipidemia,
Impingement syndrome, Basal cell carcinoma, Tremor in hands, De
Quarvain's disease, Colonic adenoma, Recent pneumonia, Nevi
excisions, Left inguinal hernia


Discharge Condition:
Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema - none


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr [**Last Name (STitle) **] [**2155-10-15**] 1pm-[**Hospital Unit Name 89343**]
Cardiologist: Dr [**First Name (STitle) **] [**Name (STitle) **] in [**Hospital1 392**] office [**2155-10-6**]
@1PM

Please call to schedule appointments with your Primary Care
Dr. [**Last Name (STitle) 68409**],[**First Name3 (LF) 20**] B. [**Telephone/Fax (1) 68410**] in [**4-8**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication -Atrial Fibrillation
Goal INR 2.0-2.5
First draw -day after discharge, [**2155-9-25**]
Results to phone [**Telephone/Fax (1) 89342**], Dr. [**Last Name (STitle) **]



Completed by:[**2155-9-24**]
{'Mitral valve disorders,Unspecified essential hypertension,Radial styloid tenosynovitis,Personal history of other malignant neoplasm of skin,Other affections of shoulder region, not elsewhere classified'}


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: Asymptomatic

PRESENT ILLNESS: 60 year old gentleman with known mitral valve prolapse for the
past 30 years which has been followed by serial echocardiograms.
His most recent echocardiogram revealed moderate to severe
bileaflet prolpase with now blunted pulmonary inflows and a
slight decrease in his left ventricular function. Given the
progression of his disease, he has now been referred for
surgical
evaluation.
Cardiac Catheterization: Date:8/17/1/11     Place:[**Hospital1 18**]
Normal Coronaries

MEDICAL HISTORY: Past Medical History:
Mitral valve proplapse
Hypertension
Hyperlipidemia
Impingement syndrome
Basal cell carcinoma
Tremor in hands
De Quarvain's disease
Colonic adenoma
Recent pneumonia
Past Surgical History:
Nevi excisions
Left inguinal hernia

MEDICATION ON ADMISSION: Zocor 40mg daily
Inderal LA 160mg daily
Primidone 250mg take twice daily as needed for tremor
Amoxicillin prophylaxis

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 63 SR    Resp: 16  O2 sat: 99%
B/P  Right: 123/76   Left: 119/80
Height: 66"    Weight: 160

FAMILY HISTORY: Father with 2 prior CABG's first at age 60. He passed away
following his second CABG. Uncle with fatal MI at age 60

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Every 6 months
Lives with: Alone
Occupation: Retired
Contact: [**Name (NI) 11320**] [**Name (NI) 41297**] (sister)phone# [**Telephone/Fax (1) 89340**]
Tobacco: Never
ETOH: 1 drink per week socially 

### Response:
{'Mitral valve disorders,Unspecified essential hypertension,Radial styloid tenosynovitis,Personal history of other malignant neoplasm of skin,Other affections of shoulder region, not elsewhere classified'}
