CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 63 year old male with history of valvular heart disease and
pulmonary embolus and DVT in [**2189**]. He describes slowly worsening
symptoms of dyspnea on exertion that was first noted one year
ago. He underwent an echocardiogram on [**2194-3-25**] which revealed
severe mitral regurgitation, left atrial enlargement and
pulmonary hypertension. Mitral regurgitation has progressed from
[**11-16**]+ in [**2189**] to [**1-16**]+ on this most recent echo. He also underwent
TEE which also revealed severe MR with significant P2 prolapse
with flail leaflet tip. He is referred for surgical evaluation.

MEDICAL HISTORY: Mitral Regurgitation
Pulmonary Hypertension
Pulmonary embolus and Deep Vein thrombosis [**2189**] (? protein
deficiency- hypercoaguable risk on pre-op coumadin)
Hyperlipidemia
Hypertension
Obesity
Psoriasis
Varicose veins
Phlebitis 25 yrs ago
s/p Tonsillectomy
s/p Appendectomy

MEDICATION ON ADMISSION: Coumadin 4 mg daily->***Last dose taken [**2194-7-22**]
Folic acid 1 mg daily
HCTZ 12.5mg daily
Cozaar 25mg daily
K-Dur 10 mEq daily
Lorazepam 0.5 mg prn->rarely uses

ALLERGIES: Monopril / Lipitor / Simvastatin / Crestor / Zetia / Niacin

PHYSICAL EXAM: Pulse: 72 Resp: 16  O2 sat: 99%
B/P  Right: 133/88   Left: 139/89
Height: 5'8"    Weight: 197 lbs

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: [**12-18**] wks ago
Lives with: husband
Occupation: retired engineer
Tobacco: former tobacco use (none since college)
ETOH: occ.
Mitral valve disorders,Primary hypercoagulable state,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Other psoriasis,Asymptomatic varicose veins,Personal history of venous thrombosis and embolism
Mitral valve disorder,Prim hypercoagulable st,Chr pulmon heart dis NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Obesity NOS,Other psoriasis,Asympt varicose veins,Hx-ven thrombosis/embols
Admission Date:  [**2194-7-28**]              Discharge Date:   [**2194-8-1**]

Date of Birth:  [**2130-12-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Monopril / Lipitor / Simvastatin / Crestor / Zetia / Niacin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2194-7-29**] Minimal Invasive Mitral Valve Replacement


History of Present Illness:
63 year old male with history of valvular heart disease and
pulmonary embolus and DVT in [**2189**]. He describes slowly worsening
symptoms of dyspnea on exertion that was first noted one year
ago. He underwent an echocardiogram on [**2194-3-25**] which revealed
severe mitral regurgitation, left atrial enlargement and
pulmonary hypertension. Mitral regurgitation has progressed from
[**11-16**]+ in [**2189**] to [**1-16**]+ on this most recent echo. He also underwent
TEE which also revealed severe MR with significant P2 prolapse
with flail leaflet tip. He is referred for surgical evaluation.

Past Medical History:
Mitral Regurgitation
Pulmonary Hypertension
Pulmonary embolus and Deep Vein thrombosis [**2189**] (? protein
deficiency- hypercoaguable risk on pre-op coumadin)
Hyperlipidemia
Hypertension
Obesity
Psoriasis
Varicose veins
Phlebitis 25 yrs ago
s/p Tonsillectomy
s/p Appendectomy

Social History:
Race: Caucasian
Last Dental Exam: [**12-18**] wks ago
Lives with: husband
Occupation: retired engineer
Tobacco: former tobacco use (none since college)
ETOH: occ.

Family History:
non-contributory

Physical Exam:
Pulse: 72 Resp: 16  O2 sat: 99%
B/P  Right: 133/88   Left: 139/89
Height: 5'8"    Weight: 197 lbs

General: Well-developed male in no acute distress
Skin: Dry [X] intact [X] psoriatic lesions on BLE
HEENT: NCAT [X] PERRLA [X] EOMI [X]
Neck: Supple [X] Full ROM [X] JVD[X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] Irregular [] Murmur 4/6 systolic murmur
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X]  Edema RLE 1+
Varicosities: R>L greatest at right upper calf
Neuro: Grossly intact [X]
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: -    Left: trans

Pertinent Results:
[**2194-7-29**] Echo: PREBYPASS: The left atrium is moderately dilated.
No spontaneous echo contrast is seen in the body of the left
atrium or left atrial appendage. Left ventricular wall
thicknesses are normal. The left ventricular cavity is
moderately dilated. Overall left ventricular systolic function
is normal (LVEF>55%). Right ventricular chamber size is normal
with normal free wall contractility. The aortic valve leaflets
(3) appear structurally normal with good leaflet excursion.
There is no aortic valve stenosis. Trace aortic regurgitation is
seen. The mitral valve leaflets are moderately thickened. There
is prolapse of the P2 mitral leaflet. The mitral valve leaflets
do not fully coapt. Moderate to severe (3+) mitral regurgitation
is seen. Due to the eccentric nature of the regurgitant jet
(directed anteriorly), its severity may be significantly
underestimated (Coanda effect). There is no pericardial
effusion. POSTBYPASS: The patient is on infusions of
norepinephrine and milrinone and transiently epinephrine. There
is a new bioprosthetic mitral valve. It is well seated without
evidence of paravalvular leak. Gradients across the valve are
peak/mean of 17/7 mmHg. Right ventricular function, initially
moderately depressed immediately postbypass, has now improved to
normal. Left ventricular systolic function continues to be
normal. Normal thoracic aorta.

[**2194-8-1**] 04:55AM BLOOD WBC-6.7 RBC-3.50* Hgb-10.8* Hct-30.6*
MCV-87 MCH-30.8 MCHC-35.3* RDW-14.1 Plt Ct-93*
[**2194-8-1**] 04:55AM BLOOD Glucose-130* UreaN-20 Creat-0.7 Na-138
K-3.8 Cl-103 HCO3-28 AnGap-11
[**2194-8-1**] 04:55AM BLOOD Mg-2.3
[**2194-7-28**] 03:45PM BLOOD %HbA1c-5.6 eAG-114

Brief Hospital Course:
[**Known firstname 1169**] [**Known lastname **] was admitted the day before surgery for a heparin
bridge.  On [**7-29**] he underwent a minimally invasive MVR
(porcine).  This procedure was performed by Dr. [**Last Name (STitle) **], please
see the operative note for details.  He tolerated this procedure
well and was tranfered in critical but stable condition to the
surgical intensive care unit.  He quickly extubated.  His chest
tubes were removed and he was tranferred to the surgical step
down floor. He was seen by the physical therapy service.  By
post-operative day #3 he was ready for discharge to home with
VNA. All follow-up appointments were advised. First blood
draw/INR check Monday [**8-4**] with results to Dr. [**First Name4 (NamePattern1) 333**] [**Last Name (NamePattern1) 69526**].
Target INR 2.0-2.5.

Medications on Admission:
Coumadin 4 mg daily->***Last dose taken [**2194-7-22**]
Folic acid 1 mg daily
HCTZ 12.5mg daily
Cozaar 25mg daily
K-Dur 10 mEq daily
Lorazepam 0.5 mg prn->rarely uses

Discharge Medications:
1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 10 days.
Disp:*20 Tab Sust.Rel. Particle/Crystal(s)* Refills:*1*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO ONCE (Once) for 3
days: 4 mg dose today, SAT, and Sunday; then all further daily
dosing by Dr. [**Last Name (STitle) 69526**].
Disp:*50 Tablet(s)* Refills:*0*
6. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
Disp:*45 Tablet(s)* Refills:*1*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 10 days.
Disp:*20 Tablet(s)* Refills:*1*
8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
9. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 1 months: take with meals.
Disp:*90 Tablet(s)* Refills:*0*
10. Fluocinonide 0.05 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
Disp:*2 tubes* Refills:*0*
11. 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:*1*
12. Outpatient Lab Work
INR goal for PE/DVT/Protein Factor Deficiency/Tissue Valve is
2-2.5
First INR draw will be on Monday [**8-4**] with results faxed to the
office of Dr. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 69526**] ([**Telephone/Fax (1) 87402**], phone ([**Telephone/Fax (1) 87403**]


Discharge Disposition:
Home With Service

Facility:
tba

Discharge Diagnosis:
Mitral Regurgitation s/p Minimal Invasive Mitral Valve
Replacement
Past medical history:
Pulmonary Hypertension
Pulmonary embolus and Deep Vein thrombosis [**2189**]( ? protein
deficiency-hypercoaguable risk/pre-op coumadin)
Hyperlipidemia
Hypertension
Obesity
Psoriasis
Varicose veins
Phlebitis 25 yrs ago
s/p Tonsillectomy
s/p Appendectomy


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


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**

First INR blood draw Monday [**8-4**] with results to Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] [**Telephone/Fax (1) 84157**], all further daily dosing of coumadin by
Dr. [**First Name (STitle) **]

Target INR 2.0-2.5



Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**First Name (STitle) **] [**Name (STitle) **] on [**8-21**] at 1:30pm
Cardiologist: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 83788**] on [**9-5**] at 12pm

Please call to schedule appointments with your
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**2-17**] weeks
Hematologist Dr. [**Last Name (STitle) **]. [**Last Name (STitle) 69526**] in [**12-18**] 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**

INR goal for PE/DVT/Protein Factor Deficiency/Tissue Valve is
2-2.5
First INR draw will be on Monday [**8-4**] with results faxed to the
office of Dr. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 69526**] ([**Telephone/Fax (1) 87402**], phone ([**Telephone/Fax (1) 87403**]



Completed by:[**2194-8-1**]

Name:  [**Known lastname 13445**],[**Known firstname 1937**]                  Unit No:   [**Numeric Identifier 13868**]

Admission Date:  [**2194-7-28**]              Discharge Date:   [**2194-8-1**]

Date of Birth:  [**2130-12-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Monopril / Lipitor / Simvastatin / Crestor / Zetia / Niacin

Attending:[**First Name3 (LF) 741**]
Addendum:
Mr. [**Known lastname **] was not started on a statin secondary to his allergy
to statins.  His primary care office was called to recommend
that he be started on tricor or another cholesterol lowering
drug which he might tolerate better.

Brief Hospital Course:
Mr. [**Known lastname **] was not started on a statin secondary to his allergy
to statins.  His primary care office was called to recommend
that he be started on tricor or another cholesterol lowering
drug which he might tolerate better.

Discharge Disposition:
Home With Service

Facility:
tba

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

Completed by:[**2194-8-1**]
{'Mitral valve disorders,Primary hypercoagulable state,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Other psoriasis,Asymptomatic varicose veins,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: Dyspnea on exertion

PRESENT ILLNESS: 63 year old male with history of valvular heart disease and
pulmonary embolus and DVT in [**2189**]. He describes slowly worsening
symptoms of dyspnea on exertion that was first noted one year
ago. He underwent an echocardiogram on [**2194-3-25**] which revealed
severe mitral regurgitation, left atrial enlargement and
pulmonary hypertension. Mitral regurgitation has progressed from
[**11-16**]+ in [**2189**] to [**1-16**]+ on this most recent echo. He also underwent
TEE which also revealed severe MR with significant P2 prolapse
with flail leaflet tip. He is referred for surgical evaluation.

MEDICAL HISTORY: Mitral Regurgitation
Pulmonary Hypertension
Pulmonary embolus and Deep Vein thrombosis [**2189**] (? protein
deficiency- hypercoaguable risk on pre-op coumadin)
Hyperlipidemia
Hypertension
Obesity
Psoriasis
Varicose veins
Phlebitis 25 yrs ago
s/p Tonsillectomy
s/p Appendectomy

MEDICATION ON ADMISSION: Coumadin 4 mg daily->***Last dose taken [**2194-7-22**]
Folic acid 1 mg daily
HCTZ 12.5mg daily
Cozaar 25mg daily
K-Dur 10 mEq daily
Lorazepam 0.5 mg prn->rarely uses

ALLERGIES: Monopril / Lipitor / Simvastatin / Crestor / Zetia / Niacin

PHYSICAL EXAM: Pulse: 72 Resp: 16  O2 sat: 99%
B/P  Right: 133/88   Left: 139/89
Height: 5'8"    Weight: 197 lbs

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: [**12-18**] wks ago
Lives with: husband
Occupation: retired engineer
Tobacco: former tobacco use (none since college)
ETOH: occ. 

### Response:
{'Mitral valve disorders,Primary hypercoagulable state,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Other psoriasis,Asymptomatic varicose veins,Personal history of venous thrombosis and embolism'}
