CHIEF COMPLAINT: DOE and fatigue.

PRESENT ILLNESS: This 60 year old african american female has history of
non-ischemic cardiomyopathy, CHF, and MR.  She hs been followed
in the heart failure clinic and has had serial echos which have
showed progression of MR over the past several years.  She now
has severe MR, DOE, and fatigue and presents for surgical
intervention.

MEDICAL HISTORY: CHF
HTN
GERD
Cardiomyopathy
Obesity
Prolapsed bladder-stress incontinence
Asthma
Bronchitis
^chol.
DJD
s/p arthroscopy of L knee
s/p partial hysterectomy
s/p pylonidal cyst

MEDICATION ON ADMISSION: Toprol XL 200 mg PO daily
Diovan 240 mg PO daily
Lasix 40 mg PO daily
Lipitor 20 mg PO daily
Prilosec 20 mg PO daily
ASA 81 mg PO daily
[**Doctor First Name **] 60 mg PO BID PRN
MVI
Tramadol 50 mg PO BID

ALLERGIES: Hydrochlorothiazide

PHYSICAL EXAM: WDWN BF in NAD
HEENT: NC/AT, PERLA, EOMI, oropharynx benign with full upper
dentures and partial lower dentures.
Neck: FROM, no lymphadenopathy or thyromegaly, carotids 2+=
bilat. without bruits.
Lungs: clear to A+P
CV: RRR without R/G, [**3-20**] HSM
Abd: + BS, obese, soft, nontender without masses or
hepatosplenomegaly
Ext: without C/C/E, pulses 2+=bilat. throughout.
Neuro: nonfocal

FAMILY HISTORY: DM
hypothyroidism

SOCIAL HISTORY: Retired inspector for [**Company 2318**].
Widowed and lives alone.
Cigs: none
ETOH: 4 drinks/month
Mitral valve disorders,Congestive heart failure, unspecified,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Asthma, unspecified type, unspecified,Obesity, unspecified
Mitral valve disorder,CHF NOS,Prim cardiomyopathy NEC,Crnry athrscl natve vssl,Hypertension NOS,Esophageal reflux,Pure hypercholesterolem,Asthma NOS,Obesity NOS
Admission Date:  [**2170-2-13**]              Discharge Date:   [**2170-2-18**]

Date of Birth:  [**2109-9-11**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Hydrochlorothiazide

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
DOE and fatigue.

Major Surgical or Invasive Procedure:
CABGx2(SVG->Diag, RCA)/MV repair(27mm [**Company 1543**] ring) [**2170-2-13**]

History of Present Illness:
This 60 year old african american female has history of
non-ischemic cardiomyopathy, CHF, and MR.  She hs been followed
in the heart failure clinic and has had serial echos which have
showed progression of MR over the past several years.  She now
has severe MR, DOE, and fatigue and presents for surgical
intervention.

Past Medical History:
CHF
HTN
GERD
Cardiomyopathy
Obesity
Prolapsed bladder-stress incontinence
Asthma
Bronchitis
^chol.
DJD
s/p arthroscopy of L knee
s/p partial hysterectomy
s/p pylonidal cyst


Social History:
Retired inspector for [**Company 2318**].
Widowed and lives alone.
Cigs: none
ETOH: 4 drinks/month

Family History:
DM
hypothyroidism

Physical Exam:
WDWN BF in NAD
HEENT: NC/AT, PERLA, EOMI, oropharynx benign with full upper
dentures and partial lower dentures.
Neck: FROM, no lymphadenopathy or thyromegaly, carotids 2+=
bilat. without bruits.
Lungs: clear to A+P
CV: RRR without R/G, [**3-20**] HSM
Abd: + BS, obese, soft, nontender without masses or
hepatosplenomegaly
Ext: without C/C/E, pulses 2+=bilat. throughout.
Neuro: nonfocal

Pertinent Results:
[**2170-2-16**] 03:50PM BLOOD WBC-10.6 RBC-3.06* Hgb-9.8* Hct-26.8*
MCV-88 MCH-31.9 MCHC-36.4* RDW-14.8 Plt Ct-110*
[**2170-2-16**] 03:46AM BLOOD PT-12.0 PTT-28.7 INR(PT)-1.0
[**2170-2-16**] 03:50PM BLOOD Glucose-112* UreaN-16 Creat-0.8 Na-136
K-5.0 Cl-101 HCO3-27 AnGap-13
CHEST (PORTABLE AP)  [**2170-2-15**] 10:31 AM
Reason: s/p ct d/c

[**Hospital 93**] MEDICAL CONDITION:
60 year old woman with CAD/MR s/p CABG/MV Repair
REASON FOR THIS EXAMINATION:
s/p ct d/c
AP CHEST 10:35 A.M., [**2-15**]

HISTORY: Coronary artery disease and mitral valve repair.

IMPRESSION: AP chest compared to [**2-13**] and preoperative
radiographs on [**1-30**]:

Postoperative caliber of the cardiomediastinal silhouette has
increased only minimally since [**2-13**], a common finding
following tracheal extubation. Borderline interstitial edema and
new right lower lobe atelectasis are other expected findings.
Tip of the Swan-Ganz line projects over the proximal right
pulmonary artery. Midline and left pleural drains have been
removed. There is no pleural effusion or pneumothorax. Right
jugular line tip projects over the superior cavoatrial junction.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: FRI [**2170-2-16**] 7:31 AM
Cardiology Report ECHO Study Date of [**2170-2-13**]


*** Report not finalized ***
PRELIMINARY REPORT

PATIENT/TEST INFORMATION:
Indication: Coronary artery disease. Dilated cardiomyopathy.
Left ventricular function. Mitral valve disease.
Weight (lb): 255
BP (mm Hg): 120/75
HR (bpm): 70
Status: Inpatient
Date/Time: [**2170-2-13**] at 10:21
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007AW-:1
Test Location: Anesthesia West OR cardiac
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name (STitle) 412**] [**Last Name (Prefixes) 413**]

MEASUREMENTS:
Left Ventricle - Septal Wall Thickness: 1.1 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: 1.1 cm (nl 0.6 - 1.1
cm)

INTERPRETATION:

Findings:

LEFT ATRIUM: Mild LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA
and extending into the RV. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Moderately dilated LV
cavity.
Moderate global LV hypokinesis.

LV WALL MOTION: Regional LV wall motion abnormalities include:
basal anterior
- hypo; mid anterior - hypo; basal anteroseptal - hypo; mid
anteroseptal -
hypo; basal inferoseptal - hypo; mid inferoseptal - hypo; basal
inferior -
hypo; mid inferior - hypo; basal inferolateral - hypo; mid
inferolateral -
hypo; basal anterolateral - hypo; mid anterolateral - hypo;
anterior apex -
hypo; septal apex - hypo; inferior apex - hypo; lateral apex -
hypo; apex -
hypo;

RIGHT VENTRICLE: Mild global RV free wall hypokinesis.

AORTA: Simple atheroma in aortic arch. Simple atheroma in
descending aorta.

AORTIC VALVE: Three aortic valve leaflets. No AR.

MITRAL VALVE: Moderately thickened mitral valve leaflets. Mild
mitral annular
calcification. Moderate (2+) MR.

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify
I was present in compliance with HCFA regulations. No TEE
related
complications. The patient was under general anesthesia
throughout the
procedure.

Conclusions:
Pre-CPB
The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or
color Doppler. Left ventricular wall thicknesses are normal. The
left
ventricular cavity is moderately dilated. There is moderate
global left
ventricular hypokinesis. There is mild global right ventricular
free wall
hypokinesis. There are simple atheroma in the aortic arch. There
are simple
atheroma in the descending thoracic aorta. There are three
aortic valve
leaflets. No aortic regurgitation is seen. The mitral valve
leaflets are
moderately thickened. Moderate (2+) mitral regurgitation is
seen.

Post-CPB (on epinephrine 0.02 mcg/kg/min, phenylephrine 0.5
mcg/kg/min)
The mitral repair shows no evidence of any regurgitation. There
is minimal
gradient across the mitral valve (4 mmHg). There is no evidence
of LVOT
obstruction. Overall LV systolic function improved with
background inotropic
support.
[**Location (un) **] PHYSICIAN:











Brief Hospital Course:
The pt. was admitted on [**2170-2-13**] and underwent CABGx2(SVG->Diag
and RCA)/MV repair(27mm ring).  The cross clamp time was 75 mins
and total bypass time was 93 mins.  She tolerated the procedure
well and was transferred to the CSRU on Epi, Neo, and Propofol.
She was changed from Epi to Milrinone on the post op night and
was extubated on POD#1.  She slowly progressed and was
transferred to the floor on POD#3.  She continued to progress
and was discharged to home on POD#5 in stable condition.

Medications on Admission:
Toprol XL 200 mg PO daily
Diovan 240 mg PO daily
Lasix 40 mg PO daily
Lipitor 20 mg PO daily
Prilosec 20 mg PO daily
ASA 81 mg PO daily
[**Doctor First Name **] 60 mg PO BID PRN
MVI
Tramadol 50 mg PO BID

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*20 Tablet(s)* Refills:*0*
3. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO once
a day.
Disp:*10 Packet(s)* Refills:*0*
6. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO once a day:
Take one (1) tablet per day for seven days.  On day eight take
one half (0.5) tablet.
Disp:*22 Tablet(s)* Refills:*1*
7. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours for 5 days.
Disp:*15 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Caregroup VNA

Discharge Diagnosis:
CABG and MV repair


Discharge Condition:
stable


Discharge Instructions:
1.  Follow d/c instructions per worksheet.
2.  Take meds as prescribed.  Take 400 mg Amiodarone per day for
seven days followed by 200 mg per day until seen by Dr [**First Name (STitle) 437**]
3.  Call EMS if develop any chest pain, shortness of breath at
rest or with exercise.
4.  Keep sternal wound dry and observe for drainage or redness
around site

Followup Instructions:
Provider: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Doctor Last Name **] Phone:[**Telephone/Fax (1) 3512**] Date/Time:[**2170-4-2**]
2:30

Call the CT surgery office on Monday to schedule an appt with Dr
[**Last Name (STitle) 1290**].



Completed by:[**2170-2-19**]
{'Mitral valve disorders,Congestive heart failure, unspecified,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Asthma, unspecified type, unspecified,Obesity, 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: DOE and fatigue.

PRESENT ILLNESS: This 60 year old african american female has history of
non-ischemic cardiomyopathy, CHF, and MR.  She hs been followed
in the heart failure clinic and has had serial echos which have
showed progression of MR over the past several years.  She now
has severe MR, DOE, and fatigue and presents for surgical
intervention.

MEDICAL HISTORY: CHF
HTN
GERD
Cardiomyopathy
Obesity
Prolapsed bladder-stress incontinence
Asthma
Bronchitis
^chol.
DJD
s/p arthroscopy of L knee
s/p partial hysterectomy
s/p pylonidal cyst

MEDICATION ON ADMISSION: Toprol XL 200 mg PO daily
Diovan 240 mg PO daily
Lasix 40 mg PO daily
Lipitor 20 mg PO daily
Prilosec 20 mg PO daily
ASA 81 mg PO daily
[**Doctor First Name **] 60 mg PO BID PRN
MVI
Tramadol 50 mg PO BID

ALLERGIES: Hydrochlorothiazide

PHYSICAL EXAM: WDWN BF in NAD
HEENT: NC/AT, PERLA, EOMI, oropharynx benign with full upper
dentures and partial lower dentures.
Neck: FROM, no lymphadenopathy or thyromegaly, carotids 2+=
bilat. without bruits.
Lungs: clear to A+P
CV: RRR without R/G, [**3-20**] HSM
Abd: + BS, obese, soft, nontender without masses or
hepatosplenomegaly
Ext: without C/C/E, pulses 2+=bilat. throughout.
Neuro: nonfocal

FAMILY HISTORY: DM
hypothyroidism

SOCIAL HISTORY: Retired inspector for [**Company 2318**].
Widowed and lives alone.
Cigs: none
ETOH: 4 drinks/month 

### Response:
{'Mitral valve disorders,Congestive heart failure, unspecified,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Asthma, unspecified type, unspecified,Obesity, unspecified'}
