CHIEF COMPLAINT: Atrial fibrillation

PRESENT ILLNESS: 60 year old male with history of proxysmal atrial fibrillation
who was admitted as an outpatiet for pulmonary vein isolation
and ablation with the ep service. Cardiac surgery was consulted
after they were unable to remove the catheter.

MEDICAL HISTORY: Paroxysmal atrial fibrillation
hypertension
dyslipidemia
s/p right ear surgery

MEDICATION ON ADMISSION: Propafenone 225 mg po qam and qpm, 150 mg po at lunch
coumadin 2.5 mg po saturday, 5 mg every other day
Simvastatin 80 mg po daily
HCTZ 25 mg po daily
Viagra 50 mg po prn
Atenolol 50 mg po daily
MVI
Fish oil
benadryl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Discharge:
98.7  141/84  79  20  92% RA
General: pleasant to speak with
Chest: Lungs clear to auscultation. Sternum stable
COR: regular, no murmurs appreciated
Sternal incision: dry and intact without drainage
Extremities: warm with trace pedal edema

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Divorced with two children. Lives with his girlfriend.
Retired police officer.
Averages 4 beers/night
Atrial fibrillation,Other mechanical complication of cardiac device, implant, and graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other iatrogenic hypotension,Long-term (current) use of anticoagulants
Atrial fibrillation,Malfunc card dev/grf NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Abn react-cardiac cath,Iatrogenc hypotnsion NEC,Long-term use anticoagul
Admission Date:  [**2194-11-5**]              Discharge Date:   [**2194-11-8**]

Date of Birth:  [**2134-6-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
s/p emergent removal of retained EP catheter, bilateral PVI,
MAZE, resection of left atrial appendage


History of Present Illness:
60 year old male with history of proxysmal atrial fibrillation
who was admitted as an outpatiet for pulmonary vein isolation
and ablation with the ep service. Cardiac surgery was consulted
after they were unable to remove the catheter.

Past Medical History:
Paroxysmal atrial fibrillation
hypertension
dyslipidemia
s/p right ear surgery

Social History:
Divorced with two children. Lives with his girlfriend.
Retired police officer.
Averages 4 beers/night

Family History:
noncontributory

Physical Exam:
Discharge:
98.7  141/84  79  20  92% RA
General: pleasant to speak with
Chest: Lungs clear to auscultation. Sternum stable
COR: regular, no murmurs appreciated
Sternal incision: dry and intact without drainage
Extremities: warm with trace pedal edema

Pertinent Results:
[**2194-11-7**] 05:15AM BLOOD WBC-10.3 RBC-3.40* Hgb-11.1* Hct-31.6*
MCV-93 MCH-32.7* MCHC-35.3* RDW-13.1 Plt Ct-199
[**2194-11-6**] 02:24AM BLOOD WBC-11.3* RBC-3.66* Hgb-12.3* Hct-33.2*
MCV-91 MCH-33.5* MCHC-36.9* RDW-13.2 Plt Ct-204
[**2194-11-5**] 08:35AM BLOOD WBC-7.1 RBC-4.66 Hgb-15.5 Hct-42.3 MCV-91
MCH-33.2* MCHC-36.7* RDW-12.7 Plt Ct-291
[**2194-11-8**] 07:10AM BLOOD PT-16.6* INR(PT)-1.5*
[**2194-11-7**] 05:15AM BLOOD PT-14.8* INR(PT)-1.3*
[**2194-11-5**] 08:35AM BLOOD PT-16.3* INR(PT)-1.5*
[**2194-11-7**] 05:15AM BLOOD Glucose-100 UreaN-13 Creat-0.9 Na-137
K-4.1 Cl-102 HCO3-31 AnGap-8
[**2194-11-5**] 08:35AM BLOOD Glucose-108* UreaN-18 Creat-1.0 Na-139
K-3.9 Cl-104 HCO3-27 AnGap-12
[**2194-11-7**] 05:15AM BLOOD Mg-2.4
[**2194-11-6**] 02:24AM BLOOD Mg-2.3

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 79774**]
(Complete) Done [**2194-11-5**] at 1:54:02 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2134-6-9**]
Age (years): 60 M  Hgt (in): 80
BP (mm Hg): 140/80  Wgt (lb): 185
HR (bpm): 90  BSA (m2): 2.23 m2
Indication: Left ventricular function. Right ventricular
function. Tamponade.
ICD-9 Codes: 440.0
Test Information
Date/Time: [**2194-11-5**] at 13:54    Interpret MD: [**Name6 (MD) 928**]
[**Name8 (MD) 929**], MD, MD
Test Type: TEE (Complete)
3D imaging. Son[**Name (NI) 930**]: [**Last Name (NamePattern5) 9958**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW06-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Diastolic Dimension:  4.1 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55% to 60%  >= 55%
Aorta - Ascending:  2.8 cm  <= 3.4 cm
Aorta - Descending Thoracic:  1.8 cm  <= 2.5 cm

Findings
Multiplanar reconstructions were generated and confirmed on an
independent workstation.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. Left-to-right shunt
across the interatrial septum at rest. Small secundum ASD. ASD.

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal regional LV systolic function.
Overall normal LVEF (>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal diameter of aorta at the sinus, ascending and arch
levels. Normal descending aorta diameter. Simple atheroma in
descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. Trace AR.


MITRAL VALVE: Normal mitral valve leaflets with trivial MR.

TRICUSPID VALVE: Physiologic TR.

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

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. Suboptimal image
quality - poor echo windows. Emergency study. Results were
Conclusions
PreBypass:

1. The patient is V paced.
2. Regional left ventricular wall motion is normal. Overall left
ventricular systolic function is normal (LVEF>55%). 3. Right
ventricular chamber size and free wall motion are normal.
4. There are simple atheroma in the descending thoracic aorta.
5. The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis. Trace aortic
regurgitation is seen.
6. The mitral valve appears structurally normal with trivial
mitral regurgitation.
7. There is no pericardial effusion.
8. A RV catheter/pacing wire is seen. A separate wire/catheter
is seen traversing the intraatrial septum and extending into the
right inferior pulmonary vein.

Post Bypass:

The patient is in sinus rhythm. Left and right ventricular
function is preserved. The aorta is intact. The entrapped
wire/catheter has been successfully removed. An atrial septal
defect is now present. The left atrial appendage has been
removed. The remainder of the examination is unchanged.

Dr. [**Last Name (STitle) 914**] was notified in person of the results
intraoperatively.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 928**] [**Name8 (MD) 929**], MD, MD,
Interpreting physician [**Last Name (NamePattern4) **] [**2194-11-5**] 22:40



Brief Hospital Course:
Patient was brought to the operating room urgently from the
electrophysiology lab. He underwent emergent removal of retained
catheter, pulmonary vein isolation, MAZE, and left atrial
appendage removal with Dr [**Last Name (STitle) 914**]. Please see operative note for
full details. Post-operatively he was admitted to the CVICU for
invasive hemodynamic monitoring. Drips were weaned and he was
extubated on POD 0. By POD 1 he was transferred to the step down
floor.
Physical therapy was consulted to work on strength and
conditioning. He was re-started on coumadin and his home doses
of propafenone. By POD 3 he passed physical therapy and was
cleared for discharge home.

Medications on Admission:
Propafenone 225 mg po qam and qpm, 150 mg po at lunch
coumadin 2.5 mg po saturday, 5 mg every other day
Simvastatin 80 mg po daily
HCTZ 25 mg po daily
Viagra 50 mg po prn
Atenolol 50 mg po daily
MVI
Fish oil
benadryl

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*
4. 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:*0*
5. Warfarin 1 mg Tablet Sig: Five (5) Tablet PO DAILY (Daily):
Please take this dose 12/20 and [**11-9**]. Dr[**Name (NI) 79775**] office will
call with dose adjustment monday after INR drawn.
Disp:*50 Tablet(s)* Refills:*0*
6. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Propafenone 225 mg Tablet Sig: One (1) Tablet PO QAM AND QPM
().
8. Propafenone 150 mg Tablet Sig: One (1) Tablet PO AFTERNOON
().
9. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q3H (every 3
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Hospice and VNA

Discharge Diagnosis:
s/p emergent removal of retained EP catheter, bilateral PVI,
MAZE, resection of left atrial appendage
AFIB
Dyslipidemia


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for
appointment
Dr. [**Last Name (STitle) 5051**] in 1 week ([**Telephone/Fax (1) 6256**]) please call for
appointment
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2194-11-8**]
{'Atrial fibrillation,Other mechanical complication of cardiac device, implant, and graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other iatrogenic hypotension,Long-term (current) use of anticoagulants'}


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: Atrial fibrillation

PRESENT ILLNESS: 60 year old male with history of proxysmal atrial fibrillation
who was admitted as an outpatiet for pulmonary vein isolation
and ablation with the ep service. Cardiac surgery was consulted
after they were unable to remove the catheter.

MEDICAL HISTORY: Paroxysmal atrial fibrillation
hypertension
dyslipidemia
s/p right ear surgery

MEDICATION ON ADMISSION: Propafenone 225 mg po qam and qpm, 150 mg po at lunch
coumadin 2.5 mg po saturday, 5 mg every other day
Simvastatin 80 mg po daily
HCTZ 25 mg po daily
Viagra 50 mg po prn
Atenolol 50 mg po daily
MVI
Fish oil
benadryl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Discharge:
98.7  141/84  79  20  92% RA
General: pleasant to speak with
Chest: Lungs clear to auscultation. Sternum stable
COR: regular, no murmurs appreciated
Sternal incision: dry and intact without drainage
Extremities: warm with trace pedal edema

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Divorced with two children. Lives with his girlfriend.
Retired police officer.
Averages 4 beers/night 

### Response:
{'Atrial fibrillation,Other mechanical complication of cardiac device, implant, and graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other iatrogenic hypotension,Long-term (current) use of anticoagulants'}
