CHIEF COMPLAINT: Palpitations

PRESENT ILLNESS: 72 y.o. old primary care physician with [**Name Initial (PRE) **] history of severe
mitral regurgitation, new onset acute diastolic congestive heart
failure. He reports occasional palpitations. He denies shortness
of breath, PND, orthopnea, presyncope, or syncope. He reports
mild dependent chronic 1+ bilateral LE edema. TEE revealed
mildly thickened and myxomatous mitral valve leaflets, moderate
to severe MVP with severe 4+MR. [**Name13 (STitle) **] was evaluated by Dr. [**Last Name (STitle) **]
and agreed to proceed with elective mitral valve repair.

MEDICAL HISTORY: Mitral Regurgitation/Mitral valve prolapse
Hypertension
SVT/Atrial Tachycardia
Diverticulosis
Nephrolithiasis
Polymyalgia Rheumatica
Osteopenia
Low Back Pain/Sciatica
OSA-compliant with cpap
Left knee arthroscopic knee surgery; case was done under general
anesthesia and patient reports post anesthesia course
complicated
by a bronchospastic reaction along with oxygen desataturation,
which required overnight observation prior to discharge. No
issues with conscious sedation during prior colonoscopy.

MEDICATION ON ADMISSION: CITALOPRAM - 40 mg Tablet - 1 Tablet(s) by mouth once a day
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - 50,000 unit Capsule -
one Capsule(s) by mouth qweek
FUROSEMIDE - 20 mg Tablet - [**11-22**] tab Tablet(s) by mouth once a
day
- No Substitution
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
METOPROLOL SUCCINATE - 50 mg Tablet Sustained Release 24 hr - 1
Tablet(s) by mouth once a day - No Substitution
SILDENAFIL [VIAGRA] - 100 mg Tablet - 1 Tablet(s) by mouth as
directed
ASPIRIN -  (OTC) - 81 mg Tablet, Chewable - 1 Tablet(s) by mouth
daily
CALCIUM CITRATE [CALCITRATE] -  (Prescribed by Other Provider) -
200 mg (950 mg) Tablet - 1 (One) Tablet(s) by mouth twice a week
CYANOCOBALAMIN (VITAMIN B-12) -  (Prescribed by Other Provider)
-
1,000 mcg Tablet Sustained Release - 1 Tablet(s) by mouth twice
a
week
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] -  (OTC) - 1,000 unit
Capsule - 1 Capsule(s) by mouth daily
RANITIDINE HCL -  (OTC) - 150 mg Tablet - 1 Tablet(s) by mouth
prn as needed for GERD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 60SR  Resp:  20  O2 sat:
B/P  Right: 112/64   Left:
Height:  5'9"   Weight: 150lb

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives with wife [**Name (NI) **]
Occupation: PCP
[**Name Initial (PRE) 1139**]: remote- quit 25 yo
ETOH: [**1-22**] drinks a week
Mitral valve disorders,Chronic systolic heart failure,Diverticulosis of colon (without mention of hemorrhage),Polymyalgia rheumatica,Disorder of bone and cartilage, unspecified,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Calculus of kidney,Sciatica,Personal history of tobacco use
Mitral valve disorder,Chr systolic hrt failure,Dvrtclo colon w/o hmrhg,Polymyalgia rheumatica,Bone & cartilage dis NOS,Obstructive sleep apnea,Hypertension NOS,Calculus of kidney,Sciatica,History of tobacco use
Admission Date:  [**2111-12-29**]              Discharge Date:   [**2112-1-3**]

Date of Birth:  [**2039-10-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
Mitral Valve Repair [**2111-12-29**]


History of Present Illness:
72 y.o. old primary care physician with [**Name Initial (PRE) **] history of severe
mitral regurgitation, new onset acute diastolic congestive heart
failure. He reports occasional palpitations. He denies shortness
of breath, PND, orthopnea, presyncope, or syncope. He reports
mild dependent chronic 1+ bilateral LE edema. TEE revealed
mildly thickened and myxomatous mitral valve leaflets, moderate
to severe MVP with severe 4+MR. [**Name13 (STitle) **] was evaluated by Dr. [**Last Name (STitle) **]
and agreed to proceed with elective mitral valve repair.


Past Medical History:
Mitral Regurgitation/Mitral valve prolapse
Hypertension
SVT/Atrial Tachycardia
Diverticulosis
Nephrolithiasis
Polymyalgia Rheumatica
Osteopenia
Low Back Pain/Sciatica
OSA-compliant with cpap
Left knee arthroscopic knee surgery; case was done under general
anesthesia and patient reports post anesthesia course
complicated
by a bronchospastic reaction along with oxygen desataturation,
which required overnight observation prior to discharge. No
issues with conscious sedation during prior colonoscopy.


Social History:
Lives with wife [**Name (NI) **]
Occupation: PCP
[**Name Initial (PRE) 1139**]: remote- quit 25 yo
ETOH: [**1-22**] drinks a week

Family History:
Non-contributory

Physical Exam:
Pulse: 60SR  Resp:  20  O2 sat:
B/P  Right: 112/64   Left:
Height:  5'9"   Weight: 150lb

General: NAD, WGWN, appears stated age
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur 3/6 systolic
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema- trace
Varicosities: None [x]
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:
no bruits


Pertinent Results:
[**2111-12-29**]:Conclusions
PRE-CPB:
The left atrium is moderately dilated. No thrombus is seen in
the left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler.
Left ventricular wall thicknesses are normal. Overall left
ventricular systolic function is normal (LVEF>55%).
The RV systolic function is borderline low normal.
There are simple atheroma in the descending thoracic aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. Trivial aortic regurgitation is seen.
The mitral valve leaflets are myxomatous. The portion of the
mitral leaflet between P2 and P3 is flail with ruptured chord.
There is a anteriorly directed jet of severe MR [**First Name (Titles) 151**] [**Last Name (Titles) 96316**]
effect. There is a smaller central MR jet.
POST-CPB:
A mitral valve annuloplasty ring is present. The anterior
leaflet spans the entire length of the mitral annulus, and the
posterior leaflet is minimally visible, consistent with a mitral
valve repair. There is no residual MR. The peak gradient across
the mitral valve is 6mmHg, the mean gradient is 3mmHg.The TR is
now mild.
The LV systolic function is borderline normal with no new wall
motion abnormalities. The RV systolic function appears improved
to normal.
There is no evidence of dissection.

[**2112-1-1**] CXR: FINDINGS: In comparison with the study of [**12-30**],
there is partial clearing of the bilateral atelectatic change,
though opacification persists in the retrocardiac region at the
left base. Blunting of the costophrenic angles is again seen. No
evidence of pneumothorax.



[**2111-12-29**] 11:32AM BLOOD WBC-1.6*# RBC-2.80*# Hgb-8.8*# Hct-25.0*#
MCV-90 MCH-31.4 MCHC-35.1* RDW-13.5 Plt Ct-95*
[**2111-12-29**] 12:10PM BLOOD WBC-4.7# RBC-3.44* Hgb-10.6* Hct-30.6*
MCV-89 MCH-30.8 MCHC-34.7 RDW-13.5 Plt Ct-103*
[**2111-12-29**] 07:15PM BLOOD Hct-32.3*
[**2111-12-30**] 04:16AM BLOOD WBC-6.1 RBC-3.54* Hgb-11.2* Hct-31.6*
MCV-89 MCH-31.6 MCHC-35.4* RDW-13.5 Plt Ct-100*
[**2111-12-31**] 04:16AM BLOOD WBC-7.6 RBC-3.70* Hgb-11.5* Hct-32.5*
MCV-88 MCH-31.0 MCHC-35.3* RDW-13.4 Plt Ct-99*
[**2112-1-1**] 05:05AM BLOOD WBC-5.7 RBC-3.46* Hgb-10.7* Hct-31.1*
MCV-90 MCH-31.0 MCHC-34.4 RDW-13.4 Plt Ct-102*
[**2111-12-29**] 11:32AM BLOOD PT-15.4* PTT-36.1* INR(PT)-1.3*
[**2111-12-29**] 11:32AM BLOOD Plt Smr-LOW Plt Ct-95*
[**2111-12-29**] 12:10PM BLOOD PT-14.4* PTT-38.4* INR(PT)-1.2*
[**2111-12-29**] 12:10PM BLOOD Plt Ct-103*
[**2111-12-30**] 04:16AM BLOOD Plt Ct-100*
[**2111-12-31**] 04:16AM BLOOD Plt Smr-LOW Plt Ct-99*
[**2112-1-1**] 05:05AM BLOOD Plt Ct-102*
[**2111-12-29**] 12:10PM BLOOD UreaN-16 Creat-0.9 Na-142 K-4.3 Cl-112*
HCO3-25 AnGap-9
[**2111-12-29**] 07:15PM BLOOD Na-142 K-4.2 Cl-112*
[**2111-12-30**] 04:16AM BLOOD Glucose-122* UreaN-17 Creat-0.9 Na-140
K-4.5 Cl-109* HCO3-26 AnGap-10
[**2111-12-31**] 04:16AM BLOOD Glucose-128* UreaN-20 Creat-1.0 Na-136
K-3.8 Cl-100 HCO3-31 AnGap-9
[**2112-1-1**] 05:05AM BLOOD UreaN-21* Creat-1.0 Na-138 K-3.9 Cl-100
[**2112-1-1**] 11:12PM BLOOD Glucose-112* UreaN-18 Creat-1.0 Na-137
K-4.2 Cl-99 HCO3-31 AnGap-11

Brief Hospital Course:
The patient was brought to the operating room on [**2111-12-29**] where
the patient underwent mitral valve repair with 28mm ring.
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.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.  The patient
was transferred to the telemetry floor for further recovery.
Chest tubes and pacing wires were discontinued without
complication.  The patient was evaluated by the physical therapy
service for assistance with strength and mobility and cleared
for discharge to home.  By the time of discharge on POD 5 the
patient was ambulating freely, the wound was healing and pain
was controlled with oral analgesics. His home ACE inhibitor was
not added back secondary to hypotension. The patient was
discharged [**2112-1-3**] in good condition with appropriate follow up
instructions.

Medications on Admission:
CITALOPRAM - 40 mg Tablet - 1 Tablet(s) by mouth once a day
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - 50,000 unit Capsule -
one Capsule(s) by mouth qweek
FUROSEMIDE - 20 mg Tablet - [**11-22**] tab Tablet(s) by mouth once a
day
- No Substitution
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
METOPROLOL SUCCINATE - 50 mg Tablet Sustained Release 24 hr - 1
Tablet(s) by mouth once a day - No Substitution
SILDENAFIL [VIAGRA] - 100 mg Tablet - 1 Tablet(s) by mouth as
directed
ASPIRIN -  (OTC) - 81 mg Tablet, Chewable - 1 Tablet(s) by mouth
daily
CALCIUM CITRATE [CALCITRATE] -  (Prescribed by Other Provider) -
200 mg (950 mg) Tablet - 1 (One) Tablet(s) by mouth twice a week
CYANOCOBALAMIN (VITAMIN B-12) -  (Prescribed by Other Provider)
-
1,000 mcg Tablet Sustained Release - 1 Tablet(s) by mouth twice
a
week
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] -  (OTC) - 1,000 unit
Capsule - 1 Capsule(s) by mouth daily
RANITIDINE HCL -  (OTC) - 150 mg Tablet - 1 Tablet(s) by mouth
prn as needed for GERD


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*75 Tablet(s)* Refills:*0*
4. citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
5. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO Q12H (every 12 hours).
Disp:*20 Tablet, ER Particles/Crystals(s)* Refills:*0*
6. furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
7. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a
day.
8. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
9. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. ergocalciferol (vitamin D2) 50,000 unit Capsule Sig: One (1)
Capsule PO once a week: Per home routine.
11. Vitamin D 1,000 unit Tablet Sig: One (1) Tablet PO once a
day: Per home routine.
12. Vitamin B-12 1,000 mcg Tablet Extended Release Sig: One (1)
Tablet Extended Release PO twice a week: Per home routine.
13. calcium citrate 200 mg (950 mg) Tablet Sig: One (1) Tablet
PO twice a week: Per home routine.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Mitral Regurgitation/Mitral Valve Prolapse
Hypertension
SVT/Atrial Tachycardia
Diverticulosis
Nephrolithiasis
Polymyalgia Rheumatica
Osteopenia
Low Back Pain/Sciatica
Obstructive Sleep Apnea


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage
Edema:2+


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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
Do not resume your lisinopril
Do not resume Viagra
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) **] [**2112-1-21**] @ 1:30pm   Phone: [**Telephone/Fax (1) 170**]
Cardiologist: Dr. [**Last Name (STitle) **] [**1-19**] @ 1:30pm

Please call to schedule the following:
Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]  in [**2-23**] 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**



Completed by:[**2112-1-3**]
{'Mitral valve disorders,Chronic systolic heart failure,Diverticulosis of colon (without mention of hemorrhage),Polymyalgia rheumatica,Disorder of bone and cartilage, unspecified,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Calculus of kidney,Sciatica,Personal history of tobacco use'}


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: Palpitations

PRESENT ILLNESS: 72 y.o. old primary care physician with [**Name Initial (PRE) **] history of severe
mitral regurgitation, new onset acute diastolic congestive heart
failure. He reports occasional palpitations. He denies shortness
of breath, PND, orthopnea, presyncope, or syncope. He reports
mild dependent chronic 1+ bilateral LE edema. TEE revealed
mildly thickened and myxomatous mitral valve leaflets, moderate
to severe MVP with severe 4+MR. [**Name13 (STitle) **] was evaluated by Dr. [**Last Name (STitle) **]
and agreed to proceed with elective mitral valve repair.

MEDICAL HISTORY: Mitral Regurgitation/Mitral valve prolapse
Hypertension
SVT/Atrial Tachycardia
Diverticulosis
Nephrolithiasis
Polymyalgia Rheumatica
Osteopenia
Low Back Pain/Sciatica
OSA-compliant with cpap
Left knee arthroscopic knee surgery; case was done under general
anesthesia and patient reports post anesthesia course
complicated
by a bronchospastic reaction along with oxygen desataturation,
which required overnight observation prior to discharge. No
issues with conscious sedation during prior colonoscopy.

MEDICATION ON ADMISSION: CITALOPRAM - 40 mg Tablet - 1 Tablet(s) by mouth once a day
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - 50,000 unit Capsule -
one Capsule(s) by mouth qweek
FUROSEMIDE - 20 mg Tablet - [**11-22**] tab Tablet(s) by mouth once a
day
- No Substitution
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
METOPROLOL SUCCINATE - 50 mg Tablet Sustained Release 24 hr - 1
Tablet(s) by mouth once a day - No Substitution
SILDENAFIL [VIAGRA] - 100 mg Tablet - 1 Tablet(s) by mouth as
directed
ASPIRIN -  (OTC) - 81 mg Tablet, Chewable - 1 Tablet(s) by mouth
daily
CALCIUM CITRATE [CALCITRATE] -  (Prescribed by Other Provider) -
200 mg (950 mg) Tablet - 1 (One) Tablet(s) by mouth twice a week
CYANOCOBALAMIN (VITAMIN B-12) -  (Prescribed by Other Provider)
-
1,000 mcg Tablet Sustained Release - 1 Tablet(s) by mouth twice
a
week
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] -  (OTC) - 1,000 unit
Capsule - 1 Capsule(s) by mouth daily
RANITIDINE HCL -  (OTC) - 150 mg Tablet - 1 Tablet(s) by mouth
prn as needed for GERD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 60SR  Resp:  20  O2 sat:
B/P  Right: 112/64   Left:
Height:  5'9"   Weight: 150lb

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives with wife [**Name (NI) **]
Occupation: PCP
[**Name Initial (PRE) 1139**]: remote- quit 25 yo
ETOH: [**1-22**] drinks a week 

### Response:
{'Mitral valve disorders,Chronic systolic heart failure,Diverticulosis of colon (without mention of hemorrhage),Polymyalgia rheumatica,Disorder of bone and cartilage, unspecified,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Calculus of kidney,Sciatica,Personal history of tobacco use'}
