CHIEF COMPLAINT: acute shortness of breath and elevated INR s/p
AVR(mechcanical)Ascending Aortic arch  replacment on [**2-3**].

PRESENT ILLNESS: SOB onset about 5 days ago, increasing with any movement. Saw
cardiologist yesterday had echo today with effusion.

MEDICAL HISTORY: Complete Heart Block(PPM)
Postop DVT in LUE [**2104-3-12**] following lead extraction
Hyperlipidemia
s/p Dual chamber pacemaker placement in [**2087**]
s/p replacement of PM generator [**2096**]
s/p Lead extraction and reimplantation of PPM [**3-/2104**]
Hernia repair as child
s/p AVR(mechcanical)Ascending Aortic arch  replacment on [**2-3**].

MEDICATION ON ADMISSION: 1. Simvastatin 40'
2. Aspirin 81'
3. Acetaminophen 325-650/PRN
4. Hydromorphone 2-4 mg/Q4H/PRN
6. Warfarin 5QD: **dose will change daily for goal INR 2.5-3.5,
7. Potassium Chloride 20 Q12H (every 12 hours) x5 days.
8. Ranitidine HCl 150'
9. Docusate Sodium 100"
10. Metoprolol Tartrate 25"
11. Furosemide 40"

ALLERGIES: Penicillins

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with: Wife in [**Name2 (NI) 1727**]
Occupation: Production manager on ship yard
Tobacco: Quit 1.5 years ago. 40 pack year history
ETOH: [**12-14**] drinks per week
Unspecified disease of pericardium,Abnormal coagulation profile,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Surgical or other procedure not carried out because of contraindication,Cardiac pacemaker in situ,Heart valve replaced by other means,Personal history of venous thrombosis and embolism,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Pericardial disease NOS,Abnrml coagultion prfile,Iatrogenc hypotnsion NEC,Hyperlipidemia NEC/NOS,No proc/contraindication,Status cardiac pacemaker,Heart valve replac NEC,Hx-ven thrombosis/embols,Abn react-cardiac cath
Admission Date:  [**2105-2-18**]              Discharge Date:   [**2105-2-21**]

Date of Birth:  [**2052-9-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
acute shortness of breath and elevated INR s/p
AVR(mechcanical)Ascending Aortic arch  replacment on [**2-3**].


Major Surgical or Invasive Procedure:
evacuation of pericardial effusion


History of Present Illness:
SOB onset about 5 days ago, increasing with any movement. Saw
cardiologist yesterday had echo today with effusion.


Past Medical History:
Complete Heart Block(PPM)
Postop DVT in LUE [**2104-3-12**] following lead extraction
Hyperlipidemia
s/p Dual chamber pacemaker placement in [**2087**]
s/p replacement of PM generator [**2096**]
s/p Lead extraction and reimplantation of PPM [**3-/2104**]
Hernia repair as child
s/p AVR(mechcanical)Ascending Aortic arch  replacment on [**2-3**].


Social History:
Lives with: Wife in [**Name2 (NI) 1727**]
Occupation: Production manager on ship yard
Tobacco: Quit 1.5 years ago. 40 pack year history
ETOH: [**12-14**] drinks per week


Family History:
non-contributory

Physical Exam:
Physical Exam

Temp 98.6  Pulse: 70 Vpaced Resp: 16 O2 sat: 96% 3LNP
B/P  Right: 109/70   Left:
Height:     Weight:

General:
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
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused []  Edema 2+ bilat
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right:   Left:
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+


Pertinent Results:
[**2105-2-18**] 03:02PM   PT-59.9* PTT-34.8 INR(PT)-6.8*

[**2105-2-21**] INR 2.2

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 83779**]Portable TTE
(Focused views) Done [**2105-2-18**] at 5:00:00 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2052-9-21**]
Age (years): 52 M  Hgt (in): 70
BP (mm Hg): 130/79  Wgt (lb): 277
HR (bpm): 70  BSA (m2): 2.40 m2
Indication: cath lab pericardiocentesis monitoring.
ICD-9 Codes: 423.3
Test Information
Date/Time: [**2105-2-18**] at 17:00    Interpret MD: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
[**Last Name (NamePattern1) **], MD
Test Type: Portable TTE (Focused views) Son[**Name (NI) 930**]: [**First Name8 (NamePattern2) 4134**]
[**Last Name (NamePattern1) 4135**], RDCS
Doppler: No Doppler Test Location: West Cath/EP Lab
Contrast: None Tech Quality: Adequate
Tape #: 2010W000-: Machine: Vivid i-3
Echocardiographic Measurements
Results  Measurements  Normal Range

Findings
Limited views were done with sterile probe cover to assess fluid
position during attempted pericardialcentesis.
PERICARDIUM: Large pericardial effusion. RV diastolic collapse,
c/w impaired fillling/tamponade physiology.
Conclusions
There is a large pericardial effusion. There is right
ventricular diastolic collapse, consistent with impaired
fillling/tamponade physiology.
  Electronically signed by [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2105-2-18**] 17:47


Post-op echo [**2105-2-20**]
Conclusions
Overall left ventricular systolic function is normal (LVEF>55%).
A bileaflet aortic valve prosthesis is present. There is a
moderate sized pericardial effusion. The effusion is echo dense,
consistent with blood, inflammation or other cellular elements.
There are no echocardiographic signs of tamponade. No right
ventricular diastolic collapse is seen.

Compared with the findings of the prior study (images reviewed)
of [**2105-2-18**], the pericardial effusion is smaller, now with
signs of consolidation; no evidence of cardiac tamponade.


Brief Hospital Course:
Mr [**Known lastname **] was admitted on [**2105-2-18**] and taken to the Operating Room
 for evacuation of large pericardaicl effusion. See operative
note for details. POst operatively he was transferred to the
CVICU intubated and sedated for hemodynamic and ventilator
management. He awoke neurologically intact and was extubated. He
was tarnsferred from the ICU to the step down unit on POD#1. His
couamdin was resumed for anticoagulation of mechanical aortic
valve. His statin, betablocker and diuretic were also resumed.
He was evaluated by physical therpay for strength and
conditioning and was claered for discharge to home on POD#3.

Medications on Admission:
1. Simvastatin 40'
2. Aspirin 81'
3. Acetaminophen 325-650/PRN
4. Hydromorphone 2-4 mg/Q4H/PRN
6. Warfarin 5QD: **dose will change daily for goal INR 2.5-3.5,
7. Potassium Chloride 20 Q12H (every 12 hours) x5 days.
8. Ranitidine HCl 150'
9. Docusate Sodium 100"
10. Metoprolol Tartrate 25"
11. Furosemide 40"


Discharge Medications:
1. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 5 days.
Disp:*20 Capsule(s)* Refills:*0*
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. 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*
8. 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:*0*
9. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days.
Disp:*20 Tablet(s)* Refills:*0*
10. Coumadin 2.5 mg Tablet Sig: Two (2) Tablet PO once a day:
take 5mg on [**2-22**] then as directed by Dr. [**Last Name (STitle) 83780**].
Disp:*60 Tablet(s)* Refills:*2*
11. Outpatient Lab Work
INR check on [**2105-2-22**] and call results to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4129**] NP
[**Telephone/Fax (1) 170**]
AFTER [**2105-2-22**] INR check and call results to Dr. [**Last Name (STitle) 80724**]
[**Telephone/Fax (1) 8226**]; Fax [**Telephone/Fax (1) 83781**]


Discharge Disposition:
Home With Service

Facility:
VNA of Southern [**State 1727**]

Discharge Diagnosis:
Complete Heart Block(PPM)
Postop DVT in LUE [**2104-3-12**] following lead extraction
Hyperlipidemia
s/p Dual chamber pacemaker placement in [**2087**]
s/p replacement of PM generator [**2096**]
s/p Lead extraction and reimplantation of PPM [**3-/2104**]
Hernia repair as child

Past Surgical History: [**2105-2-3**]
1. Ascending aortic replacement with 28-mm Gelweave graft
under deep hypothermic circulatory arrest.
2. Aortic valve replacement, 25-mm St. [**Hospital 923**] Medical Regent
mechanical valve.
3. Coronary artery bypass grafting x1 of the left internal
mammary artery graft to left anterior descending.


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with percocet prn


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your 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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Recommended Follow-up:
Surgeon Dr. [**Last Name (STitle) **] [**2105-3-12**] at 1pm  [**Telephone/Fax (1) 170**]
Please call to schedule appointments:
Primary Care Dr. [**Last Name (STitle) 28272**] [**Telephone/Fax (1) 83777**] in [**12-13**] weeks
Cardiologist Dr. [**Last Name (STitle) 80724**] in [**12-13**] weeks.
Dr. [**Last Name (STitle) 80724**] will follow your coumadin starting monday [**2105-2-23**].
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will schedule



Completed by:[**2105-2-21**]
{'Unspecified disease of pericardium,Abnormal coagulation profile,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Surgical or other procedure not carried out because of contraindication,Cardiac pacemaker in situ,Heart valve replaced by other means,Personal history of venous thrombosis and embolism,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: acute shortness of breath and elevated INR s/p
AVR(mechcanical)Ascending Aortic arch  replacment on [**2-3**].

PRESENT ILLNESS: SOB onset about 5 days ago, increasing with any movement. Saw
cardiologist yesterday had echo today with effusion.

MEDICAL HISTORY: Complete Heart Block(PPM)
Postop DVT in LUE [**2104-3-12**] following lead extraction
Hyperlipidemia
s/p Dual chamber pacemaker placement in [**2087**]
s/p replacement of PM generator [**2096**]
s/p Lead extraction and reimplantation of PPM [**3-/2104**]
Hernia repair as child
s/p AVR(mechcanical)Ascending Aortic arch  replacment on [**2-3**].

MEDICATION ON ADMISSION: 1. Simvastatin 40'
2. Aspirin 81'
3. Acetaminophen 325-650/PRN
4. Hydromorphone 2-4 mg/Q4H/PRN
6. Warfarin 5QD: **dose will change daily for goal INR 2.5-3.5,
7. Potassium Chloride 20 Q12H (every 12 hours) x5 days.
8. Ranitidine HCl 150'
9. Docusate Sodium 100"
10. Metoprolol Tartrate 25"
11. Furosemide 40"

ALLERGIES: Penicillins

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with: Wife in [**Name2 (NI) 1727**]
Occupation: Production manager on ship yard
Tobacco: Quit 1.5 years ago. 40 pack year history
ETOH: [**12-14**] drinks per week 

### Response:
{'Unspecified disease of pericardium,Abnormal coagulation profile,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Surgical or other procedure not carried out because of contraindication,Cardiac pacemaker in situ,Heart valve replaced by other means,Personal history of venous thrombosis and embolism,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
