CHIEF COMPLAINT: Congestive heart failure

PRESENT ILLNESS: The patient is a 56-year-old man with long term cardiac
cirrhosis who presents with increasing congestive heart failure.
 He was found to have severe mitral
regurgitation and moderate to severe tricuspid regurgitation. He
has been offered surgery on numerous occasions but has always
declined. He presents with an INR of 1.5 after 2 units of fresh
frozen plasma.  The patient understands the risks of surgery and
the risks of giving aprotinin.  He consents and
wishes to proceed.

MEDICAL HISTORY: 1. Congestive heart failure with 4+ mitral regurgitation and
tricuspid regurgitation. This has been longstanding, and the
patient has thus far refused surgery for valve replacement.
2. Atrial fibrillation. (past refusal of anticoagulation)
3. Gout.
4. Nephrolithiasis.
5. Prostatitis
6. hypercholesterolemia
7. hx hepatitis (unknown type)? CMV developed jaundice and RUQ
pain but no diagnosis made. Never seen a liver specialist.
8. s/p tonsillectomy
9. s/p ankle fx
10. R inguinal hernia

MEDICATION ON ADMISSION: Diltiazem 180mg QD
Toprol XL 25mg QD
Aspirin 81mg QD
Ethacrynic acid 100mg QD
KCL 20mEq QD
Inspra 25mg QD
Vitamin K 5mg QD
Folic acid
Vitamin D3
Eplerenone 50mg QD

ALLERGIES: Sulfonamides / Warfarin Sodium / Triamterene/Hctz /
Spironolactone / Amoxicillin

PHYSICAL EXAM: Vitals: BP 95/65, HR 75, RR 14, SAT 100% on room air
General: well developed male in no acute distress lying in bed
s/p cath
HEENT: oropharynx benign, poor dental health
Neck: supple, no JVD, transmitted murmur to carotid noted
Heart: regular rate, normal s1s2, 3/6 systolic ejection murmur
Lungs: clear bilaterally
Abdomen: very distended, nontender, normoactive bowel sounds.
Scrotum distended.
Ext: 1+ edema, chronic venous stasis changes
Pulses: 2+ distally
Neuro: nonfocal

FAMILY HISTORY: No fam hx CAD, HTN, DM. Father had rheumatic heart disease and a
valve replacement.

SOCIAL HISTORY: Lives with his mother. [**Name (NI) 1403**] for the Red Cross. Also plays the
trumpet and tuba.
Mitral valve disorders,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Cirrhosis of liver without mention of alcohol,Primary pulmonary hypertension,Atrial fibrillation,Abnormal coagulation profile,Gout, unspecified
Mitral valve disorder,Hemorrhage complic proc,CHF NOS,Ac posthemorrhag anemia,Cirrhosis of liver NOS,Prim pulm hypertension,Atrial fibrillation,Abnrml coagultion prfile,Gout NOS
Admission Date:  [**2187-3-14**]              Discharge Date:   [**2187-3-26**]

Date of Birth:  [**2130-12-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfonamides / Warfarin Sodium / Triamterene/Hctz /
Spironolactone / Amoxicillin

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Congestive heart failure

Major Surgical or Invasive Procedure:
[**2187-3-15**] - Mitral Valve Replacement (31mm Mosaic Porcine Heart
Valve)


History of Present Illness:
The patient is a 56-year-old man with long term cardiac
cirrhosis who presents with increasing congestive heart failure.
 He was found to have severe mitral
regurgitation and moderate to severe tricuspid regurgitation. He
has been offered surgery on numerous occasions but has always
declined. He presents with an INR of 1.5 after 2 units of fresh
frozen plasma.  The patient understands the risks of surgery and
the risks of giving aprotinin.  He consents and
wishes to proceed.


Past Medical History:
1. Congestive heart failure with 4+ mitral regurgitation and
tricuspid regurgitation. This has been longstanding, and the
patient has thus far refused surgery for valve replacement.
2. Atrial fibrillation. (past refusal of anticoagulation)
3. Gout.
4. Nephrolithiasis.
5. Prostatitis
6. hypercholesterolemia
7. hx hepatitis (unknown type)? CMV developed jaundice and RUQ
pain but no diagnosis made. Never seen a liver specialist.
8. s/p tonsillectomy
9. s/p ankle fx
10. R inguinal hernia


Social History:
Lives with his mother. [**Name (NI) 1403**] for the Red Cross. Also plays the
trumpet and tuba.


Family History:
No fam hx CAD, HTN, DM. Father had rheumatic heart disease and a
valve replacement.

Physical Exam:
Vitals: BP 95/65, HR 75, RR 14, SAT 100% on room air
General: well developed male in no acute distress lying in bed
s/p cath
HEENT: oropharynx benign, poor dental health
Neck: supple, no JVD, transmitted murmur to carotid noted
Heart: regular rate, normal s1s2, 3/6 systolic ejection murmur
Lungs: clear bilaterally
Abdomen: very distended, nontender, normoactive bowel sounds.
Scrotum distended.
Ext: 1+ edema, chronic venous stasis changes
Pulses: 2+ distally
Neuro: nonfocal


Pertinent Results:
[**2187-3-14**] 05:20PM   PT-17.0* PTT-31.5 INR(PT)-1.6*
[**2187-3-14**] 05:20PM   PLT COUNT-225
[**2187-3-14**] 05:20PM   WBC-7.1 RBC-4.03* HGB-12.9* HCT-38.7* MCV-96
MCH-32.0 MCHC-33.3 RDW-15.0
[**2187-3-14**] 05:20PM   ALT(SGPT)-8 AST(SGOT)-11 ALK PHOS-221*
AMYLASE-35 TOT BILI-1.2
[**2187-3-14**] 05:20PM   GLUCOSE-148* UREA N-20 CREAT-1.1 SODIUM-138
POTASSIUM-5.2* CHLORIDE-102 TOTAL CO2-27 ANION GAP-14
[**2187-3-14**] 06:58PM URINE  RBC-[**7-21**]* WBC-[**7-21**]* BACTERIA-MOD
YEAST-NONE EPI-0-2 TRANS EPI-[**4-15**]
[**2187-3-14**] 06:58PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-1 PH-5.0 LEUK-TR
[**2187-3-14**] 06:58PM URINE  COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.022

[**2187-3-14**] CXR
There is stable marked cardiomegaly with particular enlargement
of the left atrium. Mediastinal and hilar contours are
unchanged. Pulmonary vasculature shows upper zone
redistribution, but there is no overt pulmonary edema. The lungs
are clear. Osseous and soft tissue structures are unremarkable.

[**2187-3-24**] CXR
Since the prior study of [**2187-3-22**], left chest tube has been
removed. A tiny left apical pneumothorax is seen. The left
lateral costophrenic sulcus is cut off from view. Some fluid and
atelectasis are seen in this location. Less fluid visualized
compared to prior study. The right lung remains clear.

[**2187-3-16**] EKG
Ectopic atrial rhythm. Non-specific ST-T wave changes. Low QRS
voltage in the precordial leads. Compared to the previous
tracing of [**2187-3-16**] non-captured pacemaker spikes are absent.
Clinical correlation is suggested.


Brief Hospital Course:
Mr. [**Known lastname 52477**] was admitted to the [**Hospital1 18**] on [**2187-3-14**] for surgical
management of his mitral valve disease. Fresh frozen plasma was
given as his INR was slightly elevated due to his hepatic
dysfunction. A foley catheter was placed with some difficulty
preoperatively and thus a size 18 french was used. The On
[**2187-3-15**], Mr. [**Known lastname 52477**] was taken to the operating room where he
underwent a mitral valve replacement utilizing a 31mm mosaic
porcine heart valve. Postoperatively he was taken to the cardiac
surgical intensive care unit for monitoring. On postoperative
day one, Mr. [**Known lastname 52477**] [**Last Name (Titles) 5058**] neurologically intact and was
extubated. He was transfused for postoperative anemia. Aspirin
was started. Mr. [**Known lastname 52477**] developed atrial fibrillation which was
treated with diltiazem and amiodarone. He was gently diuresed
towards his preoperative weight. On postoperative day five, Mr.
[**Known lastname 52477**] was transferred to the cardiac surgical step down unit
for further recovery. The physical therapy service was consulted
for assistance with his postoperative strength and mobility. He
was slow to ambulate as he had foot and joint pain. As he had
extensive peripheral edema, his ethacrynic acid was resumed. His
left pleural tube remained in place as he continued to have
drainage. It was ultimately removed on [**2187-3-24**] without
complication. He needed close monitoring and repletion of his
electrolytes his diuresis on ethacrynic acid. His INR remained
stable in the range of 1.5 off vitamin K. Mr. [**Known lastname 52477**] continued
to make slow but steady progress and was discharged to the Life
Care Center rehabilitation on postoperative day eleven. His
amiodarone will be titrated appropriately. He will follow-up
with Dr. [**Last Name (STitle) **], his cardiologist Dr. [**Last Name (STitle) **] and his primary
care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] as an outpatient. His electrolytes and
INR will be monitored daily while at rehabilitation.

Medications on Admission:
Diltiazem 180mg QD
Toprol XL 25mg QD
Aspirin 81mg QD
Ethacrynic acid 100mg QD
KCL 20mEq QD
Inspra 25mg QD
Vitamin K 5mg QD
Folic acid
Vitamin D3
Eplerenone 50mg QD

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): [**Month (only) 116**] stop when off pain medication.
2. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
3. Ethacrynic Acid 25 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
4. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
Take 400 mg (two tablets) once daily for 1 week, then starting
[**2187-4-2**] take 200mg (one tablet) once daily.
5. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO twice a day.
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours) for
1 months.
7. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
8. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
9. Mineral Oil-Hydrophil Petrolat     Ointment Sig: One (1) Appl
Topical  TID (3 times a day).
10. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 1 months.
11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
12. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed for pain.
13. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO DAILY
(Daily) as needed for constipation.
14. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
15. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
Life care of [**Location (un) 5165**]

Discharge Diagnosis:
Hypercholesterolemia
CHF
Atrial Fibrillation
Mitral Regurgitation
Gout
Nephrolithiasis
Past Hepatitis
Prostatitis


Discharge Condition:
Good


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
2) Report any fever greater then 100.5.
3) Report any weight gain of greater then 2 pounds in 24 hours
or 5 pounds in 1 week.
4) No lifting greater then 10 pounds for 10 weeks.
5) No driviing for 1 month.
6) Take amiodarone 400mg once daily for 1 week then starting
[**2187-4-2**], take 200mg once daily thereafter.
7) Please monitor electrolytes and replete as needed. Please
check potassium on [**2187-3-27**]. Please check INR while at rehab.
Patient was on Vitamin K 5mg daily preop. INR has been stable at
1.5.
8) Please remove staples on postoperative day 14 ([**2187-3-28**]).
9) Please call with any questions or concerns.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 4 weeks. ([**Telephone/Fax (1) 1504**]
Follow-up with your cardiologist Dr. [**Last Name (STitle) **] in [**2-12**] weeks.
Follow-up with Dr. [**Last Name (STitle) **] in [**2-12**] weeks.
Call all providers for appointments.



Completed by:[**2187-3-26**]
{'Mitral valve disorders,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Cirrhosis of liver without mention of alcohol,Primary pulmonary hypertension,Atrial fibrillation,Abnormal coagulation profile,Gout, 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: Congestive heart failure

PRESENT ILLNESS: The patient is a 56-year-old man with long term cardiac
cirrhosis who presents with increasing congestive heart failure.
 He was found to have severe mitral
regurgitation and moderate to severe tricuspid regurgitation. He
has been offered surgery on numerous occasions but has always
declined. He presents with an INR of 1.5 after 2 units of fresh
frozen plasma.  The patient understands the risks of surgery and
the risks of giving aprotinin.  He consents and
wishes to proceed.

MEDICAL HISTORY: 1. Congestive heart failure with 4+ mitral regurgitation and
tricuspid regurgitation. This has been longstanding, and the
patient has thus far refused surgery for valve replacement.
2. Atrial fibrillation. (past refusal of anticoagulation)
3. Gout.
4. Nephrolithiasis.
5. Prostatitis
6. hypercholesterolemia
7. hx hepatitis (unknown type)? CMV developed jaundice and RUQ
pain but no diagnosis made. Never seen a liver specialist.
8. s/p tonsillectomy
9. s/p ankle fx
10. R inguinal hernia

MEDICATION ON ADMISSION: Diltiazem 180mg QD
Toprol XL 25mg QD
Aspirin 81mg QD
Ethacrynic acid 100mg QD
KCL 20mEq QD
Inspra 25mg QD
Vitamin K 5mg QD
Folic acid
Vitamin D3
Eplerenone 50mg QD

ALLERGIES: Sulfonamides / Warfarin Sodium / Triamterene/Hctz /
Spironolactone / Amoxicillin

PHYSICAL EXAM: Vitals: BP 95/65, HR 75, RR 14, SAT 100% on room air
General: well developed male in no acute distress lying in bed
s/p cath
HEENT: oropharynx benign, poor dental health
Neck: supple, no JVD, transmitted murmur to carotid noted
Heart: regular rate, normal s1s2, 3/6 systolic ejection murmur
Lungs: clear bilaterally
Abdomen: very distended, nontender, normoactive bowel sounds.
Scrotum distended.
Ext: 1+ edema, chronic venous stasis changes
Pulses: 2+ distally
Neuro: nonfocal

FAMILY HISTORY: No fam hx CAD, HTN, DM. Father had rheumatic heart disease and a
valve replacement.

SOCIAL HISTORY: Lives with his mother. [**Name (NI) 1403**] for the Red Cross. Also plays the
trumpet and tuba. 

### Response:
{'Mitral valve disorders,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Cirrhosis of liver without mention of alcohol,Primary pulmonary hypertension,Atrial fibrillation,Abnormal coagulation profile,Gout, unspecified'}
