CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 77 y/o female with known MR.MVP who has been c/o increasing DOE.
Recent echo showed worsening MR with partial flail leaflet.
Cardiac MRI confirmed MR with 45% regurgitant fraction.

MEDICAL HISTORY: Mitral Regurgitation, Coronary Artery Disease, Hypertension,
Hypercholesterolemia, Intrcranial bleed s/p MVA, s/p cataract
surgery, s/p appendectomy (ex-lap), s/p breast biopsy (benign)

MEDICATION ON ADMISSION: HCTZ 25mg qd, KCl 20mg qd, Simvastatin 20mg qd, Aspirin 81mg qd,
Atenolol 25mg qd, Fosamax, Calcium

ALLERGIES: Clindamycin / Erythromycin Base / Penicillins / Amoxicillin /
Ampicillin / Gentamicin

PHYSICAL EXAM: VS: 78 177/99 157cm 51.3kg
Gen: NAD, pleasant
Skin: unremarkable
HEENT: EOMI, perrl, NC/AT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR 2-3/6 holosystolic murmur
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, +2 edema, bilat. varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired. Denies tobacco use and admits to rare alcohol use.
Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiogenic shock,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Surgical or other procedure not carried out because of contraindication,Asymptomatic varicose veins
Mitral valve disorder,Surg compl-heart,Cardiogenic shock,Atrial fibrillation,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Anemia NOS,No proc/contraindication,Asympt varicose veins
Admission Date:  [**2162-6-21**]              Discharge Date:   [**2162-6-28**]

Date of Birth:  [**2084-8-13**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Clindamycin / Erythromycin Base / Penicillins / Amoxicillin /
Ampicillin / Gentamicin

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2162-6-25**] Mitral Valve Repair w/ 36mm CE annuloplasty band

History of Present Illness:
77 y/o female with known MR.MVP who has been c/o increasing DOE.
Recent echo showed worsening MR with partial flail leaflet.
Cardiac MRI confirmed MR with 45% regurgitant fraction.

Past Medical History:
Mitral Regurgitation, Coronary Artery Disease, Hypertension,
Hypercholesterolemia, Intrcranial bleed s/p MVA, s/p cataract
surgery, s/p appendectomy (ex-lap), s/p breast biopsy (benign)

Social History:
Retired. Denies tobacco use and admits to rare alcohol use.

Family History:
Non-contributory

Physical Exam:
VS: 78 177/99 157cm 51.3kg
Gen: NAD, pleasant
Skin: unremarkable
HEENT: EOMI, perrl, NC/AT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR 2-3/6 holosystolic murmur
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, +2 edema, bilat. varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2162-6-23**] Abd CT: 1. No evidence of retroperitoneal hemorrhage. 2.
Small foci of free air nondependently within the abdominal
cavity or just outside the parietal peritoneum (? tracking from
subcutaneous emphysema). If intraperitoneal, this is of
uncertain clinical consequence. 3. Subcutaneous emphysema seen
primarily at the right IJ central line site and at the left
groin saphenous vein harvesting site. Other scattered areas of
soft tissue air are seen tracking along the deeper left thigh
muscles (hamstring and adductors). 4. Small bilateral pleural
effusions with associated atelectasis of both lower lobes. 5.
Small amount of abdominal free fluid is present.
[**2162-6-22**] Echo: Prebypass: 1.Regional left ventricular wall motion
is normal. Overall left ventricular systolic function is normal
(LVEF>55%). [Intrinsic left ventricular systolic function is
likely more depressed given the severity of valvular
regurgitation.] 2.Right ventricular chamber size and free wall
motion are normal. 3.There are simple atheroma in the descending
thoracic aorta. 4.The aortic valve leaflets (3) are mildly
thickened. Mild (1+) aortic regurgitation is seen. 5.The mitral
valve leaflets are mildly thickened. Severe (4+) mitral
regurgitation is seen. 6. The tricuspid valve leaflets are
mildly thickened. POST CPB: Preserved biventricular systolic
function. Annuloplasty ring in mitral position, which is well
seated and mechanically stable. Minimal MR [**First Name (Titles) **] [**Last Name (Titles) **] across
the mitral valve. There is chordal [**Male First Name (un) **] and no demonstrable LVOT
[**Male First Name (un) **].
[**2162-6-21**] Chest CT: 1) Moderate aortic calcification at the level
of the ligamentum arteriosum and mild calcification of the
descending thoracic aorta. Images are available for review. 2) 3
mm right middle lobe and 1-2 mm right upper lobe non- calcified
nodules. Although statistically most likely benign, follow up CT
in twelve months may be helpful, especailly if there are risk
factors for lung neoplasm. This was emailed to [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 73912**],
critical results coordinator on [**2162-6-21**]. 3) Coronary artery
calcifications.
[**6-21**] Head CT: 1. No intracranial hemorrhage or mass effect. 2.
8-mm right frontal osteoma.

[**2162-6-22**] 11:37AM BLOOD WBC-8.9 RBC-2.86* Hgb-9.3* Hct-27.4*
MCV-96 MCH-32.5* MCHC-33.9 RDW-14.0 Plt Ct-98*#
[**2162-6-26**] 05:55AM BLOOD WBC-7.8 RBC-3.01* Hgb-9.4* Hct-27.7*
MCV-92 MCH-31.3 MCHC-34.0 RDW-17.6* Plt Ct-108*
[**2162-6-28**] 06:40AM BLOOD Hct-27.9*
[**2162-6-22**] 11:37AM BLOOD PT-19.3* PTT-46.4* INR(PT)-1.8*
[**2162-6-28**] 06:40AM BLOOD PT-13.2* INR(PT)-1.1
[**2162-6-22**] 12:41PM BLOOD UreaN-11 Creat-0.5 Cl-114* HCO3-23
[**2162-6-26**] 05:55AM BLOOD Glucose-113* UreaN-15 Creat-0.8 Na-142
K-3.7 Cl-100 HCO3-35* AnGap-11
[**2162-6-28**] 06:40AM BLOOD K-3.5
[**2162-6-26**] 05:55AM BLOOD Calcium-7.8* Phos-2.1* Mg-2.1

Brief Hospital Course:
Ms. [**Known lastname 73913**] was admitted one day prior to surgery for
additional work-up required prior to surgery. On [**6-22**] she was
brought to the operating room where she underwent a Mitral Valve
repair. Please see operative report for surgical details.
Following surgery she was transferred to the CSRU for invasive
monitoring in stable condition. On post-op day one she required
multiple pressors and appeared to be in cardiogenic shock. Due
to hypotension and labile hemodynamics an ABD CT was performed
to r/o retroperitoneal bleed (which was negative). By post-op
day two she was weaned off pressors and started on beta
blockers. Also receiving diuretics and titrated towards her
pre-op weight. On this day she had episode of atrial
fibrillation and was started on Amiodarone. Later on post-op day
two she was weaned from sedation, awoke neurologically intact
and extubated. On post-op day three her chest tubes were removed
and she was transferred to the telemetry floor for further care.
She continued to have episodes of atrial fibrillation and was
eventually started on Coumadin. Overall she continued to make
steady progress and worked with physical therapy for strength
and mobility. On post-op day six she appeared well, but was
below baseline for physical activity and was discharged to rehab
for additional physical therapy.

Medications on Admission:
HCTZ 25mg qd, KCl 20mg qd, Simvastatin 20mg qd, Aspirin 81mg qd,
Atenolol 25mg qd, Fosamax, Calcium

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x 7 days. Then 200mg [**Hospital1 **] x 7 days. Then 200mg
qd until stopped by cardiologist.
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Warfarin 1 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for 1
doses: Please titrate for a goal INR of 2. .
9. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
10. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for
7 days.


Discharge Disposition:
Extended Care

Facility:
TCU at [**Doctor Last Name **] [**Doctor Last Name **]

Discharge Diagnosis:
Mitral Regurgitation s/p Mitral Valve Repair
Post-operative Atrial Fibrillation
Coronary Artery Disease
PMH: Hypertension, Hypercholesterolemia, Intrcranial bleed s/p
MVA, s/p cataract surgery, s/p appendectomy (ex-lap), s/p breast
biopsy (benign)

Discharge Condition:
Good

Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Please shower daily.
No bathing or swimming for 1 month. Use sunscreen on incision if
exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Call with any questions or concerns.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) 6254**] in [**1-2**] weeks
Dr. [**Last Name (STitle) 36766**] in [**12-1**] weeks


Completed by:[**2162-6-28**]
{'Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiogenic shock,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Surgical or other procedure not carried out because of contraindication,Asymptomatic varicose veins'}


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: Dyspnea on exertion

PRESENT ILLNESS: 77 y/o female with known MR.MVP who has been c/o increasing DOE.
Recent echo showed worsening MR with partial flail leaflet.
Cardiac MRI confirmed MR with 45% regurgitant fraction.

MEDICAL HISTORY: Mitral Regurgitation, Coronary Artery Disease, Hypertension,
Hypercholesterolemia, Intrcranial bleed s/p MVA, s/p cataract
surgery, s/p appendectomy (ex-lap), s/p breast biopsy (benign)

MEDICATION ON ADMISSION: HCTZ 25mg qd, KCl 20mg qd, Simvastatin 20mg qd, Aspirin 81mg qd,
Atenolol 25mg qd, Fosamax, Calcium

ALLERGIES: Clindamycin / Erythromycin Base / Penicillins / Amoxicillin /
Ampicillin / Gentamicin

PHYSICAL EXAM: VS: 78 177/99 157cm 51.3kg
Gen: NAD, pleasant
Skin: unremarkable
HEENT: EOMI, perrl, NC/AT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR 2-3/6 holosystolic murmur
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, +2 edema, bilat. varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired. Denies tobacco use and admits to rare alcohol use. 

### Response:
{'Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiogenic shock,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Surgical or other procedure not carried out because of contraindication,Asymptomatic varicose veins'}
