CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 

MEDICAL HISTORY: Mitral Regurgitation, Atrial fibrillation, Hypertension,
Hyperlipidemia, Osteoarthritis, Osteopenia, Gastroesophageal
Reflux Disease, Rectal polyp s/p partial resection [**3-16**],
Diverticulosis, CHF with preserved EF on ECHO [**4-5**], cervical and
lumbar spondylosis
PSH: s/p right total knee replacement [**2188**]. [**Doctor Last Name 15568**]-NWH, s/p
cholecystectomy in [**2145**], s/p appendectomy in [**2145**], s/p
cataracts, s/p bilateral carpal tunnel release

MEDICATION ON ADMISSION: Diltiazem 240mg qd, Lasix 20mg qd, Prilosec 20mg qd, Zocor 80mg
qd, Trazadone 50mg prn, Valsartan 80mg qd

ALLERGIES: Codeine / Percocet / Lisinopril

PHYSICAL EXAM: VS: 71 116/68
Gen: NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 4/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, trace edema
Neuro: A&O x 3, MAE, Non-focal

FAMILY HISTORY: Non Contributory

SOCIAL HISTORY: The patient lives at home, she is independent in her ADLs. She
has 3 daughters. Widowed. Retired executive secretary who was
also a sales representative for Nestle. No smoking. Occasional
alcohol.
Mitral valve disorders,Rupture of chordae tendineae,Iatrogenic pneumothorax,Urinary tract infection, site not specified,Atrial fibrillation,Dermatophytosis of the body,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Disorder of bone and cartilage, unspecified,Cervical spondylosis without myelopathy,Esophageal reflux,Long-term (current) use of anticoagulants,Knee joint replacement
Mitral valve disorder,Chordae tendinae rupture,Iatrogenic pneumothorax,Urin tract infection NOS,Atrial fibrillation,Dermatophytosis of body,Iatrogenc hypotnsion NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Osteoarthros NOS-unspec,Bone & cartilage dis NOS,Cervical spondylosis,Esophageal reflux,Long-term use anticoagul,Joint replaced knee
Admission Date:  [**2192-5-23**]              Discharge Date:   [**2192-5-29**]


Service: CARDIOTHORACIC

Allergies:
Codeine / Percocet / Lisinopril

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
Mmitral valve repair (26mm CG future annuloplasty ring) [**2192-5-23**]

Past Medical History:
Mitral Regurgitation, Atrial fibrillation, Hypertension,
Hyperlipidemia, Osteoarthritis, Osteopenia, Gastroesophageal
Reflux Disease, Rectal polyp s/p partial resection [**3-16**],
Diverticulosis, CHF with preserved EF on ECHO [**4-5**], cervical and
lumbar spondylosis
PSH: s/p right total knee replacement [**2188**]. [**Doctor Last Name 15568**]-NWH, s/p
cholecystectomy in [**2145**], s/p appendectomy in [**2145**], s/p
cataracts, s/p bilateral carpal tunnel release

Social History:
The patient lives at home, she is independent in her ADLs. She
has 3 daughters. Widowed. Retired executive secretary who was
also a sales representative for Nestle. No smoking. Occasional
alcohol.

Family History:
Non Contributory

Physical Exam:
VS: 71 116/68
Gen: NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 4/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, trace edema
Neuro: A&O x 3, MAE, Non-focal

Pertinent Results:
[**5-23**] Echo: PRE CPB Suboptimal study due to heart rotation likely
due to left atrial enlargement. The left atrium is dilated. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium or left atrial appendage. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thicknesses
and cavity size are normal. Regional left ventricular wall
motion is normal. Overall left ventricular systolic function is
mildly depressed (LVEF= 45-50 %). [Intrinsic left ventricular
systolic function is likely more depressed given the severity of
valvular regurgitation.] Right ventricular chamber size and free
wall motion are normal. There are simple atheroma in the aortic
arch. The descending thoracic aorta is mildly dilated. There are
complex (>4mm) atheroma in the descending thoracic aorta. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. Mild to moderate ([**11-30**]+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is partial mitral leaflet flail that appears to
be limited to the P3 scallop though there may be some slight
involvement of P2. An eccentric, anteriorly directed jet of
moderate to severe (3+) mitral regurgitation is seen. The
tricuspid valve leaflets are mildly thickened. There is a
trivial/physiologic pericardial effusion. Dr. [**Last Name (STitle) **] was
notified in person of the results in the operating room at the
time of the study. POST CPB Normal right ventricular systolic
function. The left ventricle displays mild to moderate global
hypokinesis with an ejection fraction of about 40%. There is a
mitral valve annuloplasty ring in situ. It appears well seated.
The mitral valve is s/p repair. Mitral regurgitation is not
appreciated. The peak gradient through the mitral valve is about
7 mm Hg with a mean gradient of 3.5 mm Hg at a cardiac output of
4 liters/minute. The thoracic aorta appears intact.

Brief Hospital Course:
Ms. [**Known lastname **] was a same day admit after undergoing pre-operative
work-up prior to admission. On [**5-23**] 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 CVICU in stable condition for invasive
monitoring. Within 24 hours she was weaned from sedation, awoke
neurologically intact and extubated. On post-op day one chest
x-ray revealed right apical pneumothorax therefore a chest tube
remained in place. Beta blockers and diuretics were initiated
and she was gently diuresed towards her pre-op weight. On
post-op day two she was transferred to the telemetry floor for
further care. Pneumothorax remained small and stable and chest
tube was dc'd. She was restarted on coumadin for chronic atrial
fibrillation. She did well postoperatively and was ready for
discharge to rehab on POD # 6.

Medications on Admission:
Diltiazem 240mg qd, Lasix 20mg qd, Prilosec 20mg qd, Zocor 80mg
qd, Trazadone 50mg prn, Valsartan 80mg qd

Discharge Medications:
1. Aspirin EC 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
5. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
6. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
7. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID
(4 times a day).
8. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours) as needed.
9. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
10. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO ONCE (Once) for
1 doses: check INR [**5-30**].


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] Of [**Location (un) 620**]

Discharge Diagnosis:
Mitral Regurgitation s/p Mitral Valve Repair
PMH: Hypertension, Gastroesophageal Reflux Disease,
Hyperlipidemia, Atrial Fibrillation, Rectal polyps,
Osteoarthritis, Osteopenia

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) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

Dr [**Last Name (STitle) 311**] in 2 week ([**Telephone/Fax (1) 3070**]) please call for appointment
Dr [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] in 2 weeks  please call for appointment



Completed by:[**2192-5-29**]
{'Mitral valve disorders,Rupture of chordae tendineae,Iatrogenic pneumothorax,Urinary tract infection, site not specified,Atrial fibrillation,Dermatophytosis of the body,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Disorder of bone and cartilage, unspecified,Cervical spondylosis without myelopathy,Esophageal reflux,Long-term (current) use of anticoagulants,Knee joint replacement'}


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: Shortness of breath

PRESENT ILLNESS: 

MEDICAL HISTORY: Mitral Regurgitation, Atrial fibrillation, Hypertension,
Hyperlipidemia, Osteoarthritis, Osteopenia, Gastroesophageal
Reflux Disease, Rectal polyp s/p partial resection [**3-16**],
Diverticulosis, CHF with preserved EF on ECHO [**4-5**], cervical and
lumbar spondylosis
PSH: s/p right total knee replacement [**2188**]. [**Doctor Last Name 15568**]-NWH, s/p
cholecystectomy in [**2145**], s/p appendectomy in [**2145**], s/p
cataracts, s/p bilateral carpal tunnel release

MEDICATION ON ADMISSION: Diltiazem 240mg qd, Lasix 20mg qd, Prilosec 20mg qd, Zocor 80mg
qd, Trazadone 50mg prn, Valsartan 80mg qd

ALLERGIES: Codeine / Percocet / Lisinopril

PHYSICAL EXAM: VS: 71 116/68
Gen: NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 4/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, trace edema
Neuro: A&O x 3, MAE, Non-focal

FAMILY HISTORY: Non Contributory

SOCIAL HISTORY: The patient lives at home, she is independent in her ADLs. She
has 3 daughters. Widowed. Retired executive secretary who was
also a sales representative for Nestle. No smoking. Occasional
alcohol. 

### Response:
{'Mitral valve disorders,Rupture of chordae tendineae,Iatrogenic pneumothorax,Urinary tract infection, site not specified,Atrial fibrillation,Dermatophytosis of the body,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Disorder of bone and cartilage, unspecified,Cervical spondylosis without myelopathy,Esophageal reflux,Long-term (current) use of anticoagulants,Knee joint replacement'}
