CHIEF COMPLAINT: dyspnea on exertion

PRESENT ILLNESS: 80 yo male with known mitral regurgitation and recent stenting
of RCA in [**3-22**]. Continues to have severe dyspnea, and was
referred for mitral valve repair vs. replacement.

MEDICAL HISTORY: mitral regurgitation
coronary artery disease s/p RCA stenting [**3-22**]
premature vent. contractions with ventricular tachycardia
hypertension
chronic diastolic heart failure
prostate cancer
obstructive sleep apnea
glaucoma
arthritis
chronic back pain
? Parkinson's disease

MEDICATION ON ADMISSION: ASA 325 mg daily, Plavix 75 mg daily ( LD [**5-9**]), Atenolol 25 mg
daily, Lisinopril 20 mg [**Hospital1 **], Xalatan eye gtts, Fish oil,
Melatonin, Hyaluronic acid, Tylenol prn, Aleve prn

ALLERGIES: Ivp Dye, Iodine Containing

PHYSICAL EXAM: 98% RA sat  146/79  HR 70-90 SR, frequent PVCs, occ. runs of
VTach
RR 18-22   T 98.4
98.1 kg  73"
NAd
skin /HEENT unremarkable
elevated JVP neck supple, full ROM, no carotid bruits
appreciated
CTAB
Irregular, [**5-17**] holosystolic murmur radiates to precordium
mild hepatomegaly, soft NT, ND
warm, well-perfused, no edema
no varicosities noted
neuro grossly intact
2+ bil. fems/ radials
1+ bil. DP/PTs

FAMILY HISTORY: no premature CAD

SOCIAL HISTORY: lives alone, widowed
occasional ETOH use
remote cigar use
works as a part-time headhunter
Chronic diastolic heart failure,Rupture of chordae tendineae,Paroxysmal ventricular tachycardia,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Paralysis agitans,Obstructive sleep apnea (adult)(pediatric),Unspecified glaucoma,Arthropathy, unspecified, site unspecified,Backache, unspecified,Other chronic pain,Personal history of malignant neoplasm of prostate
Chr diastolic hrt fail,Chordae tendinae rupture,Parox ventric tachycard,Mitral valve disorder,Crnry athrscl natve vssl,Status-post ptca,Paralysis agitans,Obstructive sleep apnea,Glaucoma NOS,Arthropathy NOS-unspec,Backache NOS,Chronic pain NEC,Hx-prostatic malignancy
Admission Date:  [**2179-5-11**]              Discharge Date:   [**2179-5-19**]

Date of Birth:  [**2099-2-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ivp Dye, Iodine Containing

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2179-5-13**]  Mitral Valve repair (30 mm [**Company 1543**] ring)/ Ligation of
left atrial appendage

History of Present Illness:
80 yo male with known mitral regurgitation and recent stenting
of RCA in [**3-22**]. Continues to have severe dyspnea, and was
referred for mitral valve repair vs. replacement.

Past Medical History:
mitral regurgitation
coronary artery disease s/p RCA stenting [**3-22**]
premature vent. contractions with ventricular tachycardia
hypertension
chronic diastolic heart failure
prostate cancer
obstructive sleep apnea
glaucoma
arthritis
chronic back pain
? Parkinson's disease

Social History:
lives alone, widowed
occasional ETOH use
remote cigar use
works as a part-time headhunter

Family History:
no premature CAD

Physical Exam:
98% RA sat  146/79  HR 70-90 SR, frequent PVCs, occ. runs of
VTach
RR 18-22   T 98.4
98.1 kg  73"
NAd
skin /HEENT unremarkable
elevated JVP neck supple, full ROM, no carotid bruits
appreciated
CTAB
Irregular, [**5-17**] holosystolic murmur radiates to precordium
mild hepatomegaly, soft NT, ND
warm, well-perfused, no edema
no varicosities noted
neuro grossly intact
2+ bil. fems/ radials
1+ bil. DP/PTs

Pertinent Results:
[**2179-5-19**] 06:00AM BLOOD Hct-28.9*
[**2179-5-18**] 05:40AM BLOOD WBC-6.2 RBC-3.01* Hgb-9.9* Hct-29.0*
MCV-97 MCH-32.8* MCHC-34.0 RDW-13.4 Plt Ct-196
[**2179-5-11**] 05:58PM BLOOD WBC-5.4 RBC-4.28* Hgb-13.4* Hct-40.6
MCV-95 MCH-31.4 MCHC-33.1 RDW-14.0 Plt Ct-162
[**2179-5-18**] 05:40AM BLOOD Plt Ct-196
[**2179-5-13**] 11:56AM BLOOD PT-15.5* PTT-41.6* INR(PT)-1.4*
[**2179-5-11**] 05:58PM BLOOD PT-14.6* PTT-26.5 INR(PT)-1.3*
[**2179-5-11**] 05:58PM BLOOD Plt Ct-162
[**2179-5-19**] 06:00AM BLOOD Glucose-94 UreaN-37* Creat-1.6* Na-136
K-5.1 Cl-101 HCO3-23 AnGap-17
[**2179-5-18**] 05:40AM BLOOD Glucose-89 UreaN-34* Creat-1.3* Na-137
K-4.9 Cl-103 HCO3-25 AnGap-14
[**2179-5-11**] 05:58PM BLOOD Glucose-113* UreaN-31* Creat-1.4* Na-141
K-4.5 Cl-107 HCO3-26 AnGap-13
[**2179-5-11**] 05:58PM BLOOD ALT-23 AST-26 CK(CPK)-189* AlkPhos-68
Amylase-42 TotBili-0.3
[**2179-5-11**] 05:58PM BLOOD Lipase-36
[**2179-5-11**] 05:58PM BLOOD CK-MB-8
[**2179-5-19**] 06:00AM BLOOD Phos-4.7*# Mg-2.5
[**2179-5-11**] 05:58PM BLOOD %HbA1c-5.8

[**Known lastname **], [**Known firstname 396**]       [**Hospital1 18**] [**Numeric Identifier 92143**]Portable TTE
(Complete) Done [**2179-5-17**] at 2:25:44 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2099-2-23**]
Age (years): 80 M  Hgt (in): 73
BP (mm Hg): 112/60  Wgt (lb): 213
HR (bpm): 70  BSA (m2): 2.21 m2
Indication: S/p mitral valve repair.
ICD-9 Codes: 423.9, 424.1, 424.0
Test Information
Date/Time: [**2179-5-17**] at 14:25    Interpret MD: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4083**],
MD
Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1661**],
RDCS
Doppler: Full Doppler and color Doppler Test Location: West Echo
Lab
Contrast: None Tech Quality: Suboptimal
Tape #: 2009W008-0:41 Machine: Vivid [**8-18**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *5.2 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.4 cm  <= 5.2 cm
Right Atrium - Four Chamber Length:  *5.3 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  *1.4 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.4 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *5.8 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  4.0 cm
Left Ventricle - Fractional Shortening:  0.31  >= 0.29
Left Ventricle - Ejection Fraction:  >= 60%  >= 55%
Aorta - Sinus Level:  *4.0 cm  <= 3.6 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.3 m/sec  <= 2.0 m/sec
Aortic Valve - LVOT diam:  2.1 cm
Mitral Valve - Mean Gradient:  3 mm Hg
Mitral Valve - Pressure Half Time:  87 ms
Mitral Valve - MVA (P [**2-12**] T):  2.5 cm2
Mitral Valve - E Wave:  1.3 m/sec
Mitral Valve - A Wave:  0.8 m/sec
Mitral Valve - E/A ratio:  1.63
Mitral Valve - E Wave deceleration time:  *287 ms  140-250 ms
TR Gradient (+ RA = PASP):  *32 to 36 mm Hg  <= 25 mm Hg

Findings
LEFT ATRIUM: Moderate LA enlargement. No LA mass/thrombus (best
excluded by TEE).

LEFT VENTRICLE: Mild symmetric LVH. Top normal/borderline
dilated LV cavity size. Normal regional LV systolic function.
Overall normal LVEF (>55%). No resting LVOT gradient.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
Paradoxic septal motion consistent with prior cardiac surgery.

AORTA: Mildly dilated aortic sinus. Normal ascending aorta
diameter.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Mild (1+) AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mitral
valve annuloplasty ring. Well-seated mitral annular ring with
normal gradient. Mild thickening of mitral valve chordae. No MR.


TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild to
moderate [[**2-12**]+] TR. Mild PA systolic hypertension.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.

Conclusions
The left atrium is moderately dilated. No left atrial
mass/thrombus seen (best excluded by transesophageal
echocardiography). There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is top
normal/borderline dilated. Regional left ventricular wall motion
is normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The aortic root is mildly dilated at the sinus
level. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. Mild (1+) aortic regurgitation
is seen. The mitral valve leaflets are mildly thickened. A
mitral valve annuloplasty ring is present. The mitral annular
ring appears well seated and is not obstructing flow. No mitral
regurgitation is seen. There is mild pulmonary artery systolic
hypertension. There is no pericardial effusion.

IMPRESSION: Mild symmetric left ventricular hypertrophy with
preserved global and regional biventricular systolic function.
Normal functioning mitral valve ring. Mild pulmonary artery
systolic hypertension. Dilated ascending aorta.
Compared with the prior study (images reviewed) of [**2179-4-27**], the
mitral valve has been repaired with a normal functioning mitral
annular ring. The estimated pulmonary artery systolic pressure
is higher.

CLINICAL IMPLICATIONS:
Based on [**2177**] AHA endocarditis prophylaxis recommendations, the
echo findings indicate prophylaxis IS recommended. Clinical
decisions regarding the need for prophylaxis should be based on
clinical and echocardiographic data.
  Electronically signed by [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4083**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2179-5-17**] 15:39

[**Known lastname **],[**Known firstname 396**] [**Medical Record Number 92144**] M  80  [**2099-2-23**]

Cardiology Report ECG Study Date of [**2179-5-16**]  7:46:18 AM


Normal sinus rhythm with frequent ventricular couplets. Leftward
axis.
Except for the change in rhythm, compared to previous tracing of
[**2179-5-15**],
no diagnostic interval change. Compared to the previous tracing
of [**2179-5-14**],
except for the rhythm and taller voltage in the lateral
precordial leads, no
diagnostic interval change.
TRACING #2


Read by: [**Last Name (LF) **],[**First Name3 (LF) 125**] M.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
78 [**Telephone/Fax (3) 92145**]/453 77 -23 12



Brief Hospital Course:
Admitted preoperatively for bridge off plavix, started on
intravenous integrilin and underwent preoperative workup.  On
[**5-13**] he was brought to the operating room where he underwent a
mitral valve repair and left atrial appendage ligation. Please
see operative report for surgical details. He received
vancomycin for perioperative antibiotics because he was in the
hospital greater than twenty four hours preoperatively.
Following surgery he was transferred to the CVICU for invasive
monitoring. He was weaned from sedation, awoke neurologically
intact and was extubated. He had episodes of ectopy that
progressed to runs of ventricular tachycardia and received bolus
of lidocaine with short resolution, with reoccurance was bolused
with amiodarone and EP was consulted.  Pain medications were
adjusted to control pain without oversedation which was achieved
with dilaudid.  He contined to have episodes of NSVT and was
started on sotalol per EP service recommendations with
lopressor.  He remained in the intensive care unit for
hemodynamic monitoring.  Physical therapy worked with him on
strength and mobility.  He was transferred to the floor on
postoperative day four for the remainder of his care.  He
continued to progress and was ready for discharge to rehab on
post operative day six with plan for twice weekly BUN/CR, and
potassium.

Medications on Admission:
ASA 325 mg daily, Plavix 75 mg daily ( LD [**5-9**]), Atenolol 25 mg
daily, Lisinopril 20 mg [**Hospital1 **], Xalatan eye gtts, Fish oil,
Melatonin, Hyaluronic acid, Tylenol prn, Aleve prn

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO every
eight (8) hours.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): for stent.
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
8. Sotalol 120 mg Tablet Sig: One (1) Tablet PO twice a day.
9. Artificial Tears     Drops Sig: [**2-12**]  Ophthalmic three times a
day as needed for dry eyes.
10. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
11. Psyllium     Packet Sig: One (1) Packet PO TID (3 times a
day) as needed.
12. Outpatient Lab Work
please check BUN/cr, potassium  twice weekly while on lasix
Monday and thrusday, please call if concerns baseline cr 1-1.4
First draw [**5-20**]


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] of [**Location (un) 583**]

Discharge Diagnosis:
Mitral regurgitation s/p mitral valve repair
Secondary: Coronary artery disease s/p RCA stenting [**3-22**],
premature ventricular contractions with ventricular tachycardia,
Hypertension, Chronic diastolic heart failure, Prostate cancer,
Obstructive sleep apnea, Glaucoma, Arthritis, Chronic back pain,
? Parkinson's disease

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:
Please call to schedule appointments
Dr [**Last Name (STitle) **] (opthamologist to follow up stopping eye gtt)
Dr. [**Last Name (STitle) **] after discharge from rehab [**Telephone/Fax (1) 719**]
Dr. [**Last Name (STitle) **] in [**3-16**] weeks
Dr. [**Last Name (STitle) 914**] in 4 weeks  [**Telephone/Fax (1) 170**]



Completed by:[**2179-5-19**]
{'Chronic diastolic heart failure,Rupture of chordae tendineae,Paroxysmal ventricular tachycardia,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Paralysis agitans,Obstructive sleep apnea (adult)(pediatric),Unspecified glaucoma,Arthropathy, unspecified, site unspecified,Backache, unspecified,Other chronic pain,Personal history of malignant neoplasm of prostate'}


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: 80 yo male with known mitral regurgitation and recent stenting
of RCA in [**3-22**]. Continues to have severe dyspnea, and was
referred for mitral valve repair vs. replacement.

MEDICAL HISTORY: mitral regurgitation
coronary artery disease s/p RCA stenting [**3-22**]
premature vent. contractions with ventricular tachycardia
hypertension
chronic diastolic heart failure
prostate cancer
obstructive sleep apnea
glaucoma
arthritis
chronic back pain
? Parkinson's disease

MEDICATION ON ADMISSION: ASA 325 mg daily, Plavix 75 mg daily ( LD [**5-9**]), Atenolol 25 mg
daily, Lisinopril 20 mg [**Hospital1 **], Xalatan eye gtts, Fish oil,
Melatonin, Hyaluronic acid, Tylenol prn, Aleve prn

ALLERGIES: Ivp Dye, Iodine Containing

PHYSICAL EXAM: 98% RA sat  146/79  HR 70-90 SR, frequent PVCs, occ. runs of
VTach
RR 18-22   T 98.4
98.1 kg  73"
NAd
skin /HEENT unremarkable
elevated JVP neck supple, full ROM, no carotid bruits
appreciated
CTAB
Irregular, [**5-17**] holosystolic murmur radiates to precordium
mild hepatomegaly, soft NT, ND
warm, well-perfused, no edema
no varicosities noted
neuro grossly intact
2+ bil. fems/ radials
1+ bil. DP/PTs

FAMILY HISTORY: no premature CAD

SOCIAL HISTORY: lives alone, widowed
occasional ETOH use
remote cigar use
works as a part-time headhunter 

### Response:
{'Chronic diastolic heart failure,Rupture of chordae tendineae,Paroxysmal ventricular tachycardia,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Paralysis agitans,Obstructive sleep apnea (adult)(pediatric),Unspecified glaucoma,Arthropathy, unspecified, site unspecified,Backache, unspecified,Other chronic pain,Personal history of malignant neoplasm of prostate'}
