CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a very active
39-year-old male who was found to have a heart murmur in
[**2160-12-30**] during a routine physical exam.  An
echocardiogram done at that time revealed a mildly dilated
left ventricle with an ejection fraction of 50-55% and severe
leaflet of mitral valve prolapse with 3+ mitral
regurgitation.

MEDICAL HISTORY: History of hypoglycemia.  History of
syncope as a child, last episode being when he was 13 years
old.  History of a heart murmur with mitral valve prolapse.

MEDICATION ON ADMISSION: None.

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is a civil engineer.  He denied tobacco
use.  He has occasional ETOH use with 3-4 beers per week.  He
lives with his wife and two children in [**Name (NI) 11333**],
[**State 350**].  He also denied recreational drug use.
Mitral valve disorders
Mitral valve disorder
Admission Date:  [**2164-9-7**]       Discharge Date:  [**2164-9-20**]

Date of Birth:   [**2125-1-28**]       Sex:  M

Service:  CARDIOTHORACIC

HISTORY OF PRESENT ILLNESS:  The patient is a very active
39-year-old male who was found to have a heart murmur in
[**2160-12-30**] during a routine physical exam.  An
echocardiogram done at that time revealed a mildly dilated
left ventricle with an ejection fraction of 50-55% and severe
leaflet of mitral valve prolapse with 3+ mitral
regurgitation.

Echocardiogram was repeated in [**2164-6-29**], and it showed a
dilated left ventricular chamber with an ejection fraction of
55% and severe mitral regurgitation with mitral valve
prolapse.  ETT at that time was negative.

Cardiac catheterization done in [**2164-7-30**] showed normal
coronaries with moderate mitral regurgitation with an
ejection fraction of 44%.

Th[**Last Name (STitle) 1050**] returned for elective mitral valve replacement
with Dr. [**Last Name (Prefixes) **].

PAST MEDICAL HISTORY:  History of hypoglycemia.  History of
syncope as a child, last episode being when he was 13 years
old.  History of a heart murmur with mitral valve prolapse.

PAST SURGICAL HISTORY:  Anterior cruciate ligament repair on
the right in [**2156**].  Achilles tendon repair bilaterally in
[**2152**] and also in [**2162**].  Tonsillectomy in [**2128**].

MEDICATIONS ON ADMISSION:  None.

ALLERGIES:  NO KNOWN DRUG ALLERGIES.

SOCIAL HISTORY:  He is a civil engineer.  He denied tobacco
use.  He has occasional ETOH use with 3-4 beers per week.  He
lives with his wife and two children in [**Name (NI) 11333**],
[**State 350**].  He also denied recreational drug use.

REVIEW OF SYSTEMS:  Noncontributory.

PHYSICAL EXAMINATION:  General:  Height 5 ft 6 in, weight 155
lbs.  He was a well-defined male in no acute distress,
appearing his stated age.  Skin was well hydrated with no
rashes or lesions.  HEENT:  Pupils equal, round and reactive
to light.  Extraocular movements intact.  Normal mucosa.
Normal dentition.  Neck:  Supple.  No jugular venous
distention.  No lymphadenopathy.  No thyromegaly.  No carotid
bruits.  Chest:  Clear to auscultation bilaterally with no
rales, rhonchi or wheezing.  Heart:  Regular, rate and
rhythm.  Normal S1 and S2.  There was a 2/6 systolic ejection
murmur heard best at left sternal border.  Abdomen:  Soft,
nontender, nondistended.  Normoactive bowel sounds.  No
guarding, rebound or rigidity.  Extremities:  Warm with no
edema, cyanosis or clubbing.  He had a well-healed scar of
the right anterior cruciate ligament.  No varicosities.
Neurological:  He was alert and oriented times three.  No
motor or sensory deficits.  Cranial nerves II-XII grossly
intact.  Pulses:  Femoral 2+ bilaterally, dorsalis pedis 2+
bilaterally, right posterior tibial 2+, left posterior tibial
2+, radial 2+ bilaterally.

LABORATORY DATA:  The patient's electrocardiogram showed
normal sinus rhythm with a rate of 74 beats per minute.

All other lab work and chest x-ray were pending at PAT.

HOSPITAL COURSE:  The patient was admitted directly to the
Operating Room on [**9-17**] where he had a minimally
invasive mitral valve repair with a #36 [**Doctor Last Name 405**] annuloplasty
band.  Please see the OR report for full details.

In summary, the patient tolerated the operation well, and he
was transferred from the Operating Room to the Cardiothoracic
Intensive Care Unit.

At the time of transfer, the patient had a mean arterial
pressure of 76, was in normal sinus rhythm with a rate of 92.
He had Nitroglycerin and Propofol infusions running at that
time.

The patient did well in the immediate postoperative period.
His anesthesia was reversed.  He was weaned from the
ventilator and successfully extubated on postoperative day
#1.

The patient continued to do well, and he was transferred from
the Cardiothoracic Surgery Unit to the floor for continuing
postoperative care and cardiac rehabilitation.

Over the next two days, the patient's activity level was
increased with the assistance of Physical Therapy and nursing
staff.  On postoperative day #3, it was decided that the
patient was stable and ready to be discharged to home.

DISCHARGE PHYSICAL EXAMINATION:  Vital signs:  Temperature
99??????, heart rate 92 in sinus rhythm, blood pressure 110/60,
respirations 18, oxygen saturation 95% on room air.  Weight
preoperatively 70.5 kg, at discharge 77.9 kg.  General:  He
was alert and oriented times three.  He had a nonfocal exam.
Chest:  Clear to auscultation bilaterally.  Right thoracotomy
site with Steri-Strips, open to air, clean and dry, with no
erythema.  Cardiovascular:  regular, rate and rhythm.  S1 and
S2 with no murmurs.  Abdomen:  Soft, nontender, nondistended.
Normoactive bowel sounds.  Extremities:  Warm and well
perfused with no clubbing, cyanosis, or edema.  Right groin
cannulation site with Steri-Strips, open to air, clean and
dry.

DISCHARGE LABORATORY DATA:  White count 7.2, hematocrit 28.5,
platelet count 113; sodium 135, potassium 3.9, chloride 103,
CO2 29, BUN 13, creatinine 0.8.

DISCHARGE MEDICATIONS:  Metoprolol 25 mg b.i.d., Lasix 20 mg
q.d. x 10 days, Potassium Chloride 20 mEq q.d. x 10 days,
Dilaudid 2-4 mg q.4 hours p.r.n., Ibuprofen 600 mg q.6 hours,
Aspirin 325 q.d.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSIS:
1.  Status post mitral valve repair.
2.  Status post anterior cruciate ligament repair of the
right in [**2156**].
3.  Status post Achilles tendon repair, bilaterally, in [**2152**]
and again in [**2162**].
4.  Status post tonsillectomy in [**2128**].
5.  History of syncope.
6.  History of hypoglycemia.

DISCHARGE STATUS:  The patient is to be discharged to home.

FO[**Last Name (STitle) **]P:  He is to have follow-up in the [**Hospital 409**] Clinic in
two weeks and follow-up with Dr. [**Last Name (Prefixes) **] in four weeks.
He is also to follow-up with his primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) **], in [**1-31**] weeks.




                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 415**]
MEDQUIST36

D:  [**2164-9-20**]  18:04
T:  [**2164-9-20**]  18:06
JOB#:  [**Job Number 51402**]
{'Mitral valve disorders'}


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: 

PRESENT ILLNESS: The patient is a very active
39-year-old male who was found to have a heart murmur in
[**2160-12-30**] during a routine physical exam.  An
echocardiogram done at that time revealed a mildly dilated
left ventricle with an ejection fraction of 50-55% and severe
leaflet of mitral valve prolapse with 3+ mitral
regurgitation.

MEDICAL HISTORY: History of hypoglycemia.  History of
syncope as a child, last episode being when he was 13 years
old.  History of a heart murmur with mitral valve prolapse.

MEDICATION ON ADMISSION: None.

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is a civil engineer.  He denied tobacco
use.  He has occasional ETOH use with 3-4 beers per week.  He
lives with his wife and two children in [**Name (NI) 11333**],
[**State 350**].  He also denied recreational drug use. 

### Response:
{'Mitral valve disorders'}
