CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 50 yo F s/p MVR, ASD closure [**6-1**] with severe sharp SS CP
starting yesterday AM, now with radiation to back and left
shoulder with some shortness of breath. Pain was crampy, sharp,
and constant in nature, [**11-4**] at worst (now [**4-4**] with morphine),
nonexertional but worse with deep inhalation and laying supine.
Pt also c/o light-headedness this am upon awakening, but no
syncope. + fevers beginning overnight. Pt describes SOB as
secondary to pain - she has had difficulties with incisional
pain and SOB since [**Doctor First Name **]; had one admission mid may for SOB, no
interventions were done, however this pain was different than
previous.
.
In [**Name (NI) **], pt received morphine 4mg with good relief of pain;
however, she became hypotensive with BP down to 81/48 - up to
99/70 with fluid bolus. FAST exam showed small pericardial
effusion with good 4 chamber motion. No evidence of tamponade
physiology.

MEDICAL HISTORY: 1. Mitral valve prolapse with severe mitral regurgitation
- s/p MV repair and annuloplasty [**2150-6-1**] with 28 mm band
- s/p secundum ASD closure on [**2150-6-1**]
2. Mild pulmonary hypertension
3. Hypertension
4. diverticulitis s/p sigmoid resection
5. s/p appy
6. anxiety / depression
7. [**Date Range 17005**]
8. HA

MEDICATION ON ADMISSION: Atenolol 25mg po qd
Atorvastatin 40mg po qd
Effexor (unknown dose)
Sertraline 100mg po qd
Clonazepam 0.5mg po tid
docusate 100mg po bid
vitamin C

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T 97.8, BP 103/68, HR 113, RR 27, O2 100% on 4L NC
Gen: WDWN middle aged female in mild distress due to pain. Mood,
affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP not elevated.
CV: RRR, normal S1, fixed split S2, no murmurs/rubs/gallops, no
S3/S4. PMI nondisplaced.
Chest: midline sternotomy site, appears well-healed, no
paradoxical chest motion.
Resp: mild bibasilar crackles, no wheezes or rhonchi. mild
tachypnea with shallow breaths. no accessory muscle use.
Abd: +BS, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits. 2+ distal pulses
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: Mother with MVR/TVR at age 73. Father died of MI at age 50.

SOCIAL HISTORY: Volunteer at NEBH. Never smoked. Drinks [**4-30**] ETOH beverages per
week. Lives with mother.
Functional disturbances following cardiac surgery,Primary pulmonary hypertension,Unspecified essential hypertension
Hrt dis postcardiac surg,Prim pulm hypertension,Hypertension NOS
Admission Date:  [**2150-7-18**]              Discharge Date:   [**2150-7-21**]

Date of Birth:  [**2100-3-3**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
none

History of Present Illness:
50 yo F s/p MVR, ASD closure [**6-1**] with severe sharp SS CP
starting yesterday AM, now with radiation to back and left
shoulder with some shortness of breath. Pain was crampy, sharp,
and constant in nature, [**11-4**] at worst (now [**4-4**] with morphine),
nonexertional but worse with deep inhalation and laying supine.
Pt also c/o light-headedness this am upon awakening, but no
syncope. + fevers beginning overnight. Pt describes SOB as
secondary to pain - she has had difficulties with incisional
pain and SOB since [**Doctor First Name **]; had one admission mid may for SOB, no
interventions were done, however this pain was different than
previous.
.
In [**Name (NI) **], pt received morphine 4mg with good relief of pain;
however, she became hypotensive with BP down to 81/48 - up to
99/70 with fluid bolus. FAST exam showed small pericardial
effusion with good 4 chamber motion. No evidence of tamponade
physiology.


Past Medical History:
1. Mitral valve prolapse with severe mitral regurgitation
- s/p MV repair and annuloplasty [**2150-6-1**] with 28 mm band
- s/p secundum ASD closure on [**2150-6-1**]
2. Mild pulmonary hypertension
3. Hypertension
4. diverticulitis s/p sigmoid resection
5. s/p appy
6. anxiety / depression
7. [**Date Range 17005**]
8. HA


Social History:
Volunteer at NEBH. Never smoked. Drinks [**4-30**] ETOH beverages per
week. Lives with mother.


Family History:
Mother with MVR/TVR at age 73. Father died of MI at age 50.

Physical Exam:
VS: T 97.8, BP 103/68, HR 113, RR 27, O2 100% on 4L NC
Gen: WDWN middle aged female in mild distress due to pain. Mood,
affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP not elevated.
CV: RRR, normal S1, fixed split S2, no murmurs/rubs/gallops, no
S3/S4. PMI nondisplaced.
Chest: midline sternotomy site, appears well-healed, no
paradoxical chest motion.
Resp: mild bibasilar crackles, no wheezes or rhonchi. mild
tachypnea with shallow breaths. no accessory muscle use.
Abd: +BS, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits. 2+ distal pulses
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.


Pertinent Results:
[**2150-7-18**] 08:45AM BLOOD WBC-13.2* RBC-4.69# Hgb-13.2# Hct-38.4#
MCV-82# MCH-28.2# MCHC-34.5 RDW-16.6* Plt Ct-431
[**2150-7-20**] 05:10AM BLOOD WBC-8.0 RBC-4.03* Hgb-11.2* Hct-34.2*
MCV-85 MCH-27.9 MCHC-32.8 RDW-16.9* Plt Ct-418
[**2150-7-18**] 08:45AM BLOOD Neuts-74.2* Lymphs-18.4 Monos-6.6 Eos-0.5
Baso-0.4
[**2150-7-18**] 08:45AM BLOOD PT-11.6 PTT-26.1 INR(PT)-1.0
[**2150-7-18**] 08:45AM BLOOD Glucose-119* UreaN-14 Creat-0.7 Na-134
K-4.4 Cl-99 HCO3-22 AnGap-17
[**2150-7-18**] 08:45AM BLOOD CK(CPK)-50
[**2150-7-19**] 05:56AM BLOOD CK(CPK)-56
[**2150-7-18**] 08:45AM BLOOD cTropnT-<0.01
[**2150-7-19**] 05:56AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2150-7-19**] 05:56AM BLOOD Calcium-8.9 Phos-3.0 Mg-2.0
[**2150-7-19**] 11:30AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2150-7-19**] 11:30AM URINE RBC-0-2 WBC-0-2 Bacteri-OCC Yeast-NONE
Epi-0-2
Urine cx: negative
Blood cx: negative to date x3
.
CTA [**7-18**]:
IMPRESSION:
1. There is a moderate-sized new pericardial effusion.
2. Sternal decissence. Bony irregularity is detected in the bony
oppositional regions with stranding of the surrounding
subcutaneous and mediastinal fat. There are also prominent
superior mediastinal lymph nodes which were not present on
previous study. Infection in the region of the sternal
decissence cannot be excluded.
3. No pulmonary embolism or aortic dissection identified.
4. Bilateral small pleural effusions with associated relaxation
atelectasis, more prominent on the left.
.
CXR: IMPRESSION: Improving bibasilar atelectasis. Persistent
bilateral pleural effusions, slightly decreased on the left.
.
[**7-20**] TTE: The left atrium is mildly dilated. Left ventricular
wall thickness, cavity size, and systolic function are normal
(LVEF>55%). Regional left ventricular wall motion is normal.
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. A mitral
valve annuloplasty ring is present. The mitral annular ring
appears well seated and is not obstructing flow. The estimated
pulmonary artery systolic pressure is normal. There is a small
to moderate sized inferolateral pericardial effusion without
evidence for hemodynamic compromise.


Brief Hospital Course:
50 yo F s/p MVR, ASD closure [**6-1**] presenting with severe sharp
substernal CP, SOB, and brief episode of light-headedness.  The
patient had a CTA chest performed to rule out PE and dissection,
notable for sternal dehiscence, moderate pericardial effusion
and fat stranding with lymphadenopathy.  EKG with diffuse PR
depressions and ST elevations.  Cardiac enzymes were negative.
Cardiothoracic surgery was conulted.  Pt's presentation felt to
be consistent with post-pericardiotomy syndrome.  She was
started on ibuprofen and colchicine with significant improvement
in her pain.

On hospital day #2, the pt became febrile to a temperature of
101.2. CXR showed atelectasis at the lung bases; CXR, UA and
urine culture, and blood cultures were nonsuggestive of
infection. Cardiothoracic surgery was consulted for the
possibility of infection secondary to sternal dehiscence;
however, the CT team felt that there was no clinical evidence to
support this. Fever subsided later that day with high-dose
NSAIDs and the patient was (afebrile) for the remainder of her
hospital course.

The patient was monitored on telemetry for the duration of the
hospital stay with no significant events. The patient was
maintained on a bowel regimen, PPI, sc heparin tid  and was
discharged to home in good condition.

Medications on Admission:
Atenolol 25mg po qd
Atorvastatin 40mg po qd
Effexor (unknown dose)
Sertraline 100mg po qd
Clonazepam 0.5mg po tid
docusate 100mg po bid
vitamin C


Discharge Medications:
1. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Colchicine 0.6 mg Tablet Sig: Two (2) Tablet PO once a day
for 3 months.
Disp:*60 Tablet(s)* Refills:*2*
3. Venlafaxine 37.5 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO DAILY (Daily). Capsule, Sust.
Release 24 hr(s)
4. Ibuprofen 400 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Post pericardiotomy syndrome


Discharge Condition:
Chest pain resolved and vital signs stable


Discharge Instructions:
If you experience any increasing chest pain/ tightness,
palpitations, shortness of breath, swelling in your legs, blood
in the vomit or stool, or dark stools you should call you
doctor, but if he/she is not available you should go to the
nearest emergency.


Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2150-8-31**]
11:20
You have an appointment scheduled for Friday [**7-31**] at 1:30
with PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Telephone/Fax (1) 133**] for post hospitalization
follow-up.
{'Functional disturbances following cardiac surgery,Primary pulmonary hypertension,Unspecified essential hypertension'}


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: Chest pain

PRESENT ILLNESS: 50 yo F s/p MVR, ASD closure [**6-1**] with severe sharp SS CP
starting yesterday AM, now with radiation to back and left
shoulder with some shortness of breath. Pain was crampy, sharp,
and constant in nature, [**11-4**] at worst (now [**4-4**] with morphine),
nonexertional but worse with deep inhalation and laying supine.
Pt also c/o light-headedness this am upon awakening, but no
syncope. + fevers beginning overnight. Pt describes SOB as
secondary to pain - she has had difficulties with incisional
pain and SOB since [**Doctor First Name **]; had one admission mid may for SOB, no
interventions were done, however this pain was different than
previous.
.
In [**Name (NI) **], pt received morphine 4mg with good relief of pain;
however, she became hypotensive with BP down to 81/48 - up to
99/70 with fluid bolus. FAST exam showed small pericardial
effusion with good 4 chamber motion. No evidence of tamponade
physiology.

MEDICAL HISTORY: 1. Mitral valve prolapse with severe mitral regurgitation
- s/p MV repair and annuloplasty [**2150-6-1**] with 28 mm band
- s/p secundum ASD closure on [**2150-6-1**]
2. Mild pulmonary hypertension
3. Hypertension
4. diverticulitis s/p sigmoid resection
5. s/p appy
6. anxiety / depression
7. [**Date Range 17005**]
8. HA

MEDICATION ON ADMISSION: Atenolol 25mg po qd
Atorvastatin 40mg po qd
Effexor (unknown dose)
Sertraline 100mg po qd
Clonazepam 0.5mg po tid
docusate 100mg po bid
vitamin C

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T 97.8, BP 103/68, HR 113, RR 27, O2 100% on 4L NC
Gen: WDWN middle aged female in mild distress due to pain. Mood,
affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP not elevated.
CV: RRR, normal S1, fixed split S2, no murmurs/rubs/gallops, no
S3/S4. PMI nondisplaced.
Chest: midline sternotomy site, appears well-healed, no
paradoxical chest motion.
Resp: mild bibasilar crackles, no wheezes or rhonchi. mild
tachypnea with shallow breaths. no accessory muscle use.
Abd: +BS, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits. 2+ distal pulses
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: Mother with MVR/TVR at age 73. Father died of MI at age 50.

SOCIAL HISTORY: Volunteer at NEBH. Never smoked. Drinks [**4-30**] ETOH beverages per
week. Lives with mother. 

### Response:
{'Functional disturbances following cardiac surgery,Primary pulmonary hypertension,Unspecified essential hypertension'}
