CHIEF COMPLAINT: Decreasing activity tolerance

PRESENT ILLNESS: 83 year old male with recent episodes of heart failure, echo
revealed EF 40% with severe MR.  Further evaluation by cardiac
catheterization revealed coronary artery disease.

MEDICAL HISTORY: Mitral Regurgitation
Atrial Fibrillation
Depression
Pacemaker - [**Company **]
Chronic systolic heart failure
Epistaxis
Hypertension
Appendectomy ~ 5 years ago
Right knee surgery
Bilateral cataracts [**Doctor First Name **] with IOLs

MEDICATION ON ADMISSION: Medications at home:
COUMADIN daily last dose wed [**11-6**]
digoxin 0.125 mg daily
lisinopril 2.5 mg daily
bisoprolol 5 mg daily
lasix 20 mg prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 69 AFIB Resp: 18  O2 sat: 98 RA
B/P 135/84

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Occupation: retired car dealer
Last Dental Exam: clearance obtained
Lives alone
Race: Caucasian
Tobacco: quit 18 months ago; approx. 15-20 PYHx
ETOH: quit 18 months ago
no recr. drugs
Mitral valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Long-term (current) use of anticoagulants,Other iatrogenic hypotension,Cardiac pacemaker in situ,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of tobacco use
Mitral valve disorder,Ac on chr syst hrt fail,Crnry athrscl natve vssl,Atrial fibrillation,Long-term use anticoagul,Iatrogenc hypotnsion NEC,Status cardiac pacemaker,Hypertension NOS,Depressive disorder NEC,History of tobacco use
Admission Date:  [**2143-11-12**]              Discharge Date:   [**2143-11-18**]

Date of Birth:  [**2060-1-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Decreasing activity tolerance

Major Surgical or Invasive Procedure:
[**2143-11-13**] Coronary Artery Bypass Graft x 2 (Left internal mammary
artery to left anterior, saphenous vein graft to obtuse
marginal), Mitral Valve Replacement (33mm St. [**Male First Name (un) 923**] Epic Porcine)

History of Present Illness:
83 year old male with recent episodes of heart failure, echo
revealed EF 40% with severe MR.  Further evaluation by cardiac
catheterization revealed coronary artery disease.

Past Medical History:
Mitral Regurgitation
Atrial Fibrillation
Depression
Pacemaker - [**Company **]
Chronic systolic heart failure
Epistaxis
Hypertension
Appendectomy ~ 5 years ago
Right knee surgery
Bilateral cataracts [**Doctor First Name **] with IOLs

Social History:
Occupation: retired car dealer
Last Dental Exam: clearance obtained
Lives alone
Race: Caucasian
Tobacco: quit 18 months ago; approx. 15-20 PYHx
ETOH: quit 18 months ago
no recr. drugs

Family History:
Non-contributory

Physical Exam:
Pulse: 69 AFIB Resp: 18  O2 sat: 98 RA
B/P 135/84

General: No acute distress
Skin: Dry [x] intact [x] healed incision left lower quadrant,
scabbed area right ankle no erythema
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular [x]  Murmur [**1-25**]
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Cool Edema: trace
Neuro: Alert and oriented x3, 5/5 strength bilateral gait
unsteady
Pulses:
Femoral      Right: +2  Left: +2
DP           Right: +1  Left: +1
PT           [**Name (NI) 167**]: Doppler  Left: Doppler
Radial       Right: +1  Left: +1

Carotid Bruit        Right: no bruit    Left: no bruit

Pertinent Results:
[**2143-11-12**] Carotid U/S: Right ICA with stenosis <40%. Left ICA
with stenosis <40% .
[**2143-11-13**] Echo: PRE-BYPASS: The left atrium is markedly dilated.
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. The right atrium is dilated. No
atrial septal defect is seen by 2D or color Doppler. There is
moderate to severe regional left ventricular systolic
dysfunction with severe hypokinesis in the anteroseptal
distribution on top of global hypokinesis.. Overall left
ventricular systolic function is severely depressed (LVEF= 30
%). There are simple atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. There is a minimally
increased gradient consistent with minimal aortic valve
stenosis. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse. The eccentric mitral regurgitation vena contracta is
>=0.7cm. Severe (4+) mitral regurgitation is seen. There is no
pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the
results on [**Known lastname 49937**], A at 10AM before surgical incision. The
thoracic aorta is tortuous and pacing wires are seen in the
right atrium and ventricle. POST-BYPASS: Patient is on milrinone
0.2 mcg/kg/min. Mild RV global hypokinesis. Mild TR. The
bioprosthesis in the mitral position is well placed, and
functioning well with no residual MR and mean gradient of 2mm of
Hg. Thoracic aorta is intact. Anteroseptal hypokinesis persists
on top of global hypokinesis.
[**2143-11-18**] 05:13AM BLOOD WBC-8.2 RBC-3.14* Hgb-9.6* Hct-28.4*
MCV-91 MCH-30.7 MCHC-33.9 RDW-16.3* Plt Ct-131*
[**2143-11-12**] 03:45PM BLOOD WBC-6.5 RBC-4.65 Hgb-14.2 Hct-41.9 MCV-90
MCH-30.6 MCHC-34.0 RDW-14.4 Plt Ct-180
[**2143-11-18**] 05:14AM BLOOD PT-20.0* PTT-30.1 INR(PT)-1.8*
[**2143-11-12**] 03:45PM BLOOD PT-13.5* PTT-25.4 INR(PT)-1.2*
[**2143-11-18**] 05:13AM BLOOD Glucose-94 UreaN-23* Creat-0.8 Na-139
K-3.5 Cl-100 HCO3-31 AnGap-12
[**2143-11-12**] 03:45PM BLOOD Glucose-112* UreaN-21* Creat-1.0 Na-139
K-4.0 Cl-104 HCO3-26 AnGap-13
[**2143-11-12**] 03:45PM BLOOD ALT-17 AST-26 LD(LDH)-124 CK(CPK)-147
AlkPhos-71 Amylase-54 TotBili-1.6*

Brief Hospital Course:
Mr. [**Known lastname 49937**] was admitted one day prior to surgery for
pre-operative work-up and Heparin bridge do to history of Atrial
Fibrillation with Coumadin. On [**11-13**] he was brought to the
operating room where he underwent Coronary Artery Bypass Graft x
2 (Left internal mammary artery to left anterior, saphenous vein
graft to obtuse marginal), Mitral Valve Replacement (33mm St.
[**Male First Name (un) 923**] Epic Porcine). Cardiopulmonary Bypass time= 128 minutes.
Cross Clamp Time= 104 minutes. Please see Dr[**Last Name (STitle) **] operative
report for surgical details. He was intubated, sedated, and on
pressors and inotropes to optimize hemodynamics. He was
transferred to the CVICU in critical but stable condition. POD#1
he awoke neurologically intact and was weaned to extubation. All
drips were weaned off. Electrophysiology interrogated the
Permanent Pacemaker. All lines and drains were discontinued in a
timely fashion. Beta-blocker, statin, aspirin, and diuresis was
initiated. He continued to progress and on POD# 4 was
transferred to the step down unit for further monitoring.
Physical therapy was consulted for evaluation and assessment.
Anticoagulation with Coumadin was resumed. The remainder of
Mr.[**Known lastname 49937**] [**Last Name (Titles) **] course was essentially uneventful. He
was cleared by Dr.[**Last Name (STitle) **] for discharge to rehab on POD# 5. All
follow up appointments were advised.

Medications on Admission:
Medications at home:
COUMADIN daily last dose wed [**11-6**]
digoxin 0.125 mg daily
lisinopril 2.5 mg daily
bisoprolol 5 mg daily
lasix 20 mg prn

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 10 days.
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
4. Warfarin 1 mg Tablet Sig: MD to dose Tablet PO DAILY (Daily).

5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
7. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
8. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
11. Multivitamin,Tx-Minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
12. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days.
16. Warfarin 5 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for
1 days.
17. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 29789**] Country Manor - [**Location (un) 29789**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 2
Mitral Regurgitation s/p Mitral Valve Replacement
Past medical history:
Atrial Fibrillation
Depression
Pacemaker - [**Company **]
Chronic systolic heart failure
Epistaxis
Hypertension
Appendectomy ~ 5 years ago
Right knee surgery
Bilateral cataracts [**Doctor First Name **] with IOLs

Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month until follow up with
surgeon
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
Surgeon Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 71779**] in [**12-21**] weeks
Cardiologist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1075**] in [**12-21**] weeks
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will schedule


Completed by:[**2143-11-18**]
{'Mitral valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Long-term (current) use of anticoagulants,Other iatrogenic hypotension,Cardiac pacemaker in situ,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of tobacco use'}


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: Decreasing activity tolerance

PRESENT ILLNESS: 83 year old male with recent episodes of heart failure, echo
revealed EF 40% with severe MR.  Further evaluation by cardiac
catheterization revealed coronary artery disease.

MEDICAL HISTORY: Mitral Regurgitation
Atrial Fibrillation
Depression
Pacemaker - [**Company **]
Chronic systolic heart failure
Epistaxis
Hypertension
Appendectomy ~ 5 years ago
Right knee surgery
Bilateral cataracts [**Doctor First Name **] with IOLs

MEDICATION ON ADMISSION: Medications at home:
COUMADIN daily last dose wed [**11-6**]
digoxin 0.125 mg daily
lisinopril 2.5 mg daily
bisoprolol 5 mg daily
lasix 20 mg prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 69 AFIB Resp: 18  O2 sat: 98 RA
B/P 135/84

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Occupation: retired car dealer
Last Dental Exam: clearance obtained
Lives alone
Race: Caucasian
Tobacco: quit 18 months ago; approx. 15-20 PYHx
ETOH: quit 18 months ago
no recr. drugs 

### Response:
{'Mitral valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Long-term (current) use of anticoagulants,Other iatrogenic hypotension,Cardiac pacemaker in situ,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of tobacco use'}
