CHIEF COMPLAINT: Fatigue, Dyspnea

PRESENT ILLNESS: This is a 24 y/o male with AI/MR who had AV repair (pericardial
patch and left commisure stitch) and MV commissuroplasty in [**Month (only) 116**]
[**2107**]. Abnormal [**Year (4 digits) 113**] on [**11-20**] led to cardiac cath in [**1-22**] which
showed severe AI and MR. [**First Name (Titles) 907**] [**Last Name (Titles) 113**] on [**2114-8-28**] confirmed 4+ AI
and 2+ MR [**First Name (Titles) 151**] [**Last Name (Titles) 6878**] ascending aorta. Will now be admitted for
elective surgical intervention.

MEDICAL HISTORY: Aortic Insufficiency
Mitral Reurgitation
[**Last Name (Titles) **] Ascending Aorta
?Rheumatic Heart Disease
s/p Aortic and Mitral Valvuloplasty [**2108-4-16**]
History of Migraine HA

MEDICATION ON ADMISSION: Lisinopril 20mg qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 68 118/66 120/66 5'[**17**]" 196#
General: NAD, young active fit man
HEENT: PERLL, EOMI, non-icteric
Neck: Supple, FROM, -JVD
Chest: CTAB, well-healed keloid sternotomy scar, L. ant chest sm
keloid
Heart: RRR, 2/6 SEM, [**2-19**] diastolic murmur
Abd: Warm, well-perfused, -c/c/e, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory. Parents are alive and well.

SOCIAL HISTORY: BC/BS worker in behav. health. Admits to rare cigarette, and [**3-21**]
drinks per week. He denies recreational drug use. Currently
lives with roommates and his girlfriend.
Mitral valve insufficiency and aortic valve insufficiency,Other specified complications of procedures not elsewhere classified,Thoracic aneurysm without mention of rupture
Mitral/aortic val insuff,Oth spcf cmplc procd NEC,Thoracic aortic aneurysm
Admission Date:  [**2114-9-28**]              Discharge Date:   [**2114-10-3**]

Date of Birth:  [**2089-12-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Fatigue, Dyspnea

Major Surgical or Invasive Procedure:
[**2114-9-28**] Aortic Valve Replacement (23mm St. [**Male First Name (un) 923**] Mechanical) and
Mitral Valve Replacement (27mm St. [**Male First Name (un) 923**] Mechanical)

History of Present Illness:
This is a 24 y/o male with AI/MR who had AV repair (pericardial
patch and left commisure stitch) and MV commissuroplasty in [**Month (only) 116**]
[**2107**]. Abnormal [**Year (4 digits) 113**] on [**11-20**] led to cardiac cath in [**1-22**] which
showed severe AI and MR. [**First Name (Titles) 907**] [**Last Name (Titles) 113**] on [**2114-8-28**] confirmed 4+ AI
and 2+ MR [**First Name (Titles) 151**] [**Last Name (Titles) 6878**] ascending aorta. Will now be admitted for
elective surgical intervention.

Past Medical History:
Aortic Insufficiency
Mitral Reurgitation
[**Last Name (Titles) **] Ascending Aorta
?Rheumatic Heart Disease
s/p Aortic and Mitral Valvuloplasty [**2108-4-16**]
History of Migraine HA

Social History:
BC/BS worker in behav. health. Admits to rare cigarette, and [**3-21**]
drinks per week. He denies recreational drug use. Currently
lives with roommates and his girlfriend.

Family History:
Non-contributory. Parents are alive and well.

Physical Exam:
VS: 68 118/66 120/66 5'[**17**]" 196#
General: NAD, young active fit man
HEENT: PERLL, EOMI, non-icteric
Neck: Supple, FROM, -JVD
Chest: CTAB, well-healed keloid sternotomy scar, L. ant chest sm
keloid
Heart: RRR, 2/6 SEM, [**2-19**] diastolic murmur
Abd: Warm, well-perfused, -c/c/e, -varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2114-10-2**] 09:50AM BLOOD WBC-9.9 RBC-3.72* Hgb-11.9* Hct-32.0*
MCV-86 MCH-32.0 MCHC-37.2* RDW-12.6 Plt Ct-212#
[**2114-10-3**] 06:25AM BLOOD PT-31.4* PTT-70.5* INR(PT)-3.3*
[**2114-10-2**] 04:35PM BLOOD PT-22.5* PTT-60.1* INR(PT)-2.2*
[**2114-10-1**] 05:10PM BLOOD PT-17.2* PTT-38.9* INR(PT)-1.6*
[**2114-9-30**] 03:56PM BLOOD PT-15.4* PTT-33.4 INR(PT)-1.4*
[**2114-9-29**] 03:09AM BLOOD PT-14.3* PTT-29.4 INR(PT)-1.3*
[**2114-10-2**] 04:00AM BLOOD Calcium-8.6 Mg-2.2

[**2114-10-1**] Chest x-ray(PA and lat): Resolving pneumopericardium.
No evidence of pneumothorax. Small pleural effusions.


Brief Hospital Course:
Mr. [**Known lastname 47246**] was electively admitted and taken directly to the
operating room where Dr. [**Last Name (STitle) **] performed aortic and mitral
valve replacements. Please see operative report for further
surgical details. He tolerated the procedure well and was
transferred to the CSRU for invasive monitoring. Within 24
hours, he awoke neurologically intact and was extubated. He
maintained stable hemodynamics as beta blockers and diuretics
were started. On postoperative day one, Warfarin anticoagulation
was initiated and he transferred to the SDU for further care and
recovery. Over several days, medical therapy was optimized and
he continued to make clinical improvements with diuresis and
physical therapy. By discharge, he reached his preoperative
weight and diuretics were discontinued. He tolerated beta
blockade and remained in a normal sinus rhythm. Warfarin was
dosed daily for a goal INR between 3.0 - 3.5. He temporarily
required intravenous Heparin for a subtherapeutic prothrombin
time. Blood cultures were taken for low grade fevers but no
obvious source of infection was identified. By discharge, his
fevers improved and his white count was normal. His hospital
course was otherwise uneventful and he was medically cleared for
discharge on postoperative day five. Arrangements have been made
with Dr. [**Last Name (STitle) 14522**] to monitor his Warfarin as an outpatient. At
discharge, his BP was 110/70 with a HR of 74. His oxygen
saturations were 99% on room air and his discharge chest x-ray
showed only small bilateral pleural effusions. All surgical
wounds were clean, dry and intact.


Medications on Admission:
Lisinopril 20mg qd

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 6-8 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
4. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
Disp:*30 Tablet(s)* Refills:*0*
5. Warfarin 5 mg Tablet Sig: One (1) Tablet PO QPM(every
vary according to PT/INR.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Aortic Insufficiency and Mitral Regurgitation s/p Aortic Valve
Replacement and Mitral Valve Replacement
PMH: s/p Aortic and Mitral Valvuloplasty [**4-/2108**], Migraines,
?Rheumatic Heart Disease

Discharge Condition:
Good

Discharge Instructions:
Patient may take shower. No baths. No creams, ointments or
lotions to incision. No driving for 1 month. No lifting more
than 10 pounds for 2 months. If you develop a fever, redness or
drainage from incision, please contact office immediately. Take
Warfarin as directed. Please have INR checked within 48-72 hours
of discharge. Dr. [**Last Name (STitle) 14522**] will manage Warfarin as an outpatient.
Warfarin should be adjusted for goal INR between 3.0 - 3.5. VNA
will fax results to Dr. [**Last Name (STitle) 14522**] at [**Telephone/Fax (1) 66753**]


Followup Instructions:
Dr. [**Last Name (STitle) **] in [**3-21**] weeks
Dr. [**Last Name (STitle) 14522**] in [**1-19**] weeks
Dr. [**Last Name (STitle) 23509**] in [**12-18**] weeks
Please call to schedule all follow-up appointmets.



Completed by:[**2114-10-3**]
{'Mitral valve insufficiency and aortic valve insufficiency,Other specified complications of procedures not elsewhere classified,Thoracic aneurysm without mention of rupture'}


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: Fatigue, Dyspnea

PRESENT ILLNESS: This is a 24 y/o male with AI/MR who had AV repair (pericardial
patch and left commisure stitch) and MV commissuroplasty in [**Month (only) 116**]
[**2107**]. Abnormal [**Year (4 digits) 113**] on [**11-20**] led to cardiac cath in [**1-22**] which
showed severe AI and MR. [**First Name (Titles) 907**] [**Last Name (Titles) 113**] on [**2114-8-28**] confirmed 4+ AI
and 2+ MR [**First Name (Titles) 151**] [**Last Name (Titles) 6878**] ascending aorta. Will now be admitted for
elective surgical intervention.

MEDICAL HISTORY: Aortic Insufficiency
Mitral Reurgitation
[**Last Name (Titles) **] Ascending Aorta
?Rheumatic Heart Disease
s/p Aortic and Mitral Valvuloplasty [**2108-4-16**]
History of Migraine HA

MEDICATION ON ADMISSION: Lisinopril 20mg qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 68 118/66 120/66 5'[**17**]" 196#
General: NAD, young active fit man
HEENT: PERLL, EOMI, non-icteric
Neck: Supple, FROM, -JVD
Chest: CTAB, well-healed keloid sternotomy scar, L. ant chest sm
keloid
Heart: RRR, 2/6 SEM, [**2-19**] diastolic murmur
Abd: Warm, well-perfused, -c/c/e, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory. Parents are alive and well.

SOCIAL HISTORY: BC/BS worker in behav. health. Admits to rare cigarette, and [**3-21**]
drinks per week. He denies recreational drug use. Currently
lives with roommates and his girlfriend. 

### Response:
{'Mitral valve insufficiency and aortic valve insufficiency,Other specified complications of procedures not elsewhere classified,Thoracic aneurysm without mention of rupture'}
