CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 58 y/o male with murmur since childhood. Has been c/o increased
dyspnea on exertion over last several months. Along with fatigue
and palpitations. Found to have large atrial septal defect on
echo. Now presents for surgical intervention.

MEDICAL HISTORY: Hypothyroidism, Benign Prostatic Hypertrophy, Hiatal Hernia, s/p
Removal of benign neck mass

MEDICATION ON ADMISSION: Synthroid 50mcg qd, Avodart 0.5mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 72 20 140/82 6' 172#
Gen: 58 y/o male in NAD
Skin: Unremarkable
HEENT: EOMI, PERL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, soft systolic murmur
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused -[**Last Name (un) **]
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking 20 yrs ago after 20 pk yr hx. Admits to [**11-20**]
beers/day.
Ostium secundum type atrial septal defect,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene
Secundum atrial sept def,BPH w/o urinary obs/LUTS,Hypothyroidism NOS,Diaphragmatic hernia
Admission Date:  [**2166-6-6**]              Discharge Date:   [**2166-6-10**]

Date of Birth:  [**2107-12-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2166-6-6**] ASD Closure w/ Dacron Patch

History of Present Illness:
58 y/o male with murmur since childhood. Has been c/o increased
dyspnea on exertion over last several months. Along with fatigue
and palpitations. Found to have large atrial septal defect on
echo. Now presents for surgical intervention.

Past Medical History:
Hypothyroidism, Benign Prostatic Hypertrophy, Hiatal Hernia, s/p
Removal of benign neck mass

Social History:
Quit smoking 20 yrs ago after 20 pk yr hx. Admits to [**11-20**]
beers/day.

Family History:
Non-contributory

Physical Exam:
VS: 72 20 140/82 6' 172#
Gen: 58 y/o male in NAD
Skin: Unremarkable
HEENT: EOMI, PERL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, soft systolic murmur
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused -[**Last Name (un) **]
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**6-6**] Echo: Pre-CPB: No spontaneous echo contrast is seen in the
left atrial appendage. A left-to-right shunt across the
interatrial septum is seen at rest. A large secundum atrial
septal defect is present. Shunt fraction = 25%. The right
ventricular cavity is markedly dilated with mild global free
wall hypokinesis. There is abnormal septal motion/position
consistent with right ventricular pressure/volume overload. No
aortic regurgitation is seen. No mitral regurgitation is seen.
There is no pericardial effusion. Post-CPB: The patient is in SR
on no infusions. The ASD has been repaired with a dacron patch.
There is no flow across the inter-atrial septum. Good LV
systolic fxn. The RV is still dilated with mild global HK. Aorta
intact. No AI.
[**6-7**] CXR: In comparison with the study of [**6-6**], the left chest
tube has been removed. No convincing evidence of pneumothorax.
Atelectatic changes persist at the left base. The endotracheal
tube and right IJ catheter have also been removed.

[**2166-6-6**] 03:24PM BLOOD WBC-9.5# RBC-3.35*# Hgb-10.1*# Hct-28.6*#
MCV-86 MCH-30.2 MCHC-35.3* RDW-13.7 Plt Ct-198
[**2166-6-9**] 06:25AM BLOOD WBC-8.5 RBC-3.60* Hgb-10.7* Hct-31.7*
MCV-88 MCH-29.7 MCHC-33.8 RDW-13.1 Plt Ct-211
[**2166-6-6**] 03:24PM BLOOD PT-16.5* PTT-31.6 INR(PT)-1.5*
[**2166-6-6**] 04:44PM BLOOD PT-14.0* PTT-30.6 INR(PT)-1.2*
[**2166-6-6**] 04:44PM BLOOD UreaN-11 Creat-1.1 Cl-112* HCO3-23
[**2166-6-9**] 06:25AM BLOOD Glucose-102 UreaN-15 Creat-1.1 Na-141
K-4.4 Cl-106 HCO3-27 AnGap-12
[**2166-6-9**] 06:25AM BLOOD Calcium-8.5 Phos-2.6* Mg-1.9

Brief Hospital Course:
Mr. [**Known lastname 65698**] was a same day admit after undergoing pre-operative
work-up as an outpatient. On day of admission he was brought to
the operating room where he underwent a ASD closure. Please see
operative report for surgical details. Following surgery he was
transferred to the CVICU for invasive monitoring in stable
condition. Later that day he was weaned from sedation, awoke
neurologically intact and extubated. On post-op day one his
chest tubes were removed and he was transferred to the telemetry
floor for further care. On post-op day two his epicardial pacing
wires were removed. On post-op day three he appeared to doing
well and worked with physical therapy for strength and mobility.
He was discharged home on POD 4 with VNA services and the
appropriate follow-up appointments.

Medications on Admission:
Synthroid 50mcg qd, Avodart 0.5mg qd

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
6. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*1*
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Diversified VNA and hospice

Discharge Diagnosis:
Atrial Septal Defect (ASD) s/p ASD Closure
PMH: Hypothyroidism, Benign Prostatic Hypertrophy, Hiatal
Hernia, s/p Removal of benign neck mass

Discharge Condition:
Good

Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Call with any questions or concerns.

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 5874**] in [**12-22**] weeks
Dr. [**Last Name (STitle) 27772**] in [**11-20**] weeks


Completed by:[**2166-6-10**]

Name:  [**Known lastname 11531**],[**Known firstname **]                Unit No:   [**Numeric Identifier 11532**]

Admission Date:  [**2166-6-6**]              Discharge Date:   [**2166-6-10**]

Date of Birth:  [**2107-12-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 741**]
Addendum:
medication change

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
6. Avodart 0.5 mg Capsule Sig: One (1) Capsule PO once a day.
Disp:*30 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Diversified VNA and hospice

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2166-6-10**]
{'Ostium secundum type atrial septal defect,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene'}


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: 58 y/o male with murmur since childhood. Has been c/o increased
dyspnea on exertion over last several months. Along with fatigue
and palpitations. Found to have large atrial septal defect on
echo. Now presents for surgical intervention.

MEDICAL HISTORY: Hypothyroidism, Benign Prostatic Hypertrophy, Hiatal Hernia, s/p
Removal of benign neck mass

MEDICATION ON ADMISSION: Synthroid 50mcg qd, Avodart 0.5mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 72 20 140/82 6' 172#
Gen: 58 y/o male in NAD
Skin: Unremarkable
HEENT: EOMI, PERL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, soft systolic murmur
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused -[**Last Name (un) **]
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking 20 yrs ago after 20 pk yr hx. Admits to [**11-20**]
beers/day. 

### Response:
{'Ostium secundum type atrial septal defect,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene'}
