CHIEF COMPLAINT: flail post. MV leaflet, mod.-severe MVP found on follow up echo.
known MVP/MR [**First Name (Titles) **] [**Last Name (Titles) 10718**] of endocarditis in '[**18**].

PRESENT ILLNESS: 65yo male with known MVP/MR diagnosed '[**18**] after an [**Year (2 digits) 10718**] of
endocarditis. He only admits to mild PND at high altitude. He
now presents for surgical evaluation. Cardiac echo [**10-30**] reveals
mod-severe MVP,3+MR with partial mitral post. flail leaflet.
DR.[**Last Name (STitle) **] was consulted for MVrepair.

MEDICAL HISTORY: MVP/MR, hyperlipidemia, endocarditis'[**18**], GERD, RLL nodule, Left
periaortic mass c/w esoph. cyst vs. bronchogenic cyst stable
since '[**19**], right knee surgery, torn left rotator cuff, ?OSA

MEDICATION ON ADMISSION: Lipitor 5(1),Aciphex 15(1), Lisinopril 40(1),Amoxicillin prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam
afebrile, Pulse:72, RR:14, BP:146/78, Ht:72",Wt:188lb
General: A&Ox3, NAD
HEENT: [**Last Name (un) **], NC/AT, carotids: neg. bruits/JVD
CVS:RRR, Nl S1-S2, III/VI holosystolic murmur
Lungs:CTA
ABD:benign
EXT:0 C/C/E, no varicosities

FAMILY HISTORY: father with PPM at age [**Age over 90 **], brother and son with heart
murmurs.lives in [**Location **] with wife.

SOCIAL HISTORY: retired engineer, denies tobacco, 2-3 beers/week.
Mitral valve disorders,Unspecified disease of pericardium,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Examination of participant in clinical trial,Orthostatic hypotension,Other left bundle branch block
Mitral valve disorder,Pericardial disease NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Exam-clincal trial,Orthostatic hypotension,Left bb block NEC
Admission Date:  [**2133-5-13**]              Discharge Date:   [**2133-5-19**]

Date of Birth:  [**2067-12-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
flail post. MV leaflet, mod.-severe MVP found on follow up echo.
known MVP/MR [**First Name (Titles) **] [**Last Name (Titles) 10718**] of endocarditis in '[**18**].

Major Surgical or Invasive Procedure:
Mitral Valve repair (#34mm CE physio ring)[**5-13**]


History of Present Illness:
65yo male with known MVP/MR diagnosed '[**18**] after an [**Year (2 digits) 10718**] of
endocarditis. He only admits to mild PND at high altitude. He
now presents for surgical evaluation. Cardiac echo [**10-30**] reveals
mod-severe MVP,3+MR with partial mitral post. flail leaflet.
DR.[**Last Name (STitle) **] was consulted for MVrepair.

Past Medical History:
MVP/MR, hyperlipidemia, endocarditis'[**18**], GERD, RLL nodule, Left
periaortic mass c/w esoph. cyst vs. bronchogenic cyst stable
since '[**19**], right knee surgery, torn left rotator cuff, ?OSA

Social History:
retired engineer, denies tobacco, 2-3 beers/week.

Family History:
father with PPM at age [**Age over 90 **], brother and son with heart
murmurs.lives in [**Location **] with wife.

Physical Exam:
Admission Physical Exam
afebrile, Pulse:72, RR:14, BP:146/78, Ht:72",Wt:188lb
General: A&Ox3, NAD
HEENT: [**Last Name (un) **], NC/AT, carotids: neg. bruits/JVD
CVS:RRR, Nl S1-S2, III/VI holosystolic murmur
Lungs:CTA
ABD:benign
EXT:0 C/C/E, no varicosities

Discharge EXAM
T:99.1, P:81,BP:136/88, RR:18, O2SAT: 96%, Wt:85.9KG
General:A&Ox3,NAD
HEENT:AT/NC, [**Last Name (un) **]
CVS:RRR
Lungs:CTA
ABD:benign
EXT: neg. C/C/E

Pertinent Results:
[**2133-5-18**] 09:00PM BLOOD WBC-8.8 RBC-3.54* Hgb-11.2* Hct-31.6*
MCV-89 MCH-31.7 MCHC-35.5* RDW-15.1 Plt Ct-242#
[**2133-5-13**] 12:22PM BLOOD WBC-18.0*# RBC-3.62* Hgb-11.2*# Hct-32.4*
MCV-90 MCH-31.0 MCHC-34.6 RDW-14.8 Plt Ct-159
[**2133-5-17**] 02:40PM BLOOD Glucose-133* UreaN-16 Creat-0.8 Na-135
K-3.9 Cl-101 HCO3-28 AnGap-10
[**2133-5-13**] 01:18PM BLOOD UreaN-17 Creat-0.9 Cl-113* HCO3-24
 Approved: FRI [**2133-5-15**] 2:59 PM


[**2133-5-18**] 09:00PM BLOOD WBC-8.8 RBC-3.54* Hgb-11.2* Hct-31.6*
MCV-89 MCH-31.7 MCHC-35.5* RDW-15.1 Plt Ct-242#
[**2133-5-18**] 09:00PM BLOOD Plt Ct-242#
[**2133-5-15**] 12:25AM BLOOD PT-15.9* PTT-29.3 INR(PT)-1.4*
[**2133-5-17**] 02:40PM BLOOD Glucose-133* UreaN-16 Creat-0.8 Na-135
K-3.9 Cl-101 HCO3-28 AnGap-10

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname 28207**], [**Known firstname 870**] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) 3947**]       [**Hospital1 18**] [**Numeric Identifier 28208**]Portable
TTE (Focused views) Done [**2133-5-14**] at 4:17:57 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2067-12-14**]
Age (years): 65 M  Hgt (in): 70
BP (mm Hg): 118/65  Wgt (lb): 190
HR (bpm): 83  BSA (m2): 2.04 m2
Indication: LV function; status post mitral valev repair
ICD-9 Codes: 424.1, 424.0, 424.2
Test Information
Date/Time: [**2133-5-14**] at 16:17    Interpret MD: [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern4) **],
MD
Test Type: Portable TTE (Focused views) Son[**Name (NI) 930**]: [**First Name8 (NamePattern2) 2270**]
[**Last Name (NamePattern1) **]
Doppler: Full Doppler and color Doppler Test Location: West
SICU/CTIC/VICU
Contrast: None Tech Quality: Suboptimal
Tape #: 2008W033-0:00 Machine: Vivid [**6-28**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Four Chamber Length:  *6.3 cm  <= 5.2 cm
Right Atrium - Four Chamber Length:  *6.0 cm  <= 5.0 cm
Left Ventricle - Ejection Fraction:  70%  >= 55%
Left Ventricle - Peak Resting LVOT gradient:  *12 mm Hg  <= 10
mm Hg
Left Ventricle - Lateral Peak E':  *0.08 m/s  > 0.08 m/s
Left Ventricle - Septal Peak E':  *0.05 m/s  > 0.08 m/s
Left Ventricle - Ratio E/E':  *25  < 15
Aortic Valve - Peak Velocity:  1.7 m/sec  <= 2.0 m/sec
Mitral Valve - Mean Gradient:  5 mm Hg
Mitral Valve - E Wave:  1.6 m/sec
Mitral Valve - A Wave:  1.4 m/sec
Mitral Valve - E/A ratio:  1.14
Mitral Valve - E Wave deceleration time:  *260 ms  140-250 ms
TR Gradient (+ RA = PASP):  *18 to 30 mm Hg  <= 25 mm Hg

Findings
LEFT VENTRICLE: Normal LV wall thickness, cavity size and
regional/global systolic function (LVEF >55%). Mild resting LVOT
gradient.
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Mild (1+) AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Myxomatous
mitral valve leaflets. Mitral valve annuloplasty ring.
Well-seated mitral annular ring with normal gradient. [**Male First Name (un) **] of
mitral valve leaflets. No MR.
TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets.
Normal tricuspid valve supporting structures. No TS. Mild [1+]
TR. Borderline PA systolic hypertension.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - bandages,
defibrillator pads or electrodes.
Conclusions
Left ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF 70%) There is a mild resting
left ventricular outflow tract obstruction. Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. The mitral valve leaflets
are myxomatous. A mitral valve annuloplasty ring is present. The
mitral annular ring appears well seated and is not obstructing
flow. There is systolic anterior motion of the mitral valve
leaflets. No mitral regurgitation is seen. The tricuspid valve
leaflets are mildly thickened. There is borderline pulmonary
artery systolic hypertension. There is no pericardial effusion.

Compared with the findings of the prior study (images reviewed)
of [**2133-4-30**], the mitral valve has been repaired (ring
annuloplasty); however, there is now systolic anterior motion of
the anterior mitral leaflet with mild left ventricular outflow
tract obstruction.
  Electronically signed by [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern4) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2133-5-14**] 17:01



Brief Hospital Course:
On [**2133-5-13**] Mr [**Known lastname **] was taken to the OR where he underwent a
Mitral Valve repair with #34mm CE physio ring. Please refer to
DrKhabbaz's operative note for further details. Cross clamp
time:49" Cardiopulmonary bypass time:64". He was transferred to
the CVICU intubated on propofol and Neo to optimize his blood
pressure and cardiac output. He was extubated without incident
and tubes and lines were discontinued in a timely fashion. POD#1
he had a near syncopal [**Known lastname 10718**] and was treated with volume for
orthostatic hypotension. EKG changes postop were evident with ST
elevations and a intermittent LBBB. Mr [**Known lastname **] was started on
Ibuprofen for pericarditis. POD #2 he was doing well and
transferred to the floor. Further tele monitoring revealed LBBB
resolved. Beta blocker was optimized and he remains
hemodynamically stable. On [**2133-5-19**] it was felt that Mr [**Known lastname **]
was doing well and was ready to be discharged to home with VNA
services.

Medications on Admission:
Lipitor 5(1),Aciphex 15(1), Lisinopril 40(1),Amoxicillin prn

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*1 30* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
4. 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*
5. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed: 1 month only.
Disp:*90 Tablet(s)* Refills:*0*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
TBA

Discharge Diagnosis:
status post Mitral Valve repair (#34mm CE physio ring)
PMH: MVP/MR,hyperlipidemia, endocarditis'[**18**], GERD, RLL nodule, L
periaortic mass c/w esophageal cyst vs. bronchogenic cyst stable
since '[**19**],torn left rotator cuff, ?OSA, right knee surgery


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
wound clinic in 2 weeks
Dr [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 1 week ([**Telephone/Fax (1) 28209**]) please call for
appointment
appointment

Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2133-5-20**]
{'Mitral valve disorders,Unspecified disease of pericardium,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Examination of participant in clinical trial,Orthostatic hypotension,Other left bundle branch block'}


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: flail post. MV leaflet, mod.-severe MVP found on follow up echo.
known MVP/MR [**First Name (Titles) **] [**Last Name (Titles) 10718**] of endocarditis in '[**18**].

PRESENT ILLNESS: 65yo male with known MVP/MR diagnosed '[**18**] after an [**Year (2 digits) 10718**] of
endocarditis. He only admits to mild PND at high altitude. He
now presents for surgical evaluation. Cardiac echo [**10-30**] reveals
mod-severe MVP,3+MR with partial mitral post. flail leaflet.
DR.[**Last Name (STitle) **] was consulted for MVrepair.

MEDICAL HISTORY: MVP/MR, hyperlipidemia, endocarditis'[**18**], GERD, RLL nodule, Left
periaortic mass c/w esoph. cyst vs. bronchogenic cyst stable
since '[**19**], right knee surgery, torn left rotator cuff, ?OSA

MEDICATION ON ADMISSION: Lipitor 5(1),Aciphex 15(1), Lisinopril 40(1),Amoxicillin prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam
afebrile, Pulse:72, RR:14, BP:146/78, Ht:72",Wt:188lb
General: A&Ox3, NAD
HEENT: [**Last Name (un) **], NC/AT, carotids: neg. bruits/JVD
CVS:RRR, Nl S1-S2, III/VI holosystolic murmur
Lungs:CTA
ABD:benign
EXT:0 C/C/E, no varicosities

FAMILY HISTORY: father with PPM at age [**Age over 90 **], brother and son with heart
murmurs.lives in [**Location **] with wife.

SOCIAL HISTORY: retired engineer, denies tobacco, 2-3 beers/week. 

### Response:
{'Mitral valve disorders,Unspecified disease of pericardium,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Examination of participant in clinical trial,Orthostatic hypotension,Other left bundle branch block'}
