CHIEF COMPLAINT: Chest pain and dyspnea on exertion

PRESENT ILLNESS: 70 year old female with known Hypertrophic Obstructive
Cardiomyopathy  and mitral regurgitation with recent complaints
of chest pain and dyspnea.  She was referred for surgical
evaluation

MEDICAL HISTORY: Hypertrophic Obstructive Cardiomyopathy, Mitral Regurgitation,
Diverticulitis, Hypothyroidism, TIA after cath [**2130**], C. Diff
[**2130**], Tonsillectomy, s/p Hysterectomy

MEDICATION ON ADMISSION: Toprol 50mg [**Hospital1 **], Verapamil 240mg qd, Pravastatin 40mg qd,
Synthroid 50mcg qd, Fish Oil 1000mg qd, Calcium 600mg [**Hospital1 **], MVI
qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: No acute distress
Skin: Warm, dry, unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear lungs
Heart: Regular, rate and rhythm, -murmur
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

FAMILY HISTORY: 2 sisters heart problems
2 brothers with valve replacement

SOCIAL HISTORY: Married, lives in [**State 1727**] with husband. [**Name (NI) **] tobacco, EtOH, drug
use.
Acute posthemorrhagic anemia,Diverticulitis of colon (without mention of hemorrhage),Mitral valve disorders,Unspecified acquired hypothyroidism,Long-term (current) use of aspirin,Personal history of venous thrombosis and embolism
Ac posthemorrhag anemia,Dvrtcli colon w/o hmrhg,Mitral valve disorder,Hypothyroidism NOS,Long-term use of aspirin,Hx-ven thrombosis/embols
Admission Date:  [**2132-2-18**]              Discharge Date:   [**2132-2-23**]

Date of Birth:  [**2061-2-24**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest pain and dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2132-2-18**] Septal Myomectomy

History of Present Illness:
70 year old female with known Hypertrophic Obstructive
Cardiomyopathy  and mitral regurgitation with recent complaints
of chest pain and dyspnea.  She was referred for surgical
evaluation

Past Medical History:
Hypertrophic Obstructive Cardiomyopathy, Mitral Regurgitation,
Diverticulitis, Hypothyroidism, TIA after cath [**2130**], C. Diff
[**2130**], Tonsillectomy, s/p Hysterectomy

Social History:
Married, lives in [**State 1727**] with husband. [**Name (NI) **] tobacco, EtOH, drug
use.

Family History:
2 sisters heart problems
2 brothers with valve replacement

Physical Exam:
Gen: No acute distress
Skin: Warm, dry, unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear lungs
Heart: Regular, rate and rhythm, -murmur
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

Pertinent Results:
[**2132-2-18**] Echo: PREBYPASS: No atrial septal defect is seen by 2D or
color Doppler. Right ventricular chamber size and free wall
motion are normal. There are simple atheroma in the descending
thoracic aorta. The aortic valve leaflets are mildly thickened.
Trace aortic regurgitation is seen. The mitral valve leaflets
are mildly thickened. The mitral valve leaflets are elongated.
After induction no [**Male First Name (un) **] was visualized but after reverse
Trendelenburg and Valsalva systolic anterior motion of the
mitral valve leaflets with at least moderate (2+) posteriorly
directed MR [**First Name (Titles) **] [**Last Name (Titles) 72056**] in the LVOT is visualized. Due to the
eccentric nature of the regurgitant jet, its severity may be
significantly underestimated (Coanda effect). There is left
ventricular hypertrophy. Overall biventricular systolic function
is normal POST BYPASS: There is preserved biventricular systolic
function. At rest minimal [**Male First Name (un) **] and MR is present immediately post
bypass, however [**Male First Name (un) **] and significant MR [**First Name (Titles) **] [**Last Name (Titles) 72057**] by
Valsalva. After filling patient with volume to a CVP -14 and PA
29/14 [**Male First Name (un) **] and MR decreased but was still present. An accurate
LVOT gradient was not obtainable.

[**2132-2-18**] 10:10AM BLOOD WBC-6.9 RBC-2.57*# Hgb-8.6*# Hct-23.9*#
MCV-93 MCH-33.4* MCHC-36.0* RDW-12.8 Plt Ct-158
[**2132-2-20**] 06:05AM BLOOD WBC-10.8 RBC-2.62* Hgb-8.8* Hct-25.0*
MCV-95 MCH-33.4* MCHC-35.0 RDW-13.2 Plt Ct-129*
[**2132-2-18**] 10:10AM BLOOD PT-16.0* PTT-36.4* INR(PT)-1.4*
[**2132-2-18**] 11:38AM BLOOD UreaN-11 Creat-0.7 Cl-113* HCO3-25
[**2132-2-20**] 06:05AM BLOOD Glucose-114* UreaN-11 Creat-0.7 Na-137
K-4.2 Cl-103 HCO3-28 AnGap-10

Brief Hospital Course:
Admitted and went to the operating room for septal myomectomy.
Please see operative report for surgical details. She received
cefazolin for perioperative antibiotics.  She was transferred to
the the intensive care unit for invasive monitoring. In the
first twenty four hours she  was weaned from sedation, awoke
neurologically intact and was extubated without complications.
On post operative day one she was transferred to the telemetry
floor for the remainder of care.  Physical therapy worked with
her on strength and mobility.  On post operative day four her
hematocrit dropped from 23 to 22, postoperative anemia and she
was transfused with blood.  Her hct increased to 29 post
transfusion.  She remained hemodynamically stable and was ready
for discharge with service on post operative day five with the
plan that she would be staying with her daughter until after her
wound check.

Sternal incision with mild erythema at distal end and no
drainage
Weight on discharge 78 preop 75, edema +1 lower extremities

Medications on Admission:
Toprol 50mg [**Hospital1 **], Verapamil 240mg qd, Pravastatin 40mg qd,
Synthroid 50mcg qd, Fish Oil 1000mg qd, Calcium 600mg [**Hospital1 **], MVI
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:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Percocet 2.5-325 mg Tablet Sig: 1-2 Tablets PO every [**4-21**]
hours as needed for pain: if ultram not effective .
Disp:*20 Tablet(s)* Refills:*0*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day:
please take twice a day for 1 week and then decrease to once
daily and follow up with cardiologist within the next 2-3 weeks
.
Disp:*37 Tablet(s)* Refills:*0*
7. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours):
take with lasix twice daily for 7 days then decrease to daily -
discontinue when lasix is stopped .
Disp:*37 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
9. Pravastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
10. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*
11. Calcium 500 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*
12. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Hypertrophic Obstructive Cardiomyopathy s/p Septal Myomectomy
Mitral Regurgitation
Diverticulitis
Hypothyroidism
TIA


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 check friday [**2-29**] at [**Hospital Ward Name 121**] 6 [**Telephone/Fax (1) 3071**]
Please call to schedule appointments
Dr. [**Last Name (STitle) **] in 1 month [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) **] in [**2-19**] weeks
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 72058**] in [**1-18**] weeks [**Telephone/Fax (1) 72059**]



Completed by:[**2132-2-24**]
{'Acute posthemorrhagic anemia,Diverticulitis of colon (without mention of hemorrhage),Mitral valve disorders,Unspecified acquired hypothyroidism,Long-term (current) use of aspirin,Personal history of venous thrombosis and embolism'}


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 and dyspnea on exertion

PRESENT ILLNESS: 70 year old female with known Hypertrophic Obstructive
Cardiomyopathy  and mitral regurgitation with recent complaints
of chest pain and dyspnea.  She was referred for surgical
evaluation

MEDICAL HISTORY: Hypertrophic Obstructive Cardiomyopathy, Mitral Regurgitation,
Diverticulitis, Hypothyroidism, TIA after cath [**2130**], C. Diff
[**2130**], Tonsillectomy, s/p Hysterectomy

MEDICATION ON ADMISSION: Toprol 50mg [**Hospital1 **], Verapamil 240mg qd, Pravastatin 40mg qd,
Synthroid 50mcg qd, Fish Oil 1000mg qd, Calcium 600mg [**Hospital1 **], MVI
qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: No acute distress
Skin: Warm, dry, unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear lungs
Heart: Regular, rate and rhythm, -murmur
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

FAMILY HISTORY: 2 sisters heart problems
2 brothers with valve replacement

SOCIAL HISTORY: Married, lives in [**State 1727**] with husband. [**Name (NI) **] tobacco, EtOH, drug
use. 

### Response:
{'Acute posthemorrhagic anemia,Diverticulitis of colon (without mention of hemorrhage),Mitral valve disorders,Unspecified acquired hypothyroidism,Long-term (current) use of aspirin,Personal history of venous thrombosis and embolism'}
