CHIEF COMPLAINT: DOE x several months

PRESENT ILLNESS: This is a 61 yo female s/p CABG x 3 adn MVR on [**2184-4-27**] with nes
complaints od dyspnea on exertion.   Finding of new murmur by
PCP and echo finding 4+ MR.

MEDICAL HISTORY: MI [**4-4**]
CAD/MR
ischemia and valvular cardiomyopathy
LV systolic dysfunction
^ lipids
HTN
S/P CABG x 3 and MV repair in [**4-4**]

MEDICATION ON ADMISSION: lopressor 50 [**Hospital1 **]
lipitor 80 daily
aspirin 325 daily
plavix 75 daily
zestril 2.5 daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On presentation:
VS HR 84 regular, BP 124/66.  Ht 5'8"  Wt 200#
General: Appears stated age in NAD -- anxious.  Skin: Warm, dry,
+ rash on left knee.  Neck: supple, no JVD, no lymphadenopathy.
Chest: CTA bilat.  CV: RRR.  S1S2 with II/VI murmur in apex.
Abd: NT. ND, + BS.  Extremities: No varicosities.  Neuro: CN
II-XII intact.  A+O x 3.

FAMILY HISTORY: No known CAD

SOCIAL HISTORY: Lives alone in [**Location (un) 47**], MA.  Works in real estate.  + 80 pk
year tob hx -- quit 1.5 years ago.
Mechanical complication due to heart valve prosthesis,Iatrogenic pneumothorax,Other primary cardiomyopathies,Congestive heart failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery
Malfunc prosth hrt valve,Iatrogenic pneumothorax,Prim cardiomyopathy NEC,CHF NOS,Mitral valve disorder,Hypertension NOS,Pure hypercholesterolem,Status-post ptca,Crnry athrscl natve vssl
Admission Date:  [**2184-10-11**]              Discharge Date:   [**2184-10-27**]

Date of Birth:  [**2123-2-22**]             Sex:   M

Service: CSURG

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
DOE x several months

Major Surgical or Invasive Procedure:
redo MVR


History of Present Illness:
This is a 61 yo female s/p CABG x 3 adn MVR on [**2184-4-27**] with nes
complaints od dyspnea on exertion.   Finding of new murmur by
PCP and echo finding 4+ MR.

Past Medical History:
MI [**4-4**]
CAD/MR
ischemia and valvular cardiomyopathy
LV systolic dysfunction
^ lipids
HTN
S/P CABG x 3 and MV repair in [**4-4**]

Social History:
Lives alone in [**Location (un) 47**], MA.  Works in real estate.  + 80 pk
year tob hx -- quit 1.5 years ago.

Family History:
No known CAD

Physical Exam:
On presentation:
VS HR 84 regular, BP 124/66.  Ht 5'8"  Wt 200#
General: Appears stated age in NAD -- anxious.  Skin: Warm, dry,
+ rash on left knee.  Neck: supple, no JVD, no lymphadenopathy.
Chest: CTA bilat.  CV: RRR.  S1S2 with II/VI murmur in apex.
Abd: NT. ND, + BS.  Extremities: No varicosities.  Neuro: CN
II-XII intact.  A+O x 3.

Pertinent Results:
[**2184-10-11**] 11:05PM   WBC-15.3*# RBC-3.51* HGB-10.0*# HCT-30.2*
MCV-86 MCH-28.6 MCHC-33.3 RDW-14.0
[**2184-10-11**] 11:05PM   PLT COUNT-299
[**2184-10-11**] 11:05PM   PT-14.1* PTT-32.4 INR(PT)-1.2
[**2184-10-11**] 06:20PM   UREA N-15 CREAT-0.7 CHLORIDE-111* TOTAL
CO2-23

[**2184-10-25**] 09:30AM BLOOD WBC-11.2* RBC-3.58* Hgb-10.6* Hct-31.9*
MCV-89 MCH-29.5 MCHC-33.1 RDW-14.8 Plt Ct-676*#
[**2184-10-25**] 09:30AM BLOOD Plt Ct-676*#
[**2184-10-25**] 09:30AM BLOOD Glucose-204* UreaN-13 Creat-0.7 Na-137
K-4.8 Cl-100 HCO3-28 AnGap-14

Brief Hospital Course:
Mr [**Known lastname 55627**] was admitted on [**2184-10-11**].  He proceeded to the OR
and underwent a redo MVR with a 29mm mosiac porcine heart valve
via right thoracotomy.  Total cardio-pulmonary bypass time was
85 minutes.  There was no cross clamp time as this operation was
done with a bleeding heart approach.
He was tranferred to the ICU in NSR rate 98, MAP 62, CVP 8, on
neosynephrine, milrinone, insulin, and propofol drips.

He was extubated on the evening of his operative day without any
complications.  His IV medications were weaned and both the
milrinone and the neosynephrine being discontinued on the AM of
POD 2.

He had some post-op tachycardia for which is lopressor dose was
increased and ace inhibitor adjusted.  He was also followed by
the cradiology team and their recommendations were followed.

His chest tubes remained in longer than is typical because of
ongoing drainage.  On POD 3 he was noted to have crepitus in his
right check and upper chest.  His chest tubes x 3 remained on
suction with an air leak. On [**10-18**] (POD 7) the chest tubes were
put to water seal with a subsequent CXR showing a small
pneumthorax and they were again put to suction.  A persistent
pneumothorax remined and on [**10-21**] (POD 9) a thoracic consult was
obtained with rcommendations for doxycycline sclerosis.  The
chest tube was eft to water seal with an ongoing leak but
minimal drainage.  The chest tube was clamped for a 24-hour
period  without any respiratory distress and was eventually
discontinued on [**10-26**] (POD 15) per the recommendations of the
thoracic surgery team.

Mr. [**Name14 (STitle) 55628**] was followed by the physical therapy team
throughout his hospital stay with initial evaluation on POD 2
and on POD 7 he was found to be for for home.

On [**10-27**] POD he was found to be safe for discharge home.


Medications on Admission:
lopressor 50 [**Hospital1 **]
lipitor 80 daily
aspirin 325 daily
plavix 75 daily
zestril 2.5 daily

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. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD ().
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO QD
().
Disp:*60 Tablet(s)* Refills:*2*
4. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO QD
().
Disp:*30 Tablet(s)* Refills:*2*
5. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO every six (6)
hours: Take with food.
Disp:*120 Tablet(s)* Refills:*2*
6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO QD ().
Disp:*15 Tablet(s)* Refills:*2*
8. Oxycodone HCl 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every
4 to 6 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
9. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
10. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Hospice and VNA

Discharge Diagnosis:
s/p redo MVR (#29 Mosaic porcine) vis right thoracotomy
HTN, ^ chol, cardiomyopathy, s/p MVR/CABG '[**84**]
persistent right pneumothorax

Discharge Condition:
good

Discharge Instructions:
keep wounds clean and dry. OK to shower, no bathing or swimming.
Take all medications as prescribed
call for any fever, redness or drainage from wound

Followup Instructions:
Dr [**Last Name (STitle) 349**] in [**2-3**] wks
Dr [**Last Name (STitle) 27117**] in [**2-3**] wks
Dr [**Last Name (STitle) **] in 4 wks



Completed by:[**2184-10-27**]
{'Mechanical complication due to heart valve prosthesis,Iatrogenic pneumothorax,Other primary cardiomyopathies,Congestive heart failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery'}


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: DOE x several months

PRESENT ILLNESS: This is a 61 yo female s/p CABG x 3 adn MVR on [**2184-4-27**] with nes
complaints od dyspnea on exertion.   Finding of new murmur by
PCP and echo finding 4+ MR.

MEDICAL HISTORY: MI [**4-4**]
CAD/MR
ischemia and valvular cardiomyopathy
LV systolic dysfunction
^ lipids
HTN
S/P CABG x 3 and MV repair in [**4-4**]

MEDICATION ON ADMISSION: lopressor 50 [**Hospital1 **]
lipitor 80 daily
aspirin 325 daily
plavix 75 daily
zestril 2.5 daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On presentation:
VS HR 84 regular, BP 124/66.  Ht 5'8"  Wt 200#
General: Appears stated age in NAD -- anxious.  Skin: Warm, dry,
+ rash on left knee.  Neck: supple, no JVD, no lymphadenopathy.
Chest: CTA bilat.  CV: RRR.  S1S2 with II/VI murmur in apex.
Abd: NT. ND, + BS.  Extremities: No varicosities.  Neuro: CN
II-XII intact.  A+O x 3.

FAMILY HISTORY: No known CAD

SOCIAL HISTORY: Lives alone in [**Location (un) 47**], MA.  Works in real estate.  + 80 pk
year tob hx -- quit 1.5 years ago. 

### Response:
{'Mechanical complication due to heart valve prosthesis,Iatrogenic pneumothorax,Other primary cardiomyopathies,Congestive heart failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery'}
