CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 79 year old gentleman with a history of mitral and tricuspid
regurgitation followed by serial echocardiogram. He recently
became quite symptomatic with dyspnea on exertion. An echo was
obtained which showed severe mitral regurgitation with mild left
ventricular dilatation. Given the progression of his symptoms
and
severity of his disease, he has been referred for surgical
management.

MEDICAL HISTORY: MR/TR
- Chronic Atrial fibrillation
- Mild Dementia, Memory Loss
- History of Gout
- Hypertension
- Prostatism
- Hemorrhoids
Past Surgical History:
- s/p TURP
- Nasal Polyps

MEDICATION ON ADMISSION: ***Coumadin 2.5mg MWF and 5mg on Tu/TH/S/S.***Last dose=[**2124-7-16**]
Benicar 40mg daily
Digoxin 0.25mg daily
Colchicine 0.6mg daily
Aricept 10mg daily
Namenda 10mg twice daily
Lasix 40mg daily
Norvasc 5mg daily
Fexofenadine prn

ALLERGIES: Aspirin / Prednisone / Amoxicillin

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: Family History: Denies premature coronary disease

SOCIAL HISTORY: Race: caucasian
Last Dental Exam: full dentures
Lives with: wife
Occupation: retired teacher/football coach
Tobacco: Denies-occ.pipe smoking in past
ETOH: Denies
Mitral valve disorders,Rupture of chordae tendineae,Atrial fibrillation,Diseases of tricuspid valve,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Leukocytosis, unspecified
Mitral valve disorder,Chordae tendinae rupture,Atrial fibrillation,Tricuspid valve disease,BPH NOS w/o ur obs/LUTS,Hypertension NOS,Mental disor NEC oth dis,Leukocytosis NOS
Admission Date:  [**2124-7-20**]              Discharge Date:   [**2124-7-25**]

Date of Birth:  [**2044-9-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Aspirin / Prednisone / Amoxicillin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Shortness of breath


Major Surgical or Invasive Procedure:
-status post Mitral Valve Repair (#30mm CE Physio II ring)
 and resect P1 flail leaflet-[**2124-7-21**]


History of Present Illness:
79 year old gentleman with a history of mitral and tricuspid
regurgitation followed by serial echocardiogram. He recently
became quite symptomatic with dyspnea on exertion. An echo was
obtained which showed severe mitral regurgitation with mild left
ventricular dilatation. Given the progression of his symptoms
and
severity of his disease, he has been referred for surgical
management.


Past Medical History:
MR/TR
- Chronic Atrial fibrillation
- Mild Dementia, Memory Loss
- History of Gout
- Hypertension
- Prostatism
- Hemorrhoids
Past Surgical History:
- s/p TURP
- Nasal Polyps

Social History:
Race: caucasian
Last Dental Exam: full dentures
Lives with: wife
Occupation: retired teacher/football coach
Tobacco: Denies-occ.pipe smoking in past
ETOH: Denies

Family History:
Family History: Denies premature coronary disease


Physical Exam:
Admission Physical Exam

Pulse: 92 Resp: 18 O2 sat: 94% RA
B/P  Right: 163/86    Ht=5'[**24**].5"   wt=97.1 Kg

General: Elderly male, no acute distress
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x] - no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur - holosystolic murmur best
heard at left lower sternal border
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema trace
Varicosities: None [x]
Neuro: Grossly intact
Pulses:
Femoral   Right: 2  Left: 2
DP           Right: 1  Left: 1
PT           [**Name (NI) 167**]:   Left:
Radial       Right: 2  Left: 2

Carotid Bruit        Right: none   Left: none




Pertinent Results:
[**2124-7-25**] 04:45AM BLOOD WBC-11.3* RBC-3.87* Hgb-10.9* Hct-34.3*
MCV-88 MCH-28.2 MCHC-31.9 RDW-15.2 Plt Ct-162
[**2124-7-20**] 03:55PM BLOOD WBC-9.8 RBC-5.04 Hgb-14.2 Hct-42.5 MCV-84
MCH-28.2 MCHC-33.4 RDW-15.5 Plt Ct-228
[**2124-7-25**] 04:45AM BLOOD PT-13.1 INR(PT)-1.1
[**2124-7-20**] 03:55PM BLOOD PT-13.9* PTT-29.4 INR(PT)-1.2*
[**2124-7-25**] 04:45AM BLOOD Glucose-106* UreaN-35* Creat-1.4* Na-144
K-3.9 Cl-106 HCO3-31 AnGap-11
[**2124-7-20**] 03:55PM BLOOD Glucose-96 UreaN-20 Creat-1.1 Na-143
K-3.6 Cl-103 HCO3-32 AnGap-12
[**2124-7-20**] 03:55PM BLOOD ALT-16 AST-20 LD(LDH)-188 AlkPhos-92
TotBili-0.6


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 85152**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 85153**] (Complete)
Done [**2124-7-21**] at 9:16:04 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2044-9-14**]
Age (years): 79 M  Hgt (in): 71
BP (mm Hg): 142/78  Wgt (lb): 213
HR (bpm): 71  BSA (m2): 2.17 m2
Indication: Atrial fibrillation. Mitral valve disease. Shortness
of breath.
ICD-9 Codes: 786.05, 424.0, 424.2
Test Information
Date/Time: [**2124-7-21**] at 09:16    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 168**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW001-0:00 Machine: ie33
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *6.8 cm  <= 4.0 cm
Aorta - Ascending:  *3.5 cm  <= 3.4 cm

Findings
LEFT ATRIUM: Marked LA enlargement. No spontaneous echo contrast
or thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. Normal
interatrial septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Mildly dilated LV cavity. Overall normal LVEF
(>55%). [Intrinsic LV systolic function likely depressed given
the severity of valvular regurgitation.]

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Simple
atheroma in aortic arch. Normal descending aorta diameter.
Simple atheroma in descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
mitral annular calcification. Torn mitral chordae. Moderate to
severe (3+) MR. [**Name13 (STitle) 15110**] to the eccentric MR jet, its severity may be
underestimated (Coanda effect).

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
PREBYPASS The left atrium is markedly dilated. No spontaneous
echo contrast or thrombus is seen in the body of the left atrium
or left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler. The left ventricular cavity is mildly dilated.
Overall left ventricular systolic function is normal (LVEF>55%).
[Intrinsic left ventricular systolic function is likely more
depressed given the severity of valvular regurgitation.] Right
ventricular chamber size and free wall motion are normal. There
are simple atheroma in the aortic arch. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve leaflets
are mildly thickened. Torn mitral chordae are present. Moderate
to severe (3+) mitral regurgitation is seen. Due to the
eccentric nature of the regurgitant jet, its severity may be
significantly underestimated (Coanda effect). There is no
pericardial effusion.

POSTBYPASS The patient is not receiving inotropic support
post-CPB. There in no mitral regurgitation. An annuloplasty ring
is well-seated in the mitral position. The peak transmitral
gradient is 4 mm Hg at a cardiac output of 5.1 L/min.
Biventricular systolic function is preserved and all other
findings are consistent with pre-bypass findings. The aorta is
intact post-decannulation. All findings were discussed with the
surgeon intraoperatively.

PRELIMINARY REPORT developed by a Cardiology Fellow. Not
reviewed/approved by the Attending Echo Physician.
  [**Name Initial (NameIs) **] certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD, Interpreting
physician


?????? [**2117**] CareGroup IS. All rights reserved.


Brief Hospital Course:
Mr.[**Known lastname **] was admitted to the hospital the day prior for surgery
for Heparin bridge and groin ultrasound to evaluate for AV
fistula at cath site. Vascular was consulted for assessment of
his right groin hematoma and no intervention was required. He
was brought to the operating room on [**2124-7-21**] where he  underwent
 Mitral Valve repair (#30mm CE Physio II ring/resection of P1
flail)with Dr.[**Last Name (STitle) **]. Please see Dr[**Last Name (STitle) **] operative report
for further details. Overall the patient tolerated the procedure
well and post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring. POD 1 found the
patient extubated, alert and oriented and breathing comfortably.
 The patient was neurologically intact, at his baseline mildly
demented, and hemodynamically stable on no inotropic or
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.  The patient
was transferred to the telemetry floor for further recovery.
Chest tubes and pacing wires were discontinued without
complication.  The patient was evaluated by the physical therapy
service for assistance with strength and mobility.  By the time
of discharge on POD #4 the patient was ambulating freely, the
wound was healing and pain was controlled with oral analgesics.
The patient was discharged to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Nursing Care
Rehabilitation in good condition with appropriate follow up
instructions.

Medications on Admission:
***Coumadin 2.5mg MWF and 5mg on Tu/TH/S/S.***Last dose=[**2124-7-16**]
Benicar 40mg daily
Digoxin 0.25mg daily
Colchicine 0.6mg daily
Aricept 10mg daily
Namenda 10mg twice daily
Lasix 40mg daily
Norvasc 5mg daily
Fexofenadine prn


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
3. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
9. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheeze.
10. Insulin Lispro 100 unit/mL Solution Sig: One (1)
Subcutaneous ASDIR (AS DIRECTED).
11. Warfarin 5 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for
1 doses.
12. Warfarin 1 mg Tablet Sig: MD to dose Tablet PO Once Daily at
4 PM: **INR goal =2-2.5 for Atrial Fibrillation.


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Nursing Care - [**Location (un) 6981**]

Discharge Diagnosis:
-mitral and tricuspid regurgitation
-status post Mitral Valve Repair (#30mm CE Physio II
ring)-[**2124-7-21**]
Chronic Atrial fibrillation
- Mild Dementia, Memory Loss
- History of Gout
- Hypertension
- Prostatism
- Hemorrhoids
Past Surgical History:
- s/p TURP
- Nasal Polyps


Discharge Condition:
Alert and oriented x2-3,(baseline)dementia nonfocal.
Ambulating with  steady gait.

Incisional pain managed with Ultram/Tylenol as needed

Incisions: Clean, dry, intact

Sternal - healing well, no erythema or drainage


Discharge Instructions:
Shower daily including washing incisions gently with mild soap,
no baths or swimming until cleared by surgeon. Look at your
incisions daily for redness or drainage.

No lotions, cream, powder, or ointments to incisions.
Each morning you should weigh yourself and then in the evening
take your temperature, These should be written down on the chart
.
No driving for approximately one month, until follow up with
surgeon.
No lifting more than 10 pounds for 10 weeks.
Please call with any questions or concerns ([**Telephone/Fax (1) 170**]).
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge of sternal wound.



**Please call cardiac surgery office with any questions or
concerns ([**Telephone/Fax (1) 170**]). Answering service will contact on call
person during off hours.**


Followup Instructions:
You are scheduled for the following appointments

Surgeon:Dr.[**Last Name (STitle) **] #[**Telephone/Fax (1) 170**], appointment for  Thursday,
[**8-24**], at 1:15pm

Please call to schedule appointments with your
Primary Care: Dr.[**Last Name (STitle) 3390**]: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 78085**] in [**2-12**] weeks
Cardiologist:[**Last Name (LF) **],[**First Name3 (LF) 198**] [**Telephone/Fax (1) 14525**] in [**2-12**] weeks



**Please call cardiac surgery office with any questions or
concerns ([**Telephone/Fax (1) 170**]). Answering service will contact on call
person during off hours.**



Labs: PT/INR for Coumadin ?????? indication= chronic Atrial
Fibrillation

Goal INR: 2.0-2.5

First draw:[**2124-7-26**]



Completed by:[**2124-7-25**]
{'Mitral valve disorders,Rupture of chordae tendineae,Atrial fibrillation,Diseases of tricuspid valve,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Leukocytosis, unspecified'}


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: Shortness of breath

PRESENT ILLNESS: 79 year old gentleman with a history of mitral and tricuspid
regurgitation followed by serial echocardiogram. He recently
became quite symptomatic with dyspnea on exertion. An echo was
obtained which showed severe mitral regurgitation with mild left
ventricular dilatation. Given the progression of his symptoms
and
severity of his disease, he has been referred for surgical
management.

MEDICAL HISTORY: MR/TR
- Chronic Atrial fibrillation
- Mild Dementia, Memory Loss
- History of Gout
- Hypertension
- Prostatism
- Hemorrhoids
Past Surgical History:
- s/p TURP
- Nasal Polyps

MEDICATION ON ADMISSION: ***Coumadin 2.5mg MWF and 5mg on Tu/TH/S/S.***Last dose=[**2124-7-16**]
Benicar 40mg daily
Digoxin 0.25mg daily
Colchicine 0.6mg daily
Aricept 10mg daily
Namenda 10mg twice daily
Lasix 40mg daily
Norvasc 5mg daily
Fexofenadine prn

ALLERGIES: Aspirin / Prednisone / Amoxicillin

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: Family History: Denies premature coronary disease

SOCIAL HISTORY: Race: caucasian
Last Dental Exam: full dentures
Lives with: wife
Occupation: retired teacher/football coach
Tobacco: Denies-occ.pipe smoking in past
ETOH: Denies 

### Response:
{'Mitral valve disorders,Rupture of chordae tendineae,Atrial fibrillation,Diseases of tricuspid valve,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Leukocytosis, unspecified'}
