CHIEF COMPLAINT: Asymptomatic

PRESENT ILLNESS: 64 year old female who was found to have a new heart murmur on
physical exam in [**Month (only) 1096**]. An echocardiogram was performed which
revealed severe posterior leaflet mitral valve regurgitation.
She was referred to Dr. [**Last Name (STitle) 1655**] who performed a cardiac
catheterization which showed no significant coronary artery
disease however it confirmed severe mitral regurgitation noting
severe pulmonary hypertension. Given the severity of her mitral
valve disease, she has been referred for surgery. She presents
today for pre-admission testing prior to surgery.

MEDICAL HISTORY: Mitral regurgitation
Migraine headaches
Arthritis
Tubal ligation
Periodontal surgery

MEDICATION ON ADMISSION: Nadolol 20mg daily
Imitrex
Vitamins
Calcium

ALLERGIES: environmental

PHYSICAL EXAM: Pulse: 62 O2 sat: 98%
B/P  Left: 137/80
Height: 5'3"    Weight: 126lbs

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Recently, undergoing extractions
Lives with: Widowed x3 years. 2 Children. Lives in [**Location 47**].
Occupation: Admistrative Assistant
Tobacco: [**2-15**] ppd quit in [**2098**]
ETOH: None
Mitral valve disorders,Rupture of chordae tendineae,Ostium secundum type atrial septal defect,Other chronic pulmonary heart diseases,Atrial fibrillation,Cardiac complications, not elsewhere classified,Cardiac rhythm regulators causing adverse effects in therapeutic use,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus
Mitral valve disorder,Chordae tendinae rupture,Secundum atrial sept def,Chr pulmon heart dis NEC,Atrial fibrillation,Surg compl-heart,Adv eff card rhyth regul,Migrne unsp wo ntrc mgrn
Admission Date:  [**2133-4-8**]              Discharge Date:   [**2133-4-12**]

Date of Birth:  [**2068-5-1**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
environmental

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Asymptomatic

Major Surgical or Invasive Procedure:
[**2133-4-8**] Mitral Valve Repair, PFO closure

History of Present Illness:
64 year old female who was found to have a new heart murmur on
physical exam in [**Month (only) 1096**]. An echocardiogram was performed which
revealed severe posterior leaflet mitral valve regurgitation.
She was referred to Dr. [**Last Name (STitle) 1655**] who performed a cardiac
catheterization which showed no significant coronary artery
disease however it confirmed severe mitral regurgitation noting
severe pulmonary hypertension. Given the severity of her mitral
valve disease, she has been referred for surgery. She presents
today for pre-admission testing prior to surgery.

Past Medical History:
Mitral regurgitation
Migraine headaches
Arthritis
Tubal ligation
Periodontal surgery

Social History:
Race: Caucasian
Last Dental Exam: Recently, undergoing extractions
Lives with: Widowed x3 years. 2 Children. Lives in [**Location 47**].
Occupation: Admistrative Assistant
Tobacco: [**2-15**] ppd quit in [**2098**]
ETOH: None

Family History:
Noncontributory

Physical Exam:
Pulse: 62 O2 sat: 98%
B/P  Left: 137/80
Height: 5'3"    Weight: 126lbs

General: NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck: Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular [] Murmur 4/6 SEM radiating to
carotids
Abdomen: Soft [x] non-distended [x] non-tender [x]+ BS [x]
Extremities: Warm [x], well-perfused [x] Edema: none
Varicosities: None [x]
Neuro: Grossly intact- nonfocal exam
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit- referred murmur

Pertinent Results:
[**4-8**] Echo: Pre Bypass: The left atrium is mildly dilated. No
mass/thrombus is seen in the left atrium or left atrial
appendage. A patent foramen ovale is present. A left-to-right
shunt across the interatrial septum is seen at rest. Left
ventricular wall thicknesses are normal. The left ventricular
cavity size is normal. Regional left ventricular wall motion is
normal. [Intrinsic left ventricular systolic function is likely
more depressed given the severity of valvular regurgitation.]
The ascending aorta is mildly dilated and the st junction
appears partially effaced. There are three aortic valve
leaflets. There is no aortic valve stenosis. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are myxomatous.
There is partial Posterior mitral leaflet flail of P2 and
possibly part of P3 with a torn chordae seen. An eccentric,
anteriorly directed jet of 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).
Post Bypass: Patient is in sinus rhythm on phenylepherine
infusion. There is a partial annuloplasty ring on the mitral
valve, which is also status post partial posterior leaflet
resection. There is trace/minimal mitral regurgitation. Peak
mitral gradients 4, mean 1 mm Hg. AI remains mild. TR remains
mild. PFO is now has tiny flow from left to right s/p closure.
LVEF 50-55%. Aortic contours intact. Remaining exam is
unchanged. All findings discussed with surgeons at the time of
the exam.
[**2133-4-12**] 06:35AM BLOOD WBC-5.2 RBC-2.82* Hgb-9.2* Hct-26.7*
MCV-95 MCH-32.7* MCHC-34.6 RDW-14.2 Plt Ct-103*
[**2133-4-8**] 01:43PM BLOOD WBC-8.1 RBC-2.14*# Hgb-6.9*# Hct-20.2*#
MCV-94 MCH-32.1* MCHC-34.1 RDW-14.1 Plt Ct-94*#
[**2133-4-12**] 06:35AM BLOOD PT-20.4* INR(PT)-1.9*
[**2133-4-8**] 01:43PM BLOOD PT-15.3* PTT-36.6* INR(PT)-1.3*
[**2133-4-12**] 06:35AM BLOOD UreaN-8 Creat-0.5 Na-138 K-3.5 Cl-102
[**2133-4-8**] 02:55PM BLOOD UreaN-10 Creat-0.4 Na-141 K-4.1 Cl-118*
HCO3-20* AnGap-7*

Brief Hospital Course:
Ms. [**Known lastname **] was a same day admit after undergoing pre-operative
work-up as an outpatient. On [**4-8**] she was brought to the
operating room where she underwent a Mitral valve repair with a
triangular resection of the middle scallop of the posterior
leaflet/Mitral valve annuloplasty with a 28 mm Physio II ring/
Closure of PFO with Dr.[**Last Name (STitle) **]. Please refer to operative report
for further details.She tolerated the procedure well and was
transferred to the CVICU for further invasive monitoring in
stable condition. Within 24 hours she was weaned from sedation,
awoke neurologically intact and extubated. Beta blockade and
aspirin were resumed. All lines and drains were discontinued in
a timely fashion. She was gently diuresed towards her
preoperative weight. She continued to progress and was
transferred to the step down unit for further monitoring on
POD#1. The physical therapy service was consulted for assistance
with her postoperative strength and mobility. On POD#2 she went
into postoperative atrial fibrillation. She was administered
Amiodarone and became bradycardic. Amiodarone was discontinued
and her home medication, Nadolol, was resumed. Her atrial
fibrillation was rate controlled and she was asymptomatic. After
24 hours of remaining in Atrial fibrillation anticoagulation was
initiated with Coumadin.  She continued to make steady progress
and was discharged home on postoperative day #4. All follow up
appoinments were advised.

Medications on Admission:
Nadolol 20mg daily
Imitrex
Vitamins
Calcium

Discharge Medications:
1. furosemide 20 mg [**Last Name (STitle) 8426**] Sig: One (1) [**Last Name (STitle) 8426**] PO once a day for
5 days.
Disp:*5 [**Last Name (STitle) 8426**](s)* Refills:*0*
2. potassium chloride 10 mEq [**Last Name (STitle) 8426**] Extended Release Sig: Two
(2) [**Last Name (STitle) 8426**] Extended Release PO once a day for 5 days.
Disp:*10 [**Last Name (STitle) 8426**] Extended Release(s)* Refills:*0*
3. aspirin 81 mg [**Last Name (STitle) 8426**], Delayed Release (E.C.) Sig: One (1)
[**Last Name (STitle) 8426**], Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 [**Last Name (STitle) 8426**], Delayed Release (E.C.)(s)* Refills:*2*
4. ranitidine HCl 150 mg [**Last Name (STitle) 8426**] Sig: One (1) [**Last Name (STitle) 8426**] PO BID (2
times a day).
Disp:*60 [**Last Name (STitle) 8426**](s)* Refills:*2*
5. warfarin 1 mg [**Last Name (STitle) 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] Once Daily at 4
PM: INR goal =[**3-19**] for postop Atrial Fibrillation.
Disp:*90 [**Month/Day (3) 8426**](s)* Refills:*2*
6. warfarin 2.5 mg [**Month/Day (3) 8426**] Sig: One (1) [**Month/Day (3) 8426**] PO once a day for
2 days: 2.5 mg po today [**2133-4-12**] and 1 tab po [**2133-4-13**] .
Disp:*2 [**Month/Day/Year 8426**](s)* Refills:*0*
7. nadolol 20 mg [**Month/Day/Year 8426**] Sig: Two (2) [**Month/Day/Year 8426**] PO DAILY (Daily).
8. oxycodone-acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed for pain.
Disp:*qs ML(s)* Refills:*0*
9. potassium chloride 20 mEq [**Month/Day/Year 8426**], ER Particles/Crystals Sig:
One (1) [**Month/Day/Year 8426**], ER Particles/Crystals PO once a day for 5 days.
Disp:*5 [**Month/Day/Year 8426**], ER Particles/Crystals(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
Mitral regurgitation and PFO s/p Mitral Valve repair and PFO
closure

Past medical history:
Migraine headaches
Athritis
s/p Tubal ligation
s/p Periodontal surgery

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesia
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema


Discharge Instructions:
Please 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
Please 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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
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
**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**], office will call you to
arrange follow up appointment at MWMC
Cardiologist: Dr. [**Last Name (STitle) 1655**] #[**Telephone/Fax (1) 6256**] -office will call you to
arrange follow up appointment

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 349**] in [**5-19**] 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**

[**Hospital 197**] Clinic at MWMC to be arranged for INR/Coumadin dosing
INR 1st draw by VNA on Tues:[**2133-4-14**], Please call INR results to
[**Hospital 88272**] [**Hospital 197**] Clinic# main number= [**Telephone/Fax (1) 6256**]
INR goal [**3-19**]
Indication: postoperative Atrial Fibrillation



Completed by:[**2133-4-12**]
{'Mitral valve disorders,Rupture of chordae tendineae,Ostium secundum type atrial septal defect,Other chronic pulmonary heart diseases,Atrial fibrillation,Cardiac complications, not elsewhere classified,Cardiac rhythm regulators causing adverse effects in therapeutic use,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}


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: Asymptomatic

PRESENT ILLNESS: 64 year old female who was found to have a new heart murmur on
physical exam in [**Month (only) 1096**]. An echocardiogram was performed which
revealed severe posterior leaflet mitral valve regurgitation.
She was referred to Dr. [**Last Name (STitle) 1655**] who performed a cardiac
catheterization which showed no significant coronary artery
disease however it confirmed severe mitral regurgitation noting
severe pulmonary hypertension. Given the severity of her mitral
valve disease, she has been referred for surgery. She presents
today for pre-admission testing prior to surgery.

MEDICAL HISTORY: Mitral regurgitation
Migraine headaches
Arthritis
Tubal ligation
Periodontal surgery

MEDICATION ON ADMISSION: Nadolol 20mg daily
Imitrex
Vitamins
Calcium

ALLERGIES: environmental

PHYSICAL EXAM: Pulse: 62 O2 sat: 98%
B/P  Left: 137/80
Height: 5'3"    Weight: 126lbs

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Recently, undergoing extractions
Lives with: Widowed x3 years. 2 Children. Lives in [**Location 47**].
Occupation: Admistrative Assistant
Tobacco: [**2-15**] ppd quit in [**2098**]
ETOH: None 

### Response:
{'Mitral valve disorders,Rupture of chordae tendineae,Ostium secundum type atrial septal defect,Other chronic pulmonary heart diseases,Atrial fibrillation,Cardiac complications, not elsewhere classified,Cardiac rhythm regulators causing adverse effects in therapeutic use,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}
