CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 38 year old male with known mitral regurgitation and mitral
valve prolapse with new onset atrial fibrillation. Referred for
surgical evaluation.

MEDICAL HISTORY: Mitral regurgitation
mitral valve prolapse
Atrial fibrillation (new onset)

MEDICATION ON ADMISSION: coumadin 10, atenolol 50', lisinopril 10', lasix 20',
amoxicillin prn dental procedures

ALLERGIES: Lopressor

PHYSICAL EXAM: PREOP EXAM:
Vitals: HR 56 BP 118/76
Gen: NAD, flat after cath
Skin: Unremarkable
Neck: Supple, FROM -JVD
Lungs: CTAB
Heart: Irregular rate, 3/6 SEM
Abdomen: Soft, NT/ND +BS
Ext: Warm, no edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Father with MI/afib at 55.

SOCIAL HISTORY: Works in sales. Chews tobacco 2x/month. Admits to 18-24 ETOH
drinks per week. Admits to rare marijuana/cocaine use.
Mitral valve disorders,Chronic systolic heart failure,Atrial flutter,Other second degree atrioventricular block,Cardiac complications, not elsewhere classified,Acute pericarditis, unspecified,Other, mixed, or unspecified drug abuse, unspecified
Mitral valve disorder,Chr systolic hrt failure,Atrial flutter,Av block-2nd degree NEC,Surg compl-heart,Acute pericarditis NOS,Drug abuse NEC-unspec
Admission Date:  [**2140-4-11**]              Discharge Date:   [**2140-5-3**]

Date of Birth:  [**2101-5-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lopressor

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

Major Surgical or Invasive Procedure:
[**2140-4-12**] Mitral valve replacement ([**Street Address(2) 7163**].[**Male First Name (un) 923**] Mechanical) and
MAZE procedure
[**2140-4-18**] Permanent Pacemaker ([**Company 1543**] DDD)
[**2140-4-29**] Pericardial Window


History of Present Illness:
38 year old male with known mitral regurgitation and mitral
valve prolapse with new onset atrial fibrillation. Referred for
surgical evaluation.

Past Medical History:
Mitral regurgitation
mitral valve prolapse
Atrial fibrillation (new onset)

Social History:
Works in sales. Chews tobacco 2x/month. Admits to 18-24 ETOH
drinks per week. Admits to rare marijuana/cocaine use.

Family History:
Father with MI/afib at 55.

Physical Exam:
PREOP EXAM:
Vitals: HR 56 BP 118/76
Gen: NAD, flat after cath
Skin: Unremarkable
Neck: Supple, FROM -JVD
Lungs: CTAB
Heart: Irregular rate, 3/6 SEM
Abdomen: Soft, NT/ND +BS
Ext: Warm, no edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2140-4-12**] Intraop TEE: Prebypass: 1.No thrombus is seen in the
left atrial appendage. No atrial septal defect is seen by 2D or
color Doppler. 2. Regional left ventricular wall motion is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). [Intrinsic left ventricular systolic function is
likely more depressed given the severity of valvular
regurgitation.] 3.Right ventricular chamber size and free wall
motion are normal. 4.The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. No aortic
regurgitation is seen. 5.The mitral valve leaflets are
myxomatous. There is moderate/severe mitral valve prolapse of
anterior as well as posterior leaflets. There is partial mitral
leaflet flail ( A2 portion of the anterior leaflet). Severe (4+)
mitral regurgitation is seen. Post bypass: 1. Post bypass
patient is being AV paced and receiving an infusion of
phenylephrine. 2. Biventricular systolic function is unchanged.
3. Mechanical valve seen in the mitral position. Leaflets move
well and the valve appears well seated. Washing jets typical for
this prosthesis is seen. Mean gradient is 3. 5 mm Hg. 4. Aorta
intact post decannulation.
[**4-25**] CXR: Three radiographs of the chest again demonstrate an
enlarged cardiac silhouette, unchanged from [**2140-4-22**]. Bibasilar
atelectasis persists. No pneumothorax. Lung volumes are low.
Trachea is midline. A dual-lead left thoracic cardiac pacer is
unchanged. IMPRESSION: No interval change. Persistent bibasilar
atelectasis and cardiomegaly.
[**4-28**] Echo: Overall left ventricular systolic function is normal
(LVEF>55%). A mechanical mitral valve prosthesis is present. The
prosthesis cannot be adequately assessed. There is a large
pericardial effusion. The effusion appears circumferential with
the largest amount posterior and apically to the LV. No right
atrial or right ventricular diastolic collapse is seen. There is
significant, accentuated respiratory variation in
mitral/tricuspid valve inflows, consistent with impaired
ventricular filling.
[**2140-4-29**] 05:15AM BLOOD WBC-7.7 RBC-3.22* Hgb-9.2* Hct-27.6*
MCV-86 MCH-28.7 MCHC-33.5 RDW-13.8 Plt Ct-553*
[**2140-4-29**] 05:15AM BLOOD PT-32.5* PTT-37.2* INR(PT)-3.4*
[**2140-4-29**] 05:15AM BLOOD Plt Ct-553*
[**2140-4-29**] 05:15AM BLOOD Glucose-96 UreaN-11 Creat-0.9 Na-136
K-4.9 Cl-100 HCO3-27 AnGap-14

RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2140-4-28**] 9:55 AM

CHEST (PORTABLE AP)

Reason: eval for pleural effusions

[**Hospital 93**] MEDICAL CONDITION:
38 year old man s/p MVR/MAZE
REASON FOR THIS EXAMINATION:
eval for pleural effusions
INDICATION: 30-year-old man status post MVR.

COMPARISON: [**2140-4-25**].

PORTABLE CHEST RADIOGRAPH: No significant change seen compared
to prior study. Left-sided pacer, leads, prosthetic mitral valve
and median sternotomy wires are in unchanged position. Again
seen are low lung volumes. Large cardiac silhouette is unchanged
from prior study. Persistent bibasilar atelectasis and likely
left pleural effusion noted.

IMPRESSION: No significant change from prior.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]
Approved: FRI [**2140-4-29**] 9:13 AM





Brief Hospital Course:
He was admitted to cardiac surgery preoperatively for IV heparin
after stopping his Coumadin. He was taken to the operating room
on [**4-12**] where he underwent a mitral valve replacement and MAZE
procedure. See operative report for further details. He did
receive vancomycin perioperatively because he was in the
hospital preoperatively.  He was transferred to the ICU in
stable condition. He received 48 hours of Vancomycin due to
preoperative admission. In the first twenty four hours he was
weaned from sedation, awoke neurologically intact, and was
extubated without complications.  He was found to be in atrial
flutter which converted to 2:1 AV block with ventricular rate
30-40 and stable blood pressure POD 1.  EP was consulted for
rhythm evaluation and he was paced via epicardial wires, atrial
sense with ventricular pacing with plan to monitor rhythm.  He
was transferred to the floor and physical therapy worked with
him on strength and mobility.  On POD 2 night he developed
complete heart block under his pacing and was transferred back
to the intensive care unit.  Due to inappropriate pacing with
epicardial wires, a transvenous pacemaker was inserted.  He
remained in the ICU with transvenous pacing and heparin for his
mechanical valve to monitor his rhythm.. He still remained in
2:1 AV block and [**4-18**] had a permanent pacemaker inserted.  He
was then transferred back to the floor.  He went on to develop
symptomatic hypotension associated with decreased hematocrit.
Echocardiogram was notable for large pericarial effusion with
early signs of tamponade. He therefore returned to the operating
room for pericardial window. Following his pericardial window,
he returned to the CVICU with chest tube in place. Heparin was
eventually resumed for a subtherapeutic prothrombin time. He
returned to the floor the following day. Chest tube was removed
without complication. Warfarin was dosed daily for a goal INR
between 3.0 - 3.5. Heparin was discontinue once INR reached 2.5.
The remaineder of his postoperative course was uneventful and he
was medically cleared for discharge to home on postoperative day
21/15/4. Arrangements made with Dr. [**Last Name (STitle) **] who has agreed to
manage his Warfarin as an outpatient, spoke with [**Doctor Last Name **] in coumadin
clinic [**5-3**].


Medications on Admission:
coumadin 10, atenolol 50', lisinopril 10', lasix 20',
amoxicillin prn dental procedures

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 2 weeks.
Disp:*30 Capsule(s)* Refills:*0*
2. 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*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Outpatient [**Name (NI) **] Work
PT/INR mon-wed-fri and as needed.
First draw [**5-5**] - goal INR 3-3.5 for mechanical MVR Results to
[**Name8 (MD) **] RN coumadin clinic at Dr [**Last Name (STitle) **] office #[**Telephone/Fax (1) 7164**] fax #
[**Telephone/Fax (1) 7165**]   for further dosing
5. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*0*
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
7. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
10 days.
Disp:*10 Tablet(s)* Refills:*0*
10. Warfarin 10 mg Tablet Sig: 1.5 Tablets PO once a day: please
take 15mg [**5-3**] and [**5-4**] with [**Month/Year (2) **] draw [**5-5**] - results to [**Female First Name (un) **] at
Dr [**Last Name (STitle) **] office for further dosing.
Disp:*90 Tablet(s)* Refills:*2*
11. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15)
ML Mucous membrane [**Hospital1 **] (2 times a day) for 3 days: gargle.
12. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 2 weeks.
Disp:*42 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Mitral Regurgitation s/p Mitral Valve Replacement [**2140-4-12**]
Atrial fibrillation s/p MAZE procedure [**2140-4-12**]
Post op 2:1 AV block s/p PPM  [**2140-4-18**]
Postop Pericardial Effusion s/p Pericardial Window [**2140-4-29**]
Pulmonary edema
PMH: Congestive Heart Failure


Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming .
Pat incisions dry.
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**]
PT/INR mon-wed-fri and as needed. first draw [**5-5**] - goal INR
3-3.5 for mechanical MVR Results to [**Name8 (MD) **] RN coumadin clinic at
Dr [**Last Name (STitle) **] office #[**Telephone/Fax (1) 7164**] fax # [**Telephone/Fax (1) 7165**]   for further
dosing

Followup Instructions:
Dr. [**First Name (STitle) 7166**],[**First Name3 (LF) 7167**] S. (PCP) [**Telephone/Fax (1) 7164**] 1 weeks
Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] J. (Cardiologist) [**Telephone/Fax (1) 7164**] 1 weeks - his
office will call to set up an appointment
Dr [**Last Name (STitle) **] to follow up with pacemaker
Dr. [**Last Name (STitle) **] 4 weeks [**Telephone/Fax (1) 170**]
PT/INR mon-wed-fri and as needed.  First draw [**5-5**] - goal INR 3.0
-3.5 for mechanical MVR Results to [**Name8 (MD) **] RN coumadin clinic at Dr
[**Last Name (STitle) **] office #[**Telephone/Fax (1) 7164**] fax # [**Telephone/Fax (1) 7165**] for further
dosing



Completed by:[**2140-5-3**]
{'Mitral valve disorders,Chronic systolic heart failure,Atrial flutter,Other second degree atrioventricular block,Cardiac complications, not elsewhere classified,Acute pericarditis, unspecified,Other, mixed, or unspecified drug abuse, 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: 38 year old male with known mitral regurgitation and mitral
valve prolapse with new onset atrial fibrillation. Referred for
surgical evaluation.

MEDICAL HISTORY: Mitral regurgitation
mitral valve prolapse
Atrial fibrillation (new onset)

MEDICATION ON ADMISSION: coumadin 10, atenolol 50', lisinopril 10', lasix 20',
amoxicillin prn dental procedures

ALLERGIES: Lopressor

PHYSICAL EXAM: PREOP EXAM:
Vitals: HR 56 BP 118/76
Gen: NAD, flat after cath
Skin: Unremarkable
Neck: Supple, FROM -JVD
Lungs: CTAB
Heart: Irregular rate, 3/6 SEM
Abdomen: Soft, NT/ND +BS
Ext: Warm, no edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Father with MI/afib at 55.

SOCIAL HISTORY: Works in sales. Chews tobacco 2x/month. Admits to 18-24 ETOH
drinks per week. Admits to rare marijuana/cocaine use. 

### Response:
{'Mitral valve disorders,Chronic systolic heart failure,Atrial flutter,Other second degree atrioventricular block,Cardiac complications, not elsewhere classified,Acute pericarditis, unspecified,Other, mixed, or unspecified drug abuse, unspecified'}
