CHIEF COMPLAINT: paroxysmal atrial fibrillation

PRESENT ILLNESS: This 56 year old white female has a several year history of
paroxysmal atrial fibrillation.  She has continued this despite
multiple medication trials. She self referred for evaluation of
surgical ablation and was admitted for surgery.

MEDICAL HISTORY: paroxysmal atrial fibrillation
s/p DCCV
seizure disorder
hypertension
chronic hyponatremia
hyperlipidemia
glaucoma
obesity
s/p R knee surgery
s/p L elbow surgery
s/p bladder resusupension

MEDICATION ON ADMISSION: Keppra 1500mg [**Hospital1 **]
Tegretol XR 400mg [**Hospital1 **]
Diltiazem SR 180mg/D
Ativan 0.5 mg/D
ASA 325mg/D
Lopressor 150mg TID
Coumadin 5mg/D
Xalantan 0.05% ophth. 1 gtt OU qHS
Pantoprazole 40mg/D

ALLERGIES: Erythromycin Base / Penicillins / Claritin / Lipitor / Latex

PHYSICAL EXAM: Admission:
Alert and oriented, exam nonfocal.
lungs- clear
Cor- AF at 95 BPM, w/o murmur
Extremeties- well perfused, palplable pulses, trace edema.
Abd- obese, benign.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: The patient is a special education teacher.
non smoker, denies ETOH use
Atrial fibrillation,Mixed acid-base balance disorder,Other respiratory complications,Other ill-defined heart diseases,Diarrhea,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Abnormal coagulation profile,Endometriosis, site unspecified,Unspecified glaucoma,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Atrial fibrillation,Mixed acid-base bal dis,Respiratory comp NEC,Ill-defined hrt dis NEC,Diarrhea,Epilep NOS w/o intr epil,Hypertension NOS,Hyperlipidemia NEC/NOS,Obesity NOS,Abnrml coagultion prfile,Endometriosis NOS,Glaucoma NOS,Abn react-surg proc NEC
Admission Date:  [**2165-11-25**]              Discharge Date:   [**2165-12-9**]

Date of Birth:  [**2109-2-8**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Erythromycin Base / Penicillins / Claritin / Lipitor / Latex

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
paroxysmal atrial fibrillation

Major Surgical or Invasive Procedure:
Bilateral thoracoscopic mini-Mazes, left atrial appendage
ligation [**11-27**]


History of Present Illness:
This 56 year old white female has a several year history of
paroxysmal atrial fibrillation.  She has continued this despite
multiple medication trials. She self referred for evaluation of
surgical ablation and was admitted for surgery.

Past Medical History:
paroxysmal atrial fibrillation
s/p DCCV
seizure disorder
hypertension
chronic hyponatremia
hyperlipidemia
glaucoma
obesity
s/p R knee surgery
s/p L elbow surgery
s/p bladder resusupension


Social History:
The patient is a special education teacher.
non smoker, denies ETOH use


Family History:
noncontributory

Physical Exam:
Admission:
Alert and oriented, exam nonfocal.
lungs- clear
Cor- AF at 95 BPM, w/o murmur
Extremeties- well perfused, palplable pulses, trace edema.
Abd- obese, benign.

discharge:
General: well appearing obese female in NAD
VS: 97.9, 114/69, 80SR, 18, 99% on roomair
Chest: CTAB
Incisions: bilateral thoracotomy incisions both c/d/i without
erythema or drainage
COR: RRR, no murmur or rub
ABD: large, round, soft, NT, ND, +BS
Extrem: warm and well perfused, no edema

Pertinent Results:
Indication: Left ventricular function. Right ventricular
function. Acidosis post Maze procedure
ICD-9 Codes: 424.0, 424.2
Test Information
Date/Time: [**2165-11-28**] at 14:55    Interpret MD: [**Name6 (MD) **] [**Name8 (MD) **], MD
Test Type: Portable TEE (Complete) Son[**Name (NI) 930**]:
Doppler: Full Doppler and color Doppler Test Location: West
SICU/CTIC/VICU
Contrast: None Tech Quality: Adequate
Tape #: 2009W000-0:00 Machine: Vivid i-5
    Sedation: (See comments below for other sedation.)
Patient was monitored by a nurse throughout the procedure
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  >= 55%  >= 55%

Findings
40 mg of Propofol was given.
LEFT ATRIUM: No spontaneous echo contrast in the body of the LA.


RIGHT ATRIUM/INTERATRIAL SEPTUM: PFO is present.

LEFT VENTRICLE: Overall normal LVEF (>55%). No resting LVOT
gradient.

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

AORTA: Normal descending aorta diameter. No atheroma in
descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No masses or
vegetations on aortic valve. No AS. Trace AR.

MITRAL VALVE: Normal mitral valve leaflets. No mass or
vegetation on mitral valve. Mild (1+) MR.

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

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.


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 monitored by a nurse [**First Name (Titles) **] [**Last Name (Titles) 9833**]
throughout the procedure. The patient was under general
anesthesia throughout the procedure. No TEE related
complications.
Conclusions
No spontaneous echo contrast is seen in the body of the left
atrium. A patent foramen ovale is present. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion. No masses or vegetations are seen on the
aortic valve. There is no aortic valve stenosis. Trace aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. No mass or vegetation is seen on the mitral
valve. Mild (1+) mitral regurgitation is seen. There is no
pericardial effusion.

IMPRESSION: Normal biventricular systolic function. Stretched
patent foramen ovale is present.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) **] [**Name8 (MD) **], MD, Interpreting physician
[**Last Name (NamePattern4) **] [**2165-11-28**] 18:03


[**2165-12-9**] 07:10AM BLOOD WBC-9.7 RBC-3.74* Hgb-11.7* Hct-32.8*
MCV-88 MCH-31.5 MCHC-35.9* RDW-13.2 Plt Ct-425
[**2165-12-7**] 08:00AM BLOOD PT-41.9* INR(PT)-4.6*
[**2165-12-8**] 11:00AM BLOOD PT-23.2* INR(PT)-2.2*
[**2165-12-9**] 07:10AM BLOOD PT-17.0* INR(PT)-1.5*
[**2165-12-6**] 04:52AM BLOOD PT-35.1* INR(PT)-3.7*
[**2165-12-9**] 07:10AM BLOOD Glucose-109* UreaN-13 Creat-0.6 Na-135
K-3.9 Cl-97 HCO3-26 AnGap-16

Brief Hospital Course:
She was admitted 2 days prior to surgery for heparinization off
coumadin. She was taken to the operating room  on [**11-27**] where
bilateral thoracoscopic mini-Mazes with left atrial appendage
ligation was performed.  She tolerated the procedure well and
was transferred to the ICU in stable condition.

She weaned from the ventilator and was extubated on POD 2 after
her metabolic acidosis/respiratory failure cleared.  A TEE was
performed on POD 1 to demonstrate no cardiac pathology.
Paravertebral blocks were administered on [**11-28**] for pain control
with good results.  She was kept in the ICU for pulmonary care
and ready for transfer to the floor on POD 5 ([**12-2**]). Amiodarone,
beta blockers and antiinflammatory medications were administered
to maintain sinus rhythm and control post operative inflammatory
response. However on POD# 6 pt developed Afib, flutter which was
rate controlled. Coumadin was resumed at home dose of 5 mg but
INR rose to 5.6- coumadin was held and d/c was post-poned.  That
evening she went into atrial flutter and her lopressor was
increased.  On post-operative day 9 she was electively
cardioverted to sinus rhythm. INR normalized and the patient was
maintained on lower doses of coumadin than previously due to
concommitant amiodarone administration.
She continued to progress and she was ready for discharge to
rehab on POD # 12 where she will undergo further conditioning to
increase strength, endurance and activities of daily living. All
follow up appointments were advised.

Medications on Admission:
Keppra 1500mg [**Hospital1 **]
Tegretol XR 400mg [**Hospital1 **]
Diltiazem SR 180mg/D
Ativan 0.5 mg/D
ASA 325mg/D
Lopressor 150mg TID
Coumadin 5mg/D
Xalantan 0.05% ophth. 1 gtt OU qHS
Pantoprazole 40mg/D


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
5. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
6. Carbamazepine 100 mg Tablet Sustained Release 12 hr Sig: Four
(4) Tablet Sustained Release 12 hr PO BID (2 times a day).
7. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg 2x/day for 1 week, then 200mg 2x/day for 1 week,
then 200mg/day until further instructed.
Disp:*120 Tablet(s)* Refills:*0*
11. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day) as needed.
Disp:*qs * Refills:*0*
12. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours) as needed. Tablet(s)
13. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day).
14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
15. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**11-15**]
Puffs Inhalation Q6H (every 6 hours) as needed.
16. Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed.
17. Warfarin 1 mg Tablet Sig: .5 Tablet PO once a day: .5mg
alternating with 0mg for goal INR 2-2.5 (atrial fibrillation).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
paroxysmal strail fibrillation
s/p bilateral thoracoscopic mini-Mazes, left atrial appendage
ligation
hypertension
obesity
seizure disorder
hyperlipidemia
glaucoma
endometriosis
s/p bladder resuspension
s/p R knee surgery
s/p L elbow surgery
s/p appendectomy


Discharge Condition:
good


Discharge Instructions:
shower daily, no baths or swimming
no lotions, creams or powders to incisions
no driving for 4 weeks and off all narcotics
no lifting more than 10 pounds for 10 weeks
report any redness of, or drainage from incisions
report any fever greater than 100.5
report any weight gain greater than 2 pounds a day or 5 pounds a
week
take all medications as directed

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**])
wound clinic in 2 weeks
Dr. [**Last Name (STitle) 73**] in 2 weeks
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**11-15**] weeks ([**Telephone/Fax (1) 608**])
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (ENT) as an outpatient to evaluate mass on left
vocal cord
please call for appointments



Completed by:[**2165-12-9**]
{'Atrial fibrillation,Mixed acid-base balance disorder,Other respiratory complications,Other ill-defined heart diseases,Diarrhea,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Abnormal coagulation profile,Endometriosis, site unspecified,Unspecified glaucoma,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: paroxysmal atrial fibrillation

PRESENT ILLNESS: This 56 year old white female has a several year history of
paroxysmal atrial fibrillation.  She has continued this despite
multiple medication trials. She self referred for evaluation of
surgical ablation and was admitted for surgery.

MEDICAL HISTORY: paroxysmal atrial fibrillation
s/p DCCV
seizure disorder
hypertension
chronic hyponatremia
hyperlipidemia
glaucoma
obesity
s/p R knee surgery
s/p L elbow surgery
s/p bladder resusupension

MEDICATION ON ADMISSION: Keppra 1500mg [**Hospital1 **]
Tegretol XR 400mg [**Hospital1 **]
Diltiazem SR 180mg/D
Ativan 0.5 mg/D
ASA 325mg/D
Lopressor 150mg TID
Coumadin 5mg/D
Xalantan 0.05% ophth. 1 gtt OU qHS
Pantoprazole 40mg/D

ALLERGIES: Erythromycin Base / Penicillins / Claritin / Lipitor / Latex

PHYSICAL EXAM: Admission:
Alert and oriented, exam nonfocal.
lungs- clear
Cor- AF at 95 BPM, w/o murmur
Extremeties- well perfused, palplable pulses, trace edema.
Abd- obese, benign.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: The patient is a special education teacher.
non smoker, denies ETOH use 

### Response:
{'Atrial fibrillation,Mixed acid-base balance disorder,Other respiratory complications,Other ill-defined heart diseases,Diarrhea,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Abnormal coagulation profile,Endometriosis, site unspecified,Unspecified glaucoma,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
