CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 77 y/o male with known Aortic Stenosis being followed by serial
Echo's. Most recent revealed severe AS with [**Location (un) 109**] 0.9 cm2.
Referred for surgical intervention.

MEDICAL HISTORY: Aortic Stenosis, Hypertension, Stroke [**2121**] and ?TIA, Benign
Prostatic Hypertrophy, Nephrolithiasis, Cholelithiasis, h/o GI
bleed, Macular degeneration, Skin cancer, s/p TURP, s/p cataract
[**Doctor First Name **], s/p tonsillectomy

MEDICATION ON ADMISSION: Aspirin 81mg qd, Verapamil 240mg [**Hospital1 **], Diovan HCT 160mg qd, Zocor
40mg qd, Flomax 0.4mg qd, Coumadin-last dose 8/18

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 84 20 180/80 5'[**41**]" 216#
Gen: Well-appearing in NAD
Skin:  W/D intact
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, FROM -JVD
Chest: CTAB -w/r/r
Heart: RRR with holosstolic murmur
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused -edema, -varicosities
Neuro: A&O x 3, MAE

FAMILY HISTORY: Father died from MI at age 49

SOCIAL HISTORY: Remote Tobacco use. [**1-14**] ETOH/wk.
Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of other diseases of circulatory system,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Macular degeneration (senile), unspecified,Long-term (current) use of anticoagulants
Aortic valve disorder,Crnry athrscl natve vssl,Hypertension NOS,Hx-circulatory dis NEC,BPH w/o urinary obs/LUTS,Macular degeneration NOS,Long-term use anticoagul
Admission Date:  [**2138-9-6**]              Discharge Date:   [**2138-9-13**]

Date of Birth:  [**2060-9-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2138-8-19**] Aortic Valve Replacement with 25mm [**Company 1543**] Mosaic
Valve, Coronary Artery Bypass Graft x 1(SVG to PDA)

History of Present Illness:
77 y/o male with known Aortic Stenosis being followed by serial
Echo's. Most recent revealed severe AS with [**Location (un) 109**] 0.9 cm2.
Referred for surgical intervention.

Past Medical History:
Aortic Stenosis, Hypertension, Stroke [**2121**] and ?TIA, Benign
Prostatic Hypertrophy, Nephrolithiasis, Cholelithiasis, h/o GI
bleed, Macular degeneration, Skin cancer, s/p TURP, s/p cataract
[**Doctor First Name **], s/p tonsillectomy


Social History:
Remote Tobacco use. [**1-14**] ETOH/wk.

Family History:
Father died from MI at age 49

Physical Exam:
VS: 84 20 180/80 5'[**41**]" 216#
Gen: Well-appearing in NAD
Skin:  W/D intact
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, FROM -JVD
Chest: CTAB -w/r/r
Heart: RRR with holosstolic murmur
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused -edema, -varicosities
Neuro: A&O x 3, MAE

Pertinent Results:
[**2138-9-8**] Echo: PRE-BYPASS: 1. No atrial septal defect is seen by
2D or color Doppler. 2. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. Overall
left ventricular systolic function is normal (LVEF>55%). 3.
Right ventricular chamber size and free wall motion are normal.
4. There are simple atheroma in the aortic root. The ascending
aorta is mildly dilated. . The descending thoracic aorta is
mildly dilated. 5. There are three aortic valve leaflets. The
aortic valve leaflets are moderately thickened. There is
moderate to severe aortic valve stenosis (area 0.8-1.0cm2). Mild
(1+) aortic regurgitation is seen. 6. The mitral valve leaflets
are mildly thickened. Trivial mitral regurgitation is seen. 7.
The tricuspid valve leaflets are mildly thickened. POST-BYPASS:
1. Systolic function of the left ventricle is mildy depressed
(inferior wall). RV function is unchanged. 2. Bioprosthetic
aortic valve appears well seated with no apparent perivalvular
regurgitation. Peak gradient across the prosthetic valve is
28mmHg. 3. Aortic contours are intact post-decannulation.
[**9-9**] CXR: No definite pneumothorax identified bilaterally.
Decreasing but persistent left lower lobe
atelectasis/consolidation.
[**2138-9-6**] 03:05PM BLOOD WBC-9.7 RBC-4.06* Hgb-12.7* Hct-37.3*
MCV-92 MCH-31.2 MCHC-33.9 RDW-17.6* Plt Ct-190
[**2138-9-12**] 06:10AM BLOOD WBC-13.5* RBC-2.76* Hgb-8.5* Hct-25.6*
MCV-93 MCH-30.7 MCHC-33.2 RDW-16.8* Plt Ct-231#
[**2138-9-6**] 03:05PM BLOOD PT-10.6 PTT-23.5 INR(PT)-0.9
[**2138-9-12**] 06:10AM BLOOD PT-11.4 INR(PT)-1.0
[**2138-9-6**] 03:05PM BLOOD Glucose-84 UreaN-22* Creat-1.2 Na-142
K-4.4 Cl-105 HCO3-30 AnGap-11
[**2138-9-10**] 05:55AM BLOOD Glucose-135* UreaN-26* Creat-1.3* Na-138
K-4.6 Cl-104 HCO3-27 AnGap-12
[**2138-9-10**] 05:55AM BLOOD Calcium-8.3* Phos-3.4 Mg-2.2

Brief Hospital Course:
Mr. [**Known lastname 1024**] was pre-operatively admitted secondary to being on
Coumadin pre-op. He was admitted for work-up and started on
Heparin gtt. On [**9-8**] he was cleared for surgery and was brought
to the OR where he underwent a aortic valve replacement and
coronary artery bypass graft x 1. Please see operative report
for surgical details. Following surgery he was transferred to
the CSRU for invasive monitoring in stable condition. He was
weaned from sedation within 24 hours, awoke neurologically
intact and was extubated. On post-op day one he was started on
beta blocker and diuretics and gently diuresed towards his
pre-op weight. Also on this day he was transferred to the SDU
for further care. His chest tubes and epicardial pacing wires
were removed per protocol. Coumadin was restarted on post-op day
three for prior CVA. He worked with physical therapy for
strength and mobility during his entire post-op course. On
post-op day five he appeared suitable for discharge to home with
VNA services and the appropriate follow-up appointments.

Medications on Admission:
Aspirin 81mg qd, Verapamil 240mg [**Hospital1 **], Diovan HCT 160mg qd, Zocor
40mg qd, Flomax 0.4mg qd, Coumadin-last dose 8/18

Discharge Medications:
1. 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:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*1*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*1*
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
8. Coumadin 5 mg Tablet Sig: Two (2) Tablet PO at bedtime:
Please take 5mg on [**2138-9-13**], [**2138-9-14**] and [**2138-9-15**].  Have your INR
checked on Tues [**2138-9-16**] and report result to primary care doctor
before resuming the current dose.
Disp:*5 Tablet(s)* Refills:*0*
9. Outpatient Lab Work
CBC, INR
10. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO once a day for 10 days.
Disp:*20 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 8300**] VNA

Discharge Diagnosis:
Aortic Stenosis s/p Aortic Valve Replacement
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 1
PMH: Hypertension, Stroke [**2121**] and ?TIA, Benign Prostatic
Hypertrophy, Nephrolithiasis, Cholelithiasis, h/o GI bleed,
Macular degeneration, Skin cancer, s/p TURP, s/p cataract [**Doctor First Name **],
s/p tonsillectomy

Discharge Condition:
Good

Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increasing pain. Please contact surgeon ([**Telephone/Fax (1) 4044**] with all wound issues.
2) Please shower daily. You may wash incision and gently pat
dry. You may have steri-strips on incisions which should fall
off on their own. If still intact after 3 weeks, you mat remove
them. No lotions, creams or powders to incision until it has
healed. No swimming until wound has healed. Use sunscreen on
incision when out in sun after it has healed.
3) No lifting greater then 10 pounds for 10 weeks from the date
of surgery.
4) No driving for 1 month.
5) Report any fever greater then 100.5.
6) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
7) Call with any questions or concerns.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) 55499**] in [**2-15**] weeks


Completed by:[**2138-9-13**]
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of other diseases of circulatory system,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Macular degeneration (senile), unspecified,Long-term (current) use of anticoagulants'}


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: Dyspnea on exertion

PRESENT ILLNESS: 77 y/o male with known Aortic Stenosis being followed by serial
Echo's. Most recent revealed severe AS with [**Location (un) 109**] 0.9 cm2.
Referred for surgical intervention.

MEDICAL HISTORY: Aortic Stenosis, Hypertension, Stroke [**2121**] and ?TIA, Benign
Prostatic Hypertrophy, Nephrolithiasis, Cholelithiasis, h/o GI
bleed, Macular degeneration, Skin cancer, s/p TURP, s/p cataract
[**Doctor First Name **], s/p tonsillectomy

MEDICATION ON ADMISSION: Aspirin 81mg qd, Verapamil 240mg [**Hospital1 **], Diovan HCT 160mg qd, Zocor
40mg qd, Flomax 0.4mg qd, Coumadin-last dose 8/18

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 84 20 180/80 5'[**41**]" 216#
Gen: Well-appearing in NAD
Skin:  W/D intact
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, FROM -JVD
Chest: CTAB -w/r/r
Heart: RRR with holosstolic murmur
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused -edema, -varicosities
Neuro: A&O x 3, MAE

FAMILY HISTORY: Father died from MI at age 49

SOCIAL HISTORY: Remote Tobacco use. [**1-14**] ETOH/wk. 

### Response:
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of other diseases of circulatory system,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Macular degeneration (senile), unspecified,Long-term (current) use of anticoagulants'}
