CHIEF COMPLAINT: dyspnea on exertion

PRESENT ILLNESS: 75 yo male with history of MR/AS and possible childhood
rheumatic fever. Serial echos show worsening MR [**First Name (Titles) 151**] [**Last Name (Titles) 1192**]
MS, and increasing pulm. pressures. He now notices DOE. Seen
originally earlier this month for surgical eval.

MEDICAL HISTORY: coronary artery disease
mitral regurgitation/ stenosis
hypertension
? rheumatic heart disease
hyperlipidemia
osteoarthritis in hips
mild chronic obstructive pulmonary disease
obesity
amaurosis fugax [**2105**]
prostate cancer/radiation therapy
non-insulin dependent diabetes mellitus
cataracts
spinal stenosis
constipation
vertigo [**1-24**]

MEDICATION ON ADMISSION: allopurinol 300 mg daily, metformin 500 mg [**Hospital1 **], atenolol 25 mg
daily, lisinopril 40 mg daily, amlodipine 5 mg daily, crestor 40
mg daily, ASA 81 mg ( stopped last week on his own), naproxen
500 mg prn pain, viagra 50-75 mg prn, MVI daily, polyethylene
glycol 1 oz. daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 70"  190#
HR 72 reg  right 125/71   left 123/82  99% RA sat.
NAD
skin unremarkable
PERRLA, EOMI, anicteric sclera, OP unremarkable
neck supple, full ROM, no JVD
murmur transmits to carotids
CTAB
RRR  3/6 systolic murmur throughout precordium to carotids
soft, NT, ND, + BS; no HSM/CVA tenderness
warm, well-perfused, no edema
right leg superficial varicosities with dilated GSV; RLE GSV
suitable
gait slow, and somewhat unsteady; MAE [**5-21**] strengths
2+ bil. fem/DP/PT/radials

FAMILY HISTORY: father died of MI at 59; mother died of heart disease at 63

SOCIAL HISTORY: lives with wife
75 pack year hx- quit [**2085**]
no ETOH use
retired
Rheumatic heart failure (congestive),Unspecified transient cerebral ischemia,Cardiac complications, not elsewhere classified,Mitral stenosis with insufficiency,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Obesity, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Unspecified cataract,Constipation, unspecified,Spinal stenosis, unspecified region,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension,Hypovolemia,Personal history of irradiation, presenting hazards to health
Rheumatic heart failure,Trans cereb ischemia NOS,Surg compl-heart,Mitral stenosis w insuff,Crnry athrscl natve vssl,Atrial fibrillation,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Chr pulmon heart dis NEC,Obesity NOS,Abn react-anastom/graft,Hyperlipidemia NEC/NOS,Osteoarthros NOS-pelvis,Cataract NOS,Constipation NOS,Spinal stenosis NOS,Hx-prostatic malignancy,Iatrogenc hypotnsion NEC,Hypovolemia,Hx of irradiation
Name:  [**Known lastname 12819**],[**Known firstname **]               Unit No:   [**Numeric Identifier 13002**]

Admission Date:  [**2109-4-22**]              Discharge Date:   [**2109-4-29**]

Date of Birth:  [**2033-6-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 741**]
Addendum:
After further review of patients cardiac rhythm strips it was
noted that he had more frequent atrial fibrilation despite
treatment with Bblockers and Amiodarone. He was therefore
continued on warfarin therapy upon discharge home. INR to be
followed by Dr [**Last Name (STitle) 2031**]. First INR check [**5-1**] by VNA with
results called to Dr [**Last Name (STitle) 2031**].

Discharge Disposition:
Home With Service

Facility:
[**Hospital1 328**] VNA

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2109-4-29**]

Admission Date:  [**2109-4-22**]              Discharge Date:   [**2109-4-29**]

Date of Birth:  [**2033-6-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2109-4-22**]  Mitral Valve Replacement( [**Street Address(2) 11599**]. [**Male First Name (un) 923**] porcine)/
Coronary Artery Bypass Graft x 3 (Left internal mammary artery
to Left Anterior Descending artery, Saphenous Vein Graft to
Diagonal, Saphenous Vein Graft to Posterior Descending Artery)

History of Present Illness:
75 yo male with history of MR/AS and possible childhood
rheumatic fever. Serial echos show worsening MR [**First Name (Titles) 151**] [**Last Name (Titles) 1192**]
MS, and increasing pulm. pressures. He now notices DOE. Seen
originally earlier this month for surgical eval.

Past Medical History:
coronary artery disease
mitral regurgitation/ stenosis
hypertension
? rheumatic heart disease
hyperlipidemia
osteoarthritis in hips
mild chronic obstructive pulmonary disease
obesity
amaurosis fugax [**2105**]
prostate cancer/radiation therapy
non-insulin dependent diabetes mellitus
cataracts
spinal stenosis
constipation
vertigo [**1-24**]

Social History:
lives with wife
75 pack year hx- quit [**2085**]
no ETOH use
retired

Family History:
father died of MI at 59; mother died of heart disease at 63

Physical Exam:
70"  190#
HR 72 reg  right 125/71   left 123/82  99% RA sat.
NAD
skin unremarkable
PERRLA, EOMI, anicteric sclera, OP unremarkable
neck supple, full ROM, no JVD
murmur transmits to carotids
CTAB
RRR  3/6 systolic murmur throughout precordium to carotids
soft, NT, ND, + BS; no HSM/CVA tenderness
warm, well-perfused, no edema
right leg superficial varicosities with dilated GSV; RLE GSV
suitable
gait slow, and somewhat unsteady; MAE [**5-21**] strengths
2+ bil. fem/DP/PT/radials

Pertinent Results:
[**2109-4-22**] 01:47PM BLOOD WBC-16.0*# RBC-3.49*# Hgb-10.9*#
Hct-30.6*# MCV-88 MCH-31.2 MCHC-35.5* RDW-13.8 Plt Ct-126*
[**2109-4-25**] 08:55AM BLOOD WBC-15.9* RBC-3.93*# Hgb-12.0*# Hct-33.8*
MCV-86 MCH-30.4 MCHC-35.4* RDW-14.6 Plt Ct-107*
[**2109-4-22**] 12:08PM BLOOD PT-16.3* PTT-60.7* INR(PT)-1.5*
[**2109-4-24**] 04:21AM BLOOD PT-14.1* PTT-30.0 INR(PT)-1.2*
[**2109-4-22**] 01:47PM BLOOD UreaN-14 Creat-0.7 Cl-112* HCO3-25
[**2109-4-29**] 06:10AM BLOOD WBC-10.6 RBC-3.37* Hgb-10.2* Hct-29.9*
MCV-89 MCH-30.4 MCHC-34.3 RDW-14.3 Plt Ct-222#
[**2109-4-29**] 06:10AM BLOOD Plt Ct-222#
[**2109-4-29**] 06:10AM BLOOD PT-17.1* INR(PT)-1.6*
[**2109-4-29**] 06:10AM BLOOD K-4.1
[**2109-4-28**] 07:00AM BLOOD Glucose-112* UreaN-33* Creat-1.2 Na-137
K-4.1 Cl-101 HCO3-27 AnGap-13
[**2109-4-22**] Echo: PRE BYPASS 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. Left ventricular wall thickness,
cavity size, and global systolic function are normal (LVEF>55%).
The fright ventricle is only very poorly seen. The mid free wall
of the right ventricle appears to function well. The ascending
aorta is mildly dilated. There are simple atheroma in the aortic
arch. There are simple atheroma in the descending thoracic
aorta. The aortic valve leaflets are moderately thickened. There
is no aortic valve stenosis. Trace aortic regurgitation is seen.
The mitral valve leaflets are severely thickened/deformed. There
is severe mitral annular calcification. There is [**Month/Day/Year 1192**]
valvular mitral stenosis (area 1.5cm2). The mitral regurgitation
vena contracta is >=0.7cm. Severe (4+) mitral regurgitation is
seen. Significant pulmonic regurgitation is seen. There is a
trivial/physiologic pericardial effusion. Dr. [**Last Name (STitle) **] was
notified in person of the results in the operating room at the
time of the study. POST BYPASS: The right ventricle is poorly
seen but the mid portion of the free wall appears to function
normally. The left ventricle displays normal systolic function.
There is a bioprosthesis in the mitral position that appears
well seated. The leaflets appear to function normally. There is
no obvious mitral regurgitation seen. The maximum gradient
across the mitral valve prosthesis is about 11 mm Hg with a mean
gradient of 4 mm Hg at a cardiac output of about 4.2 liters per
minute. The thoracic aorta appears intact.
[**4-23**] Head CT: Normal CTA of the head with no evidence of
infarction on CT.
[**4-24**] Carotid U/S: Scattered calcific plaque involving both
carotid systems, no significant ICA or CCA stenosis, however.
    [**Known lastname 40127**],[**Known firstname **] [**Medical Record Number 80903**] M  75  [**2033-6-20**]
[**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG FA6A [**2109-4-26**] 3:10 PM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 80904**]
Final Report
TWO VIEW CHEST, [**2109-4-26**].
COMPARISON: [**2109-4-25**].
INDICATION: Status post coronary artery bypass surgery.
Stable postoperative widening of the cardiomediastinal contours.
No
substantial pneumothorax.
FINDINGS: Improving bibasilar atelectasis and small bilateral
pleural
effusions. Retrosternal gas in the lateral projection may be a
normal
postoperative finding, but correlation with clinical findings is
suggested to exclude the possibility of mediastinal infection.
Dilated loops of gas-filled bowel in upper abdomen are
incompletely evaluated on this chest radiograph exam.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]
Approved: FRI [**2109-4-26**] 5:58 PM




Brief Hospital Course:
Mr. [**Known lastname **] was a same day admit after undergoing pre-op
work-up prior to admission. On [**4-22**] he was brought to the
operating room where he underwent a coronary artery bypass graft
x 3 and mitral valve replacement. His bypass time was 150
minutes with a crossclamp time of 129 minutes. Please see
operative report for surgical details. Following surgery he was
transferred to the CVICU for invasive monitoring in stable
condition. Within 24 hours he was weaned from sedation, awoke
neurologically intact and extubated. On post-op day one he was
noted to have word finding difficulties and neurology was
consulted and he was brought for a head CT. Was ruled out for a
stroke but neurology felt it was possibly TIA do to
hypoperfusion. His symptoms of word finding difficulties
eventually resolved. He remained in the CVICU for another day
for observation and on post-op day two he was transferred to the
telemetry floor for further care. He was started on Bblockers
and diuretics, his chest tubes and epicardial pacing wires were
removed per protocol. Over the next several days his activity
level was advanced with the assistance of nursing and physical
therapy. He was noted to have post-op atrial fibrillation that
was treated with Amiodarone and Bblockers and subsequently
converted to sinus rhythm. The remainder of his post operative
course as uneventful. On POD 7 he was discharged home with
visiting nurses. He is to return to wound clinic in 2 weeks and
to see Dr [**Last Name (STitle) **] in 4 weeks.

Medications on Admission:
allopurinol 300 mg daily, metformin 500 mg [**Hospital1 **], atenolol 25 mg
daily, lisinopril 40 mg daily, amlodipine 5 mg daily, crestor 40
mg daily, ASA 81 mg ( stopped last week on his own), naproxen
500 mg prn pain, viagra 50-75 mg prn, MVI daily, polyethylene
glycol 1 oz. daily

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. Rosuvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.

3. Potassium Chloride 10 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO once a day for 2
weeks.
Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
4. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
400mg QD x 7 days then 200mg QD.
Disp:*60 Tablet(s)* Refills:*2*
6. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
8. Furosemide 40 mg Tablet Sig: Two (2) Tablet PO QAM (once a
day (in the morning)) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
9. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
11. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
S/P coronary artery bypass graft x3/mitral valve repair
PMH:coronary artery disease
mitral regurgitation/ stenosis
hypertension
? rheumatic heart disease
hyperlipidemia
osteoarthritis in hips
mild chronic obstructive pulmonary disease
obesity
amaurosis fugax [**2105**]
prostate cancer/radiation therapy
non-insulin dependent diabetes mellitus
cataracts
spinal stenosis
constipation
vertigo [**1-24**]


Discharge Condition:
stable

Discharge Instructions:
no driving for one month
no lifting greater than 10 pounds for 10 weeks
no lotions, creams or powders on any incision
shower daily and pat incisions dry
call for fever greater than 100.5, redness, drainage, weight
gain of 2 pounds in 2 days or 5 pounds in 1 week

Followup Instructions:
[**Hospital 409**] clinic in 2 weeks
see Dr. [**Last Name (STitle) 17025**] in [**1-18**] weeks
Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**2-19**] weeks
Dr. [**Last Name (STitle) **] in 4 weeks  [**Telephone/Fax (1) 170**]
please call for appts.



Completed by:[**2109-4-29**]
{'Rheumatic heart failure (congestive),Unspecified transient cerebral ischemia,Cardiac complications, not elsewhere classified,Mitral stenosis with insufficiency,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Obesity, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Unspecified cataract,Constipation, unspecified,Spinal stenosis, unspecified region,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension,Hypovolemia,Personal history of irradiation, presenting hazards to health'}


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: 75 yo male with history of MR/AS and possible childhood
rheumatic fever. Serial echos show worsening MR [**First Name (Titles) 151**] [**Last Name (Titles) 1192**]
MS, and increasing pulm. pressures. He now notices DOE. Seen
originally earlier this month for surgical eval.

MEDICAL HISTORY: coronary artery disease
mitral regurgitation/ stenosis
hypertension
? rheumatic heart disease
hyperlipidemia
osteoarthritis in hips
mild chronic obstructive pulmonary disease
obesity
amaurosis fugax [**2105**]
prostate cancer/radiation therapy
non-insulin dependent diabetes mellitus
cataracts
spinal stenosis
constipation
vertigo [**1-24**]

MEDICATION ON ADMISSION: allopurinol 300 mg daily, metformin 500 mg [**Hospital1 **], atenolol 25 mg
daily, lisinopril 40 mg daily, amlodipine 5 mg daily, crestor 40
mg daily, ASA 81 mg ( stopped last week on his own), naproxen
500 mg prn pain, viagra 50-75 mg prn, MVI daily, polyethylene
glycol 1 oz. daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 70"  190#
HR 72 reg  right 125/71   left 123/82  99% RA sat.
NAD
skin unremarkable
PERRLA, EOMI, anicteric sclera, OP unremarkable
neck supple, full ROM, no JVD
murmur transmits to carotids
CTAB
RRR  3/6 systolic murmur throughout precordium to carotids
soft, NT, ND, + BS; no HSM/CVA tenderness
warm, well-perfused, no edema
right leg superficial varicosities with dilated GSV; RLE GSV
suitable
gait slow, and somewhat unsteady; MAE [**5-21**] strengths
2+ bil. fem/DP/PT/radials

FAMILY HISTORY: father died of MI at 59; mother died of heart disease at 63

SOCIAL HISTORY: lives with wife
75 pack year hx- quit [**2085**]
no ETOH use
retired 

### Response:
{'Rheumatic heart failure (congestive),Unspecified transient cerebral ischemia,Cardiac complications, not elsewhere classified,Mitral stenosis with insufficiency,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Obesity, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Unspecified cataract,Constipation, unspecified,Spinal stenosis, unspecified region,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension,Hypovolemia,Personal history of irradiation, presenting hazards to health'}
