CHIEF COMPLAINT: Unstable angina, shortness of breath.

PRESENT ILLNESS: 78 yo female with known coronary artery disease, s/p PCI/stent
who presented to an outside hospital with one weeks of angina.
She r/o for MI and underwent left and right heart
catheterization with coronary angiography.
This demonstrated a 75% left main stenosis, luminal
irregularites of the LAD, RCA and circumflex, 50% 2nd diagonal
lesion and a patent distal RCA stent. Right sided pressures were
PA 38/16, CVP 12 and the [**Location (un) 109**] was 0.7cm2, with a 35mm gradient.
The CI was 2.49l/min.
She was transferred to this institution for surgical treatment.

MEDICAL HISTORY: Diabetes
hypercholesterolemia
s/p appendectomy
s/p hysterectomy
depression
s/p cholecystectomy
s/p PCI/Stent

MEDICATION ON ADMISSION: Avapro 150mg/D
Glyburide 7.5mg/D
ASA 325mg/D
Plavix 75mg/D
Protonix 40mg/D
Zoloft 50mg/D
Metformin500mg [**Hospital1 **]
Lipitor 40mg/D
Imdur 60mg/D
ToprolXL 25mg/D

ALLERGIES: Iodine; Iodine Containing / Cortisone / Adhesive Tape

PHYSICAL EXAM: Vitals:Temp 99.1     Tmax:99.4    P:59   BP:120/52  RR:18
Vent:97%
General: aaox3, no acute distress
HEENT: perrl, op clear, mmm
Neck: supple.  no lad.  no thyromeg.
Respiratory: cta bilaterally w/out wheezes/rhonchi/rales
Cardiovascular:	 III/IV systolic murmur best heard on the right
upper sternal border.  cresc/decresc.
Back: no ST tenderness
Gastrointestinal: +bs, soft, NT, ND, no organomegaly appreciated
Genitourinary: WNL
Musculoskeletal:WNL
Skin:A 5cm by 5x5cm rash in the left gluteal region. There are
multiple small pustules on an erythematous base.  Another
similar
smaller rash 2x2cm 3cm superior to this rash.  Along S2 vs S3
dermatome.
Dermatographic erythematous plaques on chest in shape of
telemetry leads.
Neurological: WNL
Psychiatric:WNL

FAMILY HISTORY: No cardiac history

SOCIAL HISTORY: remote smoker ( 30 yrs ago)
lives with husband who suffers from [**Name (NI) 2481**] disease
Denies ETOH use
Retired
Aortic valve disorders,Pneumonia due to other gram-negative bacteria,Intermediate coronary syndrome,Pressure ulcer, lower back,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Herpes simplex without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Hypovolemia
Aortic valve disorder,Pneumo oth grm-neg bact,Intermed coronary synd,Pressure ulcer, low back,Crnry athrscl natve vssl,Chr airway obstruct NEC,Herpes simplex NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Hypovolemia
Admission Date:  [**2163-8-26**]              Discharge Date:   [**2163-9-10**]

Date of Birth:  [**2084-12-12**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Iodine; Iodine Containing / Cortisone / Adhesive Tape

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Unstable angina, shortness of breath.

Major Surgical or Invasive Procedure:
[**2163-9-5**] AVR(19 mm [**Company 1543**] Mosaic Porcine) / cabg x2 (LIMA to
LAD, SVG to OM)


History of Present Illness:
78 yo female with known coronary artery disease, s/p PCI/stent
who presented to an outside hospital with one weeks of angina.
She r/o for MI and underwent left and right heart
catheterization with coronary angiography.
This demonstrated a 75% left main stenosis, luminal
irregularites of the LAD, RCA and circumflex, 50% 2nd diagonal
lesion and a patent distal RCA stent. Right sided pressures were
PA 38/16, CVP 12 and the [**Location (un) 109**] was 0.7cm2, with a 35mm gradient.
The CI was 2.49l/min.
She was transferred to this institution for surgical treatment.

Past Medical History:
Diabetes
hypercholesterolemia
s/p appendectomy
s/p hysterectomy
depression
s/p cholecystectomy
s/p PCI/Stent

Social History:
remote smoker ( 30 yrs ago)
lives with husband who suffers from [**Name (NI) 2481**] disease
Denies ETOH use
Retired


Family History:
No cardiac history

Physical Exam:
Vitals:Temp 99.1     Tmax:99.4    P:59   BP:120/52  RR:18
Vent:97%
General: aaox3, no acute distress
HEENT: perrl, op clear, mmm
Neck: supple.  no lad.  no thyromeg.
Respiratory: cta bilaterally w/out wheezes/rhonchi/rales
Cardiovascular:	 III/IV systolic murmur best heard on the right
upper sternal border.  cresc/decresc.
Back: no ST tenderness
Gastrointestinal: +bs, soft, NT, ND, no organomegaly appreciated
Genitourinary: WNL
Musculoskeletal:WNL
Skin:A 5cm by 5x5cm rash in the left gluteal region. There are
multiple small pustules on an erythematous base.  Another
similar
smaller rash 2x2cm 3cm superior to this rash.  Along S2 vs S3
dermatome.
Dermatographic erythematous plaques on chest in shape of
telemetry leads.
Neurological: WNL
Psychiatric:WNL


Pertinent Results:
[**2163-8-26**] 09:21PM   PT-13.5* PTT-21.5* INR(PT)-1.2*
[**2163-8-26**] 09:21PM   PLT COUNT-274
[**2163-8-26**] 09:21PM   WBC-6.6 RBC-3.88* HGB-12.0 HCT-35.6* MCV-92
MCH-30.8 MCHC-33.6 RDW-13.5
[**2163-8-26**] 09:21PM   ALT(SGPT)-15 AST(SGOT)-19 LD(LDH)-160 ALK
PHOS-40 AMYLASE-37 TOT BILI-0.3
[**2163-8-26**] 09:21PM   GLUCOSE-156* UREA N-20 CREAT-1.0 SODIUM-138
POTASSIUM-4.6 CHLORIDE-105 TOTAL CO2-26 ANION GAP-12

[**2163-8-29**] Carotid Duplex Ultrasound
Bilateral 1-39% ICA stenosis. Bilateral vertebral antegrade
flow.

[**2163-9-5**] ECHO
Prebypass

1. 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%).
3.Right ventricular chamber size and free wall motion are
normal.
4.There are simple atheroma in the ascending aorta. There are
simple atheroma in the descending thoracic aorta.
5.The aortic valve leaflets are severely thickened/deformed.
There is severe aortic valve stenosis (area <0.8cm2). Mild (1+)
aortic regurgitation is seen.
6. The mitral valve leaflets are moderately thickened. Moderate
(2+) mitral regurgitation is seen.
7. Dr. [**Last Name (STitle) **] was notified in person of the results on
[**2163-9-5**] at 930am.

Post bypass

1. Patient is being AV paced .
2. Biventricular systolic function is unchanged.
3. Mitral regurgitation is 2+
4. Bioprosthetic va;lve seen in the aortic position. Leaflets
move well and the valve appears well seated. Peak gradient
across the aortic valve is 17 mm Hg.
5. Aorta intact post decannulation.



Brief Hospital Course:
Ms. [**Known lastname 40009**] was transferred from [**Hospital3 417**] Hospital to the
[**Hospital1 18**] on [**2163-8-26**] for definitive surgical treatment of her aortic
stenosis and coronary artery disease. She underwent routine
preoperative testing including a carotid duplex ultrasound which
showed bilateral 1-39% internal carotid artery stenosis. She had
a brief episode of CP after admission which resolved without
intervention. Herpes zoster was noted on exam for which
acyclovir was started. An infectious disease consult was
obtained who obtained a culture which was positive for herpes
simplex virus type 2 and agreed with antiviral treatment.
Augmentin was started for moraxella catarrhalis in her sputum.
On [**2163-9-5**], Ms. [**Known lastname 40009**] was taken to the operating room where
she underwent an aortic valve replacement (porcine valve) and
coronary artery bypass grafting to two vessel. Please see
operative not for details. Postoperatively she was taken to the
cardiac surgical intensive care unit for monitoring. She was
later extubated without difficulty. Her vasoactive drips were
weaned and her chest tubes removed.  She was transferred to the
step down floor.  Her wires were removed. [**9-10**] she was
ambulating well, her sternal wound was improved. She will be
discharged today on keflex for 5 days.

Medications on Admission:
Avapro 150mg/D
Glyburide 7.5mg/D
ASA 325mg/D
Plavix 75mg/D
Protonix 40mg/D
Zoloft 50mg/D
Metformin500mg [**Hospital1 **]
Lipitor 40mg/D
Imdur 60mg/D
ToprolXL 25mg/D

Discharge Medications:
Glyburide 5mg/D
Irbesartan 150 mg Tablet/d
Metoprolol 25 mg po BID
pantoprazole EC 40 mg/d
sertraline 50 mg po/d
atorvastatin 40mg po daily
Fenofibrate Nanocrystallized [Tricor]145mg po/d
ASA 81 mg po/d
Furosemide 20mg iv q12hrs
Docusate 100mg po bid
plavix 75 mg po daily
Glucophage 500mg po bid
cephalexin 500mg po q6hrs X 5days


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
aortic stenosis
coronary artery disease
diabete mellitus
hypertension
s/p MI
dyslipidemia
s/p PCI/ stent
depression
GERD
herpes zoster
Pneumonia

Discharge Condition:
good


Discharge Instructions:
take all medications as prescribed
no lifting more than 10 pounds for 10 weeks
keep wounds clean and dry, ok to shower daily, no baths or
swimming
no creams, lotions or powders to incisions
report any drainage or redness of incisions
report any temperature greater than 101
no driving for one month AND off all narcotics

Followup Instructions:
[**Hospital 409**] clinic in 2 weeks
Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr [**Last Name (STitle) **],[**First Name3 (LF) **] M. in [**1-16**] weeks ([**Telephone/Fax (1) 3183**])



Completed by:[**2163-9-10**]
{'Aortic valve disorders,Pneumonia due to other gram-negative bacteria,Intermediate coronary syndrome,Pressure ulcer, lower back,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Herpes simplex without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Hypovolemia'}


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: Unstable angina, shortness of breath.

PRESENT ILLNESS: 78 yo female with known coronary artery disease, s/p PCI/stent
who presented to an outside hospital with one weeks of angina.
She r/o for MI and underwent left and right heart
catheterization with coronary angiography.
This demonstrated a 75% left main stenosis, luminal
irregularites of the LAD, RCA and circumflex, 50% 2nd diagonal
lesion and a patent distal RCA stent. Right sided pressures were
PA 38/16, CVP 12 and the [**Location (un) 109**] was 0.7cm2, with a 35mm gradient.
The CI was 2.49l/min.
She was transferred to this institution for surgical treatment.

MEDICAL HISTORY: Diabetes
hypercholesterolemia
s/p appendectomy
s/p hysterectomy
depression
s/p cholecystectomy
s/p PCI/Stent

MEDICATION ON ADMISSION: Avapro 150mg/D
Glyburide 7.5mg/D
ASA 325mg/D
Plavix 75mg/D
Protonix 40mg/D
Zoloft 50mg/D
Metformin500mg [**Hospital1 **]
Lipitor 40mg/D
Imdur 60mg/D
ToprolXL 25mg/D

ALLERGIES: Iodine; Iodine Containing / Cortisone / Adhesive Tape

PHYSICAL EXAM: Vitals:Temp 99.1     Tmax:99.4    P:59   BP:120/52  RR:18
Vent:97%
General: aaox3, no acute distress
HEENT: perrl, op clear, mmm
Neck: supple.  no lad.  no thyromeg.
Respiratory: cta bilaterally w/out wheezes/rhonchi/rales
Cardiovascular:	 III/IV systolic murmur best heard on the right
upper sternal border.  cresc/decresc.
Back: no ST tenderness
Gastrointestinal: +bs, soft, NT, ND, no organomegaly appreciated
Genitourinary: WNL
Musculoskeletal:WNL
Skin:A 5cm by 5x5cm rash in the left gluteal region. There are
multiple small pustules on an erythematous base.  Another
similar
smaller rash 2x2cm 3cm superior to this rash.  Along S2 vs S3
dermatome.
Dermatographic erythematous plaques on chest in shape of
telemetry leads.
Neurological: WNL
Psychiatric:WNL

FAMILY HISTORY: No cardiac history

SOCIAL HISTORY: remote smoker ( 30 yrs ago)
lives with husband who suffers from [**Name (NI) 2481**] disease
Denies ETOH use
Retired 

### Response:
{'Aortic valve disorders,Pneumonia due to other gram-negative bacteria,Intermediate coronary syndrome,Pressure ulcer, lower back,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Herpes simplex without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Hypovolemia'}
