CHIEF COMPLAINT: 

PRESENT ILLNESS: Briefly, this is a 50 year old
male who was referred in from an outside area for cardiac
catheterization and also evaluation of severe aortic
stenosis.  He presents with a past one to two years with
progressive dyspnea on exertion and chest tightness.  He
became short of breath while walking and would get chest
pain, chest tightness and dyspnea while walking up inclines.
He could not carry heavy objects.  He also gets episodes of
lightheadedness for the past six months.

MEDICAL HISTORY: 1.   Congenitally absent right kidney.
2.   Severe aortic stenosis.
3.   Left shoulder injury status post fall and surgery for
that.

MEDICATION ON ADMISSION: 1.  Zyrtec 10 mg p.o. q. day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Aortic valve disorders,Vascular complications of other vessels,Retinal vascular occlusion, unspecified
Aortic valve disorder,Vascular comp vessel NEC,Retinal vasc occlus NOS
Admission Date:  [**2114-9-19**]     Discharge Date:  [**2114-9-26**]

Date of Birth:   [**2063-9-13**]     Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  Briefly, this is a 50 year old
male who was referred in from an outside area for cardiac
catheterization and also evaluation of severe aortic
stenosis.  He presents with a past one to two years with
progressive dyspnea on exertion and chest tightness.  He
became short of breath while walking and would get chest
pain, chest tightness and dyspnea while walking up inclines.
He could not carry heavy objects.  He also gets episodes of
lightheadedness for the past six months.

A stress test was done on [**2114-9-5**], and EKG found inverted
T waves in V5 and V6; after exercise, EKG revealed one 0.[**Street Address(2) 18425**] depression in V6 and T wave inversion.

He also had an echocardiogram done which showed severe aortic
stenosis with no aortic regurgitation.  The peak gradient was
119 mm of Mercury and mean gradient was 85.  The aortic valve
area was 0.6.

PAST MEDICAL HISTORY:
1.   Congenitally absent right kidney.
2.   Severe aortic stenosis.
3.   Left shoulder injury status post fall and surgery for
that.

MEDICATIONS ON ADMISSION:
1.  Zyrtec 10 mg p.o. q. day.

ALLERGIES:   No known drug allergies.

PHYSICAL EXAMINATION:  He was afebrile and vital signs were
stable.  His pupils were equally round and reactive to light.
His extraocular muscles are intact.  He had moist mucous
membranes.  His neck was supple with no jugular venous
distention and no bruits.  His lung examination showed his
lungs were clear to auscultation bilaterally.  His heart was
regular rate and rhythm with a loud systolic ejection murmur
heard in the right upper sternal border, but radiating
throughout.  His abdomen was soft, nontender, nondistended.
His bowel sounds were present.  His extremities were warm and
well perfused.

LABORATORY:  On admission, white blood cell count was 6.0,
hematocrit was 44.7, platelet count of 171.  Sodium 140,
potassium 4.2, chloride of 104, bicarbonate of 27, BUN of 8,
creatinine 1.0, blood sugar of 109.

HOSPITAL COURSE:   The patient was taken to the Cardiac
Catheterization Laboratory where the aortic stenosis was
characterized and coronary arteries were evaluated.  The
patient was taken to the Operating Room on [**2114-9-20**], where
an aortic valve replacement, St. Jude's Valve, was done.
Postoperative he was transferred to the CSRU and weaned from
his ventilator and extubated.

Post-extubation, the patient complained of loss of vision in
his right eye.  Ophthalmology was consulted at that time and
it was found that the patient had a emboli in the right
retinal artery.  Hyperventilation as well as other
vasodilation attempts were tried, however, the emboli was not
cleared.  The patient was found to have loss of vision in his
right eye at that time.

The patient did well postoperatively.  Neurology was also
consulted at that time, however, Neurology felt that the
patient's loss of vision was due to the embolic event in
agreement with Ophthalmology.

Physical Therapy was consulted at that time for ambulation
and rehabilitation.  They felt that his function was good and
that he could appropriately be discharged to home upon
clearance of his medical issues.

The patient continued to improve while on the Floor.  His
Foley catheter was removed; his chest tubes were removed and
Lopressor was started.

The patient was transferred to the Floor postoperatively and
anti-coagulation was started.  The patient was given Coumadin
for his anti-coagulation.  His wires were also removed at
that time.  The goal INR was set to be 2.5 to 3.0.  The
patient was also given alcohol p.r.n. for prophylaxis against
withdrawal.

The patient's INR slowly started increasing and heparin was
also started on postoperative day number four for
prophylaxis.  On postoperative day number four, the patient
was also seen by the Ophthalmologist and evaluation showed
that his vision would be completely lost.  He was instructed
to follow-up with them in approximately one month after being
discharged from the hospital.

Social Work was also consulted and would follow him at that
time.  His primary care physician was [**Name (NI) 653**] and informed
and she felt comfortable managing his INR and his Coumadin.
She was also informed of the [**Hospital 228**] hospital status and
hospital course.

The INR continued to climb and on postoperative day number
six, it was found that the INR had sufficiently risen;
therefore, the patient was discharged home in stable
condition.  He was instructed to follow-up with the primary
care physician on the next day in order to have his INR
checked and to be followed.

DISCHARGE MEDICATIONS:
1.  Coumadin 7.5 mg p.o. q. h.s.
2.  Limaprost Eye Drops 0.005% solution, one drop to the
right eye q. h.s.
3.  Percocet one to two tablets p.o. q. four hours p.r.n.
4.  Motrin 400 mg p.o. q. six hours p.r.n.
5.  Zantac 150 mg p.o. q. day.
6.  Lopressor 25 mg p.o. twice a day.
7.  Colace 100 mg p.o. twice a day.
8.  [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mEq p.o. twice a day.
9.  Lasix 20 mg p.o. twice a day.

DISCHARGE STATUS:  The patient is discharged home.

CONDITION AT DISCHARGE:   Stable.

DISCHARGE INSTRUCTIONS:
1.  He is instructed to follow-up with Dr. [**Last Name (STitle) 70**] in four
weeks.
2.  He is to follow-up with his primary care physician in one
to two weeks.
3.  Follow-up with Ophthalmology in four to six weeks.



                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

Dictated By:[**Last Name (NamePattern4) 7148**]

MEDQUIST36

D:  [**2114-9-25**]  23:40
T:  [**2114-10-1**]  15:46
JOB#:  [**Job Number 44001**]
{'Aortic valve disorders,Vascular complications of other vessels,Retinal vascular occlusion, 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: 

PRESENT ILLNESS: Briefly, this is a 50 year old
male who was referred in from an outside area for cardiac
catheterization and also evaluation of severe aortic
stenosis.  He presents with a past one to two years with
progressive dyspnea on exertion and chest tightness.  He
became short of breath while walking and would get chest
pain, chest tightness and dyspnea while walking up inclines.
He could not carry heavy objects.  He also gets episodes of
lightheadedness for the past six months.

MEDICAL HISTORY: 1.   Congenitally absent right kidney.
2.   Severe aortic stenosis.
3.   Left shoulder injury status post fall and surgery for
that.

MEDICATION ON ADMISSION: 1.  Zyrtec 10 mg p.o. q. day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Aortic valve disorders,Vascular complications of other vessels,Retinal vascular occlusion, unspecified'}
