CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 77-year-old woman with known aortic stenosis and aortic
insufficiency as well as mitral regurgitation and mitral
stenosis presents with worsening CHF symptoms.  She is well
known to your practice and has been followed by you closely with
serial echocardiograms, which have revealed worsening gradients
and evidence of pulmonary hypertension.  She does complain
significantly of dyspnea on exertion, orthopnea, and increasing
fatigue.  She does deny any angina or syncope.

MEDICAL HISTORY: Aortic stenosis/insufficiency, mitral
stenosis/regurgitation(most likely rheumatic), hypertension,
elevated cholesterol, atrial fibrillation, stroke with mild
right-sided weakness, and osteoarthritis.  She has undergone a
hysterectomy and had a St. [**Male First Name (un) 923**] pacemaker placed in [**2180**].

MEDICATION ON ADMISSION: Atenolol 50 mg q.a.m. and 25 mg q.p.m., Digoxin 0.25 mg daily,
Lasix 80 mg daily, Levothyroxine 100 mcg daily, Lisinopril 20 mg
daily, Simvastatin 10 mg daily, Combivent inhaler, Coumadin
daily as directed, Aspirin 81 mg daily, Multivitamin daily, and
Tylenol p.r.n. pain.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On examination, her heart rate is 60 and irregular, respiratory
rate 18, blood pressure on the right 154/64 and on the left
153/60.  She is 68 inches tall weighing 225 pounds.  She is in
no apparent distress.  Skin was unremarkable as well as the
HEENT examination.  Neck was supple with full range of motion.
Lungs were clear bilaterally.  Heart was irregular in rate and
rhythm with a mixed II/VI diastolic and systolic murmur. Abdomen
was soft, nondistended, and nontender with positive bowel
sounds.  Extremities were warm and well perfused with 1+
peripheral.  No obvious varicosities were noted. Neurologically,
she is grossly intact with mild right upper extremity weakness.
She has 2+ plus bilateral femoral pulses and radial pulses and
1+ bilateral DP and PT pulses.  The systolic murmur transmits to
both carotids.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Mrs. [**Known lastname 6164**] is retired.  She has a remote tobacco history.  Her
last dental examination was five months ago.  She also denies
use of any alcohol.  She is currently living with her husband.
Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Atrial fibrillation,Other chronic pulmonary heart diseases,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Unspecified acquired hypothyroidism,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Personal history of tobacco use
Mitr/aortic mult involv,Rheumatic heart failure,Atrial fibrillation,Chr pulmon heart dis NEC,Anemia NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Status cardiac pacemaker,Hypothyroidism NOS,Late effect CV dis NEC,Muscskel sympt limb NEC,Osteoarthros NOS-unspec,History of tobacco use
Admission Date:  [**2192-3-9**]              Discharge Date:   [**2192-3-16**]

Date of Birth:  [**2114-8-19**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2192-3-12**] Aortic Valve Replacement(27mm Porcine), Mitral Valve
Replacement(29mm Tissue), Full Maze Procedure, Ligation of Left
Atrial Appendage, and Aortic Root Enlargement with Pericardial
Patch

History of Present Illness:
77-year-old woman with known aortic stenosis and aortic
insufficiency as well as mitral regurgitation and mitral
stenosis presents with worsening CHF symptoms.  She is well
known to your practice and has been followed by you closely with
serial echocardiograms, which have revealed worsening gradients
and evidence of pulmonary hypertension.  She does complain
significantly of dyspnea on exertion, orthopnea, and increasing
fatigue.  She does deny any angina or syncope.


Past Medical History:
Aortic stenosis/insufficiency, mitral
stenosis/regurgitation(most likely rheumatic), hypertension,
elevated cholesterol, atrial fibrillation, stroke with mild
right-sided weakness, and osteoarthritis.  She has undergone a
hysterectomy and had a St. [**Male First Name (un) 923**] pacemaker placed in [**2180**].


Social History:
Mrs. [**Known lastname 6164**] is retired.  She has a remote tobacco history.  Her
last dental examination was five months ago.  She also denies
use of any alcohol.  She is currently living with her husband.


Family History:
Noncontributory

Physical Exam:
On examination, her heart rate is 60 and irregular, respiratory
rate 18, blood pressure on the right 154/64 and on the left
153/60.  She is 68 inches tall weighing 225 pounds.  She is in
no apparent distress.  Skin was unremarkable as well as the
HEENT examination.  Neck was supple with full range of motion.
Lungs were clear bilaterally.  Heart was irregular in rate and
rhythm with a mixed II/VI diastolic and systolic murmur. Abdomen
was soft, nondistended, and nontender with positive bowel
sounds.  Extremities were warm and well perfused with 1+
peripheral.  No obvious varicosities were noted. Neurologically,
she is grossly intact with mild right upper extremity weakness.
She has 2+ plus bilateral femoral pulses and radial pulses and
1+ bilateral DP and PT pulses.  The systolic murmur transmits to
both carotids.


Pertinent Results:
[**2192-3-9**] WBC-8.3 RBC-4.37 Hgb-13.0 Hct-40.5 MCV-93 MCH-29.8
MCHC-32.1 RDW-13.5 Plt Ct-307
[**2192-3-9**] PT-16.7* PTT-25.6 INR(PT)-1.5*
[**2192-3-9**] Glucose-103 UreaN-15 Creat-0.9 Na-144 K-4.5 Cl-102
HCO3-34* [**2192-3-9**] Albumin-4.7 Calcium-10.0 Phos-3.7 Mg-2.3
[**2192-3-9**] %HbA1c-5.9
[**2192-3-12**] Intraop TEE:
PREBYPASS
1. The left atrium is markedly dilated and is elongated. A
left-to-right shunt across the interatrial septum is seen at
rest. Mod to severe left atrial contrast is noted.2. 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 arch and descending
thoracic aorta. 5. The aortic valve leaflets are moderately
thickened with some calcification. There is severe aortic valve
stenosis (area <0.8cm2) by continuity equation, area 1.1 by
planimetry which is likely inaccurate due to calcification.
Moderate to severe (3+) aortic regurgitation is seen. 6. The
mitral valve leaflets are severely thickened/deformed. The
mitral valve shows characteristic rheumatic deformity. There is
mild mitral valve prolapse of the anterior leaflet and
restriction of the posterior leaflet.. There is moderate
valvular mitral stenosis (area 1.0-1.5cm2). Mild mitral
regurgitation is seen.

POSTBYPASS
1. Patient is on no infusions and is being paced at 80 2. A
tissue mitral valve is seen. It is well seated and functioning
well. Trace central MR jet is seen, NO perivalvular leaks. Peak
gradient 13, mean gradient 4 3. A tissue aortic valve is seen.
It is well seated and functioning well. No periventricular leaks
are noted. Peak gradient 11, mean gradient 5 4. Aortic contours
are smooth after decannulation

[**2192-3-15**] 07:05AM BLOOD WBC-11.3* RBC-3.13* Hgb-9.4* Hct-29.1*
MCV-93 MCH-30.1 MCHC-32.4 RDW-14.0 Plt Ct-92*
[**2192-3-15**] 07:05AM BLOOD PT-14.8* INR(PT)-1.3*
[**2192-3-14**] 02:46AM BLOOD Glucose-115* UreaN-17 Creat-0.9 Na-138
K-4.5 Cl-105 HCO3-27 AnGap-11
[**2192-3-9**] 07:15PM BLOOD ALT-25 AST-32 LD(LDH)-241 AlkPhos-114
TotBili-0.8

Brief Hospital Course:
Mrs. [**Known lastname 6164**] was admitted preoperatively for intravenous heparin
and preoperative workup. Electrophysiologic interrogation of her
permanent pacemaker revealed that she was pacemaker dependent
with an underlying rhythm of 40 beats per minute, irregular and
with prolonged pauses. The remainder of preoperative course was
uneventful and she was cleared for surgery.  Given inpatient
stay was greater than 24 hours prior to surgery, Vancomycin was
given for perioperative antibiotic coverage. On [**3-12**], Dr.
[**Last Name (STitle) 914**] performed aortic and mitral valve replacements, along
with Full Maze procedure. For surgical details, please see
operative note. Following surgery, she was brought to the
cardiovascular intensive care unit for invasive monitoring.
Within 24 hours, she awoke neurologically intact and was
extubated without incident.  Her permanent pacemaker was
interrogated.  She was weaned from her pressors and her chest
tubes and wires were removed.  Coumadin was started given that
she has a history of atrial fibrillation and she underwent a
MAZE procedure.  She was transferred in stable condition to the
surgical step down floor.  Mrs. [**Known lastname 6164**] was aggressively
diuresed.  She was seen in consultation by the physical therapy
service.  By post-operative day three she was deemed ready by
Dr. [**Last Name (STitle) 914**] for discharge to an acute care facility for further
diuresis and rehab.

Medications on Admission:
Atenolol 50 mg q.a.m. and 25 mg q.p.m., Digoxin 0.25 mg daily,
Lasix 80 mg daily, Levothyroxine 100 mcg daily, Lisinopril 20 mg
daily, Simvastatin 10 mg daily, Combivent inhaler, Coumadin
daily as directed, Aspirin 81 mg daily, Multivitamin daily, and
Tylenol p.r.n. pain.


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:*2*
3. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Furosemide 10 mg/mL Solution Sig: One (1)  Injection [**Hospital1 **] (2
times a day): 40mg IV Lasix [**Hospital1 **].
Disp:*qs * Refills:*2*
6. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
8. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Coumadin 4 mg Tablet Sig: One (1) Tablet PO once a day:
titrate for an INR goal of [**1-31**] for atrial fibrillation.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
Lifecare Center of [**Location **]

Discharge Diagnosis:
Aortic Stenosis/Aortic Insufffiency
Mitral Stenosis/Regurgitation
Chronic Diastolic Congestive Heart Failure
Atrial Fibrillation
Cerebrovascular Disease
Hypertension
Dyslipidemia
Pacemaker In-Situ


Discharge Condition:
good


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks from date of
surgery.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 914**] in 1 month. ([**Telephone/Fax (1) 1504**]
Please follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 16004**] (PCP)in 2 weeks.
[**Telephone/Fax (1) 3183**]
Please follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (cardiology) in [**1-31**]
weeks, call for appt



Completed by:[**2192-3-15**]

Name:  [**Known lastname 749**],[**Known firstname **]                     Unit No:   [**Numeric Identifier 12995**]

Admission Date:  [**2192-3-9**]              Discharge Date:   [**2192-3-16**]

Date of Birth:  [**2114-8-19**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1543**]
Addendum:
Ms. [**Known lastname **] was kept in house until post-operative day four for
further diuresis and monitoring.  After a discussion with her
cardiologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4720**], amiodarone was started after
her MAZE procedure per our cardiac surgery protocol, digoxin was
decreased to 0.125, and her statin coverage was changed from
simvastatin to pravastatin given that she will now be on
amiodarone.  Since amiodarone was started on the day of
discharge and her INR has not yet shown much effect from the
coumadin (1.3 today), her INR level should be closely followed
over the next couple of weeks.  On post-operative day she was
discharged to rehab for further diuresis and strength training.

Major Surgical or Invasive Procedure:
[**2192-3-12**] Aortic Valve Replacement(27mm Porcine), Mitral Valve
Replacement(29mm Tissue), Full Maze Procedure with Ligation of
Left Atrial Appendage, and Aortic Root Enlargement with
Pericardial Patch




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:*2*
3. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
6. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
7. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
8. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days: then taper to 200mg daily.
Disp:*40 Tablet(s)* Refills:*0*
9. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day:
titrate for an INR goal of [**1-31**] for atrial fibrillation.
Disp:*30 Tablet(s)* Refills:*2*
10. Lasix 80 mg Tablet Sig: One (1) Tablet PO twice a day for 5
days: 80mg PO BID for 5 days, then taper to home dose of 80mg
daily.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
Lifecare Center of [**Location 12996**]

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2192-3-16**]
{'Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Atrial fibrillation,Other chronic pulmonary heart diseases,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Unspecified acquired hypothyroidism,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Personal history of tobacco use'}


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: Shortness of breath

PRESENT ILLNESS: 77-year-old woman with known aortic stenosis and aortic
insufficiency as well as mitral regurgitation and mitral
stenosis presents with worsening CHF symptoms.  She is well
known to your practice and has been followed by you closely with
serial echocardiograms, which have revealed worsening gradients
and evidence of pulmonary hypertension.  She does complain
significantly of dyspnea on exertion, orthopnea, and increasing
fatigue.  She does deny any angina or syncope.

MEDICAL HISTORY: Aortic stenosis/insufficiency, mitral
stenosis/regurgitation(most likely rheumatic), hypertension,
elevated cholesterol, atrial fibrillation, stroke with mild
right-sided weakness, and osteoarthritis.  She has undergone a
hysterectomy and had a St. [**Male First Name (un) 923**] pacemaker placed in [**2180**].

MEDICATION ON ADMISSION: Atenolol 50 mg q.a.m. and 25 mg q.p.m., Digoxin 0.25 mg daily,
Lasix 80 mg daily, Levothyroxine 100 mcg daily, Lisinopril 20 mg
daily, Simvastatin 10 mg daily, Combivent inhaler, Coumadin
daily as directed, Aspirin 81 mg daily, Multivitamin daily, and
Tylenol p.r.n. pain.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On examination, her heart rate is 60 and irregular, respiratory
rate 18, blood pressure on the right 154/64 and on the left
153/60.  She is 68 inches tall weighing 225 pounds.  She is in
no apparent distress.  Skin was unremarkable as well as the
HEENT examination.  Neck was supple with full range of motion.
Lungs were clear bilaterally.  Heart was irregular in rate and
rhythm with a mixed II/VI diastolic and systolic murmur. Abdomen
was soft, nondistended, and nontender with positive bowel
sounds.  Extremities were warm and well perfused with 1+
peripheral.  No obvious varicosities were noted. Neurologically,
she is grossly intact with mild right upper extremity weakness.
She has 2+ plus bilateral femoral pulses and radial pulses and
1+ bilateral DP and PT pulses.  The systolic murmur transmits to
both carotids.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Mrs. [**Known lastname 6164**] is retired.  She has a remote tobacco history.  Her
last dental examination was five months ago.  She also denies
use of any alcohol.  She is currently living with her husband. 

### Response:
{'Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Atrial fibrillation,Other chronic pulmonary heart diseases,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Unspecified acquired hypothyroidism,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Personal history of tobacco use'}
