CHIEF COMPLAINT: Syncope

PRESENT ILLNESS: This is a pleasant 62 year old female who was recently diagnosed
with critical aortic stenosis back in [**2161-1-15**] after being
hospitalized initially for shortness of breath and cough.
Cardiac catheterization at that time confirmed aortic stenosis
with a valve area of 0.6cm2 with a peak gradient of 73 mmHg.
Coronary angiography showed a right dominant system and clean
coronary arteries. Since that time, she has experienced multiple
syncopal episodes. She also has required hospitalization earlier
this month for congestive heart failure. Her most recent echo is
from [**2161-3-23**] which revealed severe aortic stenosis with peak and
mean gradients of 113 and 78 mmHg respectively. There was no
aortic insufficiency and only 1+ mitral regurgitation. Her LVEF
was normal, greater than 55%. She now presents for cardiac
surgical intervention.

MEDICAL HISTORY: Aortic Stenosis, Congestive Heart Failure, Hypercholesterolemia,
Hypertension, Diabetes mellitus with neuropathy, SLE, Rheumatoid
arthritis, Pseudogout, Asthma, Anxiety, Depression, s/p
Hysterectomy, s/p Right Breast Lumpectomy, s/p Knee Surgery

MEDICATION ON ADMISSION: Allopurinol 300 qd, Aspirin 81 qd, Atrovent MDI, Benicar, Prozac
20 qd, Lasix, Glyburide, Humalog and Lantus Insulin, Lipitor 10
qd, Neurontin 400 qd, Plaquenil 200 qd, Albuterol MDI

ALLERGIES: Penicillins / Iodine; Iodine Containing

PHYSICAL EXAM: Vitals: BP 126/79, HR 98, RR 18
General: obese female in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 3/6 systolic murmur
Lungs: clear bilaterally, slightly decreased at bases
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities, dark lesions left lower
extremity
Pulses: 2+ distally
Neuro: nonfocal

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Smoked ~3 cigs/day X 15 years, quit 30 years ago. Admits to only
rare ETOH. Denies recreational drugs. She is married with
children.
Aortic valve disorders,Congestive heart failure, unspecified,Systemic lupus erythematosus,Asthma, unspecified type, unspecified
Aortic valve disorder,CHF NOS,Syst lupus erythematosus,Asthma NOS
Admission Date:  [**2161-4-10**]              Discharge Date:   [**2161-4-17**]

Date of Birth:  [**2098-9-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Iodine; Iodine Containing

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Syncope

Major Surgical or Invasive Procedure:
[**2161-4-10**] Aortic Valve Replacement utilizing a [**Street Address(2) 66683**].
[**Male First Name (un) **] mechanical valve


History of Present Illness:
This is a pleasant 62 year old female who was recently diagnosed
with critical aortic stenosis back in [**2161-1-15**] after being
hospitalized initially for shortness of breath and cough.
Cardiac catheterization at that time confirmed aortic stenosis
with a valve area of 0.6cm2 with a peak gradient of 73 mmHg.
Coronary angiography showed a right dominant system and clean
coronary arteries. Since that time, she has experienced multiple
syncopal episodes. She also has required hospitalization earlier
this month for congestive heart failure. Her most recent echo is
from [**2161-3-23**] which revealed severe aortic stenosis with peak and
mean gradients of 113 and 78 mmHg respectively. There was no
aortic insufficiency and only 1+ mitral regurgitation. Her LVEF
was normal, greater than 55%. She now presents for cardiac
surgical intervention.

Past Medical History:
Aortic Stenosis, Congestive Heart Failure, Hypercholesterolemia,
Hypertension, Diabetes mellitus with neuropathy, SLE, Rheumatoid
arthritis, Pseudogout, Asthma, Anxiety, Depression, s/p
Hysterectomy, s/p Right Breast Lumpectomy, s/p Knee Surgery


Social History:
Smoked ~3 cigs/day X 15 years, quit 30 years ago. Admits to only
rare ETOH. Denies recreational drugs. She is married with
children.


Family History:
No premature coronary artery disease

Physical Exam:
Vitals: BP 126/79, HR 98, RR 18
General: obese female in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 3/6 systolic murmur
Lungs: clear bilaterally, slightly decreased at bases
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities, dark lesions left lower
extremity
Pulses: 2+ distally
Neuro: nonfocal


Pertinent Results:
[**2161-3-23**] Carotid Ultrasound - minimal disease of both internal
carotid arteries

[**Last Name (NamePattern4) 4125**]ospital Course:
On the day of admission, Mrs. [**Known lastname 106519**] underwent an aortic valve
replacement with a [**Street Address(2) 66683**]. [**Male First Name (un) 923**] mechanical prosthesis.
The operation was uneventful and she transferred to the CSRU in
stable condition. For further operative details, please see
seperate dictated operative note. Within 24 hours, she awoke
neurologically intact and was extubated. She maintained stable
hemodynamics but was noted to have decreased urine output in the
setting of a rising creatinine. Natrecor was initiated with a
good response. Her creatinine peaked to 2.0. As her renal
function, Natrecor was discontinued and she was transitioned to
intravenous Lasix. Her CSRU course was otherwise uneventful and
she transferred to the SDU on postoperative day three. She
tolerated beta blockade and remained in a normal sinus rhythm.
Her INR was monitored daily and Warfarin was dosed for a goal
INR between 2.0 - 3.0. She temporarily required Heparin for a
subtherapeutic prothrombin time. Over several days, she
continued to make clinical improvements and her renal function
returned to baseline. She was cleared for discharge on
postoperative day seven. At time of discharge, her BP was 113/57
with a HR of 82. Her chest x-ray showed small bilateral pleural
effusions and her oxygen saturations were 97% on room air. All
surgical wounds were clean, dry and intact. She will follow-up
with Dr. [**Last Name (Prefixes) **], her cardiologist and her primary care
physician as an outpatient.

Medications on Admission:
Allopurinol 300 qd, Aspirin 81 qd, Atrovent MDI, Benicar, Prozac
20 qd, Lasix, Glyburide, Humalog and Lantus Insulin, Lipitor 10
qd, Neurontin 400 qd, Plaquenil 200 qd, Albuterol MDI

Discharge Medications:
1. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily). Tablet(s)
2. 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:*0*
3. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
4. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO DAILY
(Daily). Capsule(s)
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
7. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
9. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
10. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
11. Glyburide-Metformin 2.5-500 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
12. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily):
3mg [**4-17**], check INR [**4-18**] with results called to Dr. [**Last Name (STitle) 3314**].
Disp:*90 Tablet(s)* Refills:*2*
13. Insulin Glargine 100 unit/mL Cartridge Subcutaneous
14. Insulin Lispro (Human)  Subcutaneous
15. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 1
weeks: 40mg [**Hospital1 **] x 1 week then resume preop dose of 20mg daily.
Disp:*30 Tablet(s)* Refills:*0*
16. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 1 weeks.
Disp:*14 Packet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Aortic Stenosis - s/p mechanical AVR, Postoperative Acute Renal
Insufficiency, Postop Anemia, Congestive Heart Failure,
Hypercholesterolemia, Hypertension, Diabetes mellitus with
neuropathy, SLE, Rheumatoid arthritis, Pseudogout, Asthma,
Anxiety, Depression,


Discharge Condition:
Good


Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for at least one month. No lifting more
than 10 lbs for at least 10 weeks from the date of surgery.
Monitor wounds for signs of infection. Please call with any
concerns or questions.


Followup Instructions:
Cardiac surgeon, Dr. [**Last Name (STitle) 1290**] in [**5-20**] weeks - call for appt.
Local PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 3314**] in [**3-20**] weeks - call for appt.
Local cardiologist, Dr. [**Last Name (STitle) **] in [**3-20**] weeks - call for appt.
Coumadin to be followed by Dr. [**Last Name (STitle) 3314**]



Completed by:[**2161-5-15**]
{'Aortic valve disorders,Congestive heart failure, unspecified,Systemic lupus erythematosus,Asthma, unspecified type, 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: Syncope

PRESENT ILLNESS: This is a pleasant 62 year old female who was recently diagnosed
with critical aortic stenosis back in [**2161-1-15**] after being
hospitalized initially for shortness of breath and cough.
Cardiac catheterization at that time confirmed aortic stenosis
with a valve area of 0.6cm2 with a peak gradient of 73 mmHg.
Coronary angiography showed a right dominant system and clean
coronary arteries. Since that time, she has experienced multiple
syncopal episodes. She also has required hospitalization earlier
this month for congestive heart failure. Her most recent echo is
from [**2161-3-23**] which revealed severe aortic stenosis with peak and
mean gradients of 113 and 78 mmHg respectively. There was no
aortic insufficiency and only 1+ mitral regurgitation. Her LVEF
was normal, greater than 55%. She now presents for cardiac
surgical intervention.

MEDICAL HISTORY: Aortic Stenosis, Congestive Heart Failure, Hypercholesterolemia,
Hypertension, Diabetes mellitus with neuropathy, SLE, Rheumatoid
arthritis, Pseudogout, Asthma, Anxiety, Depression, s/p
Hysterectomy, s/p Right Breast Lumpectomy, s/p Knee Surgery

MEDICATION ON ADMISSION: Allopurinol 300 qd, Aspirin 81 qd, Atrovent MDI, Benicar, Prozac
20 qd, Lasix, Glyburide, Humalog and Lantus Insulin, Lipitor 10
qd, Neurontin 400 qd, Plaquenil 200 qd, Albuterol MDI

ALLERGIES: Penicillins / Iodine; Iodine Containing

PHYSICAL EXAM: Vitals: BP 126/79, HR 98, RR 18
General: obese female in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 3/6 systolic murmur
Lungs: clear bilaterally, slightly decreased at bases
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities, dark lesions left lower
extremity
Pulses: 2+ distally
Neuro: nonfocal

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Smoked ~3 cigs/day X 15 years, quit 30 years ago. Admits to only
rare ETOH. Denies recreational drugs. She is married with
children. 

### Response:
{'Aortic valve disorders,Congestive heart failure, unspecified,Systemic lupus erythematosus,Asthma, unspecified type, unspecified'}
