CHIEF COMPLAINT: Asymptomatic

PRESENT ILLNESS: 78 year old gentleman with history of aortic stenosis followed
by serial echocardiograms. In [**2190**] his aortic valve area was
0.9cm2 and he had a 60% right coronary artery leasion. A
recently repeated echocardiogram showed his aortic valve area to
be 0.62cm2. He was admitted to [**Hospital6 3105**] on
[**2193-3-22**] for a cardiac catheterization to further evaluate his
aortic valve and coronary artery disease. This revealed his
aortic valve area to be 0.58cm2 with a mean gradient of 53mmHg.
His right coronary artery had an 80% lesion, his left anterior
descending artery was 50% stensosed and his circumflex had a 50%
stenosis. He denies any symptoms of dyspnea, fatigue, chest pain
or orthopnea. He has been transferred today from [**Hospital3 12748**] for surgical evaluation.

MEDICAL HISTORY: Aortic stenosis
Coronary artery disease
Hyperlipidemia
Hypertension
Herpes zoster with postherpatic neuralgia right ear
Surgery for diverticulitis
s/p TURP
s/p Tonsillectomy/Adenoidectomy

MEDICATION ON ADMISSION: Neurontin 300mg three times a day
Lisinopril 10mg daily
Toprol xl 50mg daily
Nortriptyline 25mg daily
Zocor 20mg daily

ALLERGIES: Aspirin

PHYSICAL EXAM: PREOP EXAM:
Pulse: 75 SR  Resp: 18 O2 sat: 100%
B/P: 121/63
Height: 64"    Weight: 154lbs  BSA 1.8

FAMILY HISTORY: Sister with valve replacement in her late 70's

SOCIAL HISTORY: Lives with: Alone
Occupation: Retired
Tobacco: [**12-9**] ppd for 21 years
ETOH: Denies
Aortic valve disorders,Cardiogenic shock,Unspecified pleural effusion,Acute posthemorrhagic anemia,Mixed acid-base balance disorder,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Carrier or suspected carrier of Methicillin susceptible Staphylococcus aureus,Tobacco use disorder,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
Aortic valve disorder,Cardiogenic shock,Pleural effusion NOS,Ac posthemorrhag anemia,Mixed acid-base bal dis,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Hypertension NOS,Meth susc Staph carrier,Tobacco use disorder,Abn react-anastom/graft
Admission Date:  [**2193-3-24**]              Discharge Date:   [**2193-4-2**]

Date of Birth:  [**2114-7-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Aspirin

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Asymptomatic

Major Surgical or Invasive Procedure:
Coronary artery bypass graft x1 (Saphenous vein graft >right
coronary artery), Aortic valve replacement ([**First Name8 (NamePattern2) 17167**] [**Male First Name (un) 923**] Epic
Supra Porcine) [**2193-3-27**]
Cardiac catheterization [**2193-3-27**]


History of Present Illness:
78 year old gentleman with history of aortic stenosis followed
by serial echocardiograms. In [**2190**] his aortic valve area was
0.9cm2 and he had a 60% right coronary artery leasion. A
recently repeated echocardiogram showed his aortic valve area to
be 0.62cm2. He was admitted to [**Hospital6 3105**] on
[**2193-3-22**] for a cardiac catheterization to further evaluate his
aortic valve and coronary artery disease. This revealed his
aortic valve area to be 0.58cm2 with a mean gradient of 53mmHg.
His right coronary artery had an 80% lesion, his left anterior
descending artery was 50% stensosed and his circumflex had a 50%
stenosis. He denies any symptoms of dyspnea, fatigue, chest pain
or orthopnea. He has been transferred today from [**Hospital3 12748**] for surgical evaluation.


Past Medical History:
Aortic stenosis
Coronary artery disease
Hyperlipidemia
Hypertension
Herpes zoster with postherpatic neuralgia right ear
Surgery for diverticulitis
s/p TURP
s/p Tonsillectomy/Adenoidectomy


Social History:
Lives with: Alone
Occupation: Retired
Tobacco: [**12-9**] ppd for 21 years
ETOH: Denies


Family History:
Sister with valve replacement in her late 70's


Physical Exam:
PREOP EXAM:
Pulse: 75 SR  Resp: 18 O2 sat: 100%
B/P: 121/63
Height: 64"    Weight: 154lbs  BSA 1.8

General: WDWN in NAD
Skin: Warm, Dry and intact.
HEENT: NCAT, PERRLA, EOMI, sclera anicteric, OP benign. Minimal
swelling in right auricular/periauricular area but tender to
palpation. Edentulous
Neck:  Supple [X] Full ROM [X] No JVD
Chest: Lungs clear bilaterally [C]
Heart: RRR, IV/VI SEM, Nl S1-S2 No S3.
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  Right radial and
brachial cath sites noted. No Edema
Varicosities: Spider varicosities bilaterally L>R. GSV appears
suitable.
Neuro: Grossly intact
Pulses:
Femoral      Right:2   Left:2
DP           Right:1   Left:1
PT           [**Name (NI) 167**]:1   Left:1
Radial       Right:2   Left:2

Carotid Bruit      Transmitted vs. Bruit


Pertinent Results:
[**2193-3-27**] Intraop ECHO
PREBYPASS: The left atrium is mildly dilated. There is moderate
symmetric left ventricular hypertrophy. Right ventricular
chamber size and free wall motion are normal. There are simple
atheroma in the ascending aorta. There are simple atheroma in
the descending thoracic aorta. The aortic valve leaflets are
severely thickened/deformed. There is severe aortic valve
stenosis (valve area 0.8-1.0cm2). The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no pericardial effusion. Diastolic function consistent with
Impaired relaxation. No clot in LAA, Intact IAS. Mildly dilated
coronary sinus. No [**Month/Day/Year 88652**], Normal EF > 55%. POSTBYPASS: normally
functioning av bioprosthesis. No other changes. No disseciton
seen after Cannula removed. No [**Last Name (LF) 88652**], [**First Name3 (LF) **] > 55%.
.
[**2193-3-27**] Cardiac Catheterization
1. Selective coronary angiography of the RCA demonstrated a
proximal 70 stenosis. The LCA demonstrated no significant
coronary artery disease.
2. Selective venous conduit angiography demonstrated the SVG to
RCA to be patent with normal flow.
.
[**2193-3-25**] CTA
Mild aortic arch calcifications extending into the descending
thoracic aorta with a small amount of calcification along the
sinotubular junction as described above.
.
[**2193-3-30**] CXR
Interval increase in small pleural effusions. The patient has
been extubated and the Swan-Ganz catheter has been withdrawn.
.
[**2193-4-1**] CXR
In comparison with study of [**3-30**], there are substantial
bilateral pleural effusions with the change in appearance most
likely reflecting the PA upright rather than portable
semi-upright position. The pulmonary vessels are essentially
within normal limits. Compressive atelectatic changes are seen
at the bases.
.
LABS:
[**2193-4-2**] WBC-8.1 RBC-3.29* Hgb-10.4* Hct-30.5*  RDW-15.1 Plt
Ct-201#
[**2193-3-31**] WBC-7.9 RBC-3.29* Hgb-10.5* Hct-29.6*  RDW-14.9 Plt
Ct-87*
[**2193-3-30**] WBC-8.6 RBC-3.36* Hgb-10.6* Hct-30.3*  RDW-14.9 Plt
Ct-72*
[**2193-3-29**] WBC-13.8*# RBC-3.50* Hgb-11.3* Hct-31.5* RDW-15.3 Plt
Ct-79*
[**2193-4-2**] Glucose-110* UreaN-15 Creat-0.8 Na-135 K-3.9 Cl-103
HCO3-25
[**2193-4-1**] Glucose-116* UreaN-14 Creat-0.2* Na-133 K-3.2* Cl-97
HCO3-29
[**2193-3-31**] Glucose-118* UreaN-15 Creat-0.8 Na-130* K-4.0 Cl-89*
HCO3-35*
[**2193-3-30**] Glucose-101* UreaN-14 Creat-0.8 Na-128* K-4.4 Cl-94*
HCO3-31
[**2193-3-29**] Glucose-104* UreaN-9 Creat-0.7 Na-131* K-5.3* Cl-98
HCO3-26
[**2193-4-2**] 04:37AM BLOOD Mg-2.2

Brief Hospital Course:
He was transferred from outside hospital and underwent
preoperative workup. On [**2193-3-27**] he was brought to the Operating
Room for coronary artery bypass graft and aortic valve
replacement surgery.  See operative report for further details.
He received Cefazolin and Vancomycin for perioperative
antibiotics.  Post operatively he was transferred to the
intensive care unit for post operative management.  He initially
required inotropes and pressors for hemodynamic instability and
a TEE was obtained that revealed RV hypokinesis.  After further
evaluation with increased lactate and acidosis he was returned
to the Operating Room and had angiogram to evaluate his right
graft which was patent.  He remained on pressors and inotropes
receiving volume with improvement overnight.

On postoperative day one he remained intubated and sedated. On
postoperative day two, his pressors and inotropes were continued
to be weaned to off and diuretics were started for gentle
diuresis. He awoke neurologically intact and was extubated
without incident. Beta blockade and statin therapy were
initiated. A contraction alkalosis was noted which responded
well to diamox. On postoperative day three he remained stable,
and all chest tubes and temporary pacing wires were removed
without complication. He was then transferred to the floor. He
remained in a normal sinus rhythm. Beta blockade and ACEI were
advanced as tolerated to optimize heart rate and blood pressure.
Over several days, he continued to make clinical improvements
with diuresis and was medically cleared for discharge to the TCU
at St. Raphaels [**Hospital3 **] Rehab on postoperative day six.

Discharge chest x-ray was notable for bibasilar atelectasis and
bilateral pleural effusions. Oxygen saturations at discharge
were 100% on room air. At discharge, he remained fluid
overloaded and will continue to require diuresis which should be
titrated accordingly.  All surgical incisions were healing well,
and his pain was well controlled with Tylenol. Percocet was
discontinued during his hospital stay secondary to some mild
confusion. Prior to discharge, followup appts with Dr. [**Last Name (STitle) **] and
his cardiologist were arranged.

Medications on Admission:
Neurontin 300mg three times a day
Lisinopril 10mg daily
Toprol xl 50mg daily
Nortriptyline 25mg daily
Zocor 20mg daily


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. nortriptyline 25 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
3. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. lisinopril 20 mg Tablet Sig: One (1) Tablet PO twice a day:
hold if sbp < 100mmHg.
8. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day): Hold for HR < 55 or SBP < 90 mmHg.
9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
10. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
11. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
12. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 weeks: Lasix 40mg daily x 1 week, then re-evaluate need
for ongoing diuresis.
13. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO DAILY (Daily) for 1 weeks.


Discharge Disposition:
Extended Care

Facility:
tba

Discharge Diagnosis:
Coronary artery disease
s/p coronary artery bypass grafts
Aortic stenosis
s/p aortic valve replacement
Hyperlipidemia
Hypertension
Postop Pleural Effusions


Discharge Condition:
Alert and oriented x3 nonfocal
Spanish speaking
Ambulating with
Incisional pain managed with Tylenol
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
2+ Edema bilaterally


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) [**2193-4-24**] at 1:15 pm
Cardiologist: Dr. [**Last Name (STitle) 29070**] [**2193-5-7**] at 1:45 pm

Please call to schedule appointments with your
Primary Care: Dr. [**Last Name (STitle) **] in [**3-12**] weeks ([**Telephone/Fax (1) 72895**])

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2193-4-2**]
{'Aortic valve disorders,Cardiogenic shock,Unspecified pleural effusion,Acute posthemorrhagic anemia,Mixed acid-base balance disorder,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Carrier or suspected carrier of Methicillin susceptible Staphylococcus aureus,Tobacco use disorder,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'}


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: Asymptomatic

PRESENT ILLNESS: 78 year old gentleman with history of aortic stenosis followed
by serial echocardiograms. In [**2190**] his aortic valve area was
0.9cm2 and he had a 60% right coronary artery leasion. A
recently repeated echocardiogram showed his aortic valve area to
be 0.62cm2. He was admitted to [**Hospital6 3105**] on
[**2193-3-22**] for a cardiac catheterization to further evaluate his
aortic valve and coronary artery disease. This revealed his
aortic valve area to be 0.58cm2 with a mean gradient of 53mmHg.
His right coronary artery had an 80% lesion, his left anterior
descending artery was 50% stensosed and his circumflex had a 50%
stenosis. He denies any symptoms of dyspnea, fatigue, chest pain
or orthopnea. He has been transferred today from [**Hospital3 12748**] for surgical evaluation.

MEDICAL HISTORY: Aortic stenosis
Coronary artery disease
Hyperlipidemia
Hypertension
Herpes zoster with postherpatic neuralgia right ear
Surgery for diverticulitis
s/p TURP
s/p Tonsillectomy/Adenoidectomy

MEDICATION ON ADMISSION: Neurontin 300mg three times a day
Lisinopril 10mg daily
Toprol xl 50mg daily
Nortriptyline 25mg daily
Zocor 20mg daily

ALLERGIES: Aspirin

PHYSICAL EXAM: PREOP EXAM:
Pulse: 75 SR  Resp: 18 O2 sat: 100%
B/P: 121/63
Height: 64"    Weight: 154lbs  BSA 1.8

FAMILY HISTORY: Sister with valve replacement in her late 70's

SOCIAL HISTORY: Lives with: Alone
Occupation: Retired
Tobacco: [**12-9**] ppd for 21 years
ETOH: Denies 

### Response:
{'Aortic valve disorders,Cardiogenic shock,Unspecified pleural effusion,Acute posthemorrhagic anemia,Mixed acid-base balance disorder,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Carrier or suspected carrier of Methicillin susceptible Staphylococcus aureus,Tobacco use disorder,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'}
