CHIEF COMPLAINT: chest burning

PRESENT ILLNESS: 60 year old gentleman has been followed for aortic stenosis
which has been noted to have gotten progressively more severe
with valve area currently of
approximately 0.8-1.0cm2 with a peak gradient of 91mmHg from
last [**Month (only) 958**].
The patient describes a chest burning that radiates across his
chest and to his back which occurs with exertion such as walking
up a [**Doctor Last Name **] or taking care of his 5 horses in his barn. His
symptoms resolve with rest and do not occur with rest. He has
had occasional associated shortness of breath, which he states
has
improved since he quit smoking 3.5 weeks ago. He has also noted
tingling in his fingers while he is sleeping. He denies any
PND/orthopnea. He has noted some occasional dizziness but denies
any syncope. He just had preop cardiac cath which per report
showed only minimal disease.

MEDICAL HISTORY: left CVA, hypercholesterolemia, DM2, degenerative arthritis

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 20 mg
Tablet - 1 Tablet(s) by mouth once a day
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth daily
METFORMIN -  (Prescribed by Other Provider) - 1,000 mg Tablet -
1.5 Tablet(s) by mouth in the am, 1 tablet in the PM

ALLERGIES: Plavix / Dipyridamole / CT contrast

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Former smoker, occasional ETOH
Aortic valve disorders,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Aortic valve disorder,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Hypertension NOS
Name:  [**Known lastname 2425**],[**Known firstname **] M.                  Unit No:   [**Numeric Identifier 8445**]

Admission Date:  [**2134-2-8**]              Discharge Date:   [**2134-2-13**]

Date of Birth:  [**2072-12-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Plavix / Dipyridamole / CT contrast

Attending:[**First Name3 (LF) 741**]
Addendum:
Mr. [**Known lastname **] was also discharged home on Lantus 30 units every
morning.

Discharge Medications:
1. Lancets, Super Thin     Misc Sig: One (1) lancet
Miscellaneous qac and hs and prn : before meals and bedtime and
as needed .
Disp:*qs qs* Refills:*2*
2. Blood glucose monitoring
Blood glucose test strips
check Blood glucose AC and HS and as needed
3. glimepiride 2 mg Tablet Sig: One (1) Tablet PO once a day:
with dinner.
Disp:*30 Tablet(s)* Refills:*2*
4. metformin 750 mg Tablet Extended Release 24 hr Sig: Three (3)
Tablet Extended Release 24 hr PO once a day.
Disp:*90 Tablet Extended Release 24 hr(s)* Refills:*2*
5. atorvastatin 20 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).
7. 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*
8. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
9. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
10. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO once a day for 7 days.
Disp:*14 Tablet Extended Release(s)* Refills:*0*
11. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain/temp.
12. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*1*
13. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
14. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
15. amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
take 400mg for 7 days then decrease to 200mg daily ongoing.
Disp:*44 Tablet(s)* Refills:*2*
16. Lantus 30 units SQ every morning.

Discharge Disposition:
Home With Service

Facility:
VNA and Hospice of [**Doctor Last Name 3065**] [**Last Name (un) 8446**]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2134-2-13**]

Admission Date:  [**2134-2-8**]              Discharge Date:   [**2134-2-13**]

Date of Birth:  [**2072-12-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Plavix / Dipyridamole / CT contrast

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
chest burning


Major Surgical or Invasive Procedure:
s/p Aortic Valve Replacement (#23mm St.[**Male First Name (un) 923**] Epic Porcine)
[**2134-2-8**]


History of Present Illness:
60 year old gentleman has been followed for aortic stenosis
which has been noted to have gotten progressively more severe
with valve area currently of
approximately 0.8-1.0cm2 with a peak gradient of 91mmHg from
last [**Month (only) 958**].
The patient describes a chest burning that radiates across his
chest and to his back which occurs with exertion such as walking
up a [**Doctor Last Name **] or taking care of his 5 horses in his barn. His
symptoms resolve with rest and do not occur with rest. He has
had occasional associated shortness of breath, which he states
has
improved since he quit smoking 3.5 weeks ago. He has also noted
tingling in his fingers while he is sleeping. He denies any
PND/orthopnea. He has noted some occasional dizziness but denies
any syncope. He just had preop cardiac cath which per report
showed only minimal disease.


Past Medical History:
left CVA, hypercholesterolemia, DM2, degenerative arthritis

Social History:
Former smoker, occasional ETOH


Family History:
Noncontributory

Physical Exam:
Physical Exam

Pulse:95 Resp:18  O2 sat:95/RA
B/P  Right:151/77    Left:130/79
Height:5'9"     Weight:109 kgs

General:
Skin: Dry [] intact [x]
HEENT: PERRLA [] EOMI [x]
Neck:  Supple [] Full ROM [x] healed scar on the left
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur: [**1-17**] high pitched murmur;
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused [x]  no Edema
no Varicosities
Neuro: Grossly intact
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right/Left: soft referred heart murmur


Pertinent Results:
[**2134-2-10**] 04:30AM BLOOD WBC-12.2* RBC-4.31* Hgb-14.5 Hct-40.7
MCV-95 MCH-33.6* MCHC-35.5* RDW-13.0 Plt Ct-138*
[**2134-2-8**] 03:50PM BLOOD WBC-14.4*# RBC-4.05* Hgb-14.0 Hct-38.0*
MCV-94 MCH-34.6* MCHC-36.9* RDW-13.0 Plt Ct-176
[**2134-2-8**] 04:48PM BLOOD PT-13.7* PTT-24.9 INR(PT)-1.2*
[**2134-2-8**] 03:50PM BLOOD PT-13.4 PTT-24.9 INR(PT)-1.1
[**2134-2-12**] 04:45AM BLOOD UreaN-27* Creat-1.3* Na-134 K-4.3 Cl-101
[**2134-2-8**] 04:48PM BLOOD UreaN-18 Creat-0.7 Na-141 K-3.7 Cl-110*
HCO3-27 AnGap-8


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 45901**] (Complete)
Done [**2134-2-8**] at 2:48:10 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2072-12-5**]
Age (years): 61 M  Hgt (in): 69
BP (mm Hg): /  Wgt (lb): 240
HR (bpm):  BSA (m2): 2.23 m2
Indication: aortic valve stenosis
ICD-9 Codes: 424.1
Test Information
Date/Time: [**2134-2-8**] at 14:48    Interpret MD: [**Name6 (MD) 3892**] [**Name8 (MD) 3893**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3893**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2011AW02-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *6.0 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.0 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  *1.6 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.6 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.0 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Left Ventricle - Stroke Volume:  75 ml/beat
Aorta - Ascending:  *3.6 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  *4.0 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *64 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  40 mm Hg
Aortic Valve - LVOT VTI:  24
Aortic Valve - LVOT diam:  2.0 cm
Aortic Valve - Valve Area:  *0.7 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Dilated LA. No spontaneous echo contrast or
thrombus in the LA/LAA or the RA/RAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Normal
interatrial septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Moderate symmetric LVH. Normal LV cavity size.
Normal regional LV systolic function. Overall normal LVEF
(>55%). No resting LVOT gradient.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Focal
calcifications in aortic root. Normal ascending aorta diameter.
Focal calcifications in ascending aorta. Normal aortic arch
diameter. Focal calcifications in aortic arch. Normal descending
aorta diameter. Focal calcifications in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Severely
thickened/deformed aortic valve leaflets. Severe AS (area
0.8-1.0cm2). Mild to moderate ([**11-15**]+) AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP.
Trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. The patient appears
to be in sinus rhythm. Resting bradycardia (HR<60bpm). Results
Conclusions for post-bypass data
Conclusions
PRE-BYPASS:
The left atrium is dilated. No spontaneous echo contrast or
thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler.
There is moderate symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are focal calcifications in the aortic arch. There are
three aortic valve leaflets. The aortic valve leaflets are
severely thickened/deformed. There is severe aortic valve
stenosis (valve area 0.8-1.0cm2). Mild to moderate ([**11-15**]+) aortic
regurgitation is seen.
The mitral valve leaflets are mildly thickened. There is no
mitral valve prolapse. Trivial mitral regurgitation is seen.
There is no pericardial effusion.

Dr. [**Last Name (STitle) **] was notified in person of the results before
surgical incision.

POST-BYPASS:
The aortic valve prosthesis is intact and functioning well with
a residual transaortic gradient (mean of 12 to 15mm of Hg).
Intact thoracic aorta.
Overall LVEF 55%.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2134-2-11**] 16:22


?????? [**2125**] CareGroup IS. All rights reserved.


Brief Hospital Course:
On [**2134-2-8**] Mr.[**Known lastname 15379**] was taken to the operating room and
underwent Aortic Valve Replacement with #[**Street Address(2) 11688**].[**Male First Name (un) 923**] Epic
porcine valve with Dr.[**Last Name (STitle) **]. Please refer to operative report
for further details. Cardiopulmonary Bypass time= 74 minutes.
Cross Clamp time=50 minutes. He tolerated the procedure well and
was transferred to the CVICU in critical but stable condition.
He awoke neurologically intact and was extubated without
incident. Weaned off pressors and Beta-Blocker/Aspirin/Statin
and diuresis were initiated. All lines and drains were
discontinued per protocol. POD#1 he was transferred to the step
down unit for further monitoring. Physical Therapy was consulted
for strength and mobility. POD#3 he transiently went into Atrial
Fibrillation which converted to normal sinus rhythm with oral
Amiodarone and electrolyte replacement. The remainder of his
hospital course was essentially uncomplicated. POD#5 he was
cleared for discharge home with VNA. All follow up appointments
were advised.

Medications on Admission:
ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 20 mg
Tablet - 1 Tablet(s) by mouth once a day
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth daily
METFORMIN -  (Prescribed by Other Provider) - 1,000 mg Tablet -
1.5 Tablet(s) by mouth in the am, 1 tablet in the PM

Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Delayed
Release (E.C.) - 2 Tablet(s) by mouth once a day


Discharge Medications:
1. Lancets, Super Thin     Misc Sig: One (1) lancet
Miscellaneous qac and hs and prn : before meals and bedtime and
as needed .
Disp:*qs qs* Refills:*2*
2. Blood glucose monitoring
Blood glucose test strips
check Blood glucose AC and HS and as needed
3. glimepiride 2 mg Tablet Sig: One (1) Tablet PO once a day:
with dinner.
Disp:*30 Tablet(s)* Refills:*2*
4. metformin 750 mg Tablet Extended Release 24 hr Sig: Three (3)
Tablet Extended Release 24 hr PO once a day.
Disp:*90 Tablet Extended Release 24 hr(s)* Refills:*2*
5. atorvastatin 20 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).
7. 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*
8. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
9. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
10. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO once a day for 7 days.
Disp:*14 Tablet Extended Release(s)* Refills:*0*
11. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain/temp.
12. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*1*
13. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
14. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
15. amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
take 400mg for 7 days then decrease to 200mg daily ongoing.
Disp:*44 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
VNA and Hospice of [**Doctor Last Name **] [**Last Name (un) 45902**]

Discharge Diagnosis:
Severe AS s/p Aortic Valve Replacement [**2134-2-8**]

Secondary:
S/P TIA and left CEA [**6-22**]
Diabetes type II on oral agents
Aortic stenosis
Hypertension
Hyperlipidemia
Past Surgical History:
s/p left shoulder surgery x 3
s/p right knee meniscus surgery
s/p left carotid endarterectomy on [**2132-7-10**]


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesia
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Trace
edema



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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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) **] on [**2134-3-4**] at 1:30pm
Cardiologist:Dr.[**Last Name (STitle) **] on [**2134-3-8**] at 2:20pm
Wound check at [**Hospital1 18**] [**Last Name (un) 2577**] 2A on [**2134-2-17**] at 10:30AM with
[**Doctor First Name **]

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) **] [**Name (STitle) 45903**] in [**11-15**] weeks

**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:[**2134-2-13**]
{'Aortic valve disorders,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}


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: chest burning

PRESENT ILLNESS: 60 year old gentleman has been followed for aortic stenosis
which has been noted to have gotten progressively more severe
with valve area currently of
approximately 0.8-1.0cm2 with a peak gradient of 91mmHg from
last [**Month (only) 958**].
The patient describes a chest burning that radiates across his
chest and to his back which occurs with exertion such as walking
up a [**Doctor Last Name **] or taking care of his 5 horses in his barn. His
symptoms resolve with rest and do not occur with rest. He has
had occasional associated shortness of breath, which he states
has
improved since he quit smoking 3.5 weeks ago. He has also noted
tingling in his fingers while he is sleeping. He denies any
PND/orthopnea. He has noted some occasional dizziness but denies
any syncope. He just had preop cardiac cath which per report
showed only minimal disease.

MEDICAL HISTORY: left CVA, hypercholesterolemia, DM2, degenerative arthritis

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 20 mg
Tablet - 1 Tablet(s) by mouth once a day
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth daily
METFORMIN -  (Prescribed by Other Provider) - 1,000 mg Tablet -
1.5 Tablet(s) by mouth in the am, 1 tablet in the PM

ALLERGIES: Plavix / Dipyridamole / CT contrast

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Former smoker, occasional ETOH 

### Response:
{'Aortic valve disorders,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
