CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 85 year old male with history of Aortic stenosis followed by
serial echo's. Recently he has noted mild dyspnea on exertion.
Repeat echo revealed progression of his Aortic stenosis with
mild LVH. Underwent cardiac cath as pre-operative work-up which
also showed some coronary artery disease and he was then
referred for surgical intervention.

MEDICAL HISTORY: Aortic Stenosis
Hyperlipidemia
Hypertension
Paroxysmal Atrial Fibrillation
Right Bundle Branch block
Restless leg syndrome
Multiple cancerous skin lesions status post removal
Pleurisy/pericarditis
Status post hernia repair [**2140**]

MEDICATION ON ADMISSION: Lisinopril 40mg daily, Metoprolol 50mg [**Hospital1 **], Mirapex 0.25mg
daily, Zocor 20mg daily, HCTZ 50mg daily, MVI, Fibercon

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 58 18 139/87 6' 178lbs
General: No acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear to auscultation bilaterally
Heart: Regular rate and rhythm
Abd: Soft, non-tender, non-distended
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

FAMILY HISTORY: lymphoma and prostate cancer

SOCIAL HISTORY: Remote tobacco use. 2 Glasses of wine/week. Retired
allergist/immunologist.
Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Atrial fibrillation,Restless legs syndrome (RLS),Personal history of other malignant neoplasm of skin
Aortic valve disorder,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Hypertension NOS,Atrial fibrillation,Restless legs syndrome,Hx-skin malignancy NEC
Admission Date:  [**2179-5-17**]              Discharge Date:   [**2179-5-23**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2179-5-17**] Aortic Valve Replacement (25mm St. [**Male First Name (un) 923**] tissue),
Coronary Artery Bypass Graft x 2 (Saphenous vein graft to Ramus,
Saphenous vein graft to obtuse marginal)

History of Present Illness:
85 year old male with history of Aortic stenosis followed by
serial echo's. Recently he has noted mild dyspnea on exertion.
Repeat echo revealed progression of his Aortic stenosis with
mild LVH. Underwent cardiac cath as pre-operative work-up which
also showed some coronary artery disease and he was then
referred for surgical intervention.

Past Medical History:
Aortic Stenosis
Hyperlipidemia
Hypertension
Paroxysmal Atrial Fibrillation
Right Bundle Branch block
Restless leg syndrome
Multiple cancerous skin lesions status post removal
Pleurisy/pericarditis
Status post hernia repair [**2140**]

Social History:
Remote tobacco use. 2 Glasses of wine/week. Retired
allergist/immunologist.

Family History:
lymphoma and prostate cancer

Physical Exam:
Vitals: 58 18 139/87 6' 178lbs
General: No acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear to auscultation bilaterally
Heart: Regular rate and rhythm
Abd: Soft, non-tender, non-distended
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

Pertinent Results:
[**5-17**] Echo: Prebypass: 1.Mild spontaneous echo contrast is
present in the left atrial appendage. The left atrial appendage
emptying velocity is depressed (<0.2m/s). 2. A patent foramen
ovale is present. A left-to-right shunt across the interatrial
septum is seen at rest. 3. There is moderate symmetric left
ventricular hypertrophy. Overall left ventricular systolic
function is normal (LVEF>55%). 4. Right ventricular chamber size
and free wall motion are normal. 5. The ascending aorta is
mildly dilated. 6.The aortic valve leaflets are severely
thickened/deformed. There is severe aortic valve stenosis (valve
area 0.8-1.0cm2). No aortic regurgitation is seen. Unable to
align doppler with flow in transgastric views and hence unable
to obtain gradients across the aortic valve. 7.The mitral valve
leaflets are mildly thickened. Mild to moderate ([**1-22**]+) mitral
regurgitation is seen. 8.There is no pericardial effusion. Dr.
[**Last Name (STitle) **] was notified in person of the results on [**2179-3-19**] at
845am. Post Bypass: 1. Patient is AV paced and receiving an
infusion of phenylephrine. 2. Biventricular systolic function is
unchanged. 3. Bioprosthetic valve seen in the aortic position.
Leaflets move well and the valve appears well seated. There is
no aortic insufficiency. 4. Aorta is intact post decannulation.
5. Mild to moderate mitral regurgitation persists.
[**2179-5-22**] 07:10AM BLOOD WBC-8.7 RBC-2.89* Hgb-8.9* Hct-26.1*
MCV-90 MCH-30.9 MCHC-34.3 RDW-14.0 Plt Ct-214#
[**2179-5-22**] 07:10AM BLOOD Glucose-123* UreaN-25* Creat-0.9 Na-137
K-4.3 Cl-100 HCO3-29 AnGap-12
[**2179-5-22**] 07:10AM BLOOD Mg-2.4

Brief Hospital Course:
Dr. [**Known lastname 14761**] was a same day admit after undergoing all
pre-operative work-up as an outpatient. On the day of admission
he was brought to the operating room where he underwent an
aortic valve replacement and coronary artery bypass graft x 2.
Please see operative report for surgical details. Following
surgery he was transferred to the CVICU for invasive monitoring
in stable condition. He later awoke neurologically intact and
was extubated. Beta blockade, aspirin and statin were resumed.
On postoperative day two, he was transferred to the step down
unit for further recovery. He was gently diuresed towards his
preoperative weight. The physical therapy service was consulted
for assistance with his postoperative strength and mobility.
Following removal of his chest tube, a moderate pneumothorax was
noted on chest x-ray.  Pigtail catheter was inserted and placed
to suction and the pneumothorax resolved. A small pneumothorax
was noted when the pigtail was placed to waterseal. The
pneumothorax remained stable and the pigtail was removed on
POD#4 with a small stable pneumothorax.  The patient made
further progress with physical therapy and was found suitable
for discharge home with VNA and PT on POD 6.

Medications on Admission:
Lisinopril 40mg daily, Metoprolol 50mg [**Hospital1 **], Mirapex 0.25mg
daily, Zocor 20mg daily, HCTZ 50mg daily, MVI, Fibercon

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Pramipexole 0.25 mg Tablet Sig: One (1) Tablet PO once a day.

4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*2*
7. Outpatient Physical Therapy
dx: aortic stenosis, coronary artery disease, s/p avr, cabg
[**2179-5-17**]
evaluate and treat for post-operative deconditioning
8. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*2*
10. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*135 Tablet(s)* Refills:*2*
11. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Aortic Stenosis
Coronary Artery Disease
Hyperlipidemia
Hypertension
Paroxysmal Atrial Fibrillation
Right Bundle Branch block
Restless leg syndrome
Multiple cancerous skin lesions status post removal
Pleurisy/pericarditis
Status post hernia repair [**2140**]


Discharge Condition:
good


Discharge Instructions:
shower daily, no baths or swimming
no lotions, creams or powders to incisions
no driving for 4 weeks and off all narcotics
no lifting more than 10 pounds for 10 weeks
report any redness of, or drainage from incisions
report any fever greater than 100.5
report any weight gain greater than 2 pounds a day or 5 pounds a
week
take all medications as directed
Call if you have any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Dr. [**First Name (STitle) **] [**Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 1504**]
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 120**] in 2 weeks [**Telephone/Fax (1) 62**]
Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) 2472**] in 3 weeks [**Telephone/Fax (1) 8683**]
Please call for all appointments



Completed by:[**2179-5-23**]

Name:  [**Known lastname 2359**] MD,[**Known firstname 2360**]                Unit No:   [**Numeric Identifier 2361**]

Admission Date:  [**2179-5-17**]              Discharge Date:   [**2179-5-23**]

Date of Birth:  [**2093-9-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 741**]
Addendum:
Clarification:
Dr. [**Known lastname **] was discharged on metoprolol tartrate 75mg TID

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Pramipexole 0.25 mg Tablet Sig: One (1) Tablet PO once a day.

4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
6. Outpatient Physical Therapy
dx: aortic stenosis, coronary artery disease, s/p avr, cabg
[**2179-5-17**]
evaluate and treat for post-operative deconditioning
7. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*2*
9. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*135 Tablet(s)* Refills:*2*
10. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 136**] Homecare

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

Completed by:[**2179-5-23**]
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Atrial fibrillation,Restless legs syndrome (RLS),Personal history of other malignant neoplasm of skin'}


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: Dyspnea on exertion

PRESENT ILLNESS: 85 year old male with history of Aortic stenosis followed by
serial echo's. Recently he has noted mild dyspnea on exertion.
Repeat echo revealed progression of his Aortic stenosis with
mild LVH. Underwent cardiac cath as pre-operative work-up which
also showed some coronary artery disease and he was then
referred for surgical intervention.

MEDICAL HISTORY: Aortic Stenosis
Hyperlipidemia
Hypertension
Paroxysmal Atrial Fibrillation
Right Bundle Branch block
Restless leg syndrome
Multiple cancerous skin lesions status post removal
Pleurisy/pericarditis
Status post hernia repair [**2140**]

MEDICATION ON ADMISSION: Lisinopril 40mg daily, Metoprolol 50mg [**Hospital1 **], Mirapex 0.25mg
daily, Zocor 20mg daily, HCTZ 50mg daily, MVI, Fibercon

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 58 18 139/87 6' 178lbs
General: No acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear to auscultation bilaterally
Heart: Regular rate and rhythm
Abd: Soft, non-tender, non-distended
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

FAMILY HISTORY: lymphoma and prostate cancer

SOCIAL HISTORY: Remote tobacco use. 2 Glasses of wine/week. Retired
allergist/immunologist. 

### Response:
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Atrial fibrillation,Restless legs syndrome (RLS),Personal history of other malignant neoplasm of skin'}
