CHIEF COMPLAINT: Fatigue and lightheadedness

PRESENT ILLNESS: 82 year old female with known aortic stenosis which has been
followed by serial echocardiograms over the past 10 years. Her
most recent echocardiogram revealed an increased mean systolic
gradient from 72 mm Hg to 93 mmHg with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.3cm2. Ms.
[**Known lastname 32245**] is fairly adament that she does not experience any
symptoms related to her disease however, when pressed, over the
last couple of months she reports mild intermittent
lightheadedness and increasing fatigue. At one point she did
experience some chest pain with walking however this is not a
frequent occurrence. Overall she is very active, climbing a
couple of flights of stairs with laundry and or groceries daily.
She denies any palpitations or syncope. Given the severity of
her disease, she now presents for surgical consultation.

MEDICAL HISTORY: Aortic Stenosis s/p Aortic valve replacement
Past medical history:
- Moderate MR
- Non sustained VT, NSVT, multifocal VEA on Holter [**2157-12-22**]
- Peripheral vascular disease
- Mild Carotid Artery Disease
- Anemia - [**2152**] found incidentally, GI workup was negative
except
for the "beginning of Barrett's Esophagus. Received 11 units of
PRBC. No recent bleeding or further work. She avoids Aspirin.
- History of hematochezia. W/U negative and this resolved. FeSO4

MEDICATION ON ADMISSION: ATENOLOL -  (Prescribed by Other Provider) - 25 mg Tablet - 0.5
(One half) Tablet(s) by mouth once a day
PREGABALIN [LYRICA] -  (Prescribed by Other Provider) - 100 mg
Capsule - 1 (One) Capsule(s) by mouth twice a day
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
(One) Tablet(s) by mouth once a day

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Pulse: 60 Resp: 16 O2 sat: 99%
B/P  Right: 148/75   Left: 149/69
Height: 5"3"   Weight: 150 lbs

FAMILY HISTORY: No premature coronary artery disease. Father with valvular heart
disease and RHD. Died at 62.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 3 weeks ago
Lives alone. Widow and lost her husband in [**2160-11-12**] with
dementia. She lives in [**Hospital1 3494**] MA. She has three supportive
children.
Contact:                      Phone #
Occupation: Retired
Cigarettes: Smoked no [X] yes [] Hx:
Other Tobacco use:
ETOH: < 1 drink/week [X]  [**1-19**] drinks/week [] >8 drinks/week []
Illicit drug use: Never
Mitral valve insufficiency and aortic valve stenosis,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Examination of participant in clinical trial,Retention of urine, unspecified
Mitral insuf/aort stenos,Surg compl-heart,Hypertension NOS,Atrial fibrillation,Abn react-artif implant,Exam-clincal trial,Retention urine NOS
Admission Date:  [**2161-10-20**]              Discharge Date:   [**2161-10-25**]

Date of Birth:  [**2078-12-21**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Fatigue and lightheadedness

Major Surgical or Invasive Procedure:
[**2161-10-20**] Aortic Valve Replacement (21 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] Epic-tissue)

History of Present Illness:
82 year old female with known aortic stenosis which has been
followed by serial echocardiograms over the past 10 years. Her
most recent echocardiogram revealed an increased mean systolic
gradient from 72 mm Hg to 93 mmHg with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.3cm2. Ms.
[**Known lastname 32245**] is fairly adament that she does not experience any
symptoms related to her disease however, when pressed, over the
last couple of months she reports mild intermittent
lightheadedness and increasing fatigue. At one point she did
experience some chest pain with walking however this is not a
frequent occurrence. Overall she is very active, climbing a
couple of flights of stairs with laundry and or groceries daily.
She denies any palpitations or syncope. Given the severity of
her disease, she now presents for surgical consultation.

Past Medical History:
Aortic Stenosis s/p Aortic valve replacement
Past medical history:
- Moderate MR
- Non sustained VT, NSVT, multifocal VEA on Holter [**2157-12-22**]
- Peripheral vascular disease
- Mild Carotid Artery Disease
- Anemia - [**2152**] found incidentally, GI workup was negative
except
for the "beginning of Barrett's Esophagus. Received 11 units of
PRBC. No recent bleeding or further work. She avoids Aspirin.
- History of hematochezia. W/U negative and this resolved. FeSO4

started.
- Irritable Bowel Syndrome
- Dyslipidemia
- Hypertension
- Vulvodynia
- Rheumatic fever at age 7
- Vertigo
Past Surgical History:
- s/p Tonsillectomy
- s/p Vocal Chord Nodule Excision (benign)
- Cataract surgery OD. Awaiting surgery for OS.
- D+C
- Cystoscopy
- H/O Varicose vein sclerosing therapy. (Posteriorly in thighs

Social History:
Race: Caucasian
Last Dental Exam: 3 weeks ago
Lives alone. Widow and lost her husband in [**2160-11-12**] with
dementia. She lives in [**Hospital1 3494**] MA. She has three supportive
children.
Contact:                      Phone #
Occupation: Retired
Cigarettes: Smoked no [X] yes [] Hx:
Other Tobacco use:
ETOH: < 1 drink/week [X]  [**1-19**] drinks/week [] >8 drinks/week []
Illicit drug use: Never

Family History:
No premature coronary artery disease. Father with valvular heart
disease and RHD. Died at 62.

Physical Exam:
Pulse: 60 Resp: 16 O2 sat: 99%
B/P  Right: 148/75   Left: 149/69
Height: 5"3"   Weight: 150 lbs

General: WDWN in NAD. Appears younger then stated age.
Skin: Warm, Dry and intact. Faint inframammary
erythematous/scaly
rash c/w fungal infection.
HEENT: NCAT, PERRLA, EOMI, Sclera anicteric, OP benign.
Neck: Supple [X] Full ROM [X] No JVD
Chest: Lungs clear bilaterally [X]
Heart: RRR, NlS1-S2, IV/VI harsh systolic ejection murmur.
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X] Edema- trace left, none
on right
Varicosities: Multiple distal lspider varicosities. Dilated
veins
posteriorly and laterally. GSV appears suitable on standing.
Neuro: Grossly intact [X]
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 R>L

Pertinent Results:
[**2161-10-20**] Echo: PRE-BYPASS: No spontaneous echo contrast is seen
in the body of the left atrium or left 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 simple atheroma in
the aortic arch. There are simple atheroma in the descending
thoracic aorta. The aortic valve leaflets are severely
thickened/deformed. There is critical aortic valve stenosis
(valve area <0.8cm2). Moderate (2+) aortic regurgitation is
seen. The mitral valve leaflets are moderately thickened. The
mitral valve leaflets are myxomatous. Mild to moderate ([**12-14**]+)
mitral regurgitation is seen. There is no pericardial effusion.
Dr. [**Last Name (STitle) **] was notified in person of the results at time of
surgery.
POST-BYPASS: The patient is AV paced. The patient is on no
inotropes. Biventricular function is unchanged. There is a
well-seated bioprosthetic valve in the aortic position. There is
a mean gradient of 12 mmHg at a cardiac output of 3.2 L/min. No
aortic regurgitation is seen. No paravalvular leak is seen.
Mitral regurgitation is mild (1+). The aorta is intact
post-decannulation.

Brief Hospital Course:
The patient was brought to the operating room on [**10-18**] where the
patient underwent Aortic valve replacement 21-mm St. [**Hospital 923**]
Medical Biocor tissue valve.

Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.

POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.

Beta blocker was initiated and the patient was gently diuresed
toward the preoperative weight. Pt went into afib post op. Amio
was started. pt in afib longer then 24 hrs. Coumadin was
iniated, Now on a amio taper with coumadin ofr new onset afib.

The patient was transferred to the telemetry floor for further
recovery.  Chest tubes and pacing wires were discontinued
without complication.

The patient was evaluated by the physical therapy service for
assistance with strength and mobility.

By the time of discharge on POD 5 the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.  The patient was discharged to rehab  in good
condition with appropriate follow up instructions.

Medications on Admission:
ATENOLOL -  (Prescribed by Other Provider) - 25 mg Tablet - 0.5
(One half) Tablet(s) by mouth once a day
PREGABALIN [LYRICA] -  (Prescribed by Other Provider) - 100 mg
Capsule - 1 (One) Capsule(s) by mouth twice a day
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
(One) Tablet(s) by mouth once a day

Medications - OTC
FERROUS SULFATE -  (OTC) - 325 mg (65 mg iron) Tablet - 1 (One)
Tablet(s) by mouth every other day
FOLIC ACID -

Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
2. pregabalin 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): TAPE 400 [**Hospital1 **] X 7 DAYS, THEN 200 [**Hospital1 **] X 7 DAYS, THEN 200
QD UNTILL F/U WITH PCP.
5. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
6. oxybutynin chloride 5 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
7. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
8. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
9. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
10. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
11. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for fever, pain.
12. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. warfarin 2 mg Tablet Sig: One (1) Tablet PO at bedtime: INR
GOAL IS 2=3, FOR AFIB. PLEASE FOLLOW INR.
14. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
15. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO once a day for 7 days: HOLD FOR K
OF GREATER THEN 4.5.
16. INSULIN
Sliding Scale

Fingerstick QACHS

Insulin SC Sliding Scale

Breakfast Lunch Dinner Bedtime

Regular
Glucose Insulin Dose

0-70      mg/dL Proceed with hypoglycemia
71-119    mg/dL 0   Units 0   Units 0   Units 0   Units
120-159   mg/dL 2   Units 2   Units 2   Units 0   Units
160-199   mg/dL 4   Units 4   Units 4   Units 2   Units
200-239   mg/dL 6   Units 6   Units 6   Units 4   Units
240-280   mg/dL 8   Units 8   Units 8   Units 6   Units


Discharge Disposition:
Extended Care

Facility:
Life Care Center at [**Location (un) 2199**]

Discharge Diagnosis:
Aortic Stenosis s/p Aortic valve replacement
Past medical history:
- Moderate MR
- Non sustained VT, NSVT, multifocal VEA on Holter [**2157-12-22**]
- Peripheral vascular disease
- Mild Carotid Artery Disease
- Anemia - [**2152**] found incidentally, GI workup was negative
except
for the "beginning of Barrett's Esophagus. Received 11 units of
PRBC. No recent bleeding or further work. She avoids Aspirin.
- History of hematochezia. W/U negative and this resolved. FeSO4

started.
- Irritable Bowel Syndrome
- Dyslipidemia
- Hypertension
- Vulvodynia
- Rheumatic fever at age 7
- Vertigo

Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage

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) **] ([**Telephone/Fax (1) 170**]) on [**2161-11-25**] at 1pm in the
[**Hospital **] Medical Office Building, [**Last Name (NamePattern1) **]., [**Hospital Unit Name **].
Cardiologist: Dr. [**Last Name (STitle) **] on [**2161-11-13**] at 1;30pm

Please call to schedule appointments with:
Primary Care: Dr. [**First Name (STitle) 15316**] [**Name (STitle) 12646**] ([**Telephone/Fax (1) 4615**]) in [**3-17**] 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:[**2161-10-25**]
{'Mitral valve insufficiency and aortic valve stenosis,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Examination of participant in clinical trial,Retention of urine, 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: Fatigue and lightheadedness

PRESENT ILLNESS: 82 year old female with known aortic stenosis which has been
followed by serial echocardiograms over the past 10 years. Her
most recent echocardiogram revealed an increased mean systolic
gradient from 72 mm Hg to 93 mmHg with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.3cm2. Ms.
[**Known lastname 32245**] is fairly adament that she does not experience any
symptoms related to her disease however, when pressed, over the
last couple of months she reports mild intermittent
lightheadedness and increasing fatigue. At one point she did
experience some chest pain with walking however this is not a
frequent occurrence. Overall she is very active, climbing a
couple of flights of stairs with laundry and or groceries daily.
She denies any palpitations or syncope. Given the severity of
her disease, she now presents for surgical consultation.

MEDICAL HISTORY: Aortic Stenosis s/p Aortic valve replacement
Past medical history:
- Moderate MR
- Non sustained VT, NSVT, multifocal VEA on Holter [**2157-12-22**]
- Peripheral vascular disease
- Mild Carotid Artery Disease
- Anemia - [**2152**] found incidentally, GI workup was negative
except
for the "beginning of Barrett's Esophagus. Received 11 units of
PRBC. No recent bleeding or further work. She avoids Aspirin.
- History of hematochezia. W/U negative and this resolved. FeSO4

MEDICATION ON ADMISSION: ATENOLOL -  (Prescribed by Other Provider) - 25 mg Tablet - 0.5
(One half) Tablet(s) by mouth once a day
PREGABALIN [LYRICA] -  (Prescribed by Other Provider) - 100 mg
Capsule - 1 (One) Capsule(s) by mouth twice a day
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
(One) Tablet(s) by mouth once a day

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Pulse: 60 Resp: 16 O2 sat: 99%
B/P  Right: 148/75   Left: 149/69
Height: 5"3"   Weight: 150 lbs

FAMILY HISTORY: No premature coronary artery disease. Father with valvular heart
disease and RHD. Died at 62.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 3 weeks ago
Lives alone. Widow and lost her husband in [**2160-11-12**] with
dementia. She lives in [**Hospital1 3494**] MA. She has three supportive
children.
Contact:                      Phone #
Occupation: Retired
Cigarettes: Smoked no [X] yes [] Hx:
Other Tobacco use:
ETOH: < 1 drink/week [X]  [**1-19**] drinks/week [] >8 drinks/week []
Illicit drug use: Never 

### Response:
{'Mitral valve insufficiency and aortic valve stenosis,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Examination of participant in clinical trial,Retention of urine, unspecified'}
