CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: This is a 48yo female with rheumatic heart disease. She is
followed by Dr. [**Last Name (STitle) **] who has obtained serial echocardiograms.
Most recent echo in [**2109-3-23**] revealed severe AS with a peak
gradient of 70 mmHg and [**Location (un) 109**] of 0.6cm2. There was 2+ AI, 4+ MR,
and 2+ TR. She had normal LV function. Cardiac cath in [**2109-6-22**]
showed normal coronary arteries, severe aortic stenosis,
moderate mitral mixed stenosis and regurgitation and normal LV
function. Given echo evidence of worsening valvular disease, she
was referred for surgical intervention. Prior to admission, her
symptoms included dyspnea on exertion and decreased exercise
tolerance.

MEDICAL HISTORY: Rheumatic Heart Disease
Aortic Stenosis, Aortic Insufficiency
Mitral Stenosis, Mitral Insufficeincy
s/p Ovarian Cyst Removal
s/p Cesarean

MEDICATION ON ADMISSION: Calcium, Vitamin D

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 130-150/60-70, HR 77, RR 16,
General: well developed female in no acute distress
HEENT: oropharynx benign, PERRL
Neck: supple, no JVD, transmitted murmur in carotid regions
Heart: regular rate, normal s1s2, [**3-28**] holosystolic murmur with
[**3-28**] diastolic murmur
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 2+ distally
Neuro: nonfocal

FAMILY HISTORY: Denied premature CAD

SOCIAL HISTORY: Denied tobacco and ETOH. Currently lives with her husband. [**Name (NI) 1403**]
in finance.
Mitral valve stenosis and aortic valve stenosis,Atrial fibrillation,Rheumatic heart disease, unspecified,Abnormal coagulation profile
Mitral/aortic stenosis,Atrial fibrillation,Rheumatic heart dis NOS,Abnrml coagultion prfile
Admission Date:  [**2109-7-15**]              Discharge Date:   [**2109-7-28**]

Date of Birth:  [**2060-7-6**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2109-7-15**] Aortic Valve Replacement utilizing a 19mm St. [**Male First Name (un) 923**]
mechanical valve. Mitral Valve Replacement utilizing a [**Street Address(2) 17009**].
[**Male First Name (un) 923**] mechanical valve


History of Present Illness:
This is a 48yo female with rheumatic heart disease. She is
followed by Dr. [**Last Name (STitle) **] who has obtained serial echocardiograms.
Most recent echo in [**2109-3-23**] revealed severe AS with a peak
gradient of 70 mmHg and [**Location (un) 109**] of 0.6cm2. There was 2+ AI, 4+ MR,
and 2+ TR. She had normal LV function. Cardiac cath in [**2109-6-22**]
showed normal coronary arteries, severe aortic stenosis,
moderate mitral mixed stenosis and regurgitation and normal LV
function. Given echo evidence of worsening valvular disease, she
was referred for surgical intervention. Prior to admission, her
symptoms included dyspnea on exertion and decreased exercise
tolerance.

Past Medical History:
Rheumatic Heart Disease
Aortic Stenosis, Aortic Insufficiency
Mitral Stenosis, Mitral Insufficeincy
s/p Ovarian Cyst Removal
s/p Cesarean

Social History:
Denied tobacco and ETOH. Currently lives with her husband. [**Name (NI) 1403**]
in finance.

Family History:
Denied premature CAD

Physical Exam:
Vitals: BP 130-150/60-70, HR 77, RR 16,
General: well developed female in no acute distress
HEENT: oropharynx benign, PERRL
Neck: supple, no JVD, transmitted murmur in carotid regions
Heart: regular rate, normal s1s2, [**3-28**] holosystolic murmur with
[**3-28**] diastolic murmur
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 2+ distally
Neuro: nonfocal


Pertinent Results:
[**2109-7-23**] 06:40AM BLOOD WBC-8.3 RBC-3.93* Hgb-12.5 Hct-34.7*
MCV-89 MCH-31.9 MCHC-36.1* RDW-12.8 Plt Ct-276#
[**2109-7-23**] 06:40AM BLOOD Glucose-120* UreaN-17 Creat-1.0 Na-137
K-3.8 Cl-94* HCO3-32 AnGap-15
[**2109-7-28**] 05:12AM BLOOD PT-23.8* PTT-88.7* INR(PT)-2.4*

Brief Hospital Course:
On the day of admission, Dr. [**Last Name (STitle) 1290**] performed aortic and
mitral valve replacments utilizing St. [**Male First Name (un) 923**] mechanical heart
valves. Surgery was uncomplicated and she was brought to the
CSRU for invasive monitoring. Within 24 hours, she awoke
neurologically intact and was extubated. She had brief episodes
of paroxysmal atrial fibrillation. Amiodarone was intiated with
successful conversion back to normal sinus rhythm. Her CSRU
course was otherwise uneventful and she transferred to the SDU
on postoperative day one. She tolerated Amiodarone and low dose
beta blockade. She remained in a normal sinus rhythm without
further episodes of atrial fibrillation. Warfarin therapy was
initiated and dosed for a goal INR between 3.0 - 3.5. She was
slow to anticoagulate and temporarily required Heparin due to a
subtherapeutic prothrombin time. Her postoperative course was
otherwise uneventful and she was discharged to home on
postoperative day 13. Her INR at the time of discharge was 2.4
with a dose of 5mg daily. She has been increasing appropriately
over the past several days. Her INR will be checked by the VNA
tomorrow [**7-29**] and called in to the office of Dr. [**First Name (STitle) **], her PCP,
[**Name10 (NameIs) 1023**] will follow her in the future.

Medications on Admission:
Calcium, Vitamin D

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 6-8 hours as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
2. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
5. Warfarin 2 mg Tablet Sig: 2.5 Tablets PO qpm: Take as
directed by MD. Daily dose may vary according to INR.
Disp:*75 Tablet(s)* Refills:*2*
6. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Outpatient Lab Work
INR
Please call results to the office of Dr. [**First Name (STitle) **]
[**Telephone/Fax (1) 12372**]


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Reumatic heart disease, aortic stenosis, mixed mitral stenosis
and regurgitation - s/p aortic and mitral valve replacements
utilizing St. [**Male First Name (un) 923**] mechanical heart valves


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 [**3-27**] weeks - call for appt.
Local PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) **] in [**1-25**] weeks - call for appt.
Local cardiologist, Dr. [**Last Name (STitle) **] in [**1-25**] weeks - call for appt.
{'Mitral valve stenosis and aortic valve stenosis,Atrial fibrillation,Rheumatic heart disease, unspecified,Abnormal coagulation profile'}


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: This is a 48yo female with rheumatic heart disease. She is
followed by Dr. [**Last Name (STitle) **] who has obtained serial echocardiograms.
Most recent echo in [**2109-3-23**] revealed severe AS with a peak
gradient of 70 mmHg and [**Location (un) 109**] of 0.6cm2. There was 2+ AI, 4+ MR,
and 2+ TR. She had normal LV function. Cardiac cath in [**2109-6-22**]
showed normal coronary arteries, severe aortic stenosis,
moderate mitral mixed stenosis and regurgitation and normal LV
function. Given echo evidence of worsening valvular disease, she
was referred for surgical intervention. Prior to admission, her
symptoms included dyspnea on exertion and decreased exercise
tolerance.

MEDICAL HISTORY: Rheumatic Heart Disease
Aortic Stenosis, Aortic Insufficiency
Mitral Stenosis, Mitral Insufficeincy
s/p Ovarian Cyst Removal
s/p Cesarean

MEDICATION ON ADMISSION: Calcium, Vitamin D

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 130-150/60-70, HR 77, RR 16,
General: well developed female in no acute distress
HEENT: oropharynx benign, PERRL
Neck: supple, no JVD, transmitted murmur in carotid regions
Heart: regular rate, normal s1s2, [**3-28**] holosystolic murmur with
[**3-28**] diastolic murmur
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 2+ distally
Neuro: nonfocal

FAMILY HISTORY: Denied premature CAD

SOCIAL HISTORY: Denied tobacco and ETOH. Currently lives with her husband. [**Name (NI) 1403**]
in finance. 

### Response:
{'Mitral valve stenosis and aortic valve stenosis,Atrial fibrillation,Rheumatic heart disease, unspecified,Abnormal coagulation profile'}
