CHIEF COMPLAINT: dyspnea on exertion, known aortic stenosis

PRESENT ILLNESS: 81yo woman w/known AS, worsening dyspnea over last several
months referred for AVR. Scheduled for preop cardiac
catheterization prior to surgery

MEDICAL HISTORY: 1. Aortic Stenosis
2. Mechanical fall c/b Subdural hematoma [**8-20**] and right orbital
and nasal fracture, s/p ORIF and closed reduction
3. Anemia with baseline HCT around 30
4. Hypertension
5. DM II
6. CHF
[**12-20**] Echo: EF 55-60%. Moderately severe AS with [**Location (un) 109**] 0.7cm2,
peak aortic gradient 43mmHG, mean gradient 23mmHG. Mild AI. 2+MR
(may be underestimated), [**1-17**]+TR. Moderate LAE, mild [**Last Name (un) **].
Moderate to severe pulmonary artery systolic hypertension. EF
55-60%.
7. Breast cancer s/p Left Mastectomy [**2148**]
8. Total abdominal Hysterectomy [**2152**]
9. Carpal tunnel surgery
[**61**]. Urge/Stress incontinence: pt straight caths self 3x/day
11. Multiple urinary tract infections
12. Left femoral neck fracture [**2154**] s/p left hip
hemiarthroplasty

MEDICATION ON ADMISSION: 1. Quinapril 20 QD
2. Atenolol 100 QAM/50 QPM
3. Lasix 40 QD
4. Lovastatin 20 QD
5. Protonix 40 QD
6. Ativan 1 QHS/prn
7. Glucophage 500 TID
8. Folate
9. Vit B&E
10. Darvocet N-100 prn

ALLERGIES: Reserpine / Phenobarbital / Niacin

PHYSICAL EXAM: Preop:
Gen- NAD
Skin- Unremarkable
HEENT- PERRL-EOMI, MMM- oropharynx benign, neck supple- no
lymphadenopathy
Pulm- CTA
C/V- RRR
Abdm- Soft, NT/ND/NABS
Ext- warm well perfused
Neuro- grossly intact

FAMILY HISTORY: Mom had diabetes and HTN.  No h/o heart disease.  Breast cancer
in mom and daughter.

SOCIAL HISTORY: retired. Lives alone in [**Location (un) 620**].  Lost 2 husbands, the last in
[**2147**].  has 3 daughters.  Remote h/o smoking [**1-17**] gigarettes/day.
No alcohol or illicit drug use.
Accidental cut, puncture, perforation or hemorrhage during surgical operation,Acidosis,Cirrhosis of liver without mention of alcohol,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other musculoskeletal symptoms referable to limbs,Anemia, unspecified,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Severe sepsis,Accidental puncture or laceration during a procedure, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Iatrogenic cerebrovascular infarction or hemorrhage,Congestive heart failure, unspecified
Acc cut/hem in surgery,Acidosis,Cirrhosis of liver NOS,Thrombocytopenia NOS,Hyp kid NOS w cr kid V,Muscskel sympt limb NEC,Anemia NOS,Aortic valve disorder,Crnry athrscl natve vssl,Severe sepsis,Accidental op laceration,Ac kidny fail, tubr necr,Acute necrosis of liver,Iatrogen CV infarc/hmrhg,CHF NOS
Admission Date:  [**2157-8-23**]              Discharge Date:   [**2157-9-5**]


Service: CARDIOTHORACIC

Allergies:
Reserpine / Phenobarbital / Niacin

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
dyspnea on exertion, known aortic stenosis

Major Surgical or Invasive Procedure:
s/p AVR/CABG


History of Present Illness:
81yo woman w/known AS, worsening dyspnea over last several
months referred for AVR. Scheduled for preop cardiac
catheterization prior to surgery

Past Medical History:
1. Aortic Stenosis
2. Mechanical fall c/b Subdural hematoma [**8-20**] and right orbital
and nasal fracture, s/p ORIF and closed reduction
3. Anemia with baseline HCT around 30
4. Hypertension
5. DM II
6. CHF
[**12-20**] Echo: EF 55-60%. Moderately severe AS with [**Location (un) 109**] 0.7cm2,
peak aortic gradient 43mmHG, mean gradient 23mmHG. Mild AI. 2+MR
(may be underestimated), [**1-17**]+TR. Moderate LAE, mild [**Last Name (un) **].
Moderate to severe pulmonary artery systolic hypertension. EF
55-60%.
7. Breast cancer s/p Left Mastectomy [**2148**]
8. Total abdominal Hysterectomy [**2152**]
9. Carpal tunnel surgery
[**61**]. Urge/Stress incontinence: pt straight caths self 3x/day
11. Multiple urinary tract infections
12. Left femoral neck fracture [**2154**] s/p left hip
hemiarthroplasty


Social History:
retired. Lives alone in [**Location (un) 620**].  Lost 2 husbands, the last in
[**2147**].  has 3 daughters.  Remote h/o smoking [**1-17**] gigarettes/day.
No alcohol or illicit drug use.


Family History:
Mom had diabetes and HTN.  No h/o heart disease.  Breast cancer
in mom and daughter.

Physical Exam:
Preop:
Gen- NAD
Skin- Unremarkable
HEENT- PERRL-EOMI, MMM- oropharynx benign, neck supple- no
lymphadenopathy
Pulm- CTA
C/V- RRR
Abdm- Soft, NT/ND/NABS
Ext- warm well perfused
Neuro- grossly intact

Postop:
Gen-NAD
Neuro- A+Ox3, lft sided weakness LUE>LLE with slight facial
droop
Pulm- CTA bilat
C/V- RRR, sternum stable
Abdm- soft, NT/ND/NABS
Incision- CDI
Ext- Warm, no edema, Lft EVH site CDI


Pertinent Results:
[**2157-8-23**] 08:30PM   UREA N-30* CREAT-1.2*
[**2157-8-23**] 08:30PM   WBC-26.5* RBC-4.36 HGB-13.2 HCT-39.9 MCV-92
MCH-30.3 MCHC-33.1 RDW-19.1*
[**2157-8-23**] 08:30PM   PLT COUNT-228
[**2157-8-23**] 03:01PM   UREA N-27* CREAT-1.0 CHLORIDE-113* TOTAL
CO2-22
[**2157-8-23**] 03:01PM   PT-15.4* PTT-36.3* INR(PT)-1.4*
[**2157-9-5**] 03:20AM BLOOD WBC-12.8* RBC-2.53* Hgb-7.9* Hct-24.2*
MCV-96 MCH-31.1 MCHC-32.5 RDW-17.1* Plt Ct-114*
[**2157-9-5**] 03:20AM BLOOD Plt Ct-114*
[**2157-9-5**] 03:20AM BLOOD PT-13.5* PTT-24.4 INR(PT)-1.2*
[**2157-9-5**] 03:20AM BLOOD Glucose-153* UreaN-46* Creat-1.3* Na-142
K-5.0 Cl-104 HCO3-29 AnGap-14
[**2157-9-1**] 01:59AM BLOOD ALT-119* AST-66* AlkPhos-106 Amylase-40
TotBili-0.5
[**2157-9-1**] 01:59AM BLOOD Lipase-41
[**2157-8-30**] 02:51AM BLOOD Albumin-2.8* Phos-3.7 Mg-2.7*
[**2157-8-25**] 10:32AM BLOOD HEPARIN DEPENDENT ANTIBODIES- neg

Brief Hospital Course:
Pt was a direct admission to operating room (please see OR
report for full details), she had an AVR(#21 pericardial
valve)CABGx3(LIMA-LAD, SVG-Diag, SVG-RCA)and repair Coronary
sinus. Pt tolerated the operation however in the immediate
post-op period she was noted to have a distended abdomen,
metabolic acidosis, poor urine output with bladder pressures of
32 and an elevated WBC. The general surgery service was
consulted and pt was tapped for 1.5 liters of acitic fluid. The
hepatobiliary service was also consulted as was ID and renal.
Over the next several days the pt had elevated BUN/Cr, LFT's and
WBC all resolved without clear explaination. The patient was
slow to wake and had diffuse muscle weakness post-op and
therefore was not extubated until POD 4, she was noted to have
left sided weakness and difficulty swallowing after extubation,
she failed a swallow evaluation and a head CT at that time
showed a subacute infarct in the same area as a previous
subdural hematoma.
The patient stayed in the ICU after extubation because her
pulmonary status was tenuous requiring vigorous pulmonary
toilet.
The patient continued to make progress over the next several
days but it was felt by the ICU team that she would require a
stay in rehabilitaion before returning home. On POD 13 it was
felt that the patient was stable and ready for discharge to
rehabilitation.

Medications on Admission:
1. Quinapril 20 QD
2. Atenolol 100 QAM/50 QPM
3. Lasix 40 QD
4. Lovastatin 20 QD
5. Protonix 40 QD
6. Ativan 1 QHS/prn
7. Glucophage 500 TID
8. Folate
9. Vit B&E
10. Darvocet N-100 prn


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
2. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  PRN
(as needed).
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
4. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours) as needed.
5. Metformin 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
6. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Ten (10)
units Subcutaneous twice a day.
7. Docusate Sodium 150 mg/15 mL Liquid Sig: Ten (10) cc PO BID
(2 times a day).
8. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty
(30) mg PO DAILY (Daily).
9. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
11. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 **]

Discharge Diagnosis:
s/p AVR(#21 pericardial)CABGx3(LIMA-LAD,SVG-Diag, SVG-RCA)Repair
of coronary sinus ([**8-23**])
s/p AVR(#21 pericardial)CABGx3(LIMA-LAD, SVG-Diag,
SVG-RCA)Repair of Coronary sinus([**8-23**])
CVA w/ residual left sided weakness
PMH:HTN, CAD, DM2, CRI, Urinary incontinance(straight cath
3x/day)frequent UTI's, SDH/orbital floor fx s/p ORIF, L hip
replacement, s/p TAH, s/p Rt mastectomy, s/p carpal tunnel


Discharge Condition:
stable


Discharge Instructions:
keep wounds clean and dry. OK to shower, no bathing or swimming.
Take all medications as prescribed
Call for any fever, redness or drainage from wounds.

Followup Instructions:
Dr [**First Name (STitle) **] [**Doctor Last Name **] 2-3 weeks after d/c from rehab
Dr [**Last Name (STitle) **] in 4 weeks



Completed by:[**2157-9-5**]
{'Accidental cut, puncture, perforation or hemorrhage during surgical operation,Acidosis,Cirrhosis of liver without mention of alcohol,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other musculoskeletal symptoms referable to limbs,Anemia, unspecified,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Severe sepsis,Accidental puncture or laceration during a procedure, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Iatrogenic cerebrovascular infarction or hemorrhage,Congestive heart failure, 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: dyspnea on exertion, known aortic stenosis

PRESENT ILLNESS: 81yo woman w/known AS, worsening dyspnea over last several
months referred for AVR. Scheduled for preop cardiac
catheterization prior to surgery

MEDICAL HISTORY: 1. Aortic Stenosis
2. Mechanical fall c/b Subdural hematoma [**8-20**] and right orbital
and nasal fracture, s/p ORIF and closed reduction
3. Anemia with baseline HCT around 30
4. Hypertension
5. DM II
6. CHF
[**12-20**] Echo: EF 55-60%. Moderately severe AS with [**Location (un) 109**] 0.7cm2,
peak aortic gradient 43mmHG, mean gradient 23mmHG. Mild AI. 2+MR
(may be underestimated), [**1-17**]+TR. Moderate LAE, mild [**Last Name (un) **].
Moderate to severe pulmonary artery systolic hypertension. EF
55-60%.
7. Breast cancer s/p Left Mastectomy [**2148**]
8. Total abdominal Hysterectomy [**2152**]
9. Carpal tunnel surgery
[**61**]. Urge/Stress incontinence: pt straight caths self 3x/day
11. Multiple urinary tract infections
12. Left femoral neck fracture [**2154**] s/p left hip
hemiarthroplasty

MEDICATION ON ADMISSION: 1. Quinapril 20 QD
2. Atenolol 100 QAM/50 QPM
3. Lasix 40 QD
4. Lovastatin 20 QD
5. Protonix 40 QD
6. Ativan 1 QHS/prn
7. Glucophage 500 TID
8. Folate
9. Vit B&E
10. Darvocet N-100 prn

ALLERGIES: Reserpine / Phenobarbital / Niacin

PHYSICAL EXAM: Preop:
Gen- NAD
Skin- Unremarkable
HEENT- PERRL-EOMI, MMM- oropharynx benign, neck supple- no
lymphadenopathy
Pulm- CTA
C/V- RRR
Abdm- Soft, NT/ND/NABS
Ext- warm well perfused
Neuro- grossly intact

FAMILY HISTORY: Mom had diabetes and HTN.  No h/o heart disease.  Breast cancer
in mom and daughter.

SOCIAL HISTORY: retired. Lives alone in [**Location (un) 620**].  Lost 2 husbands, the last in
[**2147**].  has 3 daughters.  Remote h/o smoking [**1-17**] gigarettes/day.
No alcohol or illicit drug use. 

### Response:
{'Accidental cut, puncture, perforation or hemorrhage during surgical operation,Acidosis,Cirrhosis of liver without mention of alcohol,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other musculoskeletal symptoms referable to limbs,Anemia, unspecified,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Severe sepsis,Accidental puncture or laceration during a procedure, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Iatrogenic cerebrovascular infarction or hemorrhage,Congestive heart failure, unspecified'}
