CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: This 60 year old white female underwent mechanical aortic valve
replacement on [**2191-3-4**] for aortic stenosis.  She did well and
was discharged home uneventfully.  She presented elsewhere with
dyspnea on exertion and a CXR demonstrated a left pleural
effusion. She was transferred here for evaluation with stable
vital signs and an INR of 2.5.  An echocardiogram in the ED
suggested a pericardial effusion but no evidence of tamponade.

MEDICAL HISTORY: Aortic stenosis
s/p aortic valve replacement
hyperlipidemia
hypertension
Diabetes mellitus
fibromyalgia
s/p right knee menicus repair
s/p right carpal tunnel repair
s/p tonsilectomy

MEDICATION ON ADMISSION: ezetimibe 10 mg Tablet
duloxetine 30 mg Capsule, Delayed Release(E.C.)
simvastatin 40 mg Tablet
aspirin 81 mg Tablet, Delayed Release
metformin 500 mg Tablet
metoprolol tartrate 25 mg Tablet
furosemide 40 mg Tablet
potassium chloride 10 mEq Tablet Extended Release
hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H
Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day:
coumadin for mechanical AVR, goal [**12-23**].

ALLERGIES: Codeine / IV Dye, Iodine Containing Contrast Media

PHYSICAL EXAM: Pulse: 80 Resp:18  O2 sat: 99%
B/P  Right: 132/64

FAMILY HISTORY: grandfather deceased MI at 60

SOCIAL HISTORY: Last Dental Exam: > 6months
Lives with: significant other
Occupation: program counselor - community action
Tobacco: 30 pack year history
ETOH:1-2 drinks a month
Other respiratory complications,Unspecified pleural effusion,Acute idiopathic pericarditis,Other signs and symptoms in breast,Dermatophytosis of the body,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Myalgia and myositis, unspecified,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Personal history of tobacco use
Respiratory comp NEC,Pleural effusion NOS,Ac idiopath pericarditis,Symptoms in breast NEC,Dermatophytosis of body,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Asthma NOS,Myalgia and myositis NOS,Heart valve replac NEC,Long-term use anticoagul,Abn react-artif implant,History of tobacco use
Admission Date:  [**2191-3-27**]              Discharge Date:   [**2191-4-7**]

Date of Birth:  [**2130-11-17**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / IV Dye, Iodine Containing Contrast Media

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
[**2191-3-30**] L VATS pericardial window
[**2191-3-4**] mechanical AVR


History of Present Illness:
This 60 year old white female underwent mechanical aortic valve
replacement on [**2191-3-4**] for aortic stenosis.  She did well and
was discharged home uneventfully.  She presented elsewhere with
dyspnea on exertion and a CXR demonstrated a left pleural
effusion. She was transferred here for evaluation with stable
vital signs and an INR of 2.5.  An echocardiogram in the ED
suggested a pericardial effusion but no evidence of tamponade.


Past Medical History:
Aortic stenosis
s/p aortic valve replacement
hyperlipidemia
hypertension
Diabetes mellitus
fibromyalgia
s/p right knee menicus repair
s/p right carpal tunnel repair
s/p tonsilectomy

Social History:
Last Dental Exam: > 6months
Lives with: significant other
Occupation: program counselor - community action
Tobacco: 30 pack year history
ETOH:1-2 drinks a month


Family History:
grandfather deceased MI at 60


Physical Exam:
Pulse: 80 Resp:18  O2 sat: 99%
B/P  Right: 132/64

General: awake, not in distress while sitting
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  no Murmur
Abdomen: Soft [x] non-distended [x] non-tender
[x]  bowel sounds
Extremities: Warm [x], well-perfused [x]
no Edema Varicosities: None
Neuro: Grossly intact
Pulses:
Femoral      Right:   Left:
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right: no   Left: no


Pertinent Results:
Admission labs
[**2191-3-27**] 05:25AM BLOOD WBC-7.1 RBC-3.48* Hgb-10.3* Hct-29.7*
MCV-85 MCH-29.5 MCHC-34.6 RDW-13.6 Plt Ct-443*
[**2191-3-27**] 10:40AM BLOOD PT-27.4* PTT-32.7 INR(PT)-2.6*
[**2191-3-27**] 05:25AM BLOOD PT-26.2* PTT-34.3 INR(PT)-2.5*
[**2191-3-27**] 05:25AM BLOOD Glucose-118* UreaN-11 Creat-0.7 Na-140
K-4.6 Cl-101 HCO3-30 AnGap-14
[**2191-3-28**] 03:35PM BLOOD ALT-40 AST-28 LD(LDH)-251* AlkPhos-114*
Amylase-51 TotBili-0.4
[**2191-3-27**] 05:25AM BLOOD proBNP-1111*
Discahege labs
[**2191-4-5**] 04:56AM BLOOD WBC-7.4 RBC-3.57* Hgb-10.0* Hct-30.7*
MCV-86 MCH-28.0 MCHC-32.6 RDW-14.4 Plt Ct-424
[**2191-4-7**] 03:49AM BLOOD PT-26.3* PTT-98.8* INR(PT)-2.5*
[**2191-4-6**] 03:56AM BLOOD PT-19.8* PTT-82.4* INR(PT)-1.8*
[**2191-4-5**] 04:56AM BLOOD UreaN-15 Creat-1.0 Na-141 K-4.0 Cl-99

Radiology Report CHEST (PA & LAT) [**2191-4-4**] 3:00 PM  Clip #
[**Clip Number (Radiology) 89350**]
Final Report: As compared to the previous radiograph, there is
no relevant
change. No evidence of pneumothorax. Bilateral basal atelectatic
opacities, left more than right. Presence of small bilateral
pleural effusions cannot be excluded. Unchanged course of the
left-sided PICC line. Unchanged mild cardiomegaly. Sternal wires
are in constant position.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  55% to 60%  >= 55%
Aortic Valve - Peak Gradient:  13 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  8 mm Hg
Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.
LEFT VENTRICLE: Overall normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal ascending aorta diameter. Simple atheroma in
descending aorta.
AORTIC VALVE: No AS. Trace AR.
MITRAL VALVE: Moderately thickened mitral valve leaflets.
Trivial MR.
TRICUSPID VALVE: Mild to moderate [[**11-21**]+] TR.
PERICARDIUM: Small 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. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
This is a directed study to confirm function of heart and
prosthetic aortic valve.
No spontaneous echo contrast is seen in the left atrial
appendage.
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 descending thoracic aorta.
There is no aortic valve stenosis. Trace aortic regurgitation is
seen.
The mitral valve leaflets are moderately thickened. Trivial
mitral regurgitation is seen.
There is a small pericardial effusion.
There is 1 - 2+ TR.
The prosthetic aortic valve is well-seated with trace AI and a
normal residual mean gradient.
There is a small pericardial effusion which was drained in the
OR.
A large left pleural effusion was drained in the OR.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2191-4-5**] 14:57


Brief Hospital Course:
Following admission a CTA done which revealed a large
pericaridial effusion and a moderate left pleural effusion.
Coumadin was held and heparin begun in light of the mechanical
valve.
Thoracic Surgery was consulted and on [**2191-3-30**] she went to the
Operating Room for:
Left video-assisted thoracic surgery (VATS)/pericardial window.
Please see operative report for details. She tolerated the
operation well and post-operatively was initially transferred to
the PACU and extubated however she required reintubation
secondary to hypercapnia. She was then transferred to the
cardiac surgery ICU for care. She woke neurologically intact,
she was weaned from the ventilator and extubated. On POD1 she
remained hemodynamically stable and was transferred to the
cardiac surgery stepdown floor. The next several days were
largely uneventful, heparin and coumadin were resumed. Her drain
was removed on POD3. She worked with physical therapy to improve
her strength and endurance. On POD8 her INR was within range to
be discharged home with VNA. Her Coumadin dosing and INR will be
followed by Dr [**Last Name (STitle) 35852**].



Medications on Admission:
ezetimibe 10 mg Tablet
duloxetine 30 mg Capsule, Delayed Release(E.C.)
simvastatin 40 mg Tablet
aspirin 81 mg Tablet, Delayed Release
metformin 500 mg Tablet
metoprolol tartrate 25 mg Tablet
furosemide 40 mg Tablet
potassium chloride 10 mEq Tablet Extended Release
hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H
Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day:
coumadin for mechanical AVR, goal [**12-23**].


Discharge Medications:
1. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. 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*
5. metformin 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for fever/pain.
8. tramadol 50 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
9. hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every four
(4) hours as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
10. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO DAILY (Daily).
Disp:*30 Tablet Extended Release(s)* Refills:*0*
11. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*2*
12. guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q4H (every 4
hours) as needed for cough.
13. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
Disp:*120 Capsule(s)* Refills:*2*
14. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical QID
(4 times a day) as needed for rash.
Disp:*1 bottle* Refills:*0*
15. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: [**11-21**]
Puffs Inhalation Q6H (every 6 hours) as needed for dyspnea.
16. nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
Disp:*1 tube* Refills:*0*
17. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
18. warfarin 2.5 mg Tablet Sig: as directed  Tablet PO once a
day.
Disp:*100 Tablet(s)* Refills:*2*
19. warfarin 2.5 mg Tablet Sig: Three (3) Tablet PO on [**4-7**] for
1 days.


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
pericardial effusion s/p Left VATs/pericardial window
s/p aortic valve replacement
jhyperlipidemiahypertension
noninsulin dependent diabetes mellitus
fibromyalgia
s/p carpal tunnel release
s/p tonsillectomy
s/p right knee arthroscopy


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with Dilaudid and Ultram
Incisions:
left VATS incision - healing well, no erythema or drainage
Edema: trace bilat


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) **]  Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2191-4-21**] 1:15
Cardiologist: Dr. [**Last Name (STitle) 4922**] on [**2191-4-15**] at 1:45pm
Thoracic surgeon: [**Name6 (MD) 1532**] [**Last Name (NamePattern4) 8786**], MD Phone:[**Telephone/Fax (1) 3020**]
Date/Time:[**2191-4-19**] 9:30

Please call to schedule appointments with:
Primary Care: Dr. [**Last Name (STitle) 35852**] ([**Telephone/Fax (1) 34088**]) in [**2-22**] 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**

Labs: PT/INR for Coumadin ?????? indication is mechanical AVR
Goal INR 2.5-3.0
First draw day after discharge, [**4-8**]
Results to Dr. [**Last Name (STitle) 35852**] phone [**Telephone/Fax (1) 34088**] fax [**Telephone/Fax (1) 89349**]



Completed by:[**2191-4-7**]
{'Other respiratory complications,Unspecified pleural effusion,Acute idiopathic pericarditis,Other signs and symptoms in breast,Dermatophytosis of the body,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Myalgia and myositis, unspecified,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Personal history of tobacco use'}


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: shortness of breath

PRESENT ILLNESS: This 60 year old white female underwent mechanical aortic valve
replacement on [**2191-3-4**] for aortic stenosis.  She did well and
was discharged home uneventfully.  She presented elsewhere with
dyspnea on exertion and a CXR demonstrated a left pleural
effusion. She was transferred here for evaluation with stable
vital signs and an INR of 2.5.  An echocardiogram in the ED
suggested a pericardial effusion but no evidence of tamponade.

MEDICAL HISTORY: Aortic stenosis
s/p aortic valve replacement
hyperlipidemia
hypertension
Diabetes mellitus
fibromyalgia
s/p right knee menicus repair
s/p right carpal tunnel repair
s/p tonsilectomy

MEDICATION ON ADMISSION: ezetimibe 10 mg Tablet
duloxetine 30 mg Capsule, Delayed Release(E.C.)
simvastatin 40 mg Tablet
aspirin 81 mg Tablet, Delayed Release
metformin 500 mg Tablet
metoprolol tartrate 25 mg Tablet
furosemide 40 mg Tablet
potassium chloride 10 mEq Tablet Extended Release
hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H
Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day:
coumadin for mechanical AVR, goal [**12-23**].

ALLERGIES: Codeine / IV Dye, Iodine Containing Contrast Media

PHYSICAL EXAM: Pulse: 80 Resp:18  O2 sat: 99%
B/P  Right: 132/64

FAMILY HISTORY: grandfather deceased MI at 60

SOCIAL HISTORY: Last Dental Exam: > 6months
Lives with: significant other
Occupation: program counselor - community action
Tobacco: 30 pack year history
ETOH:1-2 drinks a month 

### Response:
{'Other respiratory complications,Unspecified pleural effusion,Acute idiopathic pericarditis,Other signs and symptoms in breast,Dermatophytosis of the body,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Myalgia and myositis, unspecified,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Personal history of tobacco use'}
