CHIEF COMPLAINT: 

PRESENT ILLNESS: 

MEDICAL HISTORY: His past medical history is
significant for hypertension, aortic stenosis and mild
obesity.

MEDICATION ON ADMISSION: Effexor 37.5 mg q.o.d., Verapamil
180 mg p.o. q.d., Zestoretic 20/12.5 p.o. q.d., Calcium p.o.
q.d., Miacalcin p.o. q.d., Vitamin C q.d., garlic q.d., Fish
oil q.d. and Multivitamin q.d.

ALLERGIES: She had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for mother deceased at 79,
father deceased at 80.

SOCIAL HISTORY: She is an office manager.  She smoked 1.5
packs per day times 40 years and quit nine months ago.  She
lives with her husband.  She drinks 2 glasses of wine per
day.  She does not use cocaine.
Aortic valve disorders,Cardiac arrest,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Obesity, unspecified
Aortic valve disorder,Cardiac arrest,Surg compl-heart,Atriovent block complete,Crnry athrscl natve vssl,Hypertension NOS,Abn react-artif implant,Accid in resident instit,Obesity NOS
Admission Date:  [**2146-1-4**]       Discharge Date:  [**2146-1-16**]

Date of Birth:   [**2089-5-28**]       Sex:  F

Service:

PRIMARY DIAGNOSIS:  Coronary artery disease, aortic stenosis

PRIMARY PROCEDURE:  Aortic valve replacement with [**Street Address(2) 6158**].
[**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 50358**] mechanical valve.

BRIEF HISTORY:  Ms [**Known lastname 50359**] is a 56 year old female with a chief
complaint of increased shortness of breath and
lightheadedness over the past three months.  History of
present illness is significant for a heart murmur diagnosed
approximately 30 years ago, followed by echocardiogram.  She
had increasing shortness of breath over the past few months.
Cardiac catheterization on [**2145-11-11**] revealed [**First Name8 (NamePattern2) **] [**Location (un) 109**] of
1.0 cm squared with an ejection fraction of 52%.  An
echocardiogram in [**2145-10-4**] and revealed [**First Name8 (NamePattern2) **] [**Location (un) 109**] of .6
with a peak of 90, mean 60.

PAST MEDICAL HISTORY:  His past medical history is
significant for hypertension, aortic stenosis and mild
obesity.

PAST SURGICAL HISTORY:  Significant for a left open reduction
and internal fixation of an ankle.

MEDICATIONS ON ADMISSION:  Effexor 37.5 mg q.o.d., Verapamil
180 mg p.o. q.d., Zestoretic 20/12.5 p.o. q.d., Calcium p.o.
q.d., Miacalcin p.o. q.d., Vitamin C q.d., garlic q.d., Fish
oil q.d. and Multivitamin q.d.

ALLERGIES:  She had no known drug allergies.

FAMILY HISTORY:  Significant for mother deceased at 79,
father deceased at 80.

SOCIAL HISTORY:   She is an office manager.  She smoked 1.5
packs per day times 40 years and quit nine months ago.  She
lives with her husband.  She drinks 2 glasses of wine per
day.  She does not use cocaine.

PHYSICAL EXAMINATION:  Physical examination is significant
for being alert and oriented times three.  Her lungs are
clear to auscultation.  Her heart has a IV/VI holosystolic
murmur with radiation to the neck.  Her abdomen is soft,
nontender, nondistended.  She has no costovertebral angle
tenderness.  The extremities had no cyanosis, clubbing or
edema.  Her cranial nerves are intact II through XII,
nonfocal examination.  Excellent strength in all four
extremities.

HO[**Last Name (STitle) **] COURSE:  Mrs. [**Known lastname 50359**] was taken to the Operating Room
on [**2146-1-4**] with a diagnosis of aortic stenosis and
underwent an aortic valve replacement with a [**Street Address(2) 6158**]. [**First Name5 (NamePattern1) 923**]
[**Last Name (NamePattern1) 50358**] mechanical valve.  This was done by Dr. [**Last Name (Prefixes) 411**] and assisted by Dr. [**Last Name (STitle) 7625**], MD, and Tepperow and [**Initials (NamePattern4) **]
[**Last Name (NamePattern4) **].  She came out into the Recovery Room on Propofol 30
and EO 1.

Th[**Last Name (STitle) 1050**] was admitted to the Cardiac Surgery Recovery Unit
and had an uneventful day on postoperative day #1.  He was
transferred to R2 on [**2146-1-5**].  Of note, on [**2146-1-5**], the patient did have a cardiac arrest.  However,
this was shortlived and the patient was found immediately in
her room to have a heart rate in the 30s with a blood
pressure of approximately 90 pace was actually at that time
but she had poor capture.  Dr. [**Last Name (STitle) 70**] was at the patient's
bedside at the time.  A Dopa drip was started with some
improvement in the patient's blood pressure.  However, she
continues to have asystole and then went back into a rhythm.
The patient was taken emergently to the Electrophysiology
Laboratory where a temporary transvenous wire was placed with
ventricular capture.  The patient was then returned to the
Cardiac Surgery Recovery Unit and was being depaced, 100%,
blood pressure of 130 in stable condition.  The director of
the Cardiac Surgery Recovery Unit, Dr. [**Last Name (Prefixes) **] was
notified and was aware of all events surrounding the
patient's care.  On postoperative day #2, [**1-6**], the
patient was stable and was deemed ventricularly paced at a
rate of 96 with a blood pressure of 117/52 on no drips at
that time.  On [**2146-1-6**], the patient was taken to the
Electrophysiology Laboratory for transvenous screw and
temporary pacer.  At that time, a VVI [**Company 1543**] Sigma SGR 303
pacemaker was placed with a bipolar connector (IS-1VI).
During the HV measurement, the patient was noted to have
complete heartblock with a block below the bundle of HIS.
The placement of a permanent pacemaker was delayed until her
fever had come down.  The patient was transferred from the
Cardiac Surgery Recovery Unit to Far 2 on [**2146-1-6**].
Her pacer was interrogated on [**2146-1-7**].  At this time
she was on intravenous heparin for her valve and this was
continued.  She was on Vancomycin and Levofloxacin at this
time for this pacemaker.  She was transfused on postoperative
day #[**4-6**] for a hematocrit of 18 which came up to 24.  This
was done without complications.  She was taken back on
[**2146-1-10**] to the Electrophysiology Laboratory for the
placement of a dual chamber rate-responsive pacemaker, Model
#SDR303B.  The bipolar connector was Model #4092 and the
second bipolar connector was IS-1 VI, Model 5076.  The mode
was set at a mode of DDI with the lower rate of 55 PPM and
paced AV at 420 milliseconds, Serial # [**Serial Number 50360**], manufactured by [**Company 1543**].  On postoperative day
#7, the patient received another 2 units of blood for anemia.
Her heparin was continued and based on INR, it is not yet
therapeutic.  Her antibiotics were continued and her
Lopressor was also continued.  The plan was for discharge
upon stabilization of her INR.  The following days of her
hospitalization were significant for a physical therapy
evaluation, deeming her steady in gait and stable for
discharge.

On postoperative day #10 her temperature maximum was 100.1
and she continued to have edema in her lower extremities.
She was continued on her diuretics, and her Lopressor dose
was increased.  On [**2146-1-16**], she was deemed stable
for discharge.  Her INR was 2.6.  She was discharged with a
dose of 2.5 mg of Coumadin for [**2146-1-16**] with
[**Hospital6 407**] for blood draw the following day.
She had instructions and her primary care physician was aware
to accept a phone call from her on Monday to dose her
Coumadin appropriately, based on her mechanical aortic valve.

DISCHARGE DIAGNOSIS:
1. Improved critical aortic stenosis
2.  Hypertension
3.  Placement of a permanent pacemaker, aortic valve
replacement
4.  Infection of unknown origin
5.  Obesity
6.  Depression

DISCHARGE MEDICATIONS:
1.  Lasix 20 mg p.o. b.i.d. times two weeks
2.  Potassium 20 mg b.i.d. times two weeks
3.  Aspirin 81 mg, enteric coated one tablet p.o. q.d.
4.  Coumadin 2.5 mg p.o. times one on [**1-16**] with
rigorous follow up starting tomorrow [**2146-1-17**] with
blood draw with [**Hospital6 407**] and a phone call
to her physician who will be expecting this phone call
tomorrow afternoon with the result of her INR with meticulous
follow up after that point for her valve.



                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Dictator Info **]
MEDQUIST36

D:  [**2146-1-20**]  16:57
T:  [**2146-1-20**]  21:40
JOB#:  [**Job Number 50361**]


Name:  [**Known lastname 9318**], [**Known firstname 779**]                         Unit No:  [**Numeric Identifier 9319**]

Admission Date:  [**2146-1-4**]     Discharge Date:  [**2146-1-16**]

Date of Birth:   [**2089-5-28**]     Sex:  F

Service:

DISCHARGE MEDICATIONS:  As mentioned Coumadin 2.5 mg per day
with strict follow up starting tomorrow with [**First Name (Titles) 2050**] [**Last Name (Titles) 9167**] draw. Venlafaxine 37.5 mg p.o. q.o.d.  3.
Percocet 5/325 one to two tablets p.o. q. 4-6 hours prn for
pain.  Colace 100 mg p.o. b.i.d.  Outpatient laboratory
levels, [**Hospital6 1346**] to draw INR on Monday,
Wednesday, and Friday and forward results to Dr.[**Doctor Last Name 9320**]
office.  Lopressor 75 mg p.o. b.i.d.

CONDITION ON DISCHARGE:  Stable.

DI[**Last Name (STitle) 1390**]E FOLLOW UP:  She will follow up with Dr. [**Last Name (STitle) **]
in one week.  She will follow up with Dr. [**Last Name (Prefixes) **] in
approximately one month.

DIET:  As tolerated.

PHYSICAL THERAPY:  She will be weightbearing as tolerated
with above restrictions including weight and activity as
dictated in her paperwork upon dictation.



                          [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Dictator Info **]

MEDQUIST36

D:  [**2146-1-20**]  16:39
T:  [**2146-1-20**]  20:09
JOB#:  [**Job Number 9321**]
{'Aortic valve disorders,Cardiac arrest,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Obesity, 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: 

PRESENT ILLNESS: 

MEDICAL HISTORY: His past medical history is
significant for hypertension, aortic stenosis and mild
obesity.

MEDICATION ON ADMISSION: Effexor 37.5 mg q.o.d., Verapamil
180 mg p.o. q.d., Zestoretic 20/12.5 p.o. q.d., Calcium p.o.
q.d., Miacalcin p.o. q.d., Vitamin C q.d., garlic q.d., Fish
oil q.d. and Multivitamin q.d.

ALLERGIES: She had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for mother deceased at 79,
father deceased at 80.

SOCIAL HISTORY: She is an office manager.  She smoked 1.5
packs per day times 40 years and quit nine months ago.  She
lives with her husband.  She drinks 2 glasses of wine per
day.  She does not use cocaine. 

### Response:
{'Aortic valve disorders,Cardiac arrest,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Accidents occurring in residential institution,Obesity, unspecified'}
