CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 68 year old female with history of aortic stenosis with dyspnea
on exertion, exercise intolerance, and fatigue.  She underwent
cardiac catherization on [**6-10**] for preoperative evaluation which
revealed 40% LAD stenosis, with otherwise clean coronaries.

MEDICAL HISTORY: 1. HTN, diagnosed in her 40s, usual BP in 180s
2. DM, diagnosed in 30s, does not take insulin
3. Hyperlipidemia, diagnosed in 50s
4. DVT as a young adult when on OCPs
5. Aortic stenosis
6. 4 SVD pregnancies
7. CVA [**3-17**]
8. Anemia
9. PVD
10. Diverticulosis

MEDICATION ON ADMISSION: Plavix 75mg daily
Actos 15mg daily
Norvasc 10mg daily
Lipitor 80mg daily
Lasix 40mg alternating with 20mg daily
Metformin 1000 mg [**Hospital1 **]
NPH 20 units qhs
Glyburide 10 mg [**Hospital1 **]
Toprol XL 200 mg daily
Zetia 10 mg daily
Mavik 8 mg daily
Verapamil 240 mg daily
ASA 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General NAD HR 70, b/p 138/68, wt 150 ht 62"
Skin warm dry
HEENT NCAT, PERRLA, EOMI, op benign, edentulous
Neck supple, full ROM + rt bruit no JVD
Chest CTA bilat
Heart RRR 4/6 blowing systolic murmur
Abdomen soft ND, NT +BS
Ext warm well perfused trace LE edema
Varicosities none
Neuro a/o x3 nonfocal, gait steady, 5/5 strength

FAMILY HISTORY: Mother died of stroke in her 70s

SOCIAL HISTORY: Works as electronic assembler
Tobacco denies
Stopped drinking 7 years ago
Lives with daughter
Aortic valve disorders,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Atherosclerosis of native arteries of the extremities, unspecified,Epistaxis
Aortic valve disorder,Hypertension NOS,DMII wo cmp nt st uncntr,Anemia NOS,Athscl extrm ntv art NOS,Epistaxis
Admission Date:  [**2193-7-23**]              Discharge Date:   [**2193-7-29**]

Date of Birth:  [**2125-3-14**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
s/p Aortic valve replacement (21 mm [**Company 1543**] Porcine) [**2193-7-23**]


History of Present Illness:
68 year old female with history of aortic stenosis with dyspnea
on exertion, exercise intolerance, and fatigue.  She underwent
cardiac catherization on [**6-10**] for preoperative evaluation which
revealed 40% LAD stenosis, with otherwise clean coronaries.

Past Medical History:
1. HTN, diagnosed in her 40s, usual BP in 180s
2. DM, diagnosed in 30s, does not take insulin
3. Hyperlipidemia, diagnosed in 50s
4. DVT as a young adult when on OCPs
5. Aortic stenosis
6. 4 SVD pregnancies
7. CVA [**3-17**]
8. Anemia
9. PVD
10. Diverticulosis


Social History:
Works as electronic assembler
Tobacco denies
Stopped drinking 7 years ago
Lives with daughter

Family History:
Mother died of stroke in her 70s

Physical Exam:
General NAD HR 70, b/p 138/68, wt 150 ht 62"
Skin warm dry
HEENT NCAT, PERRLA, EOMI, op benign, edentulous
Neck supple, full ROM + rt bruit no JVD
Chest CTA bilat
Heart RRR 4/6 blowing systolic murmur
Abdomen soft ND, NT +BS
Ext warm well perfused trace LE edema
Varicosities none
Neuro a/o x3 nonfocal, gait steady, 5/5 strength


Pertinent Results:
[**2193-7-29**] 12:50PM BLOOD WBC-9.1 RBC-3.20* Hgb-9.4* Hct-27.5*
MCV-86 MCH-29.5 MCHC-34.3 RDW-14.1 Plt Ct-451*#
[**2193-7-23**] 10:05AM BLOOD WBC-7.6 RBC-2.07*# Hgb-6.0*# Hct-18.0*#
MCV-87 MCH-28.7 MCHC-33.1 RDW-14.1 Plt Ct-171#
[**2193-7-29**] 12:50PM BLOOD Plt Ct-451*#
[**2193-7-23**] 10:05AM BLOOD PT-15.8* PTT-43.7* INR(PT)-1.4*
[**2193-7-23**] 10:05AM BLOOD Fibrino-166
[**2193-7-29**] 12:50PM BLOOD Glucose-115* UreaN-11 Creat-0.8 Na-143
K-4.2 Cl-103 HCO3-27 AnGap-17
[**2193-7-23**] 12:27PM BLOOD UreaN-15 Creat-0.5 Cl-119* HCO3-23
[**2193-7-29**] 12:50PM BLOOD Mg-1.6
[**2193-7-24**] 03:10AM BLOOD Mg-1.7

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 104526**] (Complete)
Done [**2193-7-23**] at 9:00:11 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2125-3-14**]
Age (years): 68 F  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Abnormal ECG. Aortic valve disease. Hypertension.
Shortness of breath.
ICD-9 Codes: 402.90, 786.05, 440.0, 424.1
Test Information
Date/Time: [**2193-7-23**] at 09:00    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5209**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW1-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *5.5 cm  <= 4.0 cm
Left Ventricle - Septal Wall Thickness:  *1.5 cm  0.6 - 1.1 cm
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Ascending:  3.1 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  *3.8 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *62 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  42 mm Hg
Aortic Valve - Valve Area:  *0.9 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Moderate LA enlargement. No spontaneous echo
contrast in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good (>20 cm/s) LAA
ejection velocity. No thrombus in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No spontaneous
echo contrast in the RAA.

LEFT VENTRICLE: Moderate symmetric LVH. Normal LV cavity size.
Normal regional LV systolic function. No LV mass/thrombus. Low
normal LVEF.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Simple
atheroma in aortic root. Normal ascending aorta diameter. Simple
atheroma in ascending aorta. Normal aortic arch diameter. Simple
atheroma in aortic arch. Normal descending aorta diameter.
Complex (>4mm) atheroma in the descending thoracic aorta. Focal
calcifications in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Severely
thickened/deformed aortic valve leaflets. No masses or
vegetations on aortic valve. Moderate-severe AS (area
0.8-1.0cm2). Mild (1+) AR.

MITRAL VALVE: Moderately thickened mitral valve leaflets. No
mass or vegetation on mitral valve. Mild mitral annular
calcification. No MS. Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

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 patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.
patient.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-CPB:1. The left atrium is moderately dilated. No spontaneous
echo contrast is seen in the body of the left atrium or left
atrial appendage. No thrombus is seen in the left atrial
appendage. There is no ASD by color or 2-D.
2. There is moderate symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Regional left
ventricular wall motion is normal. No masses or thrombi are seen
in the left ventricle. Overall left ventricular systolic
function is low normal (LVEF 50-55%).
3. Right ventricular chamber size and free wall motion are
normal.
4. There are simple atheroma in the aortic root. There are
simple atheroma in the ascending aorta. There are simple
atheroma in the aortic arch. There are complex (>4mm) atheroma
in the descending thoracic aorta.
5. There are three aortic valve leaflets. The aortic valve
leaflets are severely thickened/deformed. No masses or
vegetations are seen on the aortic valve. There is moderate to
severe aortic valve stenosis (area 0.8-1.0cm2). Mild (1+) aortic
regurgitation is seen.
6. The mitral valve leaflets are moderately thickened. No mass
or vegetation is seen on the mitral valve. Mild (1+) mitral
regurgitation is seen.
Dr. [**Last Name (STitle) **] was notified in person of the results.

POST-CPB: On infusion of phenylephrine. Well-seated
bioprosthetic valve in the aortic position. No paravalvular
leak. Trivial AI. Flow seen in LMCA and RCA. Preserved
biventricular systolic gfunction. Mild MR [**First Name (Titles) **] [**Last Name (Titles) 1506**] from
preop. The aortic contour is normal post decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2193-7-23**] 10:17

[**Known lastname **],[**Known firstname **] M [**Medical Record Number 104527**] F  68  [**2125-3-14**]

Cardiology Report ECG Study Date of [**2193-7-23**]  12:47:02 PM


Baseline artifact. Sinus rhythm. Possible ST-T wave
abnormalities with
mild Q-T interval prolongation. Since the previous tracing of
[**2193-7-17**]
the QRS voltage has decreased. The axis is more leftward.
Clinical
correlation is suggested.


Read by: [**Last Name (LF) **],[**First Name3 (LF) 900**] A.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
81 112 90 418/454 45 -24 36



Brief Hospital Course:
Admitted same day surgery and underwent aortic valve
replacement, see operative report for further details.  Was
transferred to the intensive care unit for hemodynamic
monitoring.  In the first twenty four hours she was weaned from
sedation, awoke neurologically intact and was extubated without
complications.  She was started on beta blockers for rate
control and lasix for gentle diuresis.  Physical therapy worked
with her on strength and mobility.  Chest tubes were
discontinued on POD #2 without complication. Her wires were
removed on the following day.  With ambulation, incentive
sprirometry, lasix, and pulmonary toilet her breathing improved.
she continued to progress and was ready for discharge to rehab
on POD 6.

Medications on Admission:
Plavix 75mg daily
Actos 15mg daily
Norvasc 10mg daily
Lipitor 80mg daily
Lasix 40mg alternating with 20mg daily
Metformin 1000 mg [**Hospital1 **]
NPH 20 units qhs
Glyburide 10 mg [**Hospital1 **]
Toprol XL 200 mg daily
Zetia 10 mg daily
Mavik 8 mg daily
Verapamil 240 mg daily
ASA 81 mg daily


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
8. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day: please
evaluate weight and edema.
9. Pioglitazone 15 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO twice a day.
11. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO every six
(6) hours as needed for pain.
12. Insulin SS humalog
Insulin SC Sliding Scale
  Breakfast Lunch Dinner Bedtime
Humalog Humalog Humalog Humalog
Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose
0-60   mg/dL 4 oz. Juice 4 oz. Juice 4 oz. Juice 4 oz. Juice
61-109   mg/dL 0   Units 0   Units 0   Units 0   Units
110-130   mg/dL 2   Units 2   Units 2   Units 0   Units
131-150   mg/dL 4   Units 4   Units 4   Units 0   Units
151-180   mg/dL 6   Units 6   Units 6   Units 0   Units
181-210   mg/dL 8   Units 8   Units 8   Units 2   Units
211-240   mg/dL 10   Units 10   Units 10   Units 4   Units

13. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Twenty
(20) units Subcutaneous at bedtime.
14. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day): total - 75mg twice a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] health care

Discharge Diagnosis:
Aortic Stenosis s/p AVR
Hyperlipidemia
Hypertension
Peripheral vascular disease
Anemia
Diverticulosis
Diabetes Mellitus
CVA [**2190**]
h/o deep vein thrombosis


Discharge Condition:
Good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Please call to schedule all appointments
Dr [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 1 week ([**Telephone/Fax (1) 250**])
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**1-13**] weeks
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2193-7-29**]
{'Aortic valve disorders,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Atherosclerosis of native arteries of the extremities, unspecified,Epistaxis'}


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: 68 year old female with history of aortic stenosis with dyspnea
on exertion, exercise intolerance, and fatigue.  She underwent
cardiac catherization on [**6-10**] for preoperative evaluation which
revealed 40% LAD stenosis, with otherwise clean coronaries.

MEDICAL HISTORY: 1. HTN, diagnosed in her 40s, usual BP in 180s
2. DM, diagnosed in 30s, does not take insulin
3. Hyperlipidemia, diagnosed in 50s
4. DVT as a young adult when on OCPs
5. Aortic stenosis
6. 4 SVD pregnancies
7. CVA [**3-17**]
8. Anemia
9. PVD
10. Diverticulosis

MEDICATION ON ADMISSION: Plavix 75mg daily
Actos 15mg daily
Norvasc 10mg daily
Lipitor 80mg daily
Lasix 40mg alternating with 20mg daily
Metformin 1000 mg [**Hospital1 **]
NPH 20 units qhs
Glyburide 10 mg [**Hospital1 **]
Toprol XL 200 mg daily
Zetia 10 mg daily
Mavik 8 mg daily
Verapamil 240 mg daily
ASA 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General NAD HR 70, b/p 138/68, wt 150 ht 62"
Skin warm dry
HEENT NCAT, PERRLA, EOMI, op benign, edentulous
Neck supple, full ROM + rt bruit no JVD
Chest CTA bilat
Heart RRR 4/6 blowing systolic murmur
Abdomen soft ND, NT +BS
Ext warm well perfused trace LE edema
Varicosities none
Neuro a/o x3 nonfocal, gait steady, 5/5 strength

FAMILY HISTORY: Mother died of stroke in her 70s

SOCIAL HISTORY: Works as electronic assembler
Tobacco denies
Stopped drinking 7 years ago
Lives with daughter 

### Response:
{'Aortic valve disorders,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Atherosclerosis of native arteries of the extremities, unspecified,Epistaxis'}
