CHIEF COMPLAINT: DOE/Orthopnea

PRESENT ILLNESS: 69 year old female with h/o AS with DOE who has had progressive
worsening of symptoms over the past several months. Work-up
revealed severe aortic stenosis withoit significant coronary
artery disease. Given these findings she has been admitted for
surgical management.

MEDICAL HISTORY: cervical and lumbar spondylosis and rheumatoid arthritis /
chronic steroid use secondary to asthma
HTN
AS
Depression
Toxic Multinodular Goiter
Pulmonary fibrosis
Anemia
Asthma
Lupus

MEDICATION ON ADMISSION: Prednisone 10'
Methimazole 5'
Alphagan eye drops
MVI
Calcium/Vitamin D
Glucosamine
Omega 3
Ambien
Diovan
Prednisone eye drops

ALLERGIES: Tape / Percocet

PHYSICAL EXAM: 72 sr  14  164/70  150/72 67" 265
GEN: NAD
SKIN: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM, No JVD
LUNGS: Diminished BS at bases
HEART: RRR, [**5-10**] holosystolic murmur
ABD: S/NT/ND/NABS/Obese
EXT: Warm, well perfused, 1+ Edema. Some varicosities noted.
Faint DP/PT pulses bilaterall.
NEURO: Nonfocal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: lives with husband
Aortic valve disorders,Chronic diastolic heart failure,Asthma, unspecified type, unspecified,Postinflammatory pulmonary fibrosis,Unspecified essential hypertension,Rheumatoid arthritis,Toxic multinodular goiter without mention of thyrotoxic crisis or storm,Systemic lupus erythematosus
Aortic valve disorder,Chr diastolic hrt fail,Asthma NOS,Postinflam pulm fibrosis,Hypertension NOS,Rheumatoid arthritis,Tox multnod goit no cris,Syst lupus erythematosus
Admission Date:  [**2116-5-18**]              Discharge Date:   [**2116-5-22**]

Date of Birth:  [**2046-9-20**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Tape / Percocet

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
DOE/Orthopnea

Major Surgical or Invasive Procedure:
[**2116-5-18**] - AVR (21mm St. [**Male First Name (un) 923**] Epic Pericardial Valve)


History of Present Illness:
69 year old female with h/o AS with DOE who has had progressive
worsening of symptoms over the past several months. Work-up
revealed severe aortic stenosis withoit significant coronary
artery disease. Given these findings she has been admitted for
surgical management.

Past Medical History:
cervical and lumbar spondylosis and rheumatoid arthritis /
chronic steroid use secondary to asthma
HTN
AS
Depression
Toxic Multinodular Goiter
Pulmonary fibrosis
Anemia
Asthma
Lupus

Social History:
lives with husband


Family History:
Non-contributory

Physical Exam:
72 sr  14  164/70  150/72 67" 265
GEN: NAD
SKIN: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM, No JVD
LUNGS: Diminished BS at bases
HEART: RRR, [**5-10**] holosystolic murmur
ABD: S/NT/ND/NABS/Obese
EXT: Warm, well perfused, 1+ Edema. Some varicosities noted.
Faint DP/PT pulses bilaterall.
NEURO: Nonfocal

Pertinent Results:
[**2116-5-21**] ECHO
PRE-BYPASS:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. No atrial septal defect is seen
by 2D or color Doppler. There is mild symmetric left ventricular
hypertrophy with normal cavity size and regional/global systolic
function (LVEF>55%). Right ventricular chamber size and free
wall motion are normal. There are focal calcifications in the
aortic arch. There is moderate aortic valve stenosis (area
1.0-1.2cm2). Moderate (2+) aortic regurgitation is seen. The
ascending aorta is 3.9cm in diameter. The mitral valve leaflets
are mildly thickened. There is no pericardial effusion. Dr.
[**Last Name (STitle) **] was notified in person of the results on [**Known lastname 47344**], [**Known firstname 17**] at
9AM.

POST-BYPASS:
Thoracic aortic contour is intact.
There is a bioprosthesis seen in the native aortic position,
well positioned, stable with a peak of 30 and a mean of 15mm of
Hg.
Mild TR. No MR.


Brief Hospital Course:
Mrs. [**Known lastname 47344**] was admitted to the [**Hospital1 18**] on [**2116-5-18**] for surgical
management of her aortic valve stenosis. She was taken to the
operating room where she underwent an aortic valve replacement
using a tissue prosthesis. Please see operative note for
details. Postoperatively she was taken to the cardiac surgical
intensive care unit for monitoring. Within 24 hours, she awoke
neurologically intact and was extubated. Beta blockade and
aspirin were resumed. On postoperative day one, she was
transferred to the step down unit for further recovery. She was
gently diuresed towards her preoperative weight. Narcotics were
found to sedate her heavily and were therefore discontinued.
The physical therapy service was consulted for assistance with
her postoperative strength and mobility. She complained of
diminished strength in her left lower extremity and an
ultrasound was obtained which ruled out a deep vein thrombosis.


Medications on Admission:
Prednisone 10'
Methimazole 5'
Alphagan eye drops
MVI
Calcium/Vitamin D
Glucosamine
Omega 3
Ambien
Diovan
Prednisone eye drops

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Prednisone 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. Methimazole 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
5. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours).

6. Furosemide 40 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day).
7. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
8. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**2-5**] Sprays Nasal
QID (4 times a day) as needed.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 1439**] [**Last Name (NamePattern1) 13089**] Care Center - [**Location (un) 1439**]

Discharge Diagnosis:
AS s/p AVR(21mm St. [**Male First Name (un) 923**] epic pericardial) [**2116-5-18**]
HTN
Depression
Pulmonary fibrosis
Asthma
Anemia
Toxic multinodular goiter


Discharge Condition:
Stable


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Wear surgical bra at all times until seen in clinic with Dr.
[**Last Name (STitle) **].
8) Call with any questions or concerns.


Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with Dr. [**Last Name (STitle) 3497**] in 2 weeks.
Follow-up with Dr. [**Last Name (STitle) **] 2 weeks.



Completed by:[**2116-5-22**]
{'Aortic valve disorders,Chronic diastolic heart failure,Asthma, unspecified type, unspecified,Postinflammatory pulmonary fibrosis,Unspecified essential hypertension,Rheumatoid arthritis,Toxic multinodular goiter without mention of thyrotoxic crisis or storm,Systemic lupus erythematosus'}


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: DOE/Orthopnea

PRESENT ILLNESS: 69 year old female with h/o AS with DOE who has had progressive
worsening of symptoms over the past several months. Work-up
revealed severe aortic stenosis withoit significant coronary
artery disease. Given these findings she has been admitted for
surgical management.

MEDICAL HISTORY: cervical and lumbar spondylosis and rheumatoid arthritis /
chronic steroid use secondary to asthma
HTN
AS
Depression
Toxic Multinodular Goiter
Pulmonary fibrosis
Anemia
Asthma
Lupus

MEDICATION ON ADMISSION: Prednisone 10'
Methimazole 5'
Alphagan eye drops
MVI
Calcium/Vitamin D
Glucosamine
Omega 3
Ambien
Diovan
Prednisone eye drops

ALLERGIES: Tape / Percocet

PHYSICAL EXAM: 72 sr  14  164/70  150/72 67" 265
GEN: NAD
SKIN: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM, No JVD
LUNGS: Diminished BS at bases
HEART: RRR, [**5-10**] holosystolic murmur
ABD: S/NT/ND/NABS/Obese
EXT: Warm, well perfused, 1+ Edema. Some varicosities noted.
Faint DP/PT pulses bilaterall.
NEURO: Nonfocal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: lives with husband 

### Response:
{'Aortic valve disorders,Chronic diastolic heart failure,Asthma, unspecified type, unspecified,Postinflammatory pulmonary fibrosis,Unspecified essential hypertension,Rheumatoid arthritis,Toxic multinodular goiter without mention of thyrotoxic crisis or storm,Systemic lupus erythematosus'}
