CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 64 year old female who has been followed with serial
echocardiograms by his PCP for aortic stenosis. Most recent echo
in [**2101-11-13**] showed severe aortic stenosis. She recently
underwent a cardiac cath which revealed clean coronaries and
again showed severe AS. She is complaining of mild dyspnea on
exertion and was referred for an aortic valve replacement. She
was seen in clinic by Dr. [**Last Name (STitle) **] and presents for preadmission
testing.

MEDICAL HISTORY: Past Medical History:
Aortic stenosis
Diabetes Mellitus
Hypertension
Hypercholesterolemia
Anxiety
Past Surgical History:
s/p Left carpal tunnel surgery

MEDICATION ON ADMISSION: Medications at home:
Citalopram 40mg daily
Glyburide 10mg [**Hospital1 **]
HCTZ 12.5mg daily
Lisinopril 40mg daily
Metformin 1000mg [**Hospital1 **]
Niacin ER 500mg daily
Crestor 10mg daily
Aspirin 81mg daily
MVI daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 80  Resp: 16  O2 sat: 100%
B/P Right: 128/60    Left: 124/64
Height: 61"     Weight: 134lbs

FAMILY HISTORY: Family History:Premature coronary artery disease. Mother had
CABG x 3 in her 70's
Father MI < 55 []          Mother < 65 []

SOCIAL HISTORY: Race: Caucaisn
Last Dental Exam: [**2102-2-17**]
Lives with: Husband
Occupation: [**Name2 (NI) 1403**] at [**Company 110636**]
Cigarettes: Smoked yes [X] last cigarette _____ Hx: 1ppd x
50yr
Other Tobacco use: Denies
ETOH: < 1 drink/week [X] [**12-20**] drinks/week [] >8 drinks/week []
Illicit drug use: Denies
Aortic valve disorders,Unspecified essential hypertension,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Pure hypercholesterolemia,Personal history of tobacco use
Aortic valve disorder,Hypertension NOS,DMII oth nt st uncntrld,Long-term use of insulin,Adv eff insulin/antidiab,Pure hypercholesterolem,History of tobacco use
Admission Date:  [**2102-3-27**]              Discharge Date:   [**2102-4-2**]

Date of Birth:  [**2037-8-26**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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


Major Surgical or Invasive Procedure:
[**2102-3-27**] Aortic Valve Replacement(19 [**Doctor Last Name **] tissue)


History of Present Illness:
64 year old female who has been followed with serial
echocardiograms by his PCP for aortic stenosis. Most recent echo
in [**2101-11-13**] showed severe aortic stenosis. She recently
underwent a cardiac cath which revealed clean coronaries and
again showed severe AS. She is complaining of mild dyspnea on
exertion and was referred for an aortic valve replacement. She
was seen in clinic by Dr. [**Last Name (STitle) **] and presents for preadmission
testing.


Past Medical History:
Past Medical History:
Aortic stenosis
Diabetes Mellitus
Hypertension
Hypercholesterolemia
Anxiety
Past Surgical History:
s/p Left carpal tunnel surgery


Social History:
Race: Caucaisn
Last Dental Exam: [**2102-2-17**]
Lives with: Husband
Occupation: [**Name2 (NI) 1403**] at [**Company 110636**]
Cigarettes: Smoked yes [X] last cigarette _____ Hx: 1ppd x
50yr
Other Tobacco use: Denies
ETOH: < 1 drink/week [X] [**12-20**] drinks/week [] >8 drinks/week []
Illicit drug use: Denies


Family History:
Family History:Premature coronary artery disease. Mother had
CABG x 3 in her 70's
Father MI < 55 []          Mother < 65 []


Physical Exam:
Pulse: 80  Resp: 16  O2 sat: 100%
B/P Right: 128/60    Left: 124/64
Height: 61"     Weight: 134lbs

General: Well-developed female in no acute distress
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 [] Systolic Murmur [X] grade [**1-17**]
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X] Edema/Varicosities:
None
[X]
Neuro: Grossly intact [X]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit    Right: -   Left: -


Pertinent Results:
pre-op labs
[**2102-3-27**] 07:37AM   freeCa-1.11*
[**2102-3-27**] 07:37AM   HGB-10.6* calcHCT-32
[**2102-3-27**] 07:37AM   GLUCOSE-205* LACTATE-1.1 NA+-138 K+-3.8
CL--106
[**2102-3-27**] 10:14AM   PT-12.2 PTT-20.3* INR(PT)-1.1
[**2102-3-27**] 10:14AM   WBC-11.2* RBC-2.78* HGB-8.5*# HCT-26.4*
MCV-95 MCH-30.7 MCHC-32.3 RDW-14.0
[**2102-3-27**] 11:17AM   UREA N-16 CREAT-0.5 SODIUM-142 POTASSIUM-3.7
CHLORIDE-112* TOTAL CO2-23 ANION GAP-11

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Results  Measurements  Normal Range
Aortic Valve - Peak Gradient:  *70 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  40 mm Hg
Aortic Valve - Valve Area:  *0.5 cm2  >= 3.0 cm2
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: Severely thickened/deformed aortic valve leaflets.
Critical AS (area <0.8cm2). Mild to moderate ([**11-14**]+) AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Trivial
MR.
TRICUSPID VALVE: Physiologic TR.
PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.
PERICARDIUM: No 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. No TEE related complications.
Conclusions
Pre-CPB:
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.
The aortic valve leaflets are severely thickened/deformed. There
is critical aortic valve stenosis (valve area <0.8cm2). Mild to
moderate ([**11-14**]+) aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened.
Trivial mitral regurgitation is seen.
There is no pericardial effusion.
Posr-CPB:
There is a prosthetic aortic valve with no leak and no AI. Mean
gradient is 15 mmHg.
Preserved biventriculary systolic fxn.
No MR. [**First Name (Titles) **] [**Last Name (Titles) **].
Aorta intact.
I certify that I was present for this procedure in compliance
with HCFA regulations.
Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician


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Brief Hospital Course:
The patient was brought to the Operating Room on [**2102-3-27**] where
the patient underwent AVR (19mm tissue) with Dr. [**Last Name (STitle) **].
Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.  Transfer to
the telemetry floor was delayed due to issues with hyperglycemia
requiring insulin drip for management. Once glycemic conrol was
achieved, she was transferred to the telemtry floor for ongoing
care and recovery. [**Last Name (un) **] was consulted for assistance with
glucose management and Ms. [**Known lastname 22627**] was started on lantus. Chest
tubes and pacing wires were discontinued without complication.
The patient was evaluated by the physical therapy service for
assistance with strength and mobility.  By the time of discharge
on POD #6 the patient was ambulating freely, the wound was
healing and pain was controlled with oral analgesics.  The
patient was discharged to home in good condition with
appropriate follow up instructions.


Medications on Admission:
Medications at home:
Citalopram 40mg daily
Glyburide 10mg [**Hospital1 **]
HCTZ 12.5mg daily
Lisinopril 40mg daily
Metformin 1000mg [**Hospital1 **]
Niacin ER 500mg daily
Crestor 10mg daily
Aspirin 81mg daily
MVI daily


Discharge Medications:
1. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*75 Tablet(s)* Refills:*0*
2. 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*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
6. glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
7. lisinopril 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
8. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days: after 7 days, resume your hydrochlorothyazide.
Disp:*7 Tablet(s)* Refills:*0*
9. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. potassium chloride 10 mEq Tablet Extended Release Sig: One
(1) Tablet Extended Release PO once a day for 7 days.
Disp:*7 Tablet Extended Release(s)* Refills:*0*
11. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
2-4 Puffs Inhalation Q4H (every 4 hours) as needed for
wheezing/sob.
Disp:*1 MDI* Refills:*1*
12. rosuvastatin 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).

13. niacin 500 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily).
14. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
15. nicotine 7 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
Disp:*14 Patch 24 hr(s)* Refills:*2*
16. Lantus Solostar 100 unit/mL (3 mL) Insulin Pen Sig: Thirty
(30) units Subcutaneous every morning at breakfast.
Disp:*3 pens* Refills:*2*
17. glucose test strips- one touch
test glucose before meals and at bedtime and record values
18. Glucose monitor
One Touch glucose monitor


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA, [**Hospital1 1559**]

Discharge Diagnosis:
s/p AVR(19 [**Doctor Last Name **] tissue) [**2102-3-27**]
Past Medical History:
Aortic stenosis
Diabetes Mellitus
Hypertension
Hypercholesterolemia
Anxiety
Past Surgical History:
s/p Left carpal tunnel surgery


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Edema trace


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 one month or while taking narcotics. Driving will
be discussed at follow up appointment with surgeon.
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

Wound check [**2102-4-6**] 10:15 [**Telephone/Fax (1) 170**] in the [**Hospital **] medical
office building, [**Doctor First Name **] [**Hospital Unit Name **].

Surgeon: Dr [**Last Name (STitle) **] on [**2102-5-3**] 1:00 [**Telephone/Fax (1) 170**] in the [**Hospital **]
medical office building, [**Doctor First Name **] [**Hospital Unit Name **].

Cardiologist: Dr. [**Last Name (STitle) 7047**] at 9:45

Please call to schedule appointments with your
Primary Care Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] [**Telephone/Fax (1) 6699**] in [**2-16**] 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**




Completed by:[**2102-4-2**]
{'Aortic valve disorders,Unspecified essential hypertension,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Pure hypercholesterolemia,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: Dyspnea on exertion

PRESENT ILLNESS: 64 year old female who has been followed with serial
echocardiograms by his PCP for aortic stenosis. Most recent echo
in [**2101-11-13**] showed severe aortic stenosis. She recently
underwent a cardiac cath which revealed clean coronaries and
again showed severe AS. She is complaining of mild dyspnea on
exertion and was referred for an aortic valve replacement. She
was seen in clinic by Dr. [**Last Name (STitle) **] and presents for preadmission
testing.

MEDICAL HISTORY: Past Medical History:
Aortic stenosis
Diabetes Mellitus
Hypertension
Hypercholesterolemia
Anxiety
Past Surgical History:
s/p Left carpal tunnel surgery

MEDICATION ON ADMISSION: Medications at home:
Citalopram 40mg daily
Glyburide 10mg [**Hospital1 **]
HCTZ 12.5mg daily
Lisinopril 40mg daily
Metformin 1000mg [**Hospital1 **]
Niacin ER 500mg daily
Crestor 10mg daily
Aspirin 81mg daily
MVI daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 80  Resp: 16  O2 sat: 100%
B/P Right: 128/60    Left: 124/64
Height: 61"     Weight: 134lbs

FAMILY HISTORY: Family History:Premature coronary artery disease. Mother had
CABG x 3 in her 70's
Father MI < 55 []          Mother < 65 []

SOCIAL HISTORY: Race: Caucaisn
Last Dental Exam: [**2102-2-17**]
Lives with: Husband
Occupation: [**Name2 (NI) 1403**] at [**Company 110636**]
Cigarettes: Smoked yes [X] last cigarette _____ Hx: 1ppd x
50yr
Other Tobacco use: Denies
ETOH: < 1 drink/week [X] [**12-20**] drinks/week [] >8 drinks/week []
Illicit drug use: Denies 

### Response:
{'Aortic valve disorders,Unspecified essential hypertension,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Pure hypercholesterolemia,Personal history of tobacco use'}
