CHIEF COMPLAINT: occasional DOE

PRESENT ILLNESS: 71 yo M with known AI for many years, followed by echo. Now with
increasing LV size, referred for surgery.

MEDICAL HISTORY: HTN, ^chol, COPD, finger surgery

MEDICATION ON ADMISSION: ASA 325', Labetolol 300"", Lisinopril 40", Norvasc 5', Zocor
40', Vit B12

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 66 RR 22 BP 144/64
NAD
Lungs CTAB
Heart RRR, holosystolic murmur
Abdomen benign
Extrem warm, trace BLE edema
No varicosities
Carotids with radiated murmur

FAMILY HISTORY: NC

SOCIAL HISTORY: works as roadway inspector
quit tobacco few years ago, previous 50 pack year history
few drinks per week
lives alone
Aortic valve disorders,Cardiac complications, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia
Aortic valve disorder,Surg compl-heart,Chr airway obstruct NEC,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2181-2-20**]              Discharge Date:   [**2181-2-24**]

Date of Birth:  [**2109-1-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
occasional DOE

Major Surgical or Invasive Procedure:
AVR(#27 StJude epic tissue)[**2-20**]


History of Present Illness:
71 yo M with known AI for many years, followed by echo. Now with
increasing LV size, referred for surgery.

Past Medical History:
HTN, ^chol, COPD, finger surgery

Social History:
works as roadway inspector
quit tobacco few years ago, previous 50 pack year history
few drinks per week
lives alone

Family History:
NC

Physical Exam:
HR 66 RR 22 BP 144/64
NAD
Lungs CTAB
Heart RRR, holosystolic murmur
Abdomen benign
Extrem warm, trace BLE edema
No varicosities
Carotids with radiated murmur

Pertinent Results:
 [**2181-2-22**] 10:21 AM

CHEST (PORTABLE AP)

FRONTAL AND LATERAL CHEST RADIOGRAPHS: The patient is status
post AVR and median sternotomy wires are intact. The Swan-Ganz
catheter, endotracheal tube, nasogastric tube, and left-sided
mediastinal catheter have been removed. There is no
pneumothorax. Mild cardiac enlargement persists. There is
minimal left basilar atelectasis as well as blunting of the
costophrenic angles bilaterally likely indicating small pleural
effusions.

IMPRESSION: No pneumothorax status post removal of Swan-Ganz
catheter and mediastinal catheter.

INTRAOPERATIVE ECHO

PRE-BYPASS:
1. No atrial septal defect is seen by 2D or color Doppler.
2. The left ventricular cavity is moderately dilated. Regional
left ventricular wall motion is normal. Overall left ventricular
systolic function is low normal (LVEF 50-55%).
3. Right ventricular chamber size and free wall motion are
normal.
4. The descending thoracic aorta is mildly dilated. There are
simple atheroma in the descending thoracic aorta. 5. The aortic
valve is bicuspid. There is no aortic valve stenosis. Severe
(4+) aortic regurgitation is seen. The aortic regurgitation jet
is eccentric. The aortic regurgitation jet is eccentric,
directed toward the anterior mitral leaflet. There is also an
eccentric jet directed at the membranous interventricular
septum.
6. Physiologic mitral regurgitation is seen (within normal
limits).

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine and is AV
paced.
1.. A well-seated bioprosthetic valve is seen in the aortic
position with normal leaflet motion and gradients (mean gradient
= 18 mmHg). No aortic regurgitation is seen.
2. Biventricular function is preserved.
3. Aorta is intact post decannulation.
4. Other findings are unchanged

[**2181-2-24**] 07:35AM BLOOD

WBC-13.3* RBC-4.72 Hgb-13.5* Hct-42.6 MCV-90 MCH-28.5 MCHC-31.6
RDW-14.0 Plt Ct-521*

[**2181-2-24**] 07:35AM BLOOD

glucose-126* UreaN-26* Creat-1.2 Na-142 K-4.0 Cl-96 HCO3-32
AnGap-18

[**2181-2-24**] 07:35AM BLOOD PT-17.4* INR(PT)-1.6*

Brief Hospital Course:
He was taken to the operating room on [**2-20**] where he underwent an
AVR. He was transferred to the ICU in stable condition. He was
extubated later that same day. He had atrial fibrillation on POD
#1 and was started on amiodarone. He was transferred to the
floor on POD #1. He was gently diuresed toward his preop weight.
Chest tubes were removed on POD #2.Pacing wires removed on POD
#3. Cleared for discharge to home with services on POD #4 Target
INR is 2.0-2.5. First blood draw on Monday [**2-26**] with coumadin
dosing/INR follow up with Dr [**First Name (STitle) **]. Pt.is to make all followup
appts. as per discharge instructions.

Medications on Admission:
ASA 325', Labetolol 300"", Lisinopril 40", Norvasc 5', Zocor
40', Vit B12

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): take only while taking percocet.
Disp:*60 Capsule(s)* Refills:*0*
2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. 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:*0*
4. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 5
days.
Disp:*20 Capsule, Sustained Release(s)* Refills:*0*
5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
7. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 5 days: 400 mg [**Hospital1 **] for 5 days until [**2-28**]; then 200 mg
[**Hospital1 **] until [**3-7**], then 200 mg daily ongoing.
Disp:*60 Tablet(s)* Refills:*1*
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
9. Coumadin 1 mg Tablet Sig: Four (4) Tablet PO once a day: 1600
hrs. Dr [**First Name (STitle) **] will follow your INR. Your goal is [**1-7**]. [**2-26**] you
should see him in the office.
Disp:*120 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
AI s/p AVR
postop A fib
PMH: HTN, ^chol, COPD, finger surgery


Discharge Condition:
Good.


Discharge Instructions:
Call with fever greater than 100.5, redness or drainage from
incision or weight gain more than 2 pounds in one day or five in
one week.
Shower DAILY, no baths, no lotions, creams or powders to
incisions.
No lifting more than 10 pounds for 10 weeks.
No driving for one month or until follow up with surgeon.

Target INR 2.0-2.5. First blood draw Mon [**2-26**]. Results to
be............to Dr............ for coumadin dosing/INR
followup.

Followup Instructions:
Dr. [**Last Name (STitle) 20222**] 2 weeks

Dr. [**First Name (STitle) **] on monday. Please go to his offce. He will follow
your INR.

Dr[**Last Name (Prefixes) **] 4 weeks [**Telephone/Fax (1) 170**]



Completed by:[**2181-2-24**]
{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: occasional DOE

PRESENT ILLNESS: 71 yo M with known AI for many years, followed by echo. Now with
increasing LV size, referred for surgery.

MEDICAL HISTORY: HTN, ^chol, COPD, finger surgery

MEDICATION ON ADMISSION: ASA 325', Labetolol 300"", Lisinopril 40", Norvasc 5', Zocor
40', Vit B12

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 66 RR 22 BP 144/64
NAD
Lungs CTAB
Heart RRR, holosystolic murmur
Abdomen benign
Extrem warm, trace BLE edema
No varicosities
Carotids with radiated murmur

FAMILY HISTORY: NC

SOCIAL HISTORY: works as roadway inspector
quit tobacco few years ago, previous 50 pack year history
few drinks per week
lives alone 

### Response:
{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia'}
