CHIEF COMPLAINT: Hematoma s/p cardiac catherization

PRESENT ILLNESS: pt is 80 year old female with severe aortic stenosis (0.7 valve
area; mean grad 40.9), CAD s/p CABG '[**19**] (LIMA-LAD), SVG-ramus,
SVG-OM, SVG-RPL, SVG-PDA) presents with dyspnea and fatigue. Pt
decided to get AVR and referred for cath for pre-op assessment.
Cath revealed CI 2.6, PA 68%, LVEF 40%, LMCA-diffuse dx mild
stenosis; LAD - large patent diagnol, 70% mid; RCA diffuse dx
proximal with occlusion mid; SVG-PDA patent; SVG-RPL occluded;
SVG-OM and SVG-ramus patent; LIMA-LAD patent did not cross
midline; severe AS, +2MR; RA 10; PAP 57/26; PCWP 24.
Post cath complicated by large hematoma s/p sheath pull with SBP
decreased to 95 - tx with atropine, IV fluids, 2U PRBC - SBP
stabalized at 138 with no symptoms of CP/SOB. Pt Hct dropped
from 40 to 33. CT abd showed no evidence of RP hemorrhage;
hematoma within R groin extending along anterior aspect of R
thigh.

MEDICAL HISTORY: CABG [**2119**];
Appy;
[**First Name9 (NamePattern2) 30065**] [**Location (un) **];
Aortic Stenosis;
Immune hemolytic anemia;
small AAA;
hypothyroidism

MEDICATION ON ADMISSION: Lovoxyl 0.112mg;
ASA 81 mg;
Atenolol 25mg;
Protonix 40mg;
Xanax 0.25mg;
Lipitor 40mg;
Nitro patch 0.4mcg/hr 8am to 8pm

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afebrile P65 BP 134/60 O2Sat 100% 2L
Gen: NAD
Heent: Perrla, EOMI, oral mucosa clear
Resp: Clear to auscultation bilaterly
Cardio: Regular rate/rhythm S1/S2 grade III/VI systolic ejection
murmur
Abd: Obtunded, soft non-tender normal apparent bowel sounds
Groin: 5 x 2 inch hematoma in right thigh, tender to palpation
Ext: +2 edema bilaterly in lower extremities
Neuro: AAOx3

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives in [**Location 2498**] with son; widowed
no etoh
no tobacco
Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Hematoma complicating a procedure,Aortocoronary bypass status,Unspecified essential hypertension,Unspecified acquired hypothyroidism
Crnry athrscl natve vssl,Aortic valve disorder,Hematoma complic proc,Aortocoronary bypass,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2127-8-11**]              Discharge Date:   [**2127-8-13**]


Service: [**Hospital Unit Name 196**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Hematoma s/p cardiac catherization

Major Surgical or Invasive Procedure:
Cardiac Cath


History of Present Illness:
pt is 80 year old female with severe aortic stenosis (0.7 valve
area; mean grad 40.9), CAD s/p CABG '[**19**] (LIMA-LAD), SVG-ramus,
SVG-OM, SVG-RPL, SVG-PDA) presents with dyspnea and fatigue. Pt
decided to get AVR and referred for cath for pre-op assessment.
Cath revealed CI 2.6, PA 68%, LVEF 40%, LMCA-diffuse dx mild
stenosis; LAD - large patent diagnol, 70% mid; RCA diffuse dx
proximal with occlusion mid; SVG-PDA patent; SVG-RPL occluded;
SVG-OM and SVG-ramus patent; LIMA-LAD patent did not cross
midline; severe AS, +2MR; RA 10; PAP 57/26; PCWP 24.
Post cath complicated by large hematoma s/p sheath pull with SBP
decreased to 95 - tx with atropine, IV fluids, 2U PRBC - SBP
stabalized at 138 with no symptoms of CP/SOB. Pt Hct dropped
from 40 to 33. CT abd showed no evidence of RP hemorrhage;
hematoma within R groin extending along anterior aspect of R
thigh.


Past Medical History:
CABG [**2119**];
Appy;
[**First Name9 (NamePattern2) 30065**] [**Location (un) **];
Aortic Stenosis;
Immune hemolytic anemia;
small AAA;
hypothyroidism

Social History:
Lives in [**Location 2498**] with son; widowed
no etoh
no tobacco

Family History:
non-contributory

Physical Exam:
VS: afebrile P65 BP 134/60 O2Sat 100% 2L
Gen: NAD
Heent: Perrla, EOMI, oral mucosa clear
Resp: Clear to auscultation bilaterly
Cardio: Regular rate/rhythm S1/S2 grade III/VI systolic ejection
murmur
Abd: Obtunded, soft non-tender normal apparent bowel sounds
Groin: 5 x 2 inch hematoma in right thigh, tender to palpation
Ext: +2 edema bilaterly in lower extremities
Neuro: AAOx3

Pertinent Results:
[**2127-8-11**] 06:58PM   WBC-14.6*# RBC-4.26 HGB-13.0 HCT-37.5 MCV-88
MCH-30.4 MCHC-34.6 RDW-14.0
[**2127-8-11**] 06:58PM   PLT COUNT-176
[**2127-8-11**] 01:15PM   WBC-8.2 RBC-3.83* HGB-11.6* HCT-33.5* MCV-87
MCH-30.2 MCHC-34.6 RDW-14.2
[**2127-8-11**] 01:15PM   PLT COUNT-225
[**2127-8-11**] 12:24PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.048*
[**2127-8-11**] 12:24PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2127-8-11**] 12:00PM   ALT(SGPT)-14 AST(SGOT)-18 ALK PHOS-53 TOT
BILI-0.6
[**2127-8-11**] 12:00PM   ALBUMIN-3.4
[**2127-8-11**] 12:00PM   PT-13.4* PTT-44.3* INR(PT)-1.2

EKG: ([**2127-8-5**]): Sinus 75; RBBB pattern

Brief Hospital Course:
1) Hematoma - Pt had CT abdomin/pelvis which was negative for
retroperotinal bleed, hematoma limited to anterior thigh.  While
pt in hospital, serial Hct were checked and remained stable.  Pt
hematoma slowly improved throughout hospital course.  No bruits
were heard at site of catheter insertion.

2) AS - Pt admitted for severe AS with worsening symptoms of
dysnea and fatigue. Pt had echo on [**2127-8-12**] which revealed LVEF
45%, LA mod dilated, severe symmetric LVH, LV cavity size
normal, Ao root mild dilated, severe Ao valve stenosis, 1+ AoR.
3+ MR; aortic valve peak Gradient=87 mm Hg; mean gradient=55
mmHg; valve area = 0.6 cm2.  Cardiac thoracic surgery offered
AVR, however due to possible mortality risk of surgery patient
declined surgery at present time.

3) CAD - Pt cardiac catherization showed extensive disease
(refer to HPI).  While in hospital pt was continued on asprin,
lipitor, atenolol

4) Hypotension - After intial drop in blood pressure, pt never
had repeat incident of drop in blood pressure while in hospital.
 Pt was continued on atenolol and BP remained stable.

5) Hypothyroidism - Pt was continued on outpatient dose of
levothyroxine while in hospital.




Medications on Admission:
Lovoxyl 0.112mg;
ASA 81 mg;
Atenolol 25mg;
Protonix 40mg;
Xanax 0.25mg;
Lipitor 40mg;
Nitro patch 0.4mcg/hr 8am to 8pm

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever, pain.
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO QD (once a day).

3. Levothyroxine Sodium 112 mcg Tablet Sig: One (1) Tablet PO QD
(once a day).
4. Atenolol 25 mg Tablet Sig: One (1) Tablet PO QD (once a day).

5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

6. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
7. Alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).


Discharge Disposition:
Home

Discharge Diagnosis:
Severe Aortic Stenosis
Post-Cath hematoma


Discharge Condition:
Good

Discharge Instructions:
Please make sure you call your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 8098**] and have a
repeat Hematocrit checked to make sure it is stable.

Followup Instructions:
1. Please follow up with PCP [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 8098**] within one week.
Please call to schedule an appointment at [**Telephone/Fax (1) 58011**], you will
need to have your blood checked and report sent to Dr. [**Last Name (STitle) 8098**]
for evaluation.
{'Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Hematoma complicating a procedure,Aortocoronary bypass status,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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: Hematoma s/p cardiac catherization

PRESENT ILLNESS: pt is 80 year old female with severe aortic stenosis (0.7 valve
area; mean grad 40.9), CAD s/p CABG '[**19**] (LIMA-LAD), SVG-ramus,
SVG-OM, SVG-RPL, SVG-PDA) presents with dyspnea and fatigue. Pt
decided to get AVR and referred for cath for pre-op assessment.
Cath revealed CI 2.6, PA 68%, LVEF 40%, LMCA-diffuse dx mild
stenosis; LAD - large patent diagnol, 70% mid; RCA diffuse dx
proximal with occlusion mid; SVG-PDA patent; SVG-RPL occluded;
SVG-OM and SVG-ramus patent; LIMA-LAD patent did not cross
midline; severe AS, +2MR; RA 10; PAP 57/26; PCWP 24.
Post cath complicated by large hematoma s/p sheath pull with SBP
decreased to 95 - tx with atropine, IV fluids, 2U PRBC - SBP
stabalized at 138 with no symptoms of CP/SOB. Pt Hct dropped
from 40 to 33. CT abd showed no evidence of RP hemorrhage;
hematoma within R groin extending along anterior aspect of R
thigh.

MEDICAL HISTORY: CABG [**2119**];
Appy;
[**First Name9 (NamePattern2) 30065**] [**Location (un) **];
Aortic Stenosis;
Immune hemolytic anemia;
small AAA;
hypothyroidism

MEDICATION ON ADMISSION: Lovoxyl 0.112mg;
ASA 81 mg;
Atenolol 25mg;
Protonix 40mg;
Xanax 0.25mg;
Lipitor 40mg;
Nitro patch 0.4mcg/hr 8am to 8pm

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afebrile P65 BP 134/60 O2Sat 100% 2L
Gen: NAD
Heent: Perrla, EOMI, oral mucosa clear
Resp: Clear to auscultation bilaterly
Cardio: Regular rate/rhythm S1/S2 grade III/VI systolic ejection
murmur
Abd: Obtunded, soft non-tender normal apparent bowel sounds
Groin: 5 x 2 inch hematoma in right thigh, tender to palpation
Ext: +2 edema bilaterly in lower extremities
Neuro: AAOx3

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives in [**Location 2498**] with son; widowed
no etoh
no tobacco 

### Response:
{'Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Hematoma complicating a procedure,Aortocoronary bypass status,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
