CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 85-year-old
female who was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] with known aortic
stenosis.  She had previously had an outpatient cardiac
catheterization in [**2134-7-22**].  In [**2134-6-21**], she had
left arm heaviness and numbness along her chest and back.
She was admitted to the [**Hospital1 69**]
where her cardiac enzymes were negative and her thallium test
was negative for ischemia, but an echocardiogram showed an
ejection fraction of 55% with severe aortic stenosis.

MEDICAL HISTORY: Question of peptic ulcer
disease/gastroesophageal reflux disease

MEDICATION ON ADMISSION: Her only medication was aspirin 81
mg p.o. once per day.

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Aortic valve disorders
Aortic valve disorder
Admission Date:  [**2135-4-11**]     Discharge Date:  [**2135-4-15**]


Service:  Cardiothoracic Surgery Service

HISTORY OF PRESENT ILLNESS:  The patient is an 85-year-old
female who was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] with known aortic
stenosis.  She had previously had an outpatient cardiac
catheterization in [**2134-7-22**].  In [**2134-6-21**], she had
left arm heaviness and numbness along her chest and back.
She was admitted to the [**Hospital1 69**]
where her cardiac enzymes were negative and her thallium test
was negative for ischemia, but an echocardiogram showed an
ejection fraction of 55% with severe aortic stenosis.

She was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] for aortic valve
replacement.

PAST MEDICAL HISTORY:   Question of peptic ulcer
disease/gastroesophageal reflux disease

PAST SURGICAL HISTORY:  Appendectomy.

ALLERGIES:  She has no known drug allergies.

MEDICATIONS ON ADMISSION:  Her only medication was aspirin 81
mg p.o. once per day.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Preoperative
laboratory work was as follows; white blood cell count was
4.5 and hematocrit was 37.6.  Prothrombin time was 12.1,
partial thromboplastin time was 23.7, and INR was 1.
Platelet count was 215,000.  The patient was in a sinus
rhythm at a rate of 86.

PERTINENT RADIOLOGY/IMAGING:  Carotid studies in [**2134-6-21**] showed minimal plaque bilaterally with less than 40%
carotid stenosis.

A preoperative electrocardiogram revealed a sinus rhythm with
no atrial ectopy present at this time, but could not rule out
old inferior myocardial infarction.

HOSPITAL COURSE:   The patient was referred to Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 1537**].  On [**2135-4-11**], the patient underwent limited
access aortic valve replacement with a 19-mm pericardial
[**Last Name (un) 3843**]-[**Doctor Last Name **] tissue valve.

She was transferred to the Cardiothoracic Intensive Care Unit
in stable condition on a Neo-Synephrine drip at 0.5 mcg/kg
per minute and titrated propofol drip.

On [**Doctor Last Name **] day one, the patient had been extubated.
The patient was saturating 96% on a face mask.  She received
her perioperative antibiotics.  Blood pressure was 122/53
with a central venous pressure of 7.  She was on a
nitroglycerin drip at 1.  Her white blood cell count was 11
and hematocrit was 31.  Sodium was 139, potassium was 3.9,
chloride was 107, bicarbonate was 23, blood urea nitrogen was
11, creatinine was 0.7, and blood glucose was 109.  The
patient was also on an insulin drip at 2.  Her lungs were
clear.  There were bowel sounds.  The examination was benign.
The patient began diuresis and had been extubated without any
difficulty.  She was seen by Case Management.

On [**Doctor Last Name **] day two, the patient was alert and awake
with a heart rate in sinus rhythm at 108.  Her blood pressure
was 137/53 with good urine output.  She was started on
Lopressor and Lasix diuresis.  Blood urea nitrogen was 21.
Creatinine was 0.7.  Potassium was 3.6.  Temperature maximum
was 99.2.  Her lungs were clear.  Her sternum was stable.
She began her beta blockade.  Her H2 blockers were stopped.
Of note, her platelet count continued to drop to 92,000 on
[**Doctor Last Name **] day one and then 62,000 on [**Doctor Last Name **] day
two.  Her platelet count was rechecked.  A heparin-induced
thrombocytopenia panel was sent, and all heparin was stopped.
The central venous line was also discontinued.  The patient
was responsive and doing very well and was transferred out to
[**Hospital Ward Name 121**] Two on [**4-13**] and was also seen by Physical Therapy.
Her sternal incision was dry.  Pacing wires remained in
place.  She was monitored on the floor, and ambulation was
begun.

She was switched over to oral Percocet and encouraged to
ambulate with the physical therapist and the nurse [**First Name (Titles) **]
[**Last Name (Titles) **] day three.  She was in a sinus rhythm with a
heart rate of 90 to 100 with a blood pressure of 98/45.  She
was saturating 94% on room air.  Her blood sugar was 132.
She was making good urine output.  Her platelet count [**Known firstname **]
slightly from 62,000 to 67,000.  White blood cell count was
11, and hematocrit was 31.  She began her beta blockade as
well as Lasix diuresis.  She was continued on Protonix.  She
was alert and oriented.  She continued to work with Physical
Therapy and was seen again by Case Management to work for a
plan for discharge.

On [**Known firstname **] day four, she had a temperature maximum of
98.8.  She was in a sinus rhythm at 85.  Her blood pressure
was 103/60.  Her blood sugar was in the range of 97 to 155.
Her white blood cell count dropped to 7.1.  Her hematocrit
was 26.4.  Platelet count was holding at 67,000.  Blood urea
nitrogen was 23, and creatinine was 0.7.  Her heart was
regular in rate and rhythm.  Her lungs were clear.  Her
incision was clean, dry, and intact.  She remained on an
insulin sliding-scale with plans to discharge her to home
with [**Hospital6 407**] services.  She was transfused
one unit of packed red blood cells for her hematocrit and was
receiving oral pain medications.  She was walking
independently on the floor.  Discharge planning included
having her see her doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) 6691**] for her wound check
and to follow up there also.

DISCHARGE STATUS:  The patient was discharged to home with
her daughter on [**2135-4-15**].

DISCHARGE DIAGNOSES:
1.  Status post limited access aortic valve replacement with
pericardial tissue valve.
2.  Gastroesophageal reflux disease.
3.  Question peptic ulcer disease.
4.  Decreased vision in the left eye.

MEDICATIONS ON DISCHARGE:  (Discharge medications were as
follows)
1.  Aspirin 325 mg p.o. once per day.
2.  Lasix 20 mg p.o. twice per day (times one week).
3.  Potassium chloride 10 mEq two tablets p.o. twice per day
(for one week).
4.  Colace 100 mg p.o. twice per day (for 30 days).
5.  Tylenol 325 mg p.o. q.4h. as needed.
6.  Percocet 5/325 one to two tablets p.o. q.4h. as needed
(for pain).
7.  Metoprolol 50 mg p.o. twice per day (times 30 days).
8.  Protonix 40 mg p.o. once per day.
9.  Magnesium hydroxide 40-mg oral suspension 30 mL p.o.
q.6h. as needed for one month (for constipation).

DISCHARGE DISPOSITION:  The patient was discharged to home.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was given instructions to follow up with her
primary care physician in [**Name9 (PRE) 6691**].
2.  The patient was to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] in
four weeks in [**Location (un) 86**] for her [**Location (un) **] visit.





                          [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 76**]

MEDQUIST36

D:  [**2135-6-15**]  14:14
T:  [**2135-6-22**]  08:08
JOB#:  [**Job Number 44132**]
{'Aortic valve disorders'}


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: 

PRESENT ILLNESS: The patient is an 85-year-old
female who was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] with known aortic
stenosis.  She had previously had an outpatient cardiac
catheterization in [**2134-7-22**].  In [**2134-6-21**], she had
left arm heaviness and numbness along her chest and back.
She was admitted to the [**Hospital1 69**]
where her cardiac enzymes were negative and her thallium test
was negative for ischemia, but an echocardiogram showed an
ejection fraction of 55% with severe aortic stenosis.

MEDICAL HISTORY: Question of peptic ulcer
disease/gastroesophageal reflux disease

MEDICATION ON ADMISSION: Her only medication was aspirin 81
mg p.o. once per day.

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Aortic valve disorders'}
