CHIEF COMPLAINT: Critical symptomatic aortic stenosis.

PRESENT ILLNESS: The patient is a 69-year-old female with worsening symptoms
related to critical aortic stenosis presenting for aortic valve
replacement.

MEDICAL HISTORY: Aortic Stenosis, s/p Aortic Valve Replacement [**2145-10-29**]
PMHx: Asthma, Hypertension, Anxiety, Arthritis, Vertigo,
Bilateral total Knee Replacements, Tonsillectomy, Left breast
biopsy, C section

MEDICATION ON ADMISSION: ALBUTEROL SULFATE [PROAIR HFA] 90 mcg HFA 2 qid, FLUTICASONE
SALMETEROL 500 mcg-50 mcg/Dose 1 inhale [**Hospital1 **], HYDROCHLOROTHIAZIDE
25 mg daily, LABETALOL 100 mg daily, LOSARTAN 100 mg daily,
SERTRALINE 50 mg daily, VITAMIN D 2 TABS daily, ASPIRIN 81 mg
daily, CETIRIZINE 10 mg daily, FERROUS SULFATE 325 mg daily

ALLERGIES: Bee stings

PHYSICAL EXAM: Physical Exam:
VS: T=97.4 BP=131/89 HR=130 RR=18 O2 sat=95%RA
GENERAL: NAD, pleasant affect, laying comfortably in bed
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother: MI at age 53, died of CHF at age 57
Father - DM, CVA, Died at age 50
MGM - DM

SOCIAL HISTORY: Patient is the primary care taker of her husband who has
[**Name (NI) 2481**]. Patient is a retired speech and language
therapist for early childhood education.
-Tobacco history: 7 years 1/2ppd quit at age 23
-ETOH: None
-Illicit drugs: None
Mitral valve disorders,Acute kidney failure, unspecified,Chronic diastolic heart failure,Other chronic pulmonary heart diseases,Cardiac complications, not elsewhere classified,Body Mass Index 40.0-44.9, adult,Atrial fibrillation,Asthma, unspecified type, unspecified,Anemia, unspecified,Unspecified essential hypertension,Anxiety state, unspecified,Knee joint replacement,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of tobacco use,Obesity, unspecified
Mitral valve disorder,Acute kidney failure NOS,Chr diastolic hrt fail,Chr pulmon heart dis NEC,Surg compl-heart,BMI 40.0-44.9, adult,Atrial fibrillation,Asthma NOS,Anemia NOS,Hypertension NOS,Anxiety state NOS,Joint replaced knee,Abn react-anastom/graft,History of tobacco use,Obesity NOS
Admission Date:  [**2145-10-29**]              Discharge Date:   [**2145-11-8**]

Date of Birth:  [**2076-7-31**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Bee stings

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Critical symptomatic aortic stenosis.


Major Surgical or Invasive Procedure:
Aortic Valve Replacement (21mm pericardiac valve)[**10-29**]


History of Present Illness:
The patient is a 69-year-old female with worsening symptoms
related to critical aortic stenosis presenting for aortic valve
replacement.


Past Medical History:
Aortic Stenosis, s/p Aortic Valve Replacement [**2145-10-29**]
PMHx: Asthma, Hypertension, Anxiety, Arthritis, Vertigo,
Bilateral total Knee Replacements, Tonsillectomy, Left breast
biopsy, C section


Social History:
Patient is the primary care taker of her husband who has
[**Name (NI) 2481**]. Patient is a retired speech and language
therapist for early childhood education.
-Tobacco history: 7 years 1/2ppd quit at age 23
-ETOH: None
-Illicit drugs: None

Family History:
Mother: MI at age 53, died of CHF at age 57
Father - DM, CVA, Died at age 50
MGM - DM

Physical Exam:
Physical Exam:
VS: T=97.4 BP=131/89 HR=130 RR=18 O2 sat=95%RA
GENERAL: NAD, pleasant affect, laying comfortably in bed
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.


NECK: Supple with JVP appears to be 4cm above clavicle
CARDIAC: Tachy, regular rate, [**3-7**] crescendo decrescendo murmur
loudest over aortic window, no radiation to carotids, no carotid

bruits
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Mild crackles at the
bases.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Trace
edema in the lower extremities. Large hematoma at R
catheterization site, stable, no bruit auscultated
PULSES:
Right: Carotid 2+ Femoral 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ DP 2+ PT 2+

Pertinent Results:
[**2145-10-29**] Intra-op TEE
Conclusions
PRE-BYPASS:
The left atrium is dilated. 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 moderate symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Regional left
ventricular wall motion is normal. Right ventricular chamber
size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. The aortic valve leaflets
are severely thickened/deformed. There is critical aortic valve
stenosis (valve area <0.8cm2).
Mild (1+) aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. There is no pericardial effusion.
Dr. [**Last Name (STitle) **] was notified in person of the results before
surgical incision.
Post_Bypass:
Preserved biventricular systolic function.
LVEF55%.
The bioprosthesis in the native aortic position is stable,
functioning well. No perivalvular aortic regurgitation.
The residual peak gradient is 35 and mean gradient is 20mm of
Hg.
Intact thoracic aorta.

[**2145-11-8**] 06:07AM BLOOD WBC-8.4 RBC-3.67* Hgb-10.6* Hct-31.5*
MCV-86 MCH-28.8 MCHC-33.5 RDW-14.1 Plt Ct-280
[**2145-11-7**] 12:33PM BLOOD WBC-8.6 RBC-3.88* Hgb-11.1* Hct-33.3*
MCV-86 MCH-28.5 MCHC-33.2 RDW-14.2 Plt Ct-292
[**2145-11-8**] 06:07AM BLOOD Glucose-128* UreaN-35* Creat-0.8 Na-141
K-3.4 Cl-95* HCO3-38* AnGap-11
[**2145-11-7**] 12:33PM BLOOD UreaN-42* Creat-0.8 Na-141 K-3.6 Cl-95*
[**2145-11-6**] 05:38AM BLOOD Glucose-119* UreaN-51* Creat-1.0 Na-142
K-3.4 Cl-101 HCO3-34* AnGap-10

Brief Hospital Course:
The patient was brought to the operating room on [**2145-10-29**] where
the patient underwent Aortic valve replacement with 21-mm Magna
Ease [**Last Name (un) 3843**]-[**Doctor Last Name **] tissue valve.

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.
She remained on milrinone for pulmonary hypertension and was
diuresed wiht IV lasix. Beta blocker was initiated.  Acute
Kidney Injury developed and Toradol was discontinued. The
patient continued to make adequate urine and Creatinine returned
to baseline quickly.
She developed a brief episode of post-op atrial fibrillation,
which converted to Sinus Rhythm with Amiodarone and DC
Cardioversion.  She continued to vascilate between Sinus Rhythm
and A-Fib and was started on Coumadin.

Chest tubes and pacing wires were discontinued without
complication.  The patient was transferred to the telemetry
floor for further recovery. The patient was evaluated by the
physical therapy service for assistance with strength and
mobility.

By the time of discharge on POD 10 the patient was ambulating,
yet deconditioned.  The wound was healing and pain was
controlled with oral analgesics.  The patient was discharged to
[**Doctor Last Name 11622**] House Rehab in good condition with appropriate follow up
instructions.  She will remain on Coumadin for AFib.  INR should
be closely monitored and Chemistries should be repeated at the
end of the week in light of her recent kidney injury.

Medications on Admission:
ALBUTEROL SULFATE [PROAIR HFA] 90 mcg HFA 2 qid, FLUTICASONE
SALMETEROL 500 mcg-50 mcg/Dose 1 inhale [**Hospital1 **], HYDROCHLOROTHIAZIDE
25 mg daily, LABETALOL 100 mg daily, LOSARTAN 100 mg daily,
SERTRALINE 50 mg daily, VITAMIN D 2 TABS daily, ASPIRIN 81 mg
daily, CETIRIZINE 10 mg daily, FERROUS SULFATE 325 mg daily

Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
6. losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
7. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
8. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. ipratropium bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for wheeze.
10. sodium chloride 0.65 % Aerosol, Spray Sig: [**1-3**] Sprays Nasal
[**Hospital1 **] (2 times a day) as needed for nasal dryness.
11. fluticasone-salmeterol 500-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
12. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours).
13. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheeze.
14. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. metoprolol tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
16. hydralazine 50 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6
hours).
17. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days: re-assess need for ongoing diuresis following 1 week
course.
18. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
19. Outpatient Lab Work
- Chem 7 on [**2145-11-12**]
- PT/INR, Coumadin for AFib
Goal INR 2-2.5
First draw [**2145-11-9**], Then please do INR checks Monday, Wednesday,
and Friday for 2 weeks then decrease as directed by MD
20. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO DAILY (Daily) as needed for constipation.
21. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
22. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed for anxiety.
Disp:*20 Tablet(s)* Refills:*0*
23. diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO
Q6H (every 6 hours) as needed for itching.
24. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM: MD to dose daily for goal INR 2-2.5, dx: afib.
25. potassium chloride 20 mEq Packet Sig: One (1) Packet PO
twice a day for 1 weeks.


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Doctor Last Name 5749**] [**Doctor Last Name **] Village - [**Location (un) **]

Discharge Diagnosis:
Aortic Stenosis, s/p Aortic Valve Replacement [**2145-10-29**]
PMHx: Asthma, Hypertension, Anxiety, Arthritis, Vertigo,
Bilateral total Knee Replacements, Tonsillectomy, Left breast
biopsy, C section


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, deconditioned
Incisional pain managed with Ultram
Incisions:
Sternal - healing well, no erythema or drainage
Edema 1+


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 approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
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
Surgeon: Provider: [**Name10 (NameIs) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2145-12-8**] 1:00

Cardiologist: Dr [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **], [**12-9**] at 10:00am

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) **],[**First Name3 (LF) **] K. [**Telephone/Fax (1) 2205**] in [**4-6**] 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**

PT/INR, Coumadin for AFib Goal INR 2-2.5 First draw [**2145-11-9**],
Then please do INR checks Monday, Wednesday, and Friday for 2
weeks then decrease as directed by MD



Completed by:[**2145-11-8**]
{'Mitral valve disorders,Acute kidney failure, unspecified,Chronic diastolic heart failure,Other chronic pulmonary heart diseases,Cardiac complications, not elsewhere classified,Body Mass Index 40.0-44.9, adult,Atrial fibrillation,Asthma, unspecified type, unspecified,Anemia, unspecified,Unspecified essential hypertension,Anxiety state, unspecified,Knee joint replacement,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of tobacco use,Obesity, unspecified'}


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: Critical symptomatic aortic stenosis.

PRESENT ILLNESS: The patient is a 69-year-old female with worsening symptoms
related to critical aortic stenosis presenting for aortic valve
replacement.

MEDICAL HISTORY: Aortic Stenosis, s/p Aortic Valve Replacement [**2145-10-29**]
PMHx: Asthma, Hypertension, Anxiety, Arthritis, Vertigo,
Bilateral total Knee Replacements, Tonsillectomy, Left breast
biopsy, C section

MEDICATION ON ADMISSION: ALBUTEROL SULFATE [PROAIR HFA] 90 mcg HFA 2 qid, FLUTICASONE
SALMETEROL 500 mcg-50 mcg/Dose 1 inhale [**Hospital1 **], HYDROCHLOROTHIAZIDE
25 mg daily, LABETALOL 100 mg daily, LOSARTAN 100 mg daily,
SERTRALINE 50 mg daily, VITAMIN D 2 TABS daily, ASPIRIN 81 mg
daily, CETIRIZINE 10 mg daily, FERROUS SULFATE 325 mg daily

ALLERGIES: Bee stings

PHYSICAL EXAM: Physical Exam:
VS: T=97.4 BP=131/89 HR=130 RR=18 O2 sat=95%RA
GENERAL: NAD, pleasant affect, laying comfortably in bed
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother: MI at age 53, died of CHF at age 57
Father - DM, CVA, Died at age 50
MGM - DM

SOCIAL HISTORY: Patient is the primary care taker of her husband who has
[**Name (NI) 2481**]. Patient is a retired speech and language
therapist for early childhood education.
-Tobacco history: 7 years 1/2ppd quit at age 23
-ETOH: None
-Illicit drugs: None 

### Response:
{'Mitral valve disorders,Acute kidney failure, unspecified,Chronic diastolic heart failure,Other chronic pulmonary heart diseases,Cardiac complications, not elsewhere classified,Body Mass Index 40.0-44.9, adult,Atrial fibrillation,Asthma, unspecified type, unspecified,Anemia, unspecified,Unspecified essential hypertension,Anxiety state, unspecified,Knee joint replacement,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of tobacco use,Obesity, unspecified'}
