CHIEF COMPLAINT: Daily angina and increasing SOB

PRESENT ILLNESS: 60 yo female with long-standing history of CAD with CABG x3 in
[**2097**], and subsequent DES to CX [**8-30**], complicated by CX
dissection. Vein grafts are known to be occluded since [**2103**]. She
was recently hospitalized at OSH for RUQ pain. Seen by Dr. [**First Name (STitle) 2819**]
of general surgery for gallbladder eval/HIDA scanning. This
showed cholecystitis, and recent echo revealed severe AS. She
now presents with increasing angina, sometimes at rest, and
significant SOB with minimal exertion.
Admitted to complete pre-op evaluation and repeat cath.

MEDICAL HISTORY: Coronary Artery Disease s/p Coronary Artery Bypass Graft [**2097**]
and CX stents [**8-30**], Rheumatoid arthritis, Osteoarthritis,
Fibromyalgia, Hypertension, Elev. cholesterol, Depression
Cholelithiasis/cystic duct stenosis, Diabetes Mellitus,
Hypothyroidism, Iron deficiency anemia, s/p Total Abd.
hysterectomy, s/p Appendectomy

MEDICATION ON ADMISSION: crestor 30 mg daily, nambutemone 1000 mg [**Hospital1 **], isosorbide MN 120
mg daily, gemfibrozil 600 mg daily, trazadone 400-500 mg QHS,
toprol XL 300 mg daily, synthroid 175 mcg daily, norvasc 15 mg
daily, lisinopril 40 mg daily, Fe 325 mg TID, Vit. C daily,
morphine sulfate SR 30 mg TID, vicodin prn, lasix 40 mg daily as
directed, zantac 150 mg [**Hospital1 **], nitro spray prn

ALLERGIES: Ambien / Percocet

PHYSICAL EXAM: 98% RA sat. 142/72  HR 72   RR 20  T 99.1 63"  97.2 kg
no c/c/e
NCAT,  PERRL, anicteric sclera, OP benign
neck supple, full ROM, no JVD
CTAB
well-healed sternotomy
RRR   3/6 SEM
mild RUQ/periumbilical tenderness
extrems warm, well-perfused, no edema
well-healed left leg SVG harvest site
neuro grossly intact, slow but steady gait, strengths [**4-30**] and
equal
2+ bil. fem/radials
1+ bil. DPs/ 1+ right DP,  left non-palp.
? carotid bruits bil. versus transmitted murmur

FAMILY HISTORY: Mother had CABG at age 48, died of CAD at age 68
Father had DM, CAD, died of MI

SOCIAL HISTORY: single, has 3 children, denies ETOH or tobacco
Aortic valve disorders,Intermediate coronary syndrome,Acquired cardiac septal defect,Congestive heart failure, unspecified,Atrial fibrillation,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Pulmonary collapse,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Coronary atherosclerosis of native coronary artery,Stricture of artery,Unspecified essential hypertension,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Unspecified acquired hypothyroidism,Myalgia and myositis, unspecified,Rheumatoid arthritis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Aortic valve disorder,Intermed coronary synd,Acq cardiac septl defect,CHF NOS,Atrial fibrillation,Surg compl-heart,Urin tract infection NOS,Pulmonary collapse,Cholelith w cholecys NEC,Crnry athrscl natve vssl,Stricture of artery,Hypertension NOS,Dental caries NOS,DMII wo cmp nt st uncntr,Iron defic anemia NOS,Hypothyroidism NOS,Myalgia and myositis NOS,Rheumatoid arthritis,Abn react-artif implant
Admission Date:  [**2107-2-17**]              Discharge Date:   [**2107-2-28**]

Date of Birth:  [**2047-2-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Ambien / Percocet

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Daily angina and increasing SOB

Major Surgical or Invasive Procedure:
[**2107-2-20**] Dental extractions
[**2107-2-21**] Cardiac cath (stenting of the left subclavian artery)
[**2107-2-22**] Redo-Sternotomy, Aortic Valve Replacement, ASD closure
([**Street Address(2) 17167**].[**Male First Name (un) 923**] mechanical valve)

History of Present Illness:
60 yo female with long-standing history of CAD with CABG x3 in
[**2097**], and subsequent DES to CX [**8-30**], complicated by CX
dissection. Vein grafts are known to be occluded since [**2103**]. She
was recently hospitalized at OSH for RUQ pain. Seen by Dr. [**First Name (STitle) 2819**]
of general surgery for gallbladder eval/HIDA scanning. This
showed cholecystitis, and recent echo revealed severe AS. She
now presents with increasing angina, sometimes at rest, and
significant SOB with minimal exertion.
Admitted to complete pre-op evaluation and repeat cath.

Past Medical History:
Coronary Artery Disease s/p Coronary Artery Bypass Graft [**2097**]
and CX stents [**8-30**], Rheumatoid arthritis, Osteoarthritis,
Fibromyalgia, Hypertension, Elev. cholesterol, Depression
Cholelithiasis/cystic duct stenosis, Diabetes Mellitus,
Hypothyroidism, Iron deficiency anemia, s/p Total Abd.
hysterectomy, s/p Appendectomy

Social History:
single, has 3 children, denies ETOH or tobacco

Family History:
Mother had CABG at age 48, died of CAD at age 68
Father had DM, CAD, died of MI

Physical Exam:
98% RA sat. 142/72  HR 72   RR 20  T 99.1 63"  97.2 kg
no c/c/e
NCAT,  PERRL, anicteric sclera, OP benign
neck supple, full ROM, no JVD
CTAB
well-healed sternotomy
RRR   3/6 SEM
mild RUQ/periumbilical tenderness
extrems warm, well-perfused, no edema
well-healed left leg SVG harvest site
neuro grossly intact, slow but steady gait, strengths [**4-30**] and
equal
2+ bil. fem/radials
1+ bil. DPs/ 1+ right DP,  left non-palp.
? carotid bruits bil. versus transmitted murmur

Pertinent Results:
[**2107-2-18**] CNIS: Bilateral less than 40% carotid stenosis.
[**2107-2-21**] Cath: Initial diagnostic angiography revealed a proximal
70% left subclavian artery stenosis with a 40 mmHg gradient
across the lesion.  The stenosis was proximal to the widely
patent LIMA-LAD graft, and thus the decision was made to stent
the lesion to improve flow to the LIMA. Heparin was used for IV
anticoagulation.  A 6F Shuttle sheath was used to engage the L
subclavian artery.  The lesion was crossed with a Magic Torque
wire that was then exchange out thru a catheter for a Supracore
wire.  A 7.0x29 mm Genesis bare metal stent was deployed across
the lesion at 12 ATM.  The stent was postdilated with an 8.0x20
mm baloon at 20 ATM.  Final angiography revealed 0% residual
stenosis, no gradient, no dissection, and normal flow.
[**2107-2-22**] Echo: Pre Bypass: There is severe symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is mild regional left ventricular systolic
dysfunction with basal inferior hypokinesis. LVEF 45-50%. The
right ventricular cavity is moderately dilated. Right
ventricular systolic function is borderline normal. There are
three aortic valve leaflets. The aortic valve leaflets are
severely thickened/deformed. There is severe aortic valve
stenosis (area <0.8cm2). Mild to moderate ([**12-28**]+) aortic
regurgitation is seen. The regurgitation is central with a vena
contracta between 3 and 5 mm. With provacative manuvers and
elevation of blood pressure and heart rate, mitral regurgitation
becomes at worst, moderate. There is blunting of the pulmonary
vein flow pattern. The mitral annulus meausres, on average, 3.3
cm. The leaflets are structurally normal. The aortic
regurgitation jet is eccentric, directed toward the anterior
mitral leaflet. The mitral valve leaflets are structurally
normal. Mild to moderate ([**12-28**]+) mitral regurgitation is seen.
There is a trivial/physiologic pericardial effusion. Post
Bypass: Preserved biventricular function. LVEF 45-50%. No change
in wall motion. Aortic contours intact. Mitral regurgitation is
now trace. There is a prostethic valve in the aortic position
which appears well seated without preivavlvular leaks. Peak
gradient 31, mean 13 mm Hg. No AI. Post bypass cardiac output
calculated at 5.9 L/min. Remaining exam is unchanged. All
findings discussed with surgeons at the time of the exam.
[**2107-2-26**] Abd U/S: 1. Cholelithiasis without son[**Name (NI) 493**] evidence
of cholecystitis. 2. Prominent common bile duct with no
intrahepatic ductal dilation. 3. No ascites.
[**2107-2-27**] CXR: Increased size of small right pleural effusion.
Associated opacity in right lower lobe most likely atelectasis.
Continued mild CHF.

[**2107-2-17**] 11:30PM BLOOD WBC-4.7 RBC-4.69 Hgb-10.3* Hct-31.4*
MCV-67* MCH-22.0* MCHC-32.9 RDW-16.6* Plt Ct-254
[**2107-2-23**] 02:39AM BLOOD WBC-11.6*# RBC-3.84* Hgb-9.3* Hct-27.7*
MCV-72* MCH-24.2* MCHC-33.4 RDW-18.7* Plt Ct-205#
[**2107-2-28**] 06:55AM BLOOD WBC-5.7 RBC-3.77* Hgb-9.1* Hct-28.1*
MCV-75* MCH-24.2* MCHC-32.4 RDW-20.1* Plt Ct-333#
[**2107-2-17**] 11:30PM BLOOD PT-11.7 PTT-24.9 INR(PT)-1.0
[**2107-2-26**] 01:35AM BLOOD PT-20.6* PTT-37.9* INR(PT)-2.0*
[**2107-2-26**] 04:15AM BLOOD PT-20.7* PTT-37.2* INR(PT)-2.0*
[**2107-2-27**] 05:20AM BLOOD PT-25.7* INR(PT)-2.6*
[**2107-2-28**] 06:55AM BLOOD PT-30.7* PTT-36.5* INR(PT)-3.2*
[**2107-2-17**] 11:30PM BLOOD Glucose-105 UreaN-15 Creat-0.7 Na-138
K-3.9 Cl-106 HCO3-22 AnGap-14
[**2107-2-28**] 06:55AM BLOOD Glucose-93 UreaN-9 Creat-0.8 Na-138 K-4.0
Cl-99 HCO3-30 AnGap-13
[**2107-2-26**] 04:15AM BLOOD ALT-10 AST-16 LD(LDH)-307* AlkPhos-156*
Amylase-37 TotBili-0.2

Brief Hospital Course:
Admitted on [**2-17**] for close monitoring given angina and SOB.
Carotid US revealed no significant disease. Dental consult done,
and multiple teeth extractions done [**2-20**]. Cardiac cath performed
[**2-21**] showed mod. diff. LM dz, EF 45%, patent CX stents, 100%
RCA, vein graft occluded, 70% left subclavian stenosis.
Subclavian stent placed at time of cath. Cipro started for UTI
and ampicillin started for dental infection. Rapid AFIB treated
pre-op with associated hypertension and angina. Discussed with
cardiology and she eventually converted to SR with beta blockade
and IV NTG (which was later d/c'ed). On [**2-22**] she was brought to
the operating room where she underwent a redo sternotomy, Aortic
Valve Replacement, and ASD closure with Dr. [**Last Name (STitle) 1290**]. Please
see operative report for surgical details. Later on op day she
was weaned from sedation, awoke neurologically intact and
extubated. She was started beta blockers and diuretics on
post-op day one and then transferred to the floor. She was
gently diuresed towards her pre-op weight during post-op course.
Chest tubes removed without incident on post-op day two.
Epicardial pacing wires were removed on post-op day three.
Coumadin initiated with a Heparin bridge for her mechanical
valve. On post-op day five she was still in severe pain and pain
service was consulted. Also on this day her rhythm went into
Atrial Fibrillation and Amiodarone was started. At time of
discharge she was in SR with frequent PAC's with heart rate of
70. Physical therapy followed patient during entire post-op
course for strength and mobility. On post-op day six she
appeared to be doing well and was discharged to rehab with the
appropriate follow-up appointments.

Medications on Admission:
crestor 30 mg daily, nambutemone 1000 mg [**Hospital1 **], isosorbide MN 120
mg daily, gemfibrozil 600 mg daily, trazadone 400-500 mg QHS,
toprol XL 300 mg daily, synthroid 175 mcg daily, norvasc 15 mg
daily, lisinopril 40 mg daily, Fe 325 mg TID, Vit. C daily,
morphine sulfate SR 30 mg TID, vicodin prn, lasix 40 mg daily as
directed, zantac 150 mg [**Hospital1 **], nitro spray prn

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO BID (2 times a
day).
7. Nabumetone 500 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
8. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
9. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day.

10. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY  () as needed
for knee.
11. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q8H (every 8 hours).
12. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg twice a day for 5 days then decrease to 400mg
daily for 7 days, then decrease to 200mg daily .
13. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO ONCE (Once):
please give 2.5mg mon and tues then check INR wed - goal INR
2.5-3.0 for AVR mechanical valve .
14. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO Q12H (every
12 hours).
15. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours) as needed.
16. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO Q12H (every 12 hours):
continue while on lasix.
17. Trazodone 100 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime) as needed.
18. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Aortic Stenosis/ASD s/p Redo-Sternotomy, Aortic Valve
Replacement, ASD closure
Post-operative Atrial Fibrillation
Dental infection s/p Teeth extractions
Urinary Tract Infection
PMH: Coronary Artery Disease s/p Coronary Artery Bypass Graft
[**2097**] and CX stents [**8-30**], Rheumatoid arthritis, Osteoarthritis,
Fibromyalgia, Hypertension, Elev. cholesterol, Depression
Cholelithiasis/cystic duct stenosis, Diabetes Mellitus,
Hypothyroidism, Iron deficiency anemia, s/p Total Abd.
hysterectomy, s/p Appendectomy

Discharge Condition:
stable

Discharge Instructions:
may shower over incisions and pat dry
no lotions, creams , or powders on any incision
no driving for one month
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 100.5, redness or drainage

Followup Instructions:
see Dr. [**Last Name (STitle) **] in [**12-28**] weeks
see Dr. [**Last Name (STitle) 5293**] in [**1-29**] weeks
see Dr. [**Last Name (STitle) 1290**] in 4 weeks  [**Telephone/Fax (1) 170**]
Dental: [**Hospital Ward Name 23**] 3 Surgical services [**3-4**] at 3:00pm Dr [**First Name (STitle) **]
[**Telephone/Fax (1) 274**]



Completed by:[**2107-2-28**]
{'Aortic valve disorders,Intermediate coronary syndrome,Acquired cardiac septal defect,Congestive heart failure, unspecified,Atrial fibrillation,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Pulmonary collapse,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Coronary atherosclerosis of native coronary artery,Stricture of artery,Unspecified essential hypertension,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Unspecified acquired hypothyroidism,Myalgia and myositis, unspecified,Rheumatoid arthritis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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: Daily angina and increasing SOB

PRESENT ILLNESS: 60 yo female with long-standing history of CAD with CABG x3 in
[**2097**], and subsequent DES to CX [**8-30**], complicated by CX
dissection. Vein grafts are known to be occluded since [**2103**]. She
was recently hospitalized at OSH for RUQ pain. Seen by Dr. [**First Name (STitle) 2819**]
of general surgery for gallbladder eval/HIDA scanning. This
showed cholecystitis, and recent echo revealed severe AS. She
now presents with increasing angina, sometimes at rest, and
significant SOB with minimal exertion.
Admitted to complete pre-op evaluation and repeat cath.

MEDICAL HISTORY: Coronary Artery Disease s/p Coronary Artery Bypass Graft [**2097**]
and CX stents [**8-30**], Rheumatoid arthritis, Osteoarthritis,
Fibromyalgia, Hypertension, Elev. cholesterol, Depression
Cholelithiasis/cystic duct stenosis, Diabetes Mellitus,
Hypothyroidism, Iron deficiency anemia, s/p Total Abd.
hysterectomy, s/p Appendectomy

MEDICATION ON ADMISSION: crestor 30 mg daily, nambutemone 1000 mg [**Hospital1 **], isosorbide MN 120
mg daily, gemfibrozil 600 mg daily, trazadone 400-500 mg QHS,
toprol XL 300 mg daily, synthroid 175 mcg daily, norvasc 15 mg
daily, lisinopril 40 mg daily, Fe 325 mg TID, Vit. C daily,
morphine sulfate SR 30 mg TID, vicodin prn, lasix 40 mg daily as
directed, zantac 150 mg [**Hospital1 **], nitro spray prn

ALLERGIES: Ambien / Percocet

PHYSICAL EXAM: 98% RA sat. 142/72  HR 72   RR 20  T 99.1 63"  97.2 kg
no c/c/e
NCAT,  PERRL, anicteric sclera, OP benign
neck supple, full ROM, no JVD
CTAB
well-healed sternotomy
RRR   3/6 SEM
mild RUQ/periumbilical tenderness
extrems warm, well-perfused, no edema
well-healed left leg SVG harvest site
neuro grossly intact, slow but steady gait, strengths [**4-30**] and
equal
2+ bil. fem/radials
1+ bil. DPs/ 1+ right DP,  left non-palp.
? carotid bruits bil. versus transmitted murmur

FAMILY HISTORY: Mother had CABG at age 48, died of CAD at age 68
Father had DM, CAD, died of MI

SOCIAL HISTORY: single, has 3 children, denies ETOH or tobacco 

### Response:
{'Aortic valve disorders,Intermediate coronary syndrome,Acquired cardiac septal defect,Congestive heart failure, unspecified,Atrial fibrillation,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Pulmonary collapse,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Coronary atherosclerosis of native coronary artery,Stricture of artery,Unspecified essential hypertension,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Unspecified acquired hypothyroidism,Myalgia and myositis, unspecified,Rheumatoid arthritis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
