CHIEF COMPLAINT: dyspnea on exertion and weight gain

PRESENT ILLNESS: 83 yoM w/ a h/o CAD initially admitted on [**12-17**] to OSH with a 15
lb weight gain over past 3 months.  Dyspnea @ rest and pedal
edema upon presentation.  Upon his hospitalization he developed
atrial flutter and has atrial flutter w/ tachycardia requiring
lopressor however while asleep at night his heart rate has been
slow to low 30s at times with 3 second pauses.  Stress rates of
110-120s.    Transferred to [**Hospital1 18**] for evaluation.

MEDICAL HISTORY: Coronary Artery Disease
Systolic heart failure
HTN
Atrial Flutter
Claudication
S/p nephrectomy for Left Renal Cell Carcinoma
Hypercholesterolemia
Gout

MEDICATION ON ADMISSION: Metoprolol 100mg po daily
Lipitor 10mg po daily
Lasix 80mg po daily (patient is unsure if he takes lasix at
home)
Aspirin 81mg po daily
Cozaar 50mg po daily
Cilostozal 100mg po bid
Doxasosin 4mg po daily
Allopurinol 100mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: BP 134/82  HR 109  RR 18  O2 95% 2L
GEN: NAD, AOx3
HEENT: JVP 10cm (but difficult to see)
CARD: tachycardia, regular rhythm, [**3-10**] early peaking systolic
cres decres murmur @ USB w/o radiation to the carotids
PULM: rales [**2-4**] way up on R, bronchial breath sounds [**2-4**] way up
on L side
ABD: Soft, NT, ND, no masses, BS+
EXT: WWP, 2+ pitting edema to thigh bilaterally symmetrical

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Tobacco denies - quit many years ago
Rare ETOH
Lives alone
Mitral valve disorders,Congenital insufficiency of aortic valve,Acute on chronic systolic heart failure,Atrial flutter,Disruption of external operation (surgical) wound,Coronary atherosclerosis of autologous vein bypass graft,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Acute respiratory failure,Cardiogenic shock,Unspecified septicemia,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Other candidiasis of other specified sites,Pure hypercholesterolemia,Infection with microorganisms without mention of resistance to multiple drugs,Atherosclerosis of aorta,Other iatrogenic hypotension,Chronic kidney disease, unspecified,Acquired absence of kidney,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease
Mitral valve disorder,Cong aorta valv insuffic,Ac on chr syst hrt fail,Atrial flutter,Disrup-external op wound,Crn ath atlg vn bps grft,Surg compl-heart,Urin tract infection NOS,Acute respiratry failure,Cardiogenic shock,Septicemia NOS,Severe sepsis,Ac kidny fail, tubr necr,Candidiasis site NEC,Pure hypercholesterolem,Inf mcr rst ot drg nt ml,Aortic atherosclerosis,Iatrogenc hypotnsion NEC,Chronic kidney dis NOS,Acquired absence kidney,Old myocardial infarct,Hy kid NOS w cr kid I-IV,Anemia in chr kidney dis
Admission Date:  [**2127-12-24**]              Discharge Date:   [**2128-3-12**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
dyspnea on exertion and weight gain

Major Surgical or Invasive Procedure:
[**1-7**] redo sternotomy, AVR(23 CE pericardial)/MVrepair(28mm CE
physio ring), aortic endarterectomy
[**1-28**] Trach & PEG
[**2128-2-6**] Sternal debridement
[**2-23**] Sternal debridement
[**2-25**] Sternal closure with plating
[**3-5**] RIJ Tunnelled dialysis catheter


History of Present Illness:
83 yoM w/ a h/o CAD initially admitted on [**12-17**] to OSH with a 15
lb weight gain over past 3 months.  Dyspnea @ rest and pedal
edema upon presentation.  Upon his hospitalization he developed
atrial flutter and has atrial flutter w/ tachycardia requiring
lopressor however while asleep at night his heart rate has been
slow to low 30s at times with 3 second pauses.  Stress rates of
110-120s.    Transferred to [**Hospital1 18**] for evaluation.


Past Medical History:
Coronary Artery Disease
Systolic heart failure
HTN
Atrial Flutter
Claudication
S/p nephrectomy for Left Renal Cell Carcinoma
Hypercholesterolemia
Gout

Social History:
Tobacco denies - quit many years ago
Rare ETOH
Lives alone


Family History:
Unknown

Physical Exam:
VS: BP 134/82  HR 109  RR 18  O2 95% 2L
GEN: NAD, AOx3
HEENT: JVP 10cm (but difficult to see)
CARD: tachycardia, regular rhythm, [**3-10**] early peaking systolic
cres decres murmur @ USB w/o radiation to the carotids
PULM: rales [**2-4**] way up on R, bronchial breath sounds [**2-4**] way up
on L side
ABD: Soft, NT, ND, no masses, BS+
EXT: WWP, 2+ pitting edema to thigh bilaterally symmetrical

Pertinent Results:
[**2128-3-12**] 12:22AM BLOOD WBC-15.1* RBC-2.81* Hgb-8.7* Hct-28.3*
MCV-101* MCH-31.0 MCHC-30.9* RDW-20.5* Plt Ct-222
[**2128-3-11**] 03:01AM BLOOD WBC-10.6 RBC-2.67* Hgb-8.6* Hct-27.0*
MCV-101* MCH-32.3* MCHC-31.9 RDW-20.5* Plt Ct-192
[**2128-3-12**] 12:22AM BLOOD PT-18.6* PTT-57.9* INR(PT)-1.7*
[**2128-3-11**] 11:04AM BLOOD PT-17.6* PTT-54.3* INR(PT)-1.6*
[**2128-3-12**] 12:22AM BLOOD Glucose-112* UreaN-28* Creat-2.2* Na-136
K-4.3 Cl-99 HCO3-26 AnGap-15
[**2128-3-11**] 03:01AM BLOOD Glucose-140* UreaN-37* Creat-2.7* Na-135
K-3.9 Cl-100 HCO3-22 AnGap-17


Brief Hospital Course:
He was admitted to the floor and diuresed. TEE on [**12-26**] showed
no thrombus and on [**12-26**] he underwent a flutter ablation.  He
became hypotensive from diuresis and was started on dopamine and
tranferred to the CCU. Cardiac surgery was consulted for his
severe AS and MR. [**Name13 (STitle) **] was started on tube feeds for dysphagia. He
remained on a heparin drip. He had a VT arrest requiring CPR,
and recovered to rapid afib. He was started on amiodarone. He
was intubated electively, and cardiac cath was done and [**12-29**]
and graft to OM was stented.  He was treated for a klebsiella
UTI. Repeat echo showed no improvement in EF after stent. He was
seen by renal for increasing creatinine however continued to
have good urine output with lasix and diuril. He was extubated
on [**1-1**]. He agreed to surgery, and on [**1-7**] was taken to the
operating room wher he underwent a redo sternotomy/AVR/MV Repair
and aortic endarterectomy. He became asystolic immediately post
op and was reopened with resolution and no findings. He was
transferred to the ICU in critical but stable condition on epi,
neo and propofol. He was given vancomycin periop as he was in
the hospital preoperatively. He was hypotensive overnight,
milrinone and pitressin were added, and he was transfused. His
pressors and vent were slowly weaned and he was diuresed.   His
vasoactive drips were weaned to off and He was extubated on POD
#7. He had several runs of VT. He remained on heparin IV for
atrial fibrillation and Coumadin was held with plans for AICD.
He was started on a lasix drip, and required free water for
hypernatremia. On [**1-17**] he was reintubated for PCO2 of 90. AICD
placement was cancelled until patient is stabilized.  After
multiple extubation attempts, on [**1-28**] a trach and were placed.
Diamox was added for diuresis.  Coumadin was restarted. He
continued to progress and was able to tolerate trach collar
trials.  Diuresis was stopped.  EP was reconsulted in relation
to AICD and Mr. [**Known lastname 40177**] should follow up in one month with EP.
His distal incision began to drain serous fluid and it was
opened and packed. His trach was changed to [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 295**] on [**2-5**]. His
sternum continued to open and He was taken to the operating room
on [**2-5**] for a sternal debridement and a VAC was placed. He
suffered a cardiac arrest in the operating room and was
resuscitated. He was started on 3 pressors and vanco zosyn and
flagyl. He was seen by nephrology for decreased urine output. He
was started on fluconazole for yeast in his sternal wound. He
was started on CVVH. He remained on multiple pressors. He
remained on full ventilator support, an dpressors for a number
of days.  He stabilized hemodynamically, and weaned off
pressors.  On [**2128-2-23**], he was again taken to the OR with Dr.
[**First Name (STitle) **] (plastic surgery) for a sternal debridement.  He was
again returned to the OR for delayed sternal closure with
plating by Dr. [**First Name (STitle) **] on [**2128-2-25**].  He was able to tolerate
hemodialysis, no longer requiring CVVH, so he had a RIJ
tunnelled hemodialysis catheter placed on [**2128-3-5**] by Dr. [**Last Name (STitle) 816**].
He has remained hemodynamically stable, and is now ready to be
transferred to rehab for continued physical therapy, and
ventilator weaning.  His Zosyn will be completed on [**2128-3-22**].
Fluconazole is to be lifelong.  Daptomycin should continue for 4
week from start date of [**2128-3-11**].


Medications on Admission:
Metoprolol 100mg po daily
Lipitor 10mg po daily
Lasix 80mg po daily (patient is unsure if he takes lasix at
home)
Aspirin 81mg po daily
Cozaar 50mg po daily
Cilostozal 100mg po bid
Doxasosin 4mg po daily
Allopurinol 100mg daily

Discharge Medications:
1. Allopurinol 100 mg Tablet [**Date Range **]: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
2. Clopidogrel 75 mg Tablet [**Date Range **]: One (1) Tablet PO DAILY
(Daily): for stent .
3. Senna 8.6 mg Tablet [**Date Range **]: One (1) Tablet PO BID (2 times a
day).
4. Docusate Sodium 50 mg/5 mL Liquid [**Date Range **]: Ten (10)  PO BID (2
times a day).
5. Carvedilol 3.125 mg Tablet [**Date Range **]: One (1) Tablet PO BID (2
times a day).
6. Aspirin 81 mg Tablet, Chewable [**Date Range **]: One (1) Tablet, Chewable
PO DAILY (Daily).
7. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol [**Date Range **]: [**3-8**]
Puffs Inhalation Q6H (every 6 hours) as needed.
8. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
9. Lipitor 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day.
Tablet(s)
10. Nephrocaps 1 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO once a day.

11. Sertraline 25 mg Tablet [**Last Name (STitle) **]: Three (3) Tablet PO once a day:
75 mg daily.
12. Zosyn 2.25 gram Recon Soln [**Last Name (STitle) **]: 2.25 Gms  Intravenous every
eight (8) hours for 10 days: end date [**2128-3-22**].
13. Daptomycin 500 mg Recon Soln [**Month/Day/Year **]: 350  mg Intravenous every
other day for 4 weeks.


Discharge Disposition:
Extended Care

Facility:
tba

Discharge Diagnosis:
Aortic Stenosis s/p avr
Mitral Regurgitation s/p MV repair
Acute on chronic systolic heart failure
PMH: HTN, Aflutter (s/p ablation [**12-26**]), Claudication, Chol,
Gout, CAD (s/p MI x 3)[**2112**], CHF (EF 20%)
PSH: CABG '[**12**], Lt Nephrectomy '[**99**], Rt knee [**Doctor First Name **] 70's


Discharge Condition:
Fair


Discharge Instructions:
Call with fever, or redness or drainage from incision.
[**Telephone/Fax (1) 170**]
Please monitor weight - systolic heart failure - monitor for
weight gain more than 2 pounds in one day or five in one week.
No baths, no lotions, creams or powders to incisions.
No lifting more than 10 pounds or driving until follow up with
surgeon


Followup Instructions:
Dr. [**Last Name (STitle) 1637**] after discharge from rehab - please call to schedule
appointment [**Telephone/Fax (1) 14655**]
Dr. [**First Name (STitle) **] - [**Telephone/Fax (1) 170**] please call for appointment when
discharged from rehab
Dr. [**Last Name (STitle) **] after discharge from rehab [**Telephone/Fax (1) 285**]
Dr. [**First Name (STitle) 1075**] in [**Hospital **] clinic on [**2128-3-19**] at 10 am ([**Last Name (NamePattern1) **],
basement)  Please call if need to reschedule [**Telephone/Fax (1) 457**]


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2128-3-12**]
{'Mitral valve disorders,Congenital insufficiency of aortic valve,Acute on chronic systolic heart failure,Atrial flutter,Disruption of external operation (surgical) wound,Coronary atherosclerosis of autologous vein bypass graft,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Acute respiratory failure,Cardiogenic shock,Unspecified septicemia,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Other candidiasis of other specified sites,Pure hypercholesterolemia,Infection with microorganisms without mention of resistance to multiple drugs,Atherosclerosis of aorta,Other iatrogenic hypotension,Chronic kidney disease, unspecified,Acquired absence of kidney,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease'}


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: dyspnea on exertion and weight gain

PRESENT ILLNESS: 83 yoM w/ a h/o CAD initially admitted on [**12-17**] to OSH with a 15
lb weight gain over past 3 months.  Dyspnea @ rest and pedal
edema upon presentation.  Upon his hospitalization he developed
atrial flutter and has atrial flutter w/ tachycardia requiring
lopressor however while asleep at night his heart rate has been
slow to low 30s at times with 3 second pauses.  Stress rates of
110-120s.    Transferred to [**Hospital1 18**] for evaluation.

MEDICAL HISTORY: Coronary Artery Disease
Systolic heart failure
HTN
Atrial Flutter
Claudication
S/p nephrectomy for Left Renal Cell Carcinoma
Hypercholesterolemia
Gout

MEDICATION ON ADMISSION: Metoprolol 100mg po daily
Lipitor 10mg po daily
Lasix 80mg po daily (patient is unsure if he takes lasix at
home)
Aspirin 81mg po daily
Cozaar 50mg po daily
Cilostozal 100mg po bid
Doxasosin 4mg po daily
Allopurinol 100mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: BP 134/82  HR 109  RR 18  O2 95% 2L
GEN: NAD, AOx3
HEENT: JVP 10cm (but difficult to see)
CARD: tachycardia, regular rhythm, [**3-10**] early peaking systolic
cres decres murmur @ USB w/o radiation to the carotids
PULM: rales [**2-4**] way up on R, bronchial breath sounds [**2-4**] way up
on L side
ABD: Soft, NT, ND, no masses, BS+
EXT: WWP, 2+ pitting edema to thigh bilaterally symmetrical

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Tobacco denies - quit many years ago
Rare ETOH
Lives alone 

### Response:
{'Mitral valve disorders,Congenital insufficiency of aortic valve,Acute on chronic systolic heart failure,Atrial flutter,Disruption of external operation (surgical) wound,Coronary atherosclerosis of autologous vein bypass graft,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Acute respiratory failure,Cardiogenic shock,Unspecified septicemia,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Other candidiasis of other specified sites,Pure hypercholesterolemia,Infection with microorganisms without mention of resistance to multiple drugs,Atherosclerosis of aorta,Other iatrogenic hypotension,Chronic kidney disease, unspecified,Acquired absence of kidney,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease'}
