CHIEF COMPLAINT: Asymptomatic Aortic Stenosis

PRESENT ILLNESS: Mr. [**Known lastname 12320**] is an 84 year old male with known aortic stenosis.
On admission, he denied chest pain, shortness of breath,
orthopnea, PND, pedal edema and syncope. He is relatively
asymptomatic and performed routine ADLs without difficulty. He
was admitted for cardiac catheterization prior to aortic valve
replacement.

MEDICAL HISTORY: Chronic Systolic Congestive Heart Failure
Aortic Valve Stenosis, Coronary Artery Disease
Hypertension
Dyslipidemia
Chronic Renal Insufficiency
Atrial Fibrillation/Complete Heart Block - s/p PPM [**2151**]
History of Pulmonary Embolus
History of GI Bleed
Peripheral Vascular Disease
Diet-controlled Diabetes Mellitus
Gout
Depression
Peptic Ulcer Disease
Colon Polyps
Prostatism

MEDICATION ON ADMISSION: lisinopril 30'
propranolol LA 120'
alprazolam 0.25' qhs
aspirin 81'
lasix 10'
flomax 0.4'
lipitor 40'
probenecid 500
vitamin C 500'
beta carotene 25,000 IU'

ALLERGIES: Coumadin

PHYSICAL EXAM: Admission
VS  HR 80  BP 130/68  RR 14   Ht 5'7"  Wt 70.3K
Gen: NAD
HEENT: PERRL/EOMI. o/p MMM-full dentures
Chest: CTA-bilat
CV: RRR-paced. 3/6 SEM
Abdm: soft, NT/+BS
Ext: warm, well perfused, no pedal edema. No varicosities.
Neuro: Nonfocal exam

FAMILY HISTORY: No premature CAD.

SOCIAL HISTORY: Lives with wife and son. Denies any current cigarrette use,
smoked for 7-10 years in his youth. Occasional alcohol use.
Retired civil engineer.
Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Atrioventricular block, complete,Drug-induced delirium,Candidiasis of mouth,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Chronic kidney disease, unspecified,Cardiac pacemaker in situ,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Other specified analgesics and antipyretics causing adverse effects in therapeutic use,Gout, unspecified,Personal history of venous thrombosis and embolism
Crnry athrscl natve vssl,Chr systolic hrt failure,Atriovent block complete,Drug-induced delirium,Thrush,Aortic valve disorder,DMII wo cmp nt st uncntr,Atrial fibrillation,Chronic kidney dis NOS,Status cardiac pacemaker,Hy kid NOS w cr kid I-IV,Hyperlipidemia NEC/NOS,Adv eff analgesics NEC,Gout NOS,Hx-ven thrombosis/embols
Admission Date:  [**2165-9-26**]              Discharge Date:   [**2165-10-5**]


Service: CARDIOTHORACIC

Allergies:
Coumadin

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Asymptomatic Aortic Stenosis

Major Surgical or Invasive Procedure:
[**2165-9-27**] Cardiac Catheterization
[**2165-9-30**] Aortic Valve Replacement(21mm Porcine) and Two Vessel
Coronary Artery Bypass Grafting utilizing saphenous vein grafts
to LAD and Diagonal


History of Present Illness:
Mr. [**Known lastname 12320**] is an 84 year old male with known aortic stenosis.
On admission, he denied chest pain, shortness of breath,
orthopnea, PND, pedal edema and syncope. He is relatively
asymptomatic and performed routine ADLs without difficulty. He
was admitted for cardiac catheterization prior to aortic valve
replacement.

Past Medical History:
Chronic Systolic Congestive Heart Failure
Aortic Valve Stenosis, Coronary Artery Disease
Hypertension
Dyslipidemia
Chronic Renal Insufficiency
Atrial Fibrillation/Complete Heart Block - s/p PPM [**2151**]
History of Pulmonary Embolus
History of GI Bleed
Peripheral Vascular Disease
Diet-controlled Diabetes Mellitus
Gout
Depression
Peptic Ulcer Disease
Colon Polyps
Prostatism


Social History:
Lives with wife and son. Denies any current cigarrette use,
smoked for 7-10 years in his youth. Occasional alcohol use.
Retired civil engineer.


Family History:
No premature CAD.

Physical Exam:
Admission
VS  HR 80  BP 130/68  RR 14   Ht 5'7"  Wt 70.3K
Gen: NAD
HEENT: PERRL/EOMI. o/p MMM-full dentures
Chest: CTA-bilat
CV: RRR-paced. 3/6 SEM
Abdm: soft, NT/+BS
Ext: warm, well perfused, no pedal edema. No varicosities.
Neuro: Nonfocal exam

Discharge
VS T99.8  HR 70 VPaced BP 131/80  RR 20 O2sat 98%-2lnp
Gen NAD
Neuro A&Ox3, nonfocal exam
Pulm CTA-bilat
CV RRR, no murmur. Sternum stable, incision CDI
Abdm soft, NT/+BS
Ext warm 1+ pedal edema bilat. L leg EVH site CDI
Oral +thrush

Pertinent Results:
[**2165-9-26**] 07:15PM BLOOD WBC-8.0 RBC-4.29* Hgb-13.6* Hct-38.9*
MCV-91 MCH-31.7 MCHC-35.0 RDW-14.2 Plt Ct-256
[**2165-9-26**] 07:15PM BLOOD PT-13.5* PTT-21.9* INR(PT)-1.2*
[**2165-9-26**] 07:15PM BLOOD Glucose-186* UreaN-49* Creat-2.6* Na-134
K-5.1 Cl-98 HCO3-27 AnGap-14
[**2165-9-26**] 07:15PM BLOOD ALT-16 AST-15 LD(LDH)-200 AlkPhos-76
Amylase-60 TotBili-0.4
[**2165-9-26**] 07:15PM BLOOD Albumin-4.3
[**2165-9-26**] 07:15PM BLOOD %HbA1c-6.8*

[**2165-10-3**] 06:02AM BLOOD WBC-6.3 RBC-3.89* Hgb-12.4* Hct-34.6*
MCV-89 MCH-31.8 MCHC-35.8* RDW-14.3 Plt Ct-136*
[**2165-10-3**] 06:02AM BLOOD Glucose-124* UreaN-48* Creat-2.5* Na-134
K-4.2 Cl-100 HCO3-25 AnGap-13
[**2165-10-3**] 06:02AM BLOOD Mg-2.5

[**2165-9-27**] Cardiac Cath:
1.  Selective coronary angiography demonstrated single vessel
coronary artery disease. The LMCA had no angiographically
apparent coronary artery disease. The LAD had a 60% mid stenosis
and a 70% ostial lesion in the first diagonal artery. The LCX
had no obstructive disease. The RCA had 30% ostial narrowing
with no catheter damping.
2.  Left ventriculography revealed stroke volume index of 44
mL/m2 and an EF of 82% with normal regional wall motion. There
was aortic valve calcification and no significant mitral
regurgitation noted.
[**2165-9-27**] Carotid Ultrasound:
Bilateral less than 40% carotid stenosis.
[**2165-9-30**] Intraop TEE:
PRE-BYPASS:
1. The left atrium is moderately dilated.
2. Mild spontaneous echo contrast is present in the left atrial
appendage. The left atrial appendage emptying velocity is
depressed (<0.2m/s). No thrombus is seen in the left atrial
appendage.
3. A patent foramen ovale is present. A left-to-right shunt
across the interatrial septum is seen at rest.
4. There is severe symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. There is moderate
regional left ventricular systolic dysfunction with inferior and
infero-septal hypokinesis. Overall left ventricular systolic
function is mildly depressed (LVEF= 40 %).
5. Right ventricular chamber size and free wall motion are
normal.
6. The ascending aorta is moderately dilated. There are simple
atheroma in the ascending aorta. There are simple atheroma in
the descending thoracic aorta.
7. 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 ([**12-12**]+) aortic
regurgitation is seen.
8. The mitral valve leaflets are mildly thickened. Moderate (2+)
mitral regurgitation is seen.
9. There is no pericardial effusion.
Dr.[**Last Name (STitle) **] was notified in person of the result.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine and is
being AV paced.
1. A well-seated bioprosthetic valve is seen in the aortic
position with normal leaflet motion and gradients (mean gradient
= 13 mmHg). A trivial perivalvular leak is seen. .
2. The aorta is intact.
3. Left ventricular function is mildly improved.
4. MR is improved to Mild to moderate.
5. The remainder of the study is unchanged.

[**Known lastname **],[**Known firstname **] SR. [**Medical Record Number 12321**] M  84  [**2081-6-5**]
Radiology Report CHEST (PA & LAT) Study Date of [**2165-10-3**] 5:25 PM

[**Last Name (LF) **],[**First Name7 (NamePattern1) 1112**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2165-10-3**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 12322**]
Reason: eval for pleural effusions
 [**Hospital 93**] MEDICAL CONDITION:
   84 year old man s/p AVR/CABG
Wet Read: [**First Name9 (NamePattern2) 12323**] [**Doctor First Name **] [**2165-10-3**] 6:27 PM
Small right effusion. Retrocardiac atelectesis versus
infiltrate.

Preliminary Report !! WET READ !!
Small right effusion. Retrocardiac atelectesis versus
infiltrate.

DR. [**First Name8 (NamePattern2) 4078**] [**Name (STitle) 4079**]
DR. [**First Name (STitle) 3901**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3902**]
DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**]

[**Known lastname **],[**Known firstname **] SR. [**Medical Record Number 12321**] M  84  [**2081-6-5**]
Radiology Report CAROTID SERIES COMPLETE Study Date of [**2165-9-27**]
9:46 AM
[**Last Name (LF) **],[**First Name7 (NamePattern1) 1112**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]   [**2165-9-27**] SCHED
CAROTID SERIES COMPLETE   Clip # [**Clip Number (Radiology) 12324**]
Reason: preop aur
Final Report
STUDY: Carotid series complete.
REASON: Preop AVR.
FINDINGS: Duplex evaluation was performed of bilateral carotid
arteries.
There is heterogeneous plaque in the proximal ICA and distal CCA
bilaterally.
On the right peak velocities are 54, 71 and 65 cm/sec in the
ICA, CCA and ECA respectively. This is consistent with less than
40% stenosis.
On the left peak velocities are 49, 72 and 65 cm/sec in the ICA,
CCA and ECA respectively. This is consistent with less than 40%
stenosis.
There is antegrade vertebral flow bilaterally.

IMPRESSION: Bilateral less than 40% carotid stenosis.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Approved: MON [**2165-9-30**] 6:43 AM



Brief Hospital Course:
The patient is an 84 year old male with a history of aortic
stenosis, who was admitted for cardiac catheterization on
[**2165-9-27**].  Due to his history of renal insufficiency, he was
admitted one day early for pre-procedure hydration.  On
catheterization, he was found to have one vessel disease, with
60-70% lesions in the left anterior descending coronary artery.
The patient was further monitored and hydrated for his renal
function.  He was brought to the operating theater on
[**2165-9-30**], where he underwent aortic valve replacement with
21mm porcine tissue valve, and coronary artery bypass grafting x
2 with saphenous vein grafts to the left anterior descending and
diagonal coronary arteries. Please see operative note for
further details.  The patient received vancomycin
peri-operatively because his preoperative inpatient hospital
stay exceeded 24 hours. Overall the patient tolerated the
procedure well, and post-operatively was transferred to the
CVICU for invasive monitoring and further recovery.
By POD 1 the patient was extubated and breathing comfortably on
no inotropic or vasopressor support.  He was slightly confused,
therefore narcotics were held.  Confusion did clear.  The
patient was transferred to the step down unit where he worked
with physical therapy for improved strength and mobility.  Chest
tubes and pacing wires were discontinued  without complication.
The patient was gently diuresed toward his preoperative weight.
On [**10-3**] a sputum culture was positive for gram negative rods
and he was started on Cipro 500mg po daily for 14 days. The
remainder of his post-operative course was uneventful. He was
discharged to rehabilitation on POD 5.

Medications on Admission:
lisinopril 30'
propranolol LA 120'
alprazolam 0.25' qhs
aspirin 81'
lasix 10'
flomax 0.4'
lipitor 40'
probenecid 500
vitamin C 500'
beta carotene 25,000 IU'

Discharge Disposition:
Extended Care

Facility:
[**Hospital **] - [**Location (un) **]

Discharge Diagnosis:
Chronic Systolic Congestive Heart Failure
Aortic Valve Stenosis, Coronary Artery Disease - s/p AVR/CABG
Hypertension
Dyslipidemia
Chronic Renal Insufficiency
Atrial Fibrillation/Complete Heart Block - s/p PPM [**2151**]
History of Pulmonary Embolus
History of GI Bleed
Peripheral Vascular Disease
Diet-controlled Diabetes Mellitus


Discharge Condition:
Good

Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain. In the event that you have drainage
from your sternal wound, please contact the [**Name2 (NI) 5059**] at ([**Telephone/Fax (1) 4044**].
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
4) No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry. Please shower daily. No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for at least one month.
7) Call with any questions or concerns.
8) Take all medications as prescribed.

Followup Instructions:
Dr. [**Last Name (STitle) **] in [**3-16**] weeks, call for appt
Dr. [**Last Name (STitle) **] in [**1-13**] weeks, call for appt
Dr. [**Last Name (STitle) **] in [**1-13**] weeks, call for appt



Completed by:[**2165-10-5**]
{'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Atrioventricular block, complete,Drug-induced delirium,Candidiasis of mouth,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Chronic kidney disease, unspecified,Cardiac pacemaker in situ,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Other specified analgesics and antipyretics causing adverse effects in therapeutic use,Gout, unspecified,Personal history of venous thrombosis and embolism'}


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: Asymptomatic Aortic Stenosis

PRESENT ILLNESS: Mr. [**Known lastname 12320**] is an 84 year old male with known aortic stenosis.
On admission, he denied chest pain, shortness of breath,
orthopnea, PND, pedal edema and syncope. He is relatively
asymptomatic and performed routine ADLs without difficulty. He
was admitted for cardiac catheterization prior to aortic valve
replacement.

MEDICAL HISTORY: Chronic Systolic Congestive Heart Failure
Aortic Valve Stenosis, Coronary Artery Disease
Hypertension
Dyslipidemia
Chronic Renal Insufficiency
Atrial Fibrillation/Complete Heart Block - s/p PPM [**2151**]
History of Pulmonary Embolus
History of GI Bleed
Peripheral Vascular Disease
Diet-controlled Diabetes Mellitus
Gout
Depression
Peptic Ulcer Disease
Colon Polyps
Prostatism

MEDICATION ON ADMISSION: lisinopril 30'
propranolol LA 120'
alprazolam 0.25' qhs
aspirin 81'
lasix 10'
flomax 0.4'
lipitor 40'
probenecid 500
vitamin C 500'
beta carotene 25,000 IU'

ALLERGIES: Coumadin

PHYSICAL EXAM: Admission
VS  HR 80  BP 130/68  RR 14   Ht 5'7"  Wt 70.3K
Gen: NAD
HEENT: PERRL/EOMI. o/p MMM-full dentures
Chest: CTA-bilat
CV: RRR-paced. 3/6 SEM
Abdm: soft, NT/+BS
Ext: warm, well perfused, no pedal edema. No varicosities.
Neuro: Nonfocal exam

FAMILY HISTORY: No premature CAD.

SOCIAL HISTORY: Lives with wife and son. Denies any current cigarrette use,
smoked for 7-10 years in his youth. Occasional alcohol use.
Retired civil engineer. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Atrioventricular block, complete,Drug-induced delirium,Candidiasis of mouth,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Chronic kidney disease, unspecified,Cardiac pacemaker in situ,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Other specified analgesics and antipyretics causing adverse effects in therapeutic use,Gout, unspecified,Personal history of venous thrombosis and embolism'}
