CHIEF COMPLAINT: Fatigue

PRESENT ILLNESS: 74 year old woman was diagnosed with aortic stenosis in [**2117**]
after being worked up for a progressive decline in her activity
tolerance due to fatigue. Echocardiogram in [**2117-10-1**]
revealed moderate to severe aortic stenosis and mild to moderate
aortic regurgitation. She was recently referred for stress
testing where she was noted to have a progressive drop in
systolic blood pressure with increasing workloads. She is now
being referred for right and left heart catheterization to
further evaluate. With regard to symptoms, she denies any chest
pain or shortness of breath at rest or with exertion.  She also
denies lightheadedness, dizziness or syncope. Until recently,
she was walking from a half a mile to a mile per day at a slow
pace but she feels that her general energy level has declined
significantly. She is now being referred to cardiac surgery for
aortic valve replacement.

MEDICAL HISTORY: Aortic Stenosis
Hyperlipidemia
Hx of shingles involving chest, neck and right shoulder
COPD
Depression
Osteoporosis
Arthritis
D&C's
Benign breast biopsies
Right shoulder pain, ? Rotator cuff sprain
Diverticulitis

MEDICATION ON ADMISSION: HYDROCODONE-ACETAMINOPHEN -  (Prescribed by Other Provider) - 5
mg-500 mg Tablet - 1 Tablet(s) by mouth twice a day prn. Do not
drive, operate machinery, or  drink alcohol while taking this
medication. As your pain  decreases, take fewer tablets and
increase the time between  doses. Take a stool softener to
prevent constipation.
PAROXETINE HCL - 20 mg Tablet - 1 (One) Tablet(s) by mouth once
a day
SIMVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth at bedtime

ALLERGIES: Amoxicillin

PHYSICAL EXAM: Pulse:70 Resp:16  O2 sat: 100/RA
B/P  Right:149/69   Left:142/64
Height:5'1"     Weight:135 lbs

FAMILY HISTORY: Sister with a stroke in her early 70's.  Father with "heart
trouble", died at age 74.  Mother died at age 70 with CHF,
Sister with "valve problems".

SOCIAL HISTORY: Lives with:son is currently living with her.
Occupation:retired
Tobacco:5-pack a day for approximately 50 years. She is
attempting to quit, currently smoking 3 cigarettes per day
ETOH:denies
Aortic valve disorders,Unspecified pleural effusion,Cardiac complications, not elsewhere classified,Atrial fibrillation,Anemia, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Arthropathy, unspecified, site unspecified,Osteoporosis, unspecified,Diverticulosis of colon (without mention of hemorrhage),Tobacco use disorder,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,Pleural effusion NOS,Surg compl-heart,Atrial fibrillation,Anemia NOS,Chr airway obstruct NEC,Hyperlipidemia NEC/NOS,Depressive disorder NEC,Arthropathy NOS-unspec,Osteoporosis NOS,Dvrtclo colon w/o hmrhg,Tobacco use disorder,Abn react-artif implant
Admission Date:  [**2118-2-8**]              Discharge Date:   [**2118-2-14**]

Date of Birth:  [**2043-1-24**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Amoxicillin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Fatigue

Major Surgical or Invasive Procedure:
[**2118-2-8**] Aortic Valve Replacement (21mm St. [**Male First Name (un) 923**] Epic Porcine)

History of Present Illness:
74 year old woman was diagnosed with aortic stenosis in [**2117**]
after being worked up for a progressive decline in her activity
tolerance due to fatigue. Echocardiogram in [**2117-10-1**]
revealed moderate to severe aortic stenosis and mild to moderate
aortic regurgitation. She was recently referred for stress
testing where she was noted to have a progressive drop in
systolic blood pressure with increasing workloads. She is now
being referred for right and left heart catheterization to
further evaluate. With regard to symptoms, she denies any chest
pain or shortness of breath at rest or with exertion.  She also
denies lightheadedness, dizziness or syncope. Until recently,
she was walking from a half a mile to a mile per day at a slow
pace but she feels that her general energy level has declined
significantly. She is now being referred to cardiac surgery for
aortic valve replacement.

Past Medical History:
Aortic Stenosis
Hyperlipidemia
Hx of shingles involving chest, neck and right shoulder
COPD
Depression
Osteoporosis
Arthritis
D&C's
Benign breast biopsies
Right shoulder pain, ? Rotator cuff sprain
Diverticulitis

Social History:
Lives with:son is currently living with her.
Occupation:retired
Tobacco:5-pack a day for approximately 50 years. She is
attempting to quit, currently smoking 3 cigarettes per day
ETOH:denies

Family History:
Sister with a stroke in her early 70's.  Father with "heart
trouble", died at age 74.  Mother died at age 70 with CHF,
Sister with "valve problems".

Physical Exam:
Pulse:70 Resp:16  O2 sat: 100/RA
B/P  Right:149/69   Left:142/64
Height:5'1"     Weight:135 lbs

General: NAD, WGWN, appears stated age, pleasant
Skin: Dry [x] intact [x] no rash
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur 3/6 SEM loudest at LSB
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]
Edema- none
Varicosities: None [x]
Neuro: Grossly intact  X
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right:    Left:
no bruit or radiation of murmur appreciated

Pertinent Results:
[**2118-2-8**] Echo: Prebypass: No atrial septal defect is seen by 2D or
color Doppler. Left ventricular wall thickness, cavity size and
regional/global systolic function are normal (LVEF >55%). The
estimated cardiac index is depressed (<2.0L/min/m2). Right
ventricular chamber size and free wall motion are normal. There
are focal calcifications in the aortic arch. 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.

Postbypass: The patient is AV-paced on a phenylephrine infusion.
There is a new prosthetic valve which is well seated in the
aortic position without evidence of regurgitation or
paravalvular leak. Peak/mean gradients are 18/10 mmHg with a
cardiac output of 3.22 L/min. Mitral regurgitation is now trace.
Tricuspid regurgitation has increased from trace to mild. Left
ventricular function continues to be normal. The thoracic aorta
is intact.
[**2118-2-14**] 06:25AM BLOOD WBC-11.0 RBC-4.30 Hgb-12.6 Hct-37.9
MCV-88 MCH-29.4 MCHC-33.3 RDW-15.0 Plt Ct-315
[**2118-2-8**] 12:45PM BLOOD WBC-7.4 RBC-2.76*# Hgb-8.3*# Hct-23.8*#
MCV-86 MCH-30.3 MCHC-35.1* RDW-13.3 Plt Ct-183
[**2118-2-14**] 06:25AM BLOOD Plt Ct-315
[**2118-2-12**] 06:13AM BLOOD PT-12.7 INR(PT)-1.1
[**2118-2-8**] 12:45PM BLOOD Plt Ct-183
[**2118-2-8**] 12:45PM BLOOD PT-13.7* PTT-27.6 INR(PT)-1.2*
[**2118-2-14**] 06:25AM BLOOD UreaN-21* Creat-0.7 Na-137 K-4.7 Cl-96
[**2118-2-8**] 02:39PM BLOOD UreaN-14 Creat-0.7 Na-143 K-3.3 Cl-109*
HCO3-23 AnGap-14
[**2118-2-14**] 06:25AM BLOOD Mg-2.0
[**2118-2-8**] 07:24PM BLOOD Mg-2.9*

Brief Hospital Course:
She was admited on [**2-8**] and was brought to the operating room
where she underwent an aortic valve replacement. Please see
operative report for surgical details. Later this day she was
weaned from sedation, awoke neurologically intact and extubated.
On post-op day one beta-blockers and diuretics were initiated
and she was gently diuresed towards her pre-op weight. Later on
post-op day one she was transferred to the step-down floor for
further care. She went into atrial fibrillation which was
treated with amiodarone and lopressor and she converted back to
sinus rhythm.  Chest tubes and epicardial pacing wires were
removed per protocol. She required very aggressive pulmonary
toilet due to her COPD history. She worked with physical therapy
for strength and mobility. Her pulmonary status slowly improved
and she was ready for discharged home on post-op day six with
appropriate medications and follow-up appointments.

Medications on Admission:
HYDROCODONE-ACETAMINOPHEN -  (Prescribed by Other Provider) - 5
mg-500 mg Tablet - 1 Tablet(s) by mouth twice a day prn. Do not
drive, operate machinery, or  drink alcohol while taking this
medication. As your pain  decreases, take fewer tablets and
increase the time between  doses. Take a stool softener to
prevent constipation.
PAROXETINE HCL - 20 mg Tablet - 1 (One) Tablet(s) by mouth once
a day
SIMVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth at bedtime

Medications - OTC
ASPIRIN [ENTERIC COATED ASPIRIN] -  (OTC) - 81 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth daily
CALCIUM CARBONATE-VITAMIN D3 [OS-CAL 500 + D] -  (OTC) - 500 mg
(1,250 mg)-500 unit Tablet - 1 Tablet(s) by mouth twice  a day
MULTIVITAMIN -  (Prescribed by Other Provider) - Dosage
uncertain

Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
4. paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every four
(4) hours as needed for pain. Tablet(s)
6. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): please take 400 mg twice a day until [**2-18**] then decrease
to 400 mg daily until [**2-26**] then decrease to 200 mg daily until
follow up with cardiologist .
Disp:*60 Tablet(s)* Refills:*0*
8. simvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day:
dose reduced due to amiodraone .
Disp:*30 Tablet(s)* Refills:*0*
9. metoprolol tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day): 75 mg three times a day .
Disp:*135 Tablet(s)* Refills:*0*
10. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours).
Disp:*qs qs* Refills:*0*
11. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) puffs Inhalation every four (4) hours as needed for
shortness of breath or wheezing.
Disp:*qs qs* Refills:*0*
12. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 10
days.
Disp:*10 Tablet(s)* Refills:*0*
13. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day for 10 days.
Disp:*10 Tablet, ER Particles/Crystals(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Aortic Stenosis s/p Aortic valve replacement
Post operative atrial fibrillation
Hyperlipidemia
Chronic obtructive pulmonary disease
Depression
Osteoporosis
Arthritis
Diverticulitis


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with tylenol
Incisions:
Sternal - healing well, no erythema or drainage
Edema trace lower extremities


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: Dr. [**Last Name (STitle) **] [**3-3**] at 1:15pm
Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**] on [**4-27**] at 3:00pm
Wound check appointment [**Hospital Ward Name 121**] 6 - Wednesday [**2-23**] at 11 am on [**Hospital Ward Name **]
6 [**Telephone/Fax (1) 3071**]

Please call to schedule appointments with your
Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**4-5**] weeks [**Telephone/Fax (1) 1144**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2118-2-14**]
{'Aortic valve disorders,Unspecified pleural effusion,Cardiac complications, not elsewhere classified,Atrial fibrillation,Anemia, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Arthropathy, unspecified, site unspecified,Osteoporosis, unspecified,Diverticulosis of colon (without mention of hemorrhage),Tobacco use disorder,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: Fatigue

PRESENT ILLNESS: 74 year old woman was diagnosed with aortic stenosis in [**2117**]
after being worked up for a progressive decline in her activity
tolerance due to fatigue. Echocardiogram in [**2117-10-1**]
revealed moderate to severe aortic stenosis and mild to moderate
aortic regurgitation. She was recently referred for stress
testing where she was noted to have a progressive drop in
systolic blood pressure with increasing workloads. She is now
being referred for right and left heart catheterization to
further evaluate. With regard to symptoms, she denies any chest
pain or shortness of breath at rest or with exertion.  She also
denies lightheadedness, dizziness or syncope. Until recently,
she was walking from a half a mile to a mile per day at a slow
pace but she feels that her general energy level has declined
significantly. She is now being referred to cardiac surgery for
aortic valve replacement.

MEDICAL HISTORY: Aortic Stenosis
Hyperlipidemia
Hx of shingles involving chest, neck and right shoulder
COPD
Depression
Osteoporosis
Arthritis
D&C's
Benign breast biopsies
Right shoulder pain, ? Rotator cuff sprain
Diverticulitis

MEDICATION ON ADMISSION: HYDROCODONE-ACETAMINOPHEN -  (Prescribed by Other Provider) - 5
mg-500 mg Tablet - 1 Tablet(s) by mouth twice a day prn. Do not
drive, operate machinery, or  drink alcohol while taking this
medication. As your pain  decreases, take fewer tablets and
increase the time between  doses. Take a stool softener to
prevent constipation.
PAROXETINE HCL - 20 mg Tablet - 1 (One) Tablet(s) by mouth once
a day
SIMVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth at bedtime

ALLERGIES: Amoxicillin

PHYSICAL EXAM: Pulse:70 Resp:16  O2 sat: 100/RA
B/P  Right:149/69   Left:142/64
Height:5'1"     Weight:135 lbs

FAMILY HISTORY: Sister with a stroke in her early 70's.  Father with "heart
trouble", died at age 74.  Mother died at age 70 with CHF,
Sister with "valve problems".

SOCIAL HISTORY: Lives with:son is currently living with her.
Occupation:retired
Tobacco:5-pack a day for approximately 50 years. She is
attempting to quit, currently smoking 3 cigarettes per day
ETOH:denies 

### Response:
{'Aortic valve disorders,Unspecified pleural effusion,Cardiac complications, not elsewhere classified,Atrial fibrillation,Anemia, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Arthropathy, unspecified, site unspecified,Osteoporosis, unspecified,Diverticulosis of colon (without mention of hemorrhage),Tobacco use disorder,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
