CHIEF COMPLAINT: Increasing fatigue

PRESENT ILLNESS: Ms. [**Known lastname 3175**] is a 77 year old female who recently [**Known lastname 1834**] a
cardiac catheterization and echocardiogram secondary to
increasing fatigue.  These studies revealed severe aortic
stenosis and two vessel coronary artery disease.  Therefore she
was referred to [**Hospital1 69**] for
surgical evaluation.

MEDICAL HISTORY: MI in [**2108**]
CAD
Hypertension
Diabetes
hypothyroidism
positive PPD 1 month ago (35 mm), seen by chest clinic at
[**Location (un) 1157**] and on rifampin
COPD
lung cancer [**2111**]
s/p AAA repair 99 by Dr. [**Last Name (STitle) 1391**]
bilateral fem bypass
right lobectomy [**2111**]
bilateral cataract surgery
right hipprosthesis [**2111**]

MEDICATION ON ADMISSION: toprol XL 75 in the am and 25, lipitor 40, folic acid 800,
glucotrol 10, glucophage, levoxyl 75, lasix 30", advair 500/50",
spiriva 10, aspirin 325, flonase

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon physical exam today, Ms. [**Known lastname 3175**] is awake, alert, and
oriented times three.  Auscultation of her chest reveals
scattered rhonchi and a heart of regular rate and rhythm.  No
sternal incision drainage or erythema is noted.  Staples are
intact along the mediastinal incision.  Her abdomen is soft,
non-tender, and non-distended.  Her extremities are warm with 2+
edema.  her left lower extremity endovascular site is exhibits a
small amount of serous drainage.  Her PICC line was intact.

FAMILY HISTORY: no family h/o cancer. Mother had "heart problems"in 80's. Father
had a stroke.

SOCIAL HISTORY: Patient currently lives alone in elderly apartments. 50 pack
year history of smoking, quit [**2111**] after lung cancer diagnosed.
Rare alcohol use. She has been widowed since [**2098**]. Her pet dog
who she's had for 18 years died today.
Congestive heart failure, unspecified,Iatrogenic pneumothorax,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Other diseases of mediastinum, not elsewhere classified,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of irradiation, presenting hazards to health,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of bronchus and lung,Hip joint replacement,Peripheral vascular disease, unspecified
CHF NOS,Iatrogenic pneumothorax,Aortic valve disorder,Chr airway obstruct NEC,Thrombocytopenia NOS,Pleural effusion NOS,Crnry athrscl natve vssl,Mediastinum disease NEC,Atrial fibrillation,Iatrogenc hypotnsion NEC,DMII wo cmp nt st uncntr,Hx of irradiation,Hypertension NOS,Hypothyroidism NOS,Hx-bronchogenic malignan,Joint replaced hip,Periph vascular dis NOS
Admission Date:  [**2124-12-5**]              Discharge Date:   [**2124-12-22**]

Date of Birth:  [**2046-12-21**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Increasing fatigue

Major Surgical or Invasive Procedure:
[**2124-12-8**] Coronary Artery Bypass Graft x one (SVG to OM) and
Aortic valve replacement with a [**Company 1543**] Mosaic tissue valve


History of Present Illness:
Ms. [**Known lastname 3175**] is a 77 year old female who recently [**Known lastname 1834**] a
cardiac catheterization and echocardiogram secondary to
increasing fatigue.  These studies revealed severe aortic
stenosis and two vessel coronary artery disease.  Therefore she
was referred to [**Hospital1 69**] for
surgical evaluation.

Past Medical History:
MI in [**2108**]
CAD
Hypertension
Diabetes
hypothyroidism
positive PPD 1 month ago (35 mm), seen by chest clinic at
[**Location (un) 1157**] and on rifampin
COPD
lung cancer [**2111**]
s/p AAA repair 99 by Dr. [**Last Name (STitle) 1391**]
bilateral fem bypass
right lobectomy [**2111**]
bilateral cataract surgery
right hipprosthesis [**2111**]


Social History:
Patient currently lives alone in elderly apartments. 50 pack
year history of smoking, quit [**2111**] after lung cancer diagnosed.
Rare alcohol use. She has been widowed since [**2098**]. Her pet dog
who she's had for 18 years died today.

Family History:
no family h/o cancer. Mother had "heart problems"in 80's. Father
had a stroke.

Physical Exam:
Upon physical exam today, Ms. [**Known lastname 3175**] is awake, alert, and
oriented times three.  Auscultation of her chest reveals
scattered rhonchi and a heart of regular rate and rhythm.  No
sternal incision drainage or erythema is noted.  Staples are
intact along the mediastinal incision.  Her abdomen is soft,
non-tender, and non-distended.  Her extremities are warm with 2+
edema.  her left lower extremity endovascular site is exhibits a
small amount of serous drainage.  Her PICC line was intact.

Pertinent Results:
[**2124-12-22**] 07:10AM BLOOD Hct-29.7*
[**2124-12-22**] 07:10AM BLOOD PT-19.2* INR(PT)-1.8*
[**2124-12-22**] 07:10AM BLOOD Glucose-122* UreaN-42* Creat-0.9 Na-135
K-5.4* Cl-96 HCO3-30 AnGap-14
[**2124-12-14**] 04:49AM BLOOD Glucose-57* K-4.0

Brief Hospital Course:
Ms. [**Known lastname 3175**] [**Last Name (Titles) 1834**] a coronary artery bypass graft times one
(SVG to OM) and aortic valve replacement with a 19 mm [**Company 1543**]
Mosaic tissue valve. The patient tolerated this procedure well
and was transferred in stable condition to the surgical
intensive care unit.

In the surgical intensive care unit she was seen in consultation
by the cardiology service for atrial fibrillation and
hypotension.  She was slowly weaned from her pressors as
tolerated.  Her chest tubes and wires were removed.  Her
coumadin was restarted secondary to her atrial fibrillation.  By
post operative day 7 she was ready for transfer to the step down
floor.

On the step down floor Ms. [**Known lastname 3175**] was diuresed and encouraged to
ambulate.  She was seen in consultation by physical therapy.
Her rhythm converted to sinus spontaneously.  By post-operative
day 14 she was ready for discharge to a rehabilitation facility.

Medications on Admission:
toprol XL 75 in the am and 25, lipitor 40, folic acid 800,
glucotrol 10, glucophage, levoxyl 75, lasix 30", advair 500/50",
spiriva 10, aspirin 325, flonase

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. 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*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
6. Glipizide 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
7. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
8. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*0*
9. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
10. Guaifenesin 600 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO bid ().
Disp:*60 Tablet Sustained Release(s)* Refills:*0*
11. Levalbuterol HCl 0.63 mg/3 mL Solution Sig: 1-2 MLs
Inhalation Q6hr ().
Disp:*30 ML(s)* Refills:*0*
12. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
13. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*
14. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO BID (2 times a day).
Disp:*120 Capsule, Sustained Release(s)* Refills:*0*
15. Warfarin 1 mg Tablet Sig: 0.5 Tablet PO ONCE (Once): please
titrate dose for goal INR of [**1-5**].5.
Disp:*30 Tablet(s)* Refills:*0*
16. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
[**12-5**] Disk with Devices Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 Disk with Device(s)* Refills:*0*
17. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
[**12-5**] Caps Inhalation DAILY (Daily).
Disp:*60 Cap(s)* Refills:*0*
18. Fluticasone 50 mcg/Actuation Aerosol, Spray Sig: One (1)
Spray Nasal DAILY (Daily).
Disp:*30 * Refills:*0*
19. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 25759**] & Rehab Center - [**Location (un) **]

Discharge Diagnosis:
increasing fatigue


Discharge Condition:
good


Discharge Instructions:
Continue coumadin for paroxysmal atrial fibrillation with a goal
INR of [**1-5**].5.
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs. for 2 months.
Shower daily, let water flow over wounds, pat dry with a towel.
Do not use creams, lotions, or powders on wounds.
Call our office for temp>101.5, sternal drainage.

Followup Instructions:
Please see your PCP [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 26674**] in [**12-5**]
weeks.
Please see your cardiologist [**Last Name (un) **] [**Doctor Last Name 1911**] in [**12-5**] weeks.
Please see your surgeon [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 26675**] in [**3-9**] weeks.



Completed by:[**2124-12-22**]
{'Congestive heart failure, unspecified,Iatrogenic pneumothorax,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Other diseases of mediastinum, not elsewhere classified,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of irradiation, presenting hazards to health,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of bronchus and lung,Hip joint replacement,Peripheral vascular disease, 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: Increasing fatigue

PRESENT ILLNESS: Ms. [**Known lastname 3175**] is a 77 year old female who recently [**Known lastname 1834**] a
cardiac catheterization and echocardiogram secondary to
increasing fatigue.  These studies revealed severe aortic
stenosis and two vessel coronary artery disease.  Therefore she
was referred to [**Hospital1 69**] for
surgical evaluation.

MEDICAL HISTORY: MI in [**2108**]
CAD
Hypertension
Diabetes
hypothyroidism
positive PPD 1 month ago (35 mm), seen by chest clinic at
[**Location (un) 1157**] and on rifampin
COPD
lung cancer [**2111**]
s/p AAA repair 99 by Dr. [**Last Name (STitle) 1391**]
bilateral fem bypass
right lobectomy [**2111**]
bilateral cataract surgery
right hipprosthesis [**2111**]

MEDICATION ON ADMISSION: toprol XL 75 in the am and 25, lipitor 40, folic acid 800,
glucotrol 10, glucophage, levoxyl 75, lasix 30", advair 500/50",
spiriva 10, aspirin 325, flonase

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon physical exam today, Ms. [**Known lastname 3175**] is awake, alert, and
oriented times three.  Auscultation of her chest reveals
scattered rhonchi and a heart of regular rate and rhythm.  No
sternal incision drainage or erythema is noted.  Staples are
intact along the mediastinal incision.  Her abdomen is soft,
non-tender, and non-distended.  Her extremities are warm with 2+
edema.  her left lower extremity endovascular site is exhibits a
small amount of serous drainage.  Her PICC line was intact.

FAMILY HISTORY: no family h/o cancer. Mother had "heart problems"in 80's. Father
had a stroke.

SOCIAL HISTORY: Patient currently lives alone in elderly apartments. 50 pack
year history of smoking, quit [**2111**] after lung cancer diagnosed.
Rare alcohol use. She has been widowed since [**2098**]. Her pet dog
who she's had for 18 years died today. 

### Response:
{'Congestive heart failure, unspecified,Iatrogenic pneumothorax,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Other diseases of mediastinum, not elsewhere classified,Atrial fibrillation,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of irradiation, presenting hazards to health,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of bronchus and lung,Hip joint replacement,Peripheral vascular disease, unspecified'}
