CHIEF COMPLAINT: Shortness of Breath

PRESENT ILLNESS: 81 y/o female s/p Coronary Artery Bypass Graft x 3 [**2190**] who
presented with shortness of [**Last Name (un) **] and new onset congestive heart
failure. Echo and Cath revealed severe Aortic Stenosis with [**First Name8 (NamePattern2) **]
[**Location (un) 109**] of 0.7cm2, 2+ MR, and occluded SVG to RCA graft. She now
presents for Redo-Sternotomy, Aortic Valve Replacement.

MEDICAL HISTORY: Coronary Artery Disease (prior Myocardial Infarction) s/p
Coronary Artery Bypass Graft x 3 in [**2190**]
Hypertension
Hypercholesterolemia
h/o Pulmonary Embolism
s/p Right Total Knee Replacement in [**2190**]
s/p Cholecystectomy

MEDICATION ON ADMISSION: 1. Lasix 20mg qd
2. Lisinopril 10mg qd
3. Lopressor 50mg [**Hospital1 **]
4. Aspirin 81mg qd
5. Protonix 40mg qd
6. Zocor 40mg qd
7. Norvasc 1.25mg qd
8. Colace 100mg [**Hospital1 **]
9. KCl
10. MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 60 144/69 67" 210#
General: Elderly female in NAD, Age appropriate
Skin: W/D, -lesions w/ well-healed sternotomy incision
HEENT: EOMI, PERRL, NC/AT, OP Benign
Neck: Supple, -JVD, -lymphadenopathy, murmur vs. carotid bruit
Chest: CTAB -w/r/r
Heart: RRR +S1S2, 4/6 SEM
Abdomen: Soft NT/ND +BS
Ext: Warm, well-perfused 2+ edmea, L GSV used in 03. R GSV
suitable.
Neuro: A&O x 3, MAE, Non-focal

FAMILY HISTORY: Father with CAD hx

SOCIAL HISTORY: Remote Tobacco use > 30yrs ago
Denies ETOH
Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of autologous vein bypass graft,Unspecified essential hypertension,Pure hypercholesterolemia,Knee joint replacement,Personal history of venous thrombosis and embolism,Old myocardial infarction
Rheumatic heart failure,Mitral insuf/aort stenos,Crn ath atlg vn bps grft,Hypertension NOS,Pure hypercholesterolem,Joint replaced knee,Hx-ven thrombosis/embols,Old myocardial infarct
Admission Date:  [**2193-3-26**]              Discharge Date:   [**2193-4-4**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Shortness of Breath

Major Surgical or Invasive Procedure:
Redo-Sternotomy, Aortic Valve Replacement (21mm CE tissue valve)
on [**2193-3-26**]

History of Present Illness:
81 y/o female s/p Coronary Artery Bypass Graft x 3 [**2190**] who
presented with shortness of [**Last Name (un) **] and new onset congestive heart
failure. Echo and Cath revealed severe Aortic Stenosis with [**First Name8 (NamePattern2) **]
[**Location (un) 109**] of 0.7cm2, 2+ MR, and occluded SVG to RCA graft. She now
presents for Redo-Sternotomy, Aortic Valve Replacement.

Past Medical History:
Coronary Artery Disease (prior Myocardial Infarction) s/p
Coronary Artery Bypass Graft x 3 in [**2190**]
Hypertension
Hypercholesterolemia
h/o Pulmonary Embolism
s/p Right Total Knee Replacement in [**2190**]
s/p Cholecystectomy

Social History:
Remote Tobacco use > 30yrs ago
Denies ETOH

Family History:
Father with CAD hx

Physical Exam:
VS: 60 144/69 67" 210#
General: Elderly female in NAD, Age appropriate
Skin: W/D, -lesions w/ well-healed sternotomy incision
HEENT: EOMI, PERRL, NC/AT, OP Benign
Neck: Supple, -JVD, -lymphadenopathy, murmur vs. carotid bruit
Chest: CTAB -w/r/r
Heart: RRR +S1S2, 4/6 SEM
Abdomen: Soft NT/ND +BS
Ext: Warm, well-perfused 2+ edmea, L GSV used in 03. R GSV
suitable.
Neuro: A&O x 3, MAE, Non-focal

Pertinent Results:
Echo [**3-26**]: Pre-CPB: Overall left ventricular systolic function
is normal (LVEF>55%). The aortic valve leaflets are severely
thickened/deformed. There is severe aortic valve stenosis. Mild
to moderate ([**1-28**]+) aortic regurgitation is seen. Mild to
moderate ([**1-28**]+) mitral regurgitation is seen. There is mild to
moderate tricuspid regurgitation. Post-CPB: Aortic bioprosthesis
is very poorly seen - no obvious issues with valve seating or
leaflet function in limited views. No AI is seen. Maximum
gradient
is approximately 35 mm Hg but effective valve area is around 1.8
cm2.

[**2193-3-26**] 12:51PM BLOOD WBC-14.0*# RBC-2.78*# Hgb-8.2*#
Hct-23.3*# MCV-84 MCH-29.5 MCHC-35.2* RDW-13.9 Plt Ct-118*
[**2193-3-26**] 02:30PM BLOOD WBC-16.6* RBC-3.68*# Hgb-11.2*#
Hct-30.6*# MCV-83 MCH-30.5 MCHC-36.7* RDW-14.1 Plt Ct-126*
[**2193-4-2**] 04:59AM BLOOD Hct-27.4*
[**2193-3-28**] 04:05AM BLOOD PT-13.1 PTT-22.3 INR(PT)-1.1
[**2193-3-27**] 03:01AM BLOOD Glucose-119* UreaN-24* Creat-1.3* Na-141
K-5.5* Cl-113* HCO3-23 AnGap-11
[**2193-4-2**] 04:59AM BLOOD UreaN-27* Creat-1.3* Na-142 K-4.1
[**2193-4-2**] 04:59AM BLOOD Mg-2.1
[**2193-3-27**] 12:31PM BLOOD freeCa-1.18

Brief Hospital Course:
Ms. [**Known lastname **] was initially seen in clinic and had pre-operative
work-up prior to day of surgery. On admission day, [**2193-3-26**], she
was brought directly to the operating room where she underwent a
Redo-Sternotomy and Aortic Valve Replacement. Please see op note
for surgical details. Following surgery she was transferred to
the CSRU in stable condition. Patient remained intubated until
early post-op day one. She was weaned from sedation and awoke
neurologically intact and extubated. On this day patient had
several episodes of atrial fibrillation and was started on
Amiodarone. She remained on this throughout her hospital course
and was discharged with in sinus rhythm. Chest tubes were
removed post-op day two. She remained on Neo-Synephrine for
hemodynamic support until post-op day three. Ms. [**Known lastname **] was
transfused 1 unit of PRBC's on post-op day three and was
transferred to the cardiac surgery step-down unit. Both B
blockers and diuretics were initiated and she was gently
diuresed during her post-op period toward her pre-operative
weight. Epicardial pacing wires were removed. Physical therapy
followed patient during her post-op period for strength and
mobility. She continued to make a steady recovery, but was
unable to pass level five. She was discharged in stable
condition to rehab facility for further physical therapy and
will follow-up with the appropriate physicians.

Medications on Admission:
1. Lasix 20mg qd
2. Lisinopril 10mg qd
3. Lopressor 50mg [**Hospital1 **]
4. Aspirin 81mg qd
5. Protonix 40mg qd
6. Zocor 40mg qd
7. Norvasc 1.25mg qd
8. Colace 100mg [**Hospital1 **]
9. KCl
10. MVI

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days.
8. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO twice a day for 10 days.
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day): Take 1, 200mg twice a day for 1 week. Then, 200mg once a
day until stopped by cardiologist.

Discharge Disposition:
Extended Care

Facility:
[**Doctor Last Name **] [**Doctor Last Name **] hospital

Discharge Diagnosis:
Aortic Stenosis s/p Aortic Valve Replacement
Coronary Artery Disease (prior Myocardial Infarction) s/p
Coronary Artery Bypass Graft x 3 in [**2190**]
Hypertension
Hypercholesterolemia

Discharge Condition:
Good

Discharge Instructions:
Can take shower. Wash incisions with warm water and gentle soap.
Gently pat dry. Do not take bath. Do not apply lotions, creams,
ointments or powders to incisions.
Do not drive for 1 month.
Do not lift greater than 10 pounds for 2 months.
If you develop a fever more than 101.5 or notice sternal/chest
drainage, please contact the office immediately.
Make follow-up appointments and take prescribed medications.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) 1603**] in [**1-28**] weeks
Dr. [**Last Name (STitle) 3659**] in [**3-1**] weeks


Completed by:[**2193-4-4**]
{'Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of autologous vein bypass graft,Unspecified essential hypertension,Pure hypercholesterolemia,Knee joint replacement,Personal history of venous thrombosis and embolism,Old myocardial infarction'}


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: Shortness of Breath

PRESENT ILLNESS: 81 y/o female s/p Coronary Artery Bypass Graft x 3 [**2190**] who
presented with shortness of [**Last Name (un) **] and new onset congestive heart
failure. Echo and Cath revealed severe Aortic Stenosis with [**First Name8 (NamePattern2) **]
[**Location (un) 109**] of 0.7cm2, 2+ MR, and occluded SVG to RCA graft. She now
presents for Redo-Sternotomy, Aortic Valve Replacement.

MEDICAL HISTORY: Coronary Artery Disease (prior Myocardial Infarction) s/p
Coronary Artery Bypass Graft x 3 in [**2190**]
Hypertension
Hypercholesterolemia
h/o Pulmonary Embolism
s/p Right Total Knee Replacement in [**2190**]
s/p Cholecystectomy

MEDICATION ON ADMISSION: 1. Lasix 20mg qd
2. Lisinopril 10mg qd
3. Lopressor 50mg [**Hospital1 **]
4. Aspirin 81mg qd
5. Protonix 40mg qd
6. Zocor 40mg qd
7. Norvasc 1.25mg qd
8. Colace 100mg [**Hospital1 **]
9. KCl
10. MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 60 144/69 67" 210#
General: Elderly female in NAD, Age appropriate
Skin: W/D, -lesions w/ well-healed sternotomy incision
HEENT: EOMI, PERRL, NC/AT, OP Benign
Neck: Supple, -JVD, -lymphadenopathy, murmur vs. carotid bruit
Chest: CTAB -w/r/r
Heart: RRR +S1S2, 4/6 SEM
Abdomen: Soft NT/ND +BS
Ext: Warm, well-perfused 2+ edmea, L GSV used in 03. R GSV
suitable.
Neuro: A&O x 3, MAE, Non-focal

FAMILY HISTORY: Father with CAD hx

SOCIAL HISTORY: Remote Tobacco use > 30yrs ago
Denies ETOH 

### Response:
{'Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of autologous vein bypass graft,Unspecified essential hypertension,Pure hypercholesterolemia,Knee joint replacement,Personal history of venous thrombosis and embolism,Old myocardial infarction'}
