CHIEF COMPLAINT: DOE/SOB

PRESENT ILLNESS: 63 yo M with progressive DOE who presented to the ED the week
before [**Holiday **]. He was admitted and treated for CHF. Cardiac
cath at the timeshowed severe 3VD and moderate AS. He was
referred for surgery.

MEDICAL HISTORY: HTN, ^chol, MI, Diverticulosis, Gout, hernia, ETOH

MEDICATION ON ADMISSION: crestor, toprol, quinapril, ECASA 325, colace, NTG sl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 78 RR 14 BP 100/58
NAD
Lungs CTAB
Heart RRR 1-2/6 SEM
Abdomen soft/NT/ND
Extrem warm, no edema
Neuro nonfocal

FAMILY HISTORY: father with MI in 50s

SOCIAL HISTORY: retired currently
stopped smoking last month - 50 years of [**11-19**].5 ppd
4-5 beers/day
Aortic valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Sebaceous cyst,Old myocardial infarction,Personal history of tobacco use,Personal history of other diseases of digestive system
Aortic valve disorder,Ac on chr syst hrt fail,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Sebaceous cyst,Old myocardial infarct,History of tobacco use,Prsnl hst ot spf dgst ds
Admission Date:  [**2165-12-5**]              Discharge Date:   [**2165-12-10**]

Date of Birth:  [**2102-6-18**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
DOE/SOB

Major Surgical or Invasive Procedure:
s/p AVR(23 CE Magna tissue)/CABGx3(LIMA->LAD, SVG->[**Last Name (LF) **], [**First Name3 (LF) **])
[**12-5**]


History of Present Illness:
63 yo M with progressive DOE who presented to the ED the week
before [**Holiday **]. He was admitted and treated for CHF. Cardiac
cath at the timeshowed severe 3VD and moderate AS. He was
referred for surgery.

Past Medical History:
HTN, ^chol, MI, Diverticulosis, Gout, hernia, ETOH

Social History:
retired currently
stopped smoking last month - 50 years of [**11-19**].5 ppd
4-5 beers/day

Family History:
father with MI in 50s

Physical Exam:
HR 78 RR 14 BP 100/58
NAD
Lungs CTAB
Heart RRR 1-2/6 SEM
Abdomen soft/NT/ND
Extrem warm, no edema
Neuro nonfocal

Pertinent Results:
[**2165-12-10**] 09:00AM BLOOD WBC-6.6 RBC-3.42* Hgb-10.8* Hct-31.1*
MCV-91 MCH-31.5 MCHC-34.6 RDW-14.1 Plt Ct-186#
[**2165-12-8**] 03:00PM BLOOD WBC-8.2 RBC-3.46* Hgb-11.0* Hct-31.4*
MCV-91 MCH-31.8 MCHC-34.9 RDW-15.0 Plt Ct-96*
[**2165-12-10**] 09:00AM BLOOD Plt Ct-186#
[**2165-12-10**] 09:00AM BLOOD PT-12.2 INR(PT)-1.0
[**2165-12-10**] 09:00AM BLOOD Glucose-115* UreaN-15 Creat-0.9 Na-140
K-3.5 Cl-99 HCO3-31 AnGap-14

CHEST (PA & LAT)  [**2165-12-9**] 8:16 AM

CHEST (PA & LAT)

Reason: assess for sternal instability

[**Hospital 93**] MEDICAL CONDITION:
63 year old man s/p CABG
REASON FOR THIS EXAMINATION:
assess for sternal instability
PA AND LATERAL CHEST ON [**2165-12-9**] AT 08:25

INDICATION: CABG.

COMPARISON: [**2165-12-7**].

FINDINGS: Median sternotomy wires are intact in this patient
with CABG changes and aortic valve prosthesis. Bilateral pleural
effusions are noted with some associated basilar atelectasis.
The remainder of the lungs is clear. Pulmonary vascular markings
and cardiac silhouette normal.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 98488**]
(Complete) Done [**2165-12-5**] at 10:45:32 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2102-6-18**]
Age (years): 63 M  Hgt (in): 72
BP (mm Hg): 130/50  Wgt (lb): 200
HR (bpm): 70  BSA (m2): 2.13 m2
Indication: CABG, AVR
ICD-9 Codes: 410.92, 786.05, 424.1, 424.0
Test Information
Date/Time: [**2165-12-5**] at 10:45    Interpret MD: [**Name6 (MD) 3892**] [**Name8 (MD) 3893**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3893**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW02-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *7.0 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *5.9 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *6.5 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  20%  >= 55%
Aorta - Sinus Level:  2.7 cm  <= 3.6 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  2.0 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *20 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  10 mm Hg
Aortic Valve - Valve Area:  *1.0 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Dilated LA. No spontaneous echo contrast or
thrombus in the LA/LAA or the RA/RAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or
color Doppler.

LEFT VENTRICLE: Moderately dilated LV cavity. Severe regional LV
systolic dysfunction. Severely depressed LVEF.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Focal
calcifications in aortic root. Normal ascending aorta diameter.
Focal calcifications in ascending aorta. Normal aortic arch
diameter. Focal calcifications in aortic arch. Normal descending
aorta diameter. Simple atheroma in descending aorta.

AORTIC VALVE: Severely thickened/deformed aortic valve leaflets.
Moderate AS (AoVA 1.0-1.2cm2) Mild (1+) AR.

MITRAL VALVE: No MVP. Moderate (2+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with physiologic PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient.

Conclusions
PRE-BYPASS:
The left atrium is dilated. No spontaneous echo contrast or
thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler. The left ventricular cavity is moderately dilated.
There is severe regional left ventricular systolic dysfunction
consistent with severe 3 vessel coronary artery diseae and with
EF 20%. Overall left ventricular systolic function is severely
depressed (LVEF= 20 %).
Right ventricular chamber size and free wall motion are normal.
There are focal calcifications in the aortic arch. There are
simple atheroma in the descending thoracic aorta. The aortic
valve leaflets are severely thickened/deformed. There is
moderate aortic valve stenosis (area 1.0-1.2cm2). Mild (1+)
aortic regurgitation is seen. There is no mitral valve prolapse.
Moderate (2+) mitral regurgitation is seen. There is no
pericardial effusion.

Post_Bypass:
Patient is on infusion of epinephrine, milrinone and levophed.
Normal RV systolic function.
There is mild improvement of previous severely hypokinetic
segments of the LV with anEF of 20 to 25%.
There is moderate MR>
Thoracic aortic contour is intact.
There is a bioprosthesis in the native aortic position, well
seated and stable with a peak of 12 and a mean of 6mm at a
cardiac output of 6L/min


Brief Hospital Course:
He was taken to the operating room on [**12-5**] where he underwent a
CABG x 3 and AVR (tissue). He was tarnsferred to the ICU in
critical but stable condition on epinephrine, levophed,
milrinone, and propofol. Postoperatively he was seen by urology
for scrotal masses. He was extubated on POD #1. His vasoactive
drips were weaned on POD #2 and he was transferred to the floor
on POD #3. He has several episodes of rate controlled atrial
fibrillation and was started on amiodarone. ON POD #5 he was in
sinus rhythm and was ready for discharge home.

Medications on Admission:
crestor, toprol, quinapril, ECASA 325, colace, NTG sl

Discharge Medications:
1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 7 days.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. 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:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
7. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily)
for 7 days: Decrease dose to 200 mg PO daily after dose
completed.
Disp:*40 Tablet(s)* Refills:*0*
8. Rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
9. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*
10. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*0*
11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
12. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
13. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
CAD
Aortic stenosis


Discharge Condition:
Good.


Discharge Instructions:
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:
repeat scrotal u/s in 2 months
f/u after u/s with Dr [**Last Name (STitle) 3748**] from urology
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 170**]  Follow-up appointment
should be in 1 month
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 5457**]  Appointment should
be in [**5-29**] days
Dr. [**Last Name (STitle) **] (cardiologist) 2 weeks



Completed by:[**2165-12-10**]
{'Aortic valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Sebaceous cyst,Old myocardial infarction,Personal history of tobacco use,Personal history of other diseases of digestive system'}


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: DOE/SOB

PRESENT ILLNESS: 63 yo M with progressive DOE who presented to the ED the week
before [**Holiday **]. He was admitted and treated for CHF. Cardiac
cath at the timeshowed severe 3VD and moderate AS. He was
referred for surgery.

MEDICAL HISTORY: HTN, ^chol, MI, Diverticulosis, Gout, hernia, ETOH

MEDICATION ON ADMISSION: crestor, toprol, quinapril, ECASA 325, colace, NTG sl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 78 RR 14 BP 100/58
NAD
Lungs CTAB
Heart RRR 1-2/6 SEM
Abdomen soft/NT/ND
Extrem warm, no edema
Neuro nonfocal

FAMILY HISTORY: father with MI in 50s

SOCIAL HISTORY: retired currently
stopped smoking last month - 50 years of [**11-19**].5 ppd
4-5 beers/day 

### Response:
{'Aortic valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Sebaceous cyst,Old myocardial infarction,Personal history of tobacco use,Personal history of other diseases of digestive system'}
