CHIEF COMPLAINT: lightheadedness, slight DOE

PRESENT ILLNESS: 68 yo female trasnferred in from Catholic Med. Ctr. with
periprosthetic aortic valve stenosis and aortic valve thrombus.
No cath done, but echo [**3-3**] showed EF 60-65%, stenotic mech.
valve, mean gradient 33 mm, decreased disc motion, mobile mass
in LVOT, mild AI, mild to moderate MR, trace TR. Referred for
surgical evaluation.

MEDICAL HISTORY: HTN
elev. lipids
hypothyroidism
back pain
GERD

MEDICATION ON ADMISSION: synthroid 75 mcg daily
HCTZ 37.5 mg daily
MVI daily
Vit.C 500 mg daily
prevacid 15 mg daily
coumadin ( held)
toprol XL 100 mg daily
zocor 40 mg daily
KCl [**10-23**] mEq daily
cozaar 25 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 180/88  HR 68  RR 18  95% sat
65.5"    87 kg
NAD
skin/HEENT unremarkable
neck supple, murmur radiates bilat. to carotids
CTAB
RRR with holosystolic murmur
soft, NT, ND, + BS
warm, well-perfused, no edema , superficial varicosities
neuro grossly intact
2+ bil. fem/ radials
1+ bil. DP/PTs

FAMILY HISTORY: father died at 57 of heart problems
brother died at age 7 of "leaky valve"
sister with CAD/CABG

SOCIAL HISTORY: retired, lives alone, widowed
quit smoking 20+ years ago
no ETOH use
Other complications due to heart valve prosthesis,Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Other and unspecified hyperlipidemia
Comp-heart valve prosth,Aortic valve disorder,Surg compl-heart,Atrial fibrillation,Hypertension NOS,Hypothyroidism NOS,Esophageal reflux,Hyperlipidemia NEC/NOS
Admission Date:  [**2184-3-4**]              Discharge Date:   [**2184-3-15**]

Date of Birth:  [**2115-11-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
lightheadedness, slight DOE

Major Surgical or Invasive Procedure:
[**2184-3-7**]  Redo AVR with aortic root enlargement ( 21 mm CE Magna
pericardial valve)

History of Present Illness:
68 yo female trasnferred in from Catholic Med. Ctr. with
periprosthetic aortic valve stenosis and aortic valve thrombus.
No cath done, but echo [**3-3**] showed EF 60-65%, stenotic mech.
valve, mean gradient 33 mm, decreased disc motion, mobile mass
in LVOT, mild AI, mild to moderate MR, trace TR. Referred for
surgical evaluation.

Past Medical History:
HTN
elev. lipids
hypothyroidism
back pain
GERD

PSH: s/p AVR [**2177**]
remote tonsillectomy/adenoidectomy
partial thyroidectomy
rem. right wrist ganglion cyst
left foot bunionectomy
breast biopsies


Social History:
retired, lives alone, widowed
quit smoking 20+ years ago
no ETOH use

Family History:
father died at 57 of heart problems
brother died at age 7 of "leaky valve"
sister with CAD/CABG

Physical Exam:
180/88  HR 68  RR 18  95% sat
65.5"    87 kg
NAD
skin/HEENT unremarkable
neck supple, murmur radiates bilat. to carotids
CTAB
RRR with holosystolic murmur
soft, NT, ND, + BS
warm, well-perfused, no edema , superficial varicosities
neuro grossly intact
2+ bil. fem/ radials
1+ bil. DP/PTs


Pertinent Results:
Cardiology Report ECHO Study Date of [**2184-3-7**]
POST-BYPASS: Pt is being AV paced, on an infusion of
phenylephrine
1. A bioprosthesis is well seated in the aortic position,
leaflets open well,
trace central AI is seen. Trace AI is also noted between the
left and right
coronary cusps. There is a small paravavluar leak in the area
adjacent to the
anterior mitral leaflet, resulting in some trace insuffiency
outside the
sewing ring.
2. Mitral regurgitation is unchanged from before.
3. Biventricular systolic function is unchanged.
4. Aorta is intact post decannulation
5. Other findings are unchanged
6. All findings discussed with surgeon at the time of the exam.


[**2184-3-14**] 05:45AM BLOOD Hct-29.2*
[**2184-3-13**] 04:40AM BLOOD WBC-12.4* RBC-2.89* Hgb-9.0* Hct-26.0*
MCV-90 MCH-31.3 MCHC-34.9 RDW-13.5 Plt Ct-262
[**2184-3-14**] 05:45AM BLOOD PT-16.8* PTT-65.3* INR(PT)-1.5*
[**2184-3-15**] 07:10AM BLOOD Glucose-115* UreaN-20 Creat-1.3* Na-137
K-4.8 Cl-96 HCO3-34* AnGap-12

Brief Hospital Course:
Admitted [**3-4**] to cardiology service for surgical work-up. INR 2.7
and echo repeated, coumadin held,and heparin drips started.
Review of OSH echo revealed peak gradient of 64mm ( not 30's).
New echo showed pannus involving the valve and ? thrombus. Seen
by Dr. [**First Name (STitle) **] of cardiac surgery and underwent redo AVR with
aortic root enlargement on [**3-7**].Transferred to the CSRU in stable
condition on phenylephrine and propofol drips. Weaned to
extubation on POD #2 and off all drips. Episode of AFib that
evening treated with amiodarone and converted to SR. Transferred
to the floor on POD #3 to begin increasing her activity level.
Chest tubes and wires removed without incident. Cleared for
discharge to home with services. Pt. to make all follow-up
appts. per discharge instructions.

Medications on Admission:
synthroid 75 mcg daily
HCTZ 37.5 mg daily
MVI daily
Vit.C 500 mg daily
prevacid 15 mg daily
coumadin ( held)
toprol XL 100 mg daily
zocor 40 mg daily
KCl [**10-23**] mEq daily
cozaar 25 mg daily


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
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:*40 Tablet(s)* Refills:*0*
5. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily)
for 2 days: for 2 days, then start 200 mg daily ongoing on [**3-16**].
Disp:*60 Tablet(s)* Refills:*1*
9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO once a day for 7 days.
Disp:*14 Capsule, Sustained Release(s)* Refills:*0*
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 7 days.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Community Health and Hospice

Discharge Diagnosis:
prosthetic aortic valve stenosis
HTN
elev. lipds
hypothyroidism
back pain
GERD
A Fib
s/p AVR [**2177**]


Discharge Condition:
stable

Discharge Instructions:
no driving for one month
no lifting greater than 10 pounds for 10 weeks
no lotions, creams or powders on any incision
may shower over incisions and pat dry
call for fever greater than 100.5, redness or drainage

Followup Instructions:
see Dr. [**Last Name (STitle) 11250**] in [**1-6**] weeks
see Dr. [**First Name (STitle) **] in 4 weeks  [**Telephone/Fax (1) 170**]


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2184-3-15**]
{'Other complications due to heart valve prosthesis,Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Other and unspecified hyperlipidemia'}


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: lightheadedness, slight DOE

PRESENT ILLNESS: 68 yo female trasnferred in from Catholic Med. Ctr. with
periprosthetic aortic valve stenosis and aortic valve thrombus.
No cath done, but echo [**3-3**] showed EF 60-65%, stenotic mech.
valve, mean gradient 33 mm, decreased disc motion, mobile mass
in LVOT, mild AI, mild to moderate MR, trace TR. Referred for
surgical evaluation.

MEDICAL HISTORY: HTN
elev. lipids
hypothyroidism
back pain
GERD

MEDICATION ON ADMISSION: synthroid 75 mcg daily
HCTZ 37.5 mg daily
MVI daily
Vit.C 500 mg daily
prevacid 15 mg daily
coumadin ( held)
toprol XL 100 mg daily
zocor 40 mg daily
KCl [**10-23**] mEq daily
cozaar 25 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 180/88  HR 68  RR 18  95% sat
65.5"    87 kg
NAD
skin/HEENT unremarkable
neck supple, murmur radiates bilat. to carotids
CTAB
RRR with holosystolic murmur
soft, NT, ND, + BS
warm, well-perfused, no edema , superficial varicosities
neuro grossly intact
2+ bil. fem/ radials
1+ bil. DP/PTs

FAMILY HISTORY: father died at 57 of heart problems
brother died at age 7 of "leaky valve"
sister with CAD/CABG

SOCIAL HISTORY: retired, lives alone, widowed
quit smoking 20+ years ago
no ETOH use 

### Response:
{'Other complications due to heart valve prosthesis,Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Other and unspecified hyperlipidemia'}
