CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a [**Age over 90 **]-year-old female
with a history of critical aortic stenosis, status post
aortic valvuloplasty in [**2123-8-7**] by Dr. [**Last Name (STitle) **], now
presenting as a direct admission by Dr. [**First Name (STitle) **] for worsening
shortness of breath and dyspnea on exertion increasing over
the last several weeks.  She has also had weight loss over
the last several weeks.

MEDICAL HISTORY: 1.  Hypertension.
2.  Ovarian islet cell tumor.
3.  Decreased hearing.
4.  Poor gait and balance.
5.  Critical aortic stenosis.
6.  Status post aortic valvuloplasty in [**2123-8-7**] with
aortic valve area going from 0.4 to 0.7; previous
echocardiogram in [**2124-10-7**] showed an ejection
fraction of 55%, moderate-to-severe aortic stenosis, 1 to 2+
aortic regurgitation, 1 to 2+ mitral regurgitation.

MEDICATION ON ADMISSION: 1.  Multivitamin 1 tablet p.o. q.d.
 2.  Lasix 40 mg p.o. q.d.
 3.  Ditropan 5 mg p.o. b.i.d.
 4.  Lanoxin 0.125 mg p.o. q.d.
 5.  Aspirin 81 mg p.o. q.d.
 6.  Iron sulfate 300 mg p.o. q.d.
 7.  Potassium chloride 20 mEq p.o. q.d.
 8.  Celebrex 100 mg p.o. q.d.
 9.  Ibuprofen 200 mg p.o. b.i.d.
10.  Peri-Colace p.r.n.
11.  Vitamin C and vitamin E.
12.  Aricept 10 mg p.o. q.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke.  She uses
occasional alcohol.  She lives in an [**Hospital3 **]
facility.
Aortic valve disorders,Congestive heart failure, unspecified,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Abnormality of gait,Other persistent mental disorders due to conditions classified elsewhere
Aortic valve disorder,CHF NOS,Intermed coronary synd,Surg compl-heart,Atriovent block complete,Crnry athrscl natve vssl,Abnormality of gait,Mental disor NEC oth dis
Admission Date:  [**2125-5-9**]     Discharge Date:  [**2125-5-14**]


Service:

HISTORY OF PRESENT ILLNESS:  This is a [**Age over 90 **]-year-old female
with a history of critical aortic stenosis, status post
aortic valvuloplasty in [**2123-8-7**] by Dr. [**Last Name (STitle) **], now
presenting as a direct admission by Dr. [**First Name (STitle) **] for worsening
shortness of breath and dyspnea on exertion increasing over
the last several weeks.  She has also had weight loss over
the last several weeks.

The patient denies chest pain or syncope.  The patient
presented for an echocardiographic evaluation of her heart
and will undergo aortic valvuloplasty on [**2125-5-10**].

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Ovarian islet cell tumor.
3.  Decreased hearing.
4.  Poor gait and balance.
5.  Critical aortic stenosis.
6.  Status post aortic valvuloplasty in [**2123-8-7**] with
aortic valve area going from 0.4 to 0.7; previous
echocardiogram in [**2124-10-7**] showed an ejection
fraction of 55%, moderate-to-severe aortic stenosis, 1 to 2+
aortic regurgitation, 1 to 2+ mitral regurgitation.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS ON ADMISSION:
 1.  Multivitamin 1 tablet p.o. q.d.
 2.  Lasix 40 mg p.o. q.d.
 3.  Ditropan 5 mg p.o. b.i.d.
 4.  Lanoxin 0.125 mg p.o. q.d.
 5.  Aspirin 81 mg p.o. q.d.
 6.  Iron sulfate 300 mg p.o. q.d.
 7.  Potassium chloride 20 mEq p.o. q.d.
 8.  Celebrex 100 mg p.o. q.d.
 9.  Ibuprofen 200 mg p.o. b.i.d.
10.  Peri-Colace p.r.n.
11.  Vitamin C and vitamin E.
12.  Aricept 10 mg p.o. q.d.

SOCIAL HISTORY:  The patient does not smoke.  She uses
occasional alcohol.  She lives in an [**Hospital3 **]
facility.

PHYSICAL EXAMINATION ON PRESENTATION:  Vital signs revealed
temperature of 95.3, blood pressure of 122/72, heart rate
of 82, respirations of 20, 98% on 2 liters.  Head, eyes,
ears, nose, and throat revealed normocephalic and atraumatic.
Mucous membranes were moist.  The neck had no jugular venous
distention.  The lungs had faint crackles at the bases.
Cardiovascular revealed a regular rate and rhythm.  First
heart sound and second heart sound.  A [**3-14**] high-pitched
systolic ejection murmur.  The abdomen was soft, nontender,
and nondistended.  Extremities revealed 1+ edema.

PERTINENT LABORATORY DATA ON PRESENTATION:  Laboratories
revealed white blood cell count of 8.7, hematocrit of 30.5,
platelets of 213.  Sodium of 143, potassium of 3.9, chloride
of 105, bicarbonate of 27, blood urea nitrogen of 24,
creatinine of 1.4, glucose of 108.  Digoxin level of 1.4.  PT
of 13.3, PTT of 24.5, INR of 1.2.  Calcium of 8.5, magnesium
of 1.9, phosphorous of 3.6.  Creatine kinase of 150, MB of 2.
Troponin I was less than 0.3.

RADIOLOGY/IMAGING:  Electrocardiogram had a left
bundle-branch block at rate of 79; this was new compared to
[**2123-8-7**].

Chest x-ray showed slight congestive heart failure.

An echocardiogram revealed an ejection fraction of 20%,
aortic valve area was 0.4, peak in the 70s, and mean in
the 40s, moderate-to-severe mitral regurgitation.

HOSPITAL COURSE:  The patient was admitted.  An
echocardiogram was obtained which had the results as above.
Although is elderly and has an overall poor prognosis, it was
felt that she would obtain benefit for aortic valvoplasty, as
she was not a surgical candidate.

For her congestive heart failure, she was continued on
Lasix 40 mg p.o. q.d.   She was continued on digoxin.  She
was continued on aspirin q.d.  She was continued on Aricept
for her dementia.

On [**2125-5-10**], the patient underwent a left heart
catheterization, coronary angiography, aortic valvuloplasty,
RVTPM and RHC.  Indications were coronary artery disease,
unstable angina, congestive heart failure, and critical
aortic stenosis.  Findings revealed the patient had a
right-dominant system.  Her left main coronary artery had
mild calcification.  The left anterior descending artery had
no significant lesions.  The left circumflex was a
nondominant vessel without critical lesions.  The right
coronary artery was a dominant vessel without critical
lesions.  An aortic valvuloplasty was performed with and
increase in the aortic valve are from 0.3 cm2 to 0.6 cm2.
Cardiac index remained very low at 1.7 L/min/kg.  The patient
was transferred to the Coronary Care Unit until hemodynamic
stability was obtained.

She was placed on dobutamine to maintain mean arterial
pressure.  The patient went into complete heart block and had
a transvenous pacemaker placed.  The complete heart block
spontaneously resolved and was felt to be due to irritation
of the right bundle-branch in the setting of the left
bundle-branch block.

On [**2125-5-11**], the patient was called out to the floor as
she remained hemodynamically stable and did not re-enter into
complete heart block with her transvenous pacing
discontinued.

On [**2125-5-12**], the patient was doing well with no
complaints.  She was afebrile with stable vital signs.  Her
blood pressure was 129/72.  Her examination was unremarkable.
Her groin had no hematoma, oozing, or bruits.  A Physical
Therapy consultation was requested, and her diet was
supplemented with Boost shakes three times per day.

A Physical Therapy evaluation was obtained on [**2125-5-13**].
The patient was able to ambulate 60 feet with slow gait and
frequent standing and rest breaks.  Physical Therapy
recommended further physical therapy treatments.  On [**2125-5-13**], the patient was doing well with no complaints.  Her
blood pressure was stable at 110/58.  Her examination was
unchanged.  Laboratories were significant for a hematocrit
of 29, a potassium of 3.4, and a magnesium of 1.8.  Potassium
was supplemented with 40 mEq of p.o. potassium chloride.
Magnesium was supplemented as well.  Case Management was
consulted concerning placement of the patient versus going
back to her [**Hospital3 **] facility with 24-hour nursing.
The family felt that they would prefer the second option.

On [**2125-5-14**], the patient was doing well with no
complaints of chest pain or shortness of breath.  She report
some mild nausea which is chronic in nature.  Her blood
pressure was stable at 105/61.  She tolerated 1420 p.o. on
the previous day.  Her examination was unchanged.  Her
laboratories were significant for a hematocrit of 30.4,
potassium of 4.3, an albumin of 3.1, and a magnesium of 1.9.
Telemetry revealed a normal sinus rhythm with premature
ventricular contractions.

ISSUES:

1.  CARDIOVASCULAR:  We will continue the Lasix and digoxin
for the patient's congestive heart failure and maintain her
fluid balance.  Her blood pressure remained stable.

2.  NUTRITION:  We need to continue to encourage p.o. and
supplement with boost three times per day.  The patient
should have a cardiac low-salt diet.

3.  PHYSICAL THERAPY:  We need to continue physical therapy
and encourage ambulation and strength training.

4.  HEMATOLOGY:  The patient's hematocrit is stable at 30.4.

5.  GASTROINTESTINAL:  The patient has had nausea and reflux
for months.  She should continue on her Prilosec, and she
should consider an outpatient gastrointestinal workup.

DISCHARGE DISPOSITION:  Discharged to [**Hospital3 **]
facility with 24-hour nursing and physical therapy.

DISCHARGE FOLLOWUP:  The patient was to follow up with
Dr. [**First Name (STitle) **] in six to eight weeks.

CODE STATUS:  The patient's code status is no chest
compression and do not intubate.

CONDITION AT DISCHARGE:  Condition on discharge was fair.

DISCHARGE STATUS:  Discharged to [**Hospital3 **] facility
with 24[**Hospital 8018**] nursing care.

DISCHARGE DIAGNOSES:
1.  Critical aortic stenosis.
2.  Status post aortic valvuloplasty.
3.  Congestive heart failure.
4.  Elderly.
5.  Cardiac cachexia.
6.  Anemia.
7.  Ovarian islet cell tumor.
8.  Decreased hearing.
9.  Poor gait and balance.

MEDICATIONS ON DISCHARGE:
 1.  Multivitamin 1 tablet p.o. q.d.
 2.  Lasix 40 mg p.o. q.d.
 3.  Ditropan 5 mg p.o. b.i.d.
 4.  Lanoxin 0.125 mg p.o. q.d.
 5.  Iron sulfate 300 mg p.o. q.d.
 6.  Potassium chloride 20 mEq p.o. q.d.
 7.  Celebrex 100 mg p.o. q.d.
 8.  Aricept 10 mg p.o. q.h.s.
 9.  Enteric-coated aspirin 81 mg p.o. q.d.
10.  Colace 100 mg p.o. b.i.d.
11.  Prilosec 20 mg p.o. q.d.
12.  Oxycodone 5 mg p.o. q.6h. p.r.n. for pain.
13.  Maalox 30 cc p.o. t.i.d. p.r.n.





                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D.  [**MD Number(1) 5211**]

Dictated By:[**Last Name (NamePattern1) 23443**]

MEDQUIST36

D:  [**2125-5-14**]  08:56
T:  [**2125-5-15**]  07:27
JOB#:  [**Job Number 104938**]


Name:  [**Known lastname 17072**], [**Known firstname 6758**]                        Unit No:  [**Numeric Identifier 17073**]

Admission Date:                 Discharge Date:

Date of Birth:                  Sex:  F

Service:

DICTATOR STATES:  "I had put in this report as a regular
Discharge Summary and need this to be changed to a STAT
Discharge Summary."








Dictated By:[**Last Name (NamePattern1) 4779**]

MEDQUIST36

D:  [**2125-5-14**]  14:57
T:  [**2125-5-14**]  15:02
JOB#:  [**Job Number 17074**]
{'Aortic valve disorders,Congestive heart failure, unspecified,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Abnormality of gait,Other persistent mental disorders due to conditions classified elsewhere'}


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: 

PRESENT ILLNESS: This is a [**Age over 90 **]-year-old female
with a history of critical aortic stenosis, status post
aortic valvuloplasty in [**2123-8-7**] by Dr. [**Last Name (STitle) **], now
presenting as a direct admission by Dr. [**First Name (STitle) **] for worsening
shortness of breath and dyspnea on exertion increasing over
the last several weeks.  She has also had weight loss over
the last several weeks.

MEDICAL HISTORY: 1.  Hypertension.
2.  Ovarian islet cell tumor.
3.  Decreased hearing.
4.  Poor gait and balance.
5.  Critical aortic stenosis.
6.  Status post aortic valvuloplasty in [**2123-8-7**] with
aortic valve area going from 0.4 to 0.7; previous
echocardiogram in [**2124-10-7**] showed an ejection
fraction of 55%, moderate-to-severe aortic stenosis, 1 to 2+
aortic regurgitation, 1 to 2+ mitral regurgitation.

MEDICATION ON ADMISSION: 1.  Multivitamin 1 tablet p.o. q.d.
 2.  Lasix 40 mg p.o. q.d.
 3.  Ditropan 5 mg p.o. b.i.d.
 4.  Lanoxin 0.125 mg p.o. q.d.
 5.  Aspirin 81 mg p.o. q.d.
 6.  Iron sulfate 300 mg p.o. q.d.
 7.  Potassium chloride 20 mEq p.o. q.d.
 8.  Celebrex 100 mg p.o. q.d.
 9.  Ibuprofen 200 mg p.o. b.i.d.
10.  Peri-Colace p.r.n.
11.  Vitamin C and vitamin E.
12.  Aricept 10 mg p.o. q.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke.  She uses
occasional alcohol.  She lives in an [**Hospital3 **]
facility. 

### Response:
{'Aortic valve disorders,Congestive heart failure, unspecified,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Abnormality of gait,Other persistent mental disorders due to conditions classified elsewhere'}
