CHIEF COMPLAINT: 1. Aortic stenosis.
2. Severe 1 vessel coronary artery disease.

PRESENT ILLNESS: The patient is an 80-year-old woman referred by Dr. [**Last Name (STitle) **]
for aortic valve replacement.  Preoperative cardiac cath
demonstrated least 50% mid LAD stenosis at the takeoff of first
diagonal coronary artery.  The patient
understood the risks, benefits and possible alternatives
including but not limited to bleeding, infection, myocardial
infarction, stroke, death, renal and pulmonary insufficiency as
well as possibility of a blood transfusion and future
revascularization procedures and agreed to proceed.  All
questions were answered to her satisfaction prior to proceeding
with said surgery.

MEDICAL HISTORY: PMH:Aortic Stenosis,Mitral Regurgitation,Hypothyroidism
Hyperlipidemia,Breast surgery s/p surgery, chemo and radiation
Ostepenia,Colon adenomas,Varicose veins, s/p breast surgery,s/p
Bilateral greater and lesser saphenous vein stripping

MEDICATION ON ADMISSION: Aspirin 81mg daily,Synthroid 75,Simvastatin 20mg daily
Vitamin D

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Every 6 months
Lives with: Alone. House connected to family.
Occupation: Retired
Tobacco: Never
ETOH: Glass of wine twice a week
Mitral valve insufficiency and aortic valve stenosis,Candidiasis of mouth,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Carrier or suspected carrier of Methicillin susceptible Staphylococcus aureus
Mitral insuf/aort stenos,Thrush,Ac posthemorrhag anemia,Crnry athrscl natve vssl,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Meth susc Staph carrier
Admission Date:  [**2127-3-24**]              Discharge Date:   [**2127-4-1**]

Date of Birth:  [**2047-10-27**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
1. Aortic stenosis.
2. Severe 1 vessel coronary artery disease.


Major Surgical or Invasive Procedure:
PROCEDURE:
1. Aortic valve replacement with a 21-mm [**Doctor Last Name **] Magna Ease
    aortic valve bioprosthesis.
2. Coronary artery bypass grafting x1 with left internal
    mammary artery to left anterior descending coronary
    artery.


History of Present Illness:
The patient is an 80-year-old woman referred by Dr. [**Last Name (STitle) **]
for aortic valve replacement.  Preoperative cardiac cath
demonstrated least 50% mid LAD stenosis at the takeoff of first
diagonal coronary artery.  The patient
understood the risks, benefits and possible alternatives
including but not limited to bleeding, infection, myocardial
infarction, stroke, death, renal and pulmonary insufficiency as
well as possibility of a blood transfusion and future
revascularization procedures and agreed to proceed.  All
questions were answered to her satisfaction prior to proceeding
with said surgery.


Past Medical History:
PMH:Aortic Stenosis,Mitral Regurgitation,Hypothyroidism
Hyperlipidemia,Breast surgery s/p surgery, chemo and radiation
Ostepenia,Colon adenomas,Varicose veins, s/p breast surgery,s/p
Bilateral greater and lesser saphenous vein stripping


Social History:
Race: Caucasian
Last Dental Exam: Every 6 months
Lives with: Alone. House connected to family.
Occupation: Retired
Tobacco: Never
ETOH: Glass of wine twice a week


Family History:
Non-contributory


Physical Exam:
Physical Exam

Pulse: 68 SR Resp: 18  O2 sat:100%
B/P  Right: 174/83   Left: 158/70
Height: 60"    Weight: 158 lb

General: WDWN in NAD
Skin: Warm, Dry and intact.
HEENT: NCAT, PERRLA, EOMI, sclera anicteric, OP benign
Neck: Supple [X] Full ROM [X] No JVD
Chest: Lungs clear bilaterally [X]
Heart: RRR, Normal S1-S2, III-IV/VI high pitched SEM
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X] Trace Edema
Varicosities: Varicosities noted along bilateral legs. Incisions
noted on bilateral legs c/w GSV/LSV vein stripping
Neuro: Grossly intact
Pulses:
Femoral      Right: 2  Left: 2
DP           Right: 1  Left: 1
PT           [**Name (NI) 167**]: 1  Left: 1
Radial       Right: 2  Left: 2

Carotid Bruit    Transmitted vs. bruit


Pertinent Results:
ECHO: PRE-CBP:
The left atrium is moderately dilated. The left atrium is
elongated. No thrombus is seen in the left atrial appendage. No
atrial septal defect is seen by 2D or color Doppler.
Overall left ventricular systolic function is low normal (LVEF
50-55%).
There are simple atheroma in the descending thoracic aorta. No
thoracic aortic dissection is seen.
There are three aortic valve leaflets. The aortic valve leaflets
are severely thickened/deformed. There is critical aortic valve
stenosis (valve area <0.8cm2). Mild (1+) aortic regurgitation is
seen.
The mitral valve leaflets are moderately thickened. There is
severe mitral annular calcification. Mild to moderate ([**1-5**]+)
mitral regurgitation is seen.
POST-CPB:
There is a bioprosthetic valve in the aortic position. The valve
is well seated with normal leaflet mobility. The peak gradient
across the aortic valve is 11mmHg, the mean gradient is 6mmHg.
No paravalvular leak is seen. There is mild central AI.
There is normal biventricular systolic function. There continues
to be mild to moderate MR. There is no evidence of aortic
dissection.

Day of surgery labs:
[**2127-3-24**] 08:21AM   HGB-10.9* calcHCT-33
[**2127-3-24**] 12:02PM   FIBRINOGE-123*
[**2127-3-24**] 12:02PM   PT-16.6* PTT-58.3* INR(PT)-1.5*
[**2127-3-24**] 12:02PM   PLT COUNT-118*
[**2127-3-24**] 12:02PM   WBC-6.8# RBC-1.90*# HGB-6.5*# HCT-18.1*#
MCV-95 MCH-34.0* MCHC-35.6* RDW-13.3
[**2127-3-24**] 12:06PM   GLUCOSE-136* LACTATE-2.3* NA+-136 K+-4.1
CL--108
[**2127-3-24**] 04:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5
LEUK-NEG
[**2127-3-24**] 04:00PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.014
Discharge labs:
[**2127-3-31**] 01:00PM BLOOD WBC-6.5 RBC-3.33* Hgb-11.1* Hct-31.6*
MCV-95 MCH-33.2* MCHC-35.0 RDW-14.0 Plt Ct-183
[**2127-3-31**] 01:00PM BLOOD Plt Ct-183
[**2127-4-1**] 08:40AM BLOOD Glucose-141* UreaN-27* Creat-1.0 Na-138
K-4.8 Cl-99 HCO3-33* AnGap-11
[**2127-4-1**] 08:40AM BLOOD Mg-1.9

Radiology Report CHEST (PA & LAT) Study Date of [**2127-4-1**] 11:01
AM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 89631**]
Final Report: In comparison with study of [**3-31**], the patient has
taken a somewhat better inspiration. The small apical
pneumothorax persists on the right.
Blunting of the costophrenic angle on the left is again seen. No
definite
vascular congestion or pleural effusion.



Brief Hospital Course:
The patient was a same day admission to the operating room on
[**3-24**] where the patient underwent:
1. Aortic valve replacement with a 21-mm [**Doctor Last Name **] Magna Ease
aortic valve bioprosthesis.
2. Coronary artery bypass grafting x1 with left internal mammary
artery to left anterior descending coronary artery.
Her bypass time was 83 minutes with a crossclamp of 70 minutes.
She tolerated the operation well and was transferred from the
operating room to the cardiac surgery ICU in stable condition
for recovery and invasive monitoring.  She remained
hemodynamically stable and was extubated shortly after arrival
in the ICU.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was started on diuretics with a goal of reaching the
preoperative weight.
The patient was transferred to the telemetry floor for further
recovery.
Once on the floor the chest tubes and pacing wires were
discontinued according to cardiac surgery protocol without
complication.  The patient was seen by the physical therapy
service for assistance with strength and mobility daily.
The remainder of her hospital course was uneventful.
By the time of discharge on POD8 the patient was ambulating with
assistance, the wound was healing and pain was controlled with
Tramadol.

The patient was discharged to Alliance of [**Location (un) 38**] in good
condition with appropriate follow up instructions and
appointments scheduled

Medications on Admission:
Aspirin 81mg daily,Synthroid 75,Simvastatin 20mg daily
Vitamin D


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for fever, pain.
3. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
4. Lopressor 50 mg Tablet Sig: One (1) Tablet PO twice a day.
5. nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) for 4 days.
6. polyethylene glycol 3350 17 gram/dose Powder Sig: Seventeen
(17) gram PO DAILY (Daily).
7. camphor-menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed for itching : to back .
8. amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q6H
(every 6 hours) as needed for constipation.
11. aspirin, buffered 81 mg Tablet Sig: One (1) Tablet PO once a
day.
12. potassium chloride 10 mEq Tablet Extended Release Sig: One
(1) Tablet Extended Release PO twice a day.
13. Outpatient Lab Work
Chem 7 [**4-3**] to evaluate electrolytes
14. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
15. Synthroid 75 mcg Tablet Sig: One (1) Tablet PO once a day.
16. Zantac 150 mg Tablet Sig: One (1) Tablet PO once a day.
17. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.

18. Vitamin D 400 unit Capsule Sig: One (1) Capsule PO once a
day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 4470**] HealthCare Center at [**Location (un) 38**]

Discharge Diagnosis:
1. Aortic stenosis.
2. Severe 1 vessel coronary artery disease.
3. MSSA positive

Hypothyroidism
Hyperlipidemia


Discharge Condition:
DISCHARGE CONDITION:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
DISCHARGE INSTRUCTIONS:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive

No lifting more than 10 pounds for 10 weeks

Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr [**Last Name (STitle) 914**] [**Telephone/Fax (1) 170**] on [**2127-4-15**] at 1:15
Cardiologist: Dr [**Last Name (STitle) **] on [**2127-4-14**] at 12:30

Please call to schedule appointments with your Primary Care Dr
[**Last Name (STitle) 3708**] in [**4-8**] weeks [**Telephone/Fax (1) 68410**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2127-4-1**]
{'Mitral valve insufficiency and aortic valve stenosis,Candidiasis of mouth,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Carrier or suspected carrier of Methicillin susceptible Staphylococcus aureus'}


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: 1. Aortic stenosis.
2. Severe 1 vessel coronary artery disease.

PRESENT ILLNESS: The patient is an 80-year-old woman referred by Dr. [**Last Name (STitle) **]
for aortic valve replacement.  Preoperative cardiac cath
demonstrated least 50% mid LAD stenosis at the takeoff of first
diagonal coronary artery.  The patient
understood the risks, benefits and possible alternatives
including but not limited to bleeding, infection, myocardial
infarction, stroke, death, renal and pulmonary insufficiency as
well as possibility of a blood transfusion and future
revascularization procedures and agreed to proceed.  All
questions were answered to her satisfaction prior to proceeding
with said surgery.

MEDICAL HISTORY: PMH:Aortic Stenosis,Mitral Regurgitation,Hypothyroidism
Hyperlipidemia,Breast surgery s/p surgery, chemo and radiation
Ostepenia,Colon adenomas,Varicose veins, s/p breast surgery,s/p
Bilateral greater and lesser saphenous vein stripping

MEDICATION ON ADMISSION: Aspirin 81mg daily,Synthroid 75,Simvastatin 20mg daily
Vitamin D

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Every 6 months
Lives with: Alone. House connected to family.
Occupation: Retired
Tobacco: Never
ETOH: Glass of wine twice a week 

### Response:
{'Mitral valve insufficiency and aortic valve stenosis,Candidiasis of mouth,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Carrier or suspected carrier of Methicillin susceptible Staphylococcus aureus'}
