CHIEF COMPLAINT: DOE/fatigue

PRESENT ILLNESS: 62 yo M with history of AS which has been followed by serial
echo. Over the past 6 months his DOE has worsened and most
recent echo showed severe AS with a dilated ascending aorta. He
was referred for surgery.

MEDICAL HISTORY: CAD s/p '[**65**] stent, AS (bicuspid), ^lipid, htn, copd, gerd,
childhood rheumatic fever

MEDICATION ON ADMISSION: asa 325', carvedilol 6.25'', chantix .5'', lipitor 40', protonix
40'.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 86 RR 14 BP 152/70
NAD
Lungs CTAB
Heart RRR 4/6 SEM
Abdomen benign
Extrem arm, no edema
Mild anterior varicose veins
carotids with transmitted bruits

FAMILY HISTORY: sister with MI at age 37

SOCIAL HISTORY: retired
90 pack year smoking history Quit [**2169-11-21**]
1 etoh/week
Rheumatic aortic stenosis,Congenital insufficiency of aortic valve,Cardiac complications, not elsewhere classified,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux
Rheumat aortic stenosis,Cong aorta valv insuffic,Surg compl-heart,Pleural effusion NOS,Chr airway obstruct NEC,Atrial fibrillation,Abn react-artif implant,Hypertension NOS,Tobacco use disorder,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Esophageal reflux
Admission Date:  [**2170-2-21**]              Discharge Date:   [**2170-2-26**]

Date of Birth:  [**2107-9-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
AVR([**Doctor Last Name **] Tissue #23) [**2-21**]


History of Present Illness:
62 yo M with history of AS which has been followed by serial
echo. Over the past 6 months his DOE has worsened and most
recent echo showed severe AS with a dilated ascending aorta. He
was referred for surgery.

Past Medical History:
CAD s/p '[**65**] stent, AS (bicuspid), ^lipid, htn, copd, gerd,
childhood rheumatic fever

Social History:
retired
90 pack year smoking history Quit [**2169-11-21**]
1 etoh/week


Family History:
sister with MI at age 37

Physical Exam:
HR 86 RR 14 BP 152/70
NAD
Lungs CTAB
Heart RRR 4/6 SEM
Abdomen benign
Extrem arm, no edema
Mild anterior varicose veins
carotids with transmitted bruits

Pertinent Results:
[**2170-2-26**] 05:15AM BLOOD WBC-8.3 RBC-2.90* Hgb-9.1* Hct-26.1*
MCV-90 MCH-31.4 MCHC-34.9 RDW-13.3 Plt Ct-194
[**2170-2-24**] 07:15AM BLOOD PT-13.9* PTT-28.0 INR(PT)-1.2*
[**2170-2-26**] 05:15AM BLOOD Glucose-107* UreaN-22* Creat-0.8 Na-140
K-4.2 Cl-102 HCO3-29 AnGap-13

CHEST (PA & LAT)  [**2170-2-24**] 9:01 AM

CHEST (PA & LAT)

Reason: eval for pleural effusions

[**Hospital 93**] MEDICAL CONDITION:
62 year old man s/p AVR
REASON FOR THIS EXAMINATION:
eval for pleural effusions
EXAMINATION: PA and lateral chest.

INDICATION: Status post AVR. Pleural effusion.

PA and lateral views of the chest are obtained [**2170-2-24**] at 0906
hours and are compared with the prior study performed on [**2170-2-22**]
1310 hours. Patient is status post AVR. Small bilateral pleural
effusions are seen, more marked on the left side and increased
slightly since prior examination. Patchy increase in density is
seen in the right base, likely in the right lower lobe, which
was not present on the prior examination and may represent some
developing airspace disease. The examination is otherwise
unchanged from the prior study.

IMPRESSION:

Slight increase in bilateral pleural effusions, more marked on
the left side. Patchy airspace disease developing in the right
base. Increased retrocardiac density are not significantly
changed since prior examination and likely representing
subsegmental atelectasis.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

O'[**Known lastname **], [**Known firstname 1955**]       [**Hospital1 18**] [**Numeric Identifier 55540**] (Complete)
Done [**2170-2-21**] at 11:19:40 AM      FINAL
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: [**2107-9-21**]
Age (years): 62 M  Hgt (in): 67
BP (mm Hg): 150/70  Wgt (lb): 150
HR (bpm): 60  BSA (m2): 1.79 m2
Indication: Intraoperative TEE for AVR, ? Ascending aortic
replacement
ICD-9 Codes: 746.9, 786.05, 440.0, 424.1
Test Information
Date/Time: [**2170-2-21**] at 11:19    Interpret MD: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5740**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW2-: Machine: [**Pager number **]
Echocardiographic Measurements
Results  Measurements  Normal Range
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:  5.3 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Annulus:  2.4 cm  <= 3.0 cm
Aorta - Sinus Level:  *3.8 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  *3.4 cm  <= 3.0 cm
Aorta - Ascending:  *4.2 cm  <= 3.4 cm
Aorta - Descending Thoracic:  *3.0 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *3.7 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *54 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  35 mm Hg
Aortic Valve - LVOT pk vel:  0.80 m/sec
Aortic Valve - LVOT diam:  2.3 cm
Aortic Valve - Valve Area:  *0.6 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Normal LA size. Good (>20 cm/s) LAA ejection
velocity.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. Normal interatrial
septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size. Low
normal LVEF.

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

AORTA: Mildly dilated aortic sinus. Focal calcifications in
aortic root. Moderately dilated ascending aorta. Simple atheroma
in aortic arch. Mildly dilated descending aorta. Simple atheroma
in descending aorta.

AORTIC VALVE: Bicuspid aortic valve. Moderately thickened aortic
valve leaflets. Severe AS (AoVA <0.8cm2). Mild to moderate
([**11-22**]+) AR. AR may be underestimated. Eccentric AR jet directed
toward the anterior mitral leaflet.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR.

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
Physiologic (normal) PR.

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. Resting bradycardia
for the patient. See Conclusions for post-bypass data The
post-bypass study was performed while the patient was receiving
vasoactive infusions (see Conclusions for listing of
medications).
Conclusions
PRE-BYPASS:
1. The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler.
2. There is mild symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Overall left ventricular
systolic function is low normal (LVEF 50-55%).
3. Right ventricular chamber size and free wall motion are
normal.
4. The aortic root is mildly dilated at the sinus level. The
ascending aorta is moderately dilated. There are simple atheroma
in the aortic arch. The descending thoracic aorta is mildly
dilated. There are simple atheroma in the descending thoracic
aorta.
5. The aortic valve is bicuspid. The aortic valve leaflets are
moderately thickened. There is severe aortic valve stenosis
(area <0.8cm2). At least mild to moderate aortic regurgitation
is seen. The aortic regurgitation jet is eccentric, directed
toward the anterior mitral leaflet.
6. The mitral valve appears structurally normal with trivial
mitral regurgitation.

POST-BYPASS: During the post-bypass study, the patient was
initially AV paced and, later, A paced.
1. A well-seated bioprosthetic valve is seen in the aortic
position with normal leaflet motion and gradients (mean gradient
=12 mmHg, peak gradient = 16mmHg with CO 5.1L/min). Trace
valvular aortic regurgitation is seen.
2. Regional and global left ventricular systolic function is
normal.
3. Right ventricular systolic function is normal.
4. Trace Mitral Regurgitation and other valves are as noted
prebypass.
5. Aortic contours are intact post-decannulation.


Brief Hospital Course:
He was taken to the operating room on [**2170-2-21**] where he
underwent an AVR. He was transferred to the ICU in stable
condition. He was extubated later that same day. He was
transferred to the floor on POD #1.  He was seen by speech and
swallow for preoperative dysphagia. Video swallow showed no
aspiraton. He had atrial fibrillation and was started on
amiodarone, his PR interval lengthened and the amio was dc'd. He
did well postoperatively and he was ready for discharge home on
POD #5.

Medications on Admission:
asa 325', carvedilol 6.25'', chantix .5'', lipitor 40', protonix
40'.

Discharge Medications:
1. 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:*0*
2. 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*
3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*0*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 1 weeks.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA

Discharge Diagnosis:
AS/bicuspid AV s/p AVR
CAD s/p '[**65**] stent, ^lipid, htn, copd, gerd, childhood rheumatic
fever


Discharge Condition:
Good.


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.
No lifting more than 10 pounds for 10 weeks.
No driving until follow up with surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) **] 2 weeks
Dr. [**Last Name (STitle) 3302**] 2 weeks
Dr. [**Last Name (STitle) **] 4 weeks



Completed by:[**2170-2-26**]
{'Rheumatic aortic stenosis,Congenital insufficiency of aortic valve,Cardiac complications, not elsewhere classified,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux'}


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/fatigue

PRESENT ILLNESS: 62 yo M with history of AS which has been followed by serial
echo. Over the past 6 months his DOE has worsened and most
recent echo showed severe AS with a dilated ascending aorta. He
was referred for surgery.

MEDICAL HISTORY: CAD s/p '[**65**] stent, AS (bicuspid), ^lipid, htn, copd, gerd,
childhood rheumatic fever

MEDICATION ON ADMISSION: asa 325', carvedilol 6.25'', chantix .5'', lipitor 40', protonix
40'.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 86 RR 14 BP 152/70
NAD
Lungs CTAB
Heart RRR 4/6 SEM
Abdomen benign
Extrem arm, no edema
Mild anterior varicose veins
carotids with transmitted bruits

FAMILY HISTORY: sister with MI at age 37

SOCIAL HISTORY: retired
90 pack year smoking history Quit [**2169-11-21**]
1 etoh/week 

### Response:
{'Rheumatic aortic stenosis,Congenital insufficiency of aortic valve,Cardiac complications, not elsewhere classified,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux'}
