CHIEF COMPLAINT: worsening SOB

PRESENT ILLNESS: History of Present Illness:
This is a 65 year old female who complains of worsening
exertional dyspnea and fatigue over the last several months. She
underwent evaluation at outside institution, including
echocardiography, that showed severe aortic stenosis. She
recently saw Dr. [**Last Name (STitle) **] and underwent a repeat echocardiogram
that confirmed severe AS with [**Location (un) 109**] 0.9cm2. She presents today for
surgical evaluation. Currently she denies chest pain, syncopce,
pre-syncope, orthopnea, PND and pedal edema. She has mild
symptoms with routine ADLs.

MEDICAL HISTORY: - Aortic Stenosis, Calcified Ascending Aorta
- Hypertension
- Hyperlipidemia
- Emphysema and Pulmonary Nodules found on recent CT scan
- Diabetes mellitus type II
- Hiatal hernia with reflux
- Esophageal Stricture s/p dilitaton [**2137**]
- Overactive bladder
Past Surgical History
- Tonsillectomy
- Appendectomy
- Cesarean Section x 3

MEDICATION ON ADMISSION: Diovan 80 mg daily
Atorvastatin 40 mg daily
Aspirin 81 mg daily
HCTZ 25mg daily
Metformin 500mg twice daily
Omeprazole 20mg twice daily
Oxybutynin 5mg twice daily
Multivitamin

ALLERGIES: Penicillins / lisinopril / Shellfish / Sulfa (Sulfonamide
Antibiotics) / metal

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Family History: Denies premature coronary artery disease

SOCIAL HISTORY: Race: Originally from [**Country 12649**]
Last Dental Exam: 3 months ago
Lives with: Husband
Occupation: Retired
Cigarettes: 40+ PYH, quit 12 years ago
ETOH: < 1 drink/week [x] [**3-14**] drinks/week [] >8 drinks/week []
Illicit drug use: Denies
Aortic valve disorders,Unspecified pleural effusion,Atherosclerosis of aorta,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other emphysema,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux
Aortic valve disorder,Pleural effusion NOS,Aortic atherosclerosis,Hypertension NOS,Hyperlipidemia NEC/NOS,Emphysema NEC,DMII wo cmp nt st uncntr,Diaphragmatic hernia,Esophageal reflux
Admission Date:  [**2141-3-15**]              Discharge Date:   [**2141-3-20**]

Date of Birth:  [**2075-7-25**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / lisinopril / Shellfish / Sulfa (Sulfonamide
Antibiotics) / metal

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
worsening SOB

Major Surgical or Invasive Procedure:
1. Aortic valve replacement with a 21-mm On-X mechanical
    valve.  Reference number [**Serial Number 42227**], serial number [**Serial Number 42228**].
2. Replacement of ascending aorta and hemi arch with a 26-
    mm Vascutek Dacron tube graft using deep hypothermic
    circulatory arrest.  Graft data: Catalog number [**Numeric Identifier 42229**],
lot number [**Serial Number 42230**], serialnumber [**Serial Number 42231**].
3. Reconstruction of pericardium with Core Matrix product.
    Reference number [**Serial Number 42232**], lot number [**Serial Number 42233**].
4. Epiaortic duplex scanning.


History of Present Illness:
History of Present Illness:
This is a 65 year old female who complains of worsening
exertional dyspnea and fatigue over the last several months. She
underwent evaluation at outside institution, including
echocardiography, that showed severe aortic stenosis. She
recently saw Dr. [**Last Name (STitle) **] and underwent a repeat echocardiogram
that confirmed severe AS with [**Location (un) 109**] 0.9cm2. She presents today for
surgical evaluation. Currently she denies chest pain, syncopce,
pre-syncope, orthopnea, PND and pedal edema. She has mild
symptoms with routine ADLs.


Past Medical History:
- Aortic Stenosis, Calcified Ascending Aorta
- Hypertension
- Hyperlipidemia
- Emphysema and Pulmonary Nodules found on recent CT scan
- Diabetes mellitus type II
- Hiatal hernia with reflux
- Esophageal Stricture s/p dilitaton [**2137**]
- Overactive bladder
Past Surgical History
- Tonsillectomy
- Appendectomy
- Cesarean Section x 3


Social History:
Race: Originally from [**Country 12649**]
Last Dental Exam: 3 months ago
Lives with: Husband
Occupation: Retired
Cigarettes: 40+ PYH, quit 12 years ago
ETOH: < 1 drink/week [x] [**3-14**] drinks/week [] >8 drinks/week []
Illicit drug use: Denies


Family History:
Family History: Denies premature coronary artery disease


Physical Exam:
Physical Exam

Pulse: 92  Resp: 16  O2 sat: 99% room air
B/P  Right: 135/89   Left: 131/95
Height: 58 inches    Weight: 130 lbs

General: WDWN female in no acute distress
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck: Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x] Irregular [] Murmur [x] grade 4/6 SEM
Abdomen: Soft, non-distended, non-tender, bowel sounds +
Extremities: Warm [x], well-perfused [x]
Edema: None
Varicosities: Bilateral GSV appears suitable. Spider veins
noted.
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: 1  Left: 1
DP           Right: 1  Left: 1
PT           [**Name (NI) 167**]: 1  Left: 1
Radial       Right: 2  Left: 2
Carotid Bruit: transmitted murmur bilaterally


Pertinent Results:
[**2141-3-19**] 06:14AM BLOOD WBC-6.3 RBC-3.17* Hgb-9.6* Hct-28.2*
MCV-89 MCH-30.3 MCHC-34.1 RDW-14.7 Plt Ct-225
[**2141-3-20**] 05:51AM BLOOD PT-29.9* INR(PT)-2.9*
[**2141-3-20**] 05:51AM BLOOD UreaN-19 Creat-0.7 Na-133 K-4.0 Cl-101
[**2141-3-20**] 05:51AM BLOOD Mg-1.9

PA AND LATERAL CHEST, [**3-18**]


IMPRESSION: PA and lateral chest compared to [**3-15**] through
10:

Severe left lower lobe atelectasis has improved slightly, and
small left
pleural effusion has decreased. Less severe right lower lobe
atelectasis and
smaller right pleural effusion have remained relatively stable.
There is no
pneumothorax or pulmonary edema. Enlargement of the
postoperative cardiac
silhouette is what one would expect given the preoperative size,
and
unchanged. Right jugular line ends in the upper SVC.

[**3-16**] EKG: Sinus rhythm. Cannot exclude a prior inferior
myocardial infarction.
Poor R wave progression with precordial ST segment elevation.
Cannot exclude
myocardial injury. Clinical correlation is suggested. Compared
to the
previous tracing of [**2141-3-8**] there is loss of R wave in lead aVF.
Precordial
ST segment elevation is new.





Brief Hospital Course:
The patient was admitted to the hospital and brought to the
operating room on [**2141-3-15**] where the patient underwent aortic
valve replacement with a 21-mm On-X mechanical
valve, replacement of ascending aorta and hemi arch with a 26-
mm Vascutek Dacron tube graft using deep hypothermic circulatory
arrest and reconstruction of pericardium with Core Matrix
product.
Overall the patient tolerated the procedure well please see
intraop note for further deatails. She transferred to the CVICU
in stable condition for recovery and invasive monitoring. POD 1
found the patient extubated, alert and oriented and breathing
comfortably.  The patient was neurologically intact and
hemodynamically stable initially hypertensive but transitioned
off Nitro and Nicardipine to Beta blockers. She transferred to
the floor on POD #2. She was gently diuresed and remained stable
on the floor. Chest tubes and pacing wires were discontinued
without complication.  The patient was evaluated by the physical
therapy service for assistance with strength and mobility.  She
was started on anticoagulation and her INR was therapeutic at
discharge.Her PCP will manage her coumadin therapy. She was
ambulating freely, her wounds were healing and pain was
controlled with oral analgesics.  The patient was discharged to
home on POD#5 in good condition with appropriate follow up
instructions.

Medications on Admission:
Diovan 80 mg daily
Atorvastatin 40 mg daily
Aspirin 81 mg daily
HCTZ 25mg daily
Metformin 500mg twice daily
Omeprazole 20mg twice daily
Oxybutynin 5mg twice daily
Multivitamin


Discharge Medications:
1. oxybutynin chloride 5 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
6. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
7. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
Disp:*60 Tablet(s)* Refills:*2*
8. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
9. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
10. metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
11. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 10
days.
Disp:*10 Tablet(s)* Refills:*0*
12. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO twice a day for 10
days.
Disp:*20 Tablet, ER Particles/Crystals(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
1. Severe critical aortic stenosis.
2. Severely calcified ascending aorta.


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
+lower extremity edema


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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge


Followup Instructions:
*** CT scan in 6 months for f/u of LUL pulm. nodules****

Dr. [**Last Name (STitle) 914**] [**2141-4-17**] @ 1:30
Dr.[**Last Name (STitle) 5543**]  [**2141-4-13**] @ 3:20pm Dr.
[**Last Name (STitle) 409**] check [**3-28**] @ 10:30

Please call PCP for [**Name Initial (PRE) **]/u visit within 2 weeks [**0-0-**]

Coumadin therapy to be managed by PCP's office [**0-0-**]



Completed by:[**2141-3-20**]
{'Aortic valve disorders,Unspecified pleural effusion,Atherosclerosis of aorta,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other emphysema,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diaphragmatic hernia without mention of obstruction or gangrene,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: worsening SOB

PRESENT ILLNESS: History of Present Illness:
This is a 65 year old female who complains of worsening
exertional dyspnea and fatigue over the last several months. She
underwent evaluation at outside institution, including
echocardiography, that showed severe aortic stenosis. She
recently saw Dr. [**Last Name (STitle) **] and underwent a repeat echocardiogram
that confirmed severe AS with [**Location (un) 109**] 0.9cm2. She presents today for
surgical evaluation. Currently she denies chest pain, syncopce,
pre-syncope, orthopnea, PND and pedal edema. She has mild
symptoms with routine ADLs.

MEDICAL HISTORY: - Aortic Stenosis, Calcified Ascending Aorta
- Hypertension
- Hyperlipidemia
- Emphysema and Pulmonary Nodules found on recent CT scan
- Diabetes mellitus type II
- Hiatal hernia with reflux
- Esophageal Stricture s/p dilitaton [**2137**]
- Overactive bladder
Past Surgical History
- Tonsillectomy
- Appendectomy
- Cesarean Section x 3

MEDICATION ON ADMISSION: Diovan 80 mg daily
Atorvastatin 40 mg daily
Aspirin 81 mg daily
HCTZ 25mg daily
Metformin 500mg twice daily
Omeprazole 20mg twice daily
Oxybutynin 5mg twice daily
Multivitamin

ALLERGIES: Penicillins / lisinopril / Shellfish / Sulfa (Sulfonamide
Antibiotics) / metal

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Family History: Denies premature coronary artery disease

SOCIAL HISTORY: Race: Originally from [**Country 12649**]
Last Dental Exam: 3 months ago
Lives with: Husband
Occupation: Retired
Cigarettes: 40+ PYH, quit 12 years ago
ETOH: < 1 drink/week [x] [**3-14**] drinks/week [] >8 drinks/week []
Illicit drug use: Denies 

### Response:
{'Aortic valve disorders,Unspecified pleural effusion,Atherosclerosis of aorta,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other emphysema,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux'}
