CHIEF COMPLAINT: Exertional dyspnea

PRESENT ILLNESS: Mr. [**Known lastname **] is a 77yo male with known aortic stenosis and
coronary artery disease. He has been followed with serial
echocardiograms which have shown progression of his aortic valve
disease. Over the last year to six months, he
has developed slight exertional dyspnea most notable on his one
mile walk, which he does routinely as well as taking out the
trash barrels subtle but a change. Dr [**Last Name (STitle) 914**] was consulted for
surgical evaluation

MEDICAL HISTORY: Past Medical History
- Aortic Stenosis
- Coronary Artery Disease
- Dyslipidemia
- Hypertension
- Prior CVA, affecting left eye ( 10 yrs ago)
- Carotid Disease, Right ICA
- L subclavian steal
- Left Renal Artery Stent
- Chronic Renal Insufficiency, baseline Cr around 2.0
- Rheumatoid Arthritis
- Macular Degeneration ( legally blind)
- Cognitive Impairment, progressive memory loss
- History of Mesenteric artery insufficiency
- Cataracts
- Anemia
Past Surgical History:
-tonsillectomy
-R cataract [**Doctor First Name **]

MEDICATION ON ADMISSION: ATENOLOL 25mg daily,
CALCITRIOL 0.25 mwf,
Hctz 25mg,
MELOXICAM 7.5mg daily,
METHOTREXATE 5mg WEEKLY,
NIFEDIPINE 60mg daily,
SIMVASTATIN 40mg daily,
VALSARTAN 80mg daily,
ASA 325mg daily

ALLERGIES: Demerol

PHYSICAL EXAM: Admission
Pulse: 60 Resp:16  O2 sat:  98%
B/P  Right:124/54    Left: 96/55
Height: 67"    Weight:150#

FAMILY HISTORY: Pt reports that his father had heart problems, but unsure what
kind as died when pt was 9 at age 60.  [**Name (NI) 1094**] sister had a valve
replaced at age 81, but died at age 82 from colon cancer.  [**Name (NI) 1094**]
brother also had rhematic fever when he was a child, but died of
alcoholism related causes.

SOCIAL HISTORY: -Tobacco history:  quit 45 yrs ago, used to smoke 1PPD x 25 yrs
-ETOH:  drinks 4-6 beers on wknd
-Illicit drugs:  denies
Aortic valve disorders,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Rheumatoid arthritis,Legal blindness, as defined in U.S.A.
Aortic valve disorder,Thrombocytopenia NOS,Hy kid NOS w cr kid I-IV,Atrial fibrillation,Chronic kidney dis NOS,Hyperlipidemia NEC/NOS,Status-post ptca,Rheumatoid arthritis,Legal blindness-usa def
Admission Date:  [**2176-3-19**]              Discharge Date:   [**2176-3-25**]

Date of Birth:  [**2098-7-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Demerol

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Exertional dyspnea

Major Surgical or Invasive Procedure:
[**2176-3-19**]
1. Aortic valve replacement with a 27-mm [**Company 1543**] Ultra
    Aortic Valve Bioprosthesis.
2. Epiaortic duplex scanning.


History of Present Illness:
Mr. [**Known lastname **] is a 77yo male with known aortic stenosis and
coronary artery disease. He has been followed with serial
echocardiograms which have shown progression of his aortic valve
disease. Over the last year to six months, he
has developed slight exertional dyspnea most notable on his one
mile walk, which he does routinely as well as taking out the
trash barrels subtle but a change. Dr [**Last Name (STitle) 914**] was consulted for
surgical evaluation

Past Medical History:
Past Medical History
- Aortic Stenosis
- Coronary Artery Disease
- Dyslipidemia
- Hypertension
- Prior CVA, affecting left eye ( 10 yrs ago)
- Carotid Disease, Right ICA
- L subclavian steal
- Left Renal Artery Stent
- Chronic Renal Insufficiency, baseline Cr around 2.0
- Rheumatoid Arthritis
- Macular Degeneration ( legally blind)
- Cognitive Impairment, progressive memory loss
- History of Mesenteric artery insufficiency
- Cataracts
- Anemia
Past Surgical History:
-tonsillectomy
-R cataract [**Doctor First Name **]


Social History:
-Tobacco history:  quit 45 yrs ago, used to smoke 1PPD x 25 yrs
-ETOH:  drinks 4-6 beers on wknd
-Illicit drugs:  denies



Family History:
Pt reports that his father had heart problems, but unsure what
kind as died when pt was 9 at age 60.  [**Name (NI) 1094**] sister had a valve
replaced at age 81, but died at age 82 from colon cancer.  [**Name (NI) 1094**]
brother also had rhematic fever when he was a child, but died of
alcoholism related causes.

Physical Exam:
Admission
Pulse: 60 Resp:16  O2 sat:  98%
B/P  Right:124/54    Left: 96/55
Height: 67"    Weight:150#

General: NAD, takes time to formulate his sentences
Skin: Dry [x] intact [x]dry rash B hands and L forearm
HEENT: PERRLA [x] EOMI [x]injected sclera B; OP unremarkable
Neck:  Supple [x] Full ROM []no JVd appreciated
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular []  Murmur [x] grade [**6-16**] harsh systolic
that radiates to B carotids
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
no HSM; mild dry rash B groins
Extremities: Warm [x] well-perfused [x]  Edema []none
Varicosities: None [x]; mild rubor B hands with deformity of
digits
Neuro: Grossly intact , nonfocal exam, MAE [**6-15**] strengths; mild
memory loss
Pulses:
Femoral      Right: 2+  Left:2+
DP           Right: 1+  Left:1+
PT           [**Name (NI) 167**]: 1+  Left:1+
Radial       Right: 2+  Left:1+

Carotid Bruit:      murmur radiates loudly to B carotids

Discharge
 99.1  75SR  137/66  20  97%-RA
Gen NAD
CV RRR, no murmur. Sternum stable, incision CDI
Pulm CTA-bilat
Abdm soft, NT/ND/NABS
Ext warm, well perfused, trace edema

Pertinent Results:
Admission labs
[**2176-3-19**] 08:10AM   HGB-11.5* calcHCT-35
[**2176-3-19**] 08:10AM   GLUCOSE-97 LACTATE-1.7 NA+-140 K+-4.1 CL--106
[**2176-3-19**] 01:30PM   UREA N-28* CREAT-1.6* SODIUM-142
POTASSIUM-4.6 CHLORIDE-113* TOTAL CO2-23 ANION GAP-11
[**2176-3-19**] 01:30PM   WBC-13.7*# RBC-3.33* HGB-11.1* HCT-32.4*
MCV-98 MCH-33.5* MCHC-34.3 RDW-15.3
[**2176-3-19**] 01:30PM   PLT COUNT-101*
[**2176-3-19**] 01:30PM   PT-11.9 PTT-29.7 INR(PT)-1.1
Discharge labs
[**2176-3-25**] 04:30AM BLOOD WBC-7.9 RBC-3.11* Hgb-10.1* Hct-31.1*
MCV-100* MCH-32.4* MCHC-32.3 RDW-15.5 Plt Ct-176#
[**2176-3-25**] 04:30AM BLOOD Plt Ct-176#
[**2176-3-25**] 04:30AM BLOOD PT-28.5* INR(PT)-2.7*
[**2176-3-24**] 05:40AM BLOOD PT-35.3* INR(PT)-3.4*
[**2176-3-23**] 06:20AM BLOOD PT-16.8* INR(PT)-1.6*
[**2176-3-25**] 04:30AM BLOOD UreaN-30* Creat-1.7* Na-137 K-4.1 Cl-96
[**2176-3-25**] 04:30AM BLOOD Mg-2.0

Radiology Report CHEST (PA & LAT) Study Date of [**2176-3-24**] 5:34 PM

Preliminary Report Small bilateral pleural effusions are
smaller. Lungs are clear. Heart size normal. Thoracic aorta
generally large but not focally dilated. Slight misalignment of
the lower four sternal wires with respect to the upper three has
been a constant feature since surgery. The wires are intact and
there has been no interval displacement. No pneumothorax.
DR. [**Last Name (STitle) 3889**] [**Name (STitle) 3890**]
DR. [**Known firstname **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  4.0 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  4.0 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  *1.3 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.3 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.8 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Ascending:  *3.7 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  *3.9 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *59 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  35 mm Hg
Aortic Valve - LVOT diam:  1.9 cm
Aortic Valve - Valve Area:  *0.6 cm2  >= 3.0 cm2
Findings
LEFT ATRIUM: Normal LA size. No spontaneous echo contrast or
thrombus in the LA/LAA or the RA/RAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or
color Doppler.
LEFT VENTRICLE: Mild symmetric LVH with normal cavity size and
regional/global systolic function (LVEF>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal aortic diameter at the sinus level. Simple
atheroma in aortic root. Focal calcifications in aortic root.
Normal ascending aorta diameter. Focal calcifications in
ascending aorta. Normal aortic arch diameter.
AORTIC VALVE: Severely thickened/deformed aortic valve leaflets.
Critical AS (area <0.8cm2). Mild (1+) AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.
PERICARDIUM: No pericardial effusion.
GENERAL COMMENTS: Written informed consent was obtained from the
patient. The patient was under general anesthesia throughout the
procedure. No TEE related complications. The patient appears to
be in sinus rhythm. Results were personally reviewed with the MD
caring for the patient. See Conclusions for post-bypass data
Conclusions
PRE-BYPASS:
The left atrium is normal in size. No spontaneous echo contrast
or thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler.
There is mild symmetric left ventricular hypertrophy with normal
cavity size and regional/global systolic function (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the aortic root.
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 mildly thickened. Mild (1+) mitral
regurgitation is seen.
There is no pericardial effusion.
Dr. [**Last Name (STitle) 914**] was notified in person of the results before
surgical incision..
POST-BYPASS:
Preserved biventricular systolic function.
LVEF 55%.
Intact thoracic aorta.
The aortic valve bioprosthesis is stable, functioning well with
a residual mean gradient of 3 mm of Hg.
Mild MR.
Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2176-3-19**] 12:35

Brief Hospital Course:
Mr [**Known lastname **] was a same day admission to the operating room for
aortic valve replacement with Dr [**Last Name (STitle) 914**]. Please see the
operative report for details, in summary he had:
1. Aortic valve replacement with a 27-mm [**Company 1543**] Ultra Aortic
Valve Bioprosthesis.
2. Epiaortic duplex scanning.
His CARDIOPULMONARY BYPASS TIME was 108 minutes, with a
CROSS-CLAMP TIME of 90 minutes. He tolerated the operation well
and was transferred post-operatively to the cardiac surgery ICU
in stable condition.
He remained hemodynamically stable in the immediate post-op
period, woke neeurologically intact and was extubated. He
remained hemodynamically stable throughout the operative day and
on POD1 was transferred to the stepdown floor for continued
post-operative care. He was noted to have several bursts of
atrial fibrillation for which he was started on BBlockers,
amiodarone and anticoagulation. All tubes lines and drains were
removed per cardiac surgery protocol. Once on the floor he had
an umeventful post-op course. He worked with nursin and physical
therapy to increase his strength and endurance and by POD6 was
ready for discharge home with a visiting nurse. He is to follow
up with Dr [**Last Name (STitle) 914**] in 1 month . Dr [**First Name (STitle) 1022**] will follow INR and dose
Coumadin.


Medications on Admission:
ATENOLOL 25mg daily,
CALCITRIOL 0.25 mwf,
Hctz 25mg,
MELOXICAM 7.5mg daily,
METHOTREXATE 5mg WEEKLY,
NIFEDIPINE 60mg daily,
SIMVASTATIN 40mg daily,
VALSARTAN 80mg daily,
ASA 325mg daily

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:*2*
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain/fever.
3. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO once a day for 10 days.
Disp:*20 Tablet Extended Release(s)* Refills:*0*
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*2*
7. amiodarone 200 mg Tablet Sig: One (1) Tablet PO twice a day:
200mg [**Hospital1 **] x7days then 200mg QD.
Disp:*40 Tablet(s)* Refills:*1*
8. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
10. warfarin 2 mg Tablet Sig: as directed by Dr [**First Name (STitle) 1022**] Tablet PO
once a day: titrate to keep INR 2-2.5.
Patient to take 1mg on [**3-25**].
Disp:*45 Tablet(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 3894**] Health VNA

Discharge Diagnosis:
s/p AVR-tissue
Past Medical History
- Aortic Stenosis
- Coronary Artery Disease
- Dyslipidemia
- Hypertension
- Prior CVA, affecting left eye ( 10 yrs ago)
- Carotid Disease, Right ICA
- L subclavian steal
- Left Renal Artery Stent
- Chronic Renal Insufficiency, baseline Cr around 2.0
- Rheumatoid Arthritis
- Macular Degeneration ( legally blind)
- Cognitive Impairment, progressive memory loss
- History of Mesenteric artery insufficiency
- Cataracts
- Anemia
Past Surgical History:
-tonsillectomy
-R cataract [**Doctor First Name **]


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with Percocet
Incisions:
Sternal - healing well, no erythema or drainage
Edema: trace bilat LE


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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 one month or while taking narcotics. Driving will
be discussed at follow up appointment with surgeon.
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**


Followup Instructions:
You are scheduled for the following appointments
Surgeon:[**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**] :[**2176-4-22**] @1:15PM
Cardiologist:[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2176-4-25**] 11:40A

Please call to schedule appointments with your
Primary Care Dr.[**First Name (STitle) **],[**Last Name (un) 3895**] [**Doctor First Name 3896**] [**Telephone/Fax (1) 719**] in [**5-16**] weeks

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

Labs: PT/INR for Coumadin ?????? indication Atrial Fibrillation
Goal INR 2-2.5
First draw [**3-26**]
Results to phone [**Doctor Last Name **],[**Last Name (un) 3895**] [**Doctor First Name 3896**] [**Telephone/Fax (1) 719**] fax [**Telephone/Fax (1) 3897**]



Completed by:[**2176-3-25**]
{'Aortic valve disorders,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Rheumatoid arthritis,Legal blindness, as defined in U.S.A.'}


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: Exertional dyspnea

PRESENT ILLNESS: Mr. [**Known lastname **] is a 77yo male with known aortic stenosis and
coronary artery disease. He has been followed with serial
echocardiograms which have shown progression of his aortic valve
disease. Over the last year to six months, he
has developed slight exertional dyspnea most notable on his one
mile walk, which he does routinely as well as taking out the
trash barrels subtle but a change. Dr [**Last Name (STitle) 914**] was consulted for
surgical evaluation

MEDICAL HISTORY: Past Medical History
- Aortic Stenosis
- Coronary Artery Disease
- Dyslipidemia
- Hypertension
- Prior CVA, affecting left eye ( 10 yrs ago)
- Carotid Disease, Right ICA
- L subclavian steal
- Left Renal Artery Stent
- Chronic Renal Insufficiency, baseline Cr around 2.0
- Rheumatoid Arthritis
- Macular Degeneration ( legally blind)
- Cognitive Impairment, progressive memory loss
- History of Mesenteric artery insufficiency
- Cataracts
- Anemia
Past Surgical History:
-tonsillectomy
-R cataract [**Doctor First Name **]

MEDICATION ON ADMISSION: ATENOLOL 25mg daily,
CALCITRIOL 0.25 mwf,
Hctz 25mg,
MELOXICAM 7.5mg daily,
METHOTREXATE 5mg WEEKLY,
NIFEDIPINE 60mg daily,
SIMVASTATIN 40mg daily,
VALSARTAN 80mg daily,
ASA 325mg daily

ALLERGIES: Demerol

PHYSICAL EXAM: Admission
Pulse: 60 Resp:16  O2 sat:  98%
B/P  Right:124/54    Left: 96/55
Height: 67"    Weight:150#

FAMILY HISTORY: Pt reports that his father had heart problems, but unsure what
kind as died when pt was 9 at age 60.  [**Name (NI) 1094**] sister had a valve
replaced at age 81, but died at age 82 from colon cancer.  [**Name (NI) 1094**]
brother also had rhematic fever when he was a child, but died of
alcoholism related causes.

SOCIAL HISTORY: -Tobacco history:  quit 45 yrs ago, used to smoke 1PPD x 25 yrs
-ETOH:  drinks 4-6 beers on wknd
-Illicit drugs:  denies 

### Response:
{'Aortic valve disorders,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Rheumatoid arthritis,Legal blindness, as defined in U.S.A.'}
