CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 73 year-old
male with known history of aortic stenosis had progressive
exertional dyspnea over the last two years now accompanied by
chest pain.  Echo in [**2168**] and [**2169**] had showed an aortic
stenosis greater than approximately 70 mm of mercury with a
cross sectional valvular area of 0.8 cm squared.
Catheterization done in [**2170-10-29**] as well showing mild
to moderate aortic stenosis at a gradient of only 20 mm of
mercury.  Echo re-performed on [**2172-10-17**] showed a gradient
of 72 mm of mercury followed a [**2172-11-6**]
catheterization showing severe as well as right coronary
artery to be 78% diseased. There was LAD irregularities and a
circumflex lesion of 60%. There was also a cross section
valvular area of the area involved measured 0.6 cm squared.
The patient was therefore evaluated for aortic valve
replacement and coronary artery bypass graft.

MEDICAL HISTORY: Otherwise negative.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Negative for tobacco, rare ethanol ingestion.
Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified disease of pericardium,Unspecified acquired hypothyroidism,Anemia, unspecified
Aortic valve disorder,Crnry athrscl natve vssl,Acute kidney failure NOS,Surg compl-heart,Atrial fibrillation,Pericardial disease NOS,Hypothyroidism NOS,Anemia NOS
Admission Date:  [**2172-12-7**]       Discharge Date:  [**2172-12-14**]

Date of Birth:   [**2099-3-7**]       Sex:  M

Service:  CARDIOTHOR

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 73 year-old
male with known history of aortic stenosis had progressive
exertional dyspnea over the last two years now accompanied by
chest pain.  Echo in [**2168**] and [**2169**] had showed an aortic
stenosis greater than approximately 70 mm of mercury with a
cross sectional valvular area of 0.8 cm squared.
Catheterization done in [**2170-10-29**] as well showing mild
to moderate aortic stenosis at a gradient of only 20 mm of
mercury.  Echo re-performed on [**2172-10-17**] showed a gradient
of 72 mm of mercury followed a [**2172-11-6**]
catheterization showing severe as well as right coronary
artery to be 78% diseased. There was LAD irregularities and a
circumflex lesion of 60%. There was also a cross section
valvular area of the area involved measured 0.6 cm squared.
The patient was therefore evaluated for aortic valve
replacement and coronary artery bypass graft.

PAST MEDICAL HISTORY:  Otherwise negative.

SOCIAL HISTORY: Negative for tobacco, rare ethanol ingestion.

PHYSICAL EXAMINATION ON ADMISSION: Vital signs blood pressure
133/70, heart rate of 60, no acute distress. Trachea is
midline.  There was no carotid bruit. Heart had a III/VI
systolic murmur heard at the right sternal border.  The point
of maximal impulse was displaced laterally in the fifth
intercostal space. Lungs were clear to auscultation
bilaterally.  Lower extremities were non-edematous and
palpable pulses to dorsalis pedis and posterior tibialis.

LABORATORIES ON ADMISSION:  Hematocrit initially was 39, BUN
and creatinine 26 and 1.4 with BUN at baseline with normal
sufficiency.

EKG sinus rhythm with left ventricular hypertrophy.

Chest x-ray showed no acute cardiopulmonary disease.

HOSPITAL COURSE:  The patient went to the operating room and
underwent coronary artery bypass graft times four LIMA to LAD
saphenous vein graft diagonal saphenous and then sequential
to the obtuse marginal as well as saphenous vein graft to the
posterior descending artery as well as tissue valve aortic
valve repair.

He went to the ICU where postoperative day one he was
extubated.  His pressures were already weaned. Lasix and
aspirin were started due to some hypotension he was
transfused a unit of packed cells for a crit of 25.  His
Lopressor was held. He was ultimately transferred to the
floor and started on a regular diet.

Postoperative day one once he arrived on the floor he was
complaining of significant substernal chest pain.  EKG showed
ST elevations diffusely across the anterior leads as well as
PR depressions. Bedside echocardiogram showed no evidence of
wall motion abnormalities but he did have a rub on
auscultation.  It was felt that he was suffering from
pericarditis and was therefore started on hydrous ibuprofen
around the clock which subsequently palliated his pain.

Postoperative day two his creatinine was noted to be 2.7.  It
should also be noted on the evening of postoperative day one
going into postoperative day two he did have hypotension to
the 60s and 70s which was asymptomatic.  A combination of the
hypotension which was ultimately resuscitated fluid and blood
and the setting with the pericarditis being treated by
nonsteroidals it was felt that this was the etiology for his
acute renal failure.  A nephrology consultation was obtained.
They recommended to check the normal urine studies including
urine fenas and urine urinarias, stop the Ansaid, stop the
diuresis, transfuse blood as needed as well as stop anything
like Zantac or other interstitial nephritis inciting agents.
His renal function began to improve.

The following day after a transfusion on postoperative day
three his crit was 25. His BUN and creatinine were down to 51
and 1.5.  He was ambulating at this point although only at a
level two. He was having issues of shortness of breath.  His
chest x-ray at this time post chest tube removal just showed
markedly hypo-expanded lung fields. He was therefore given
more aggressive pulmonary toilet.  He had bursts of SVT with
atrial fibrillation. Therefore Amiodarone was started and he
had a load of beta blockers started back once his pressure
was over 100 systolic.

On postoperative day four he was in sinus rhythm. He was on
his Amiodarone and beta blockade.  His pressures were
climbing into the 120s.  His labs at this time showed a crit
of 26 and BUN and creatinine of 56 and 1.5. His was
ambulating a level four at this time.  He was therefore felt
appropriate for discharge and was being screened as such.

He had a temperature of 98.0 F, heart rate of 55, blood
pressure 178/77, respiratory rate of 20 and a room air
saturation of 93%.  His heart is without any click, no
murmur, regular rhythm. Lungs were decreased at the bases
bilaterally, no crackles.  Lower extremities were trace
edema, warm and well perfused with palpable pulses distally.
His discharge labs were as mentioned.

DISCHARGE STATUS:  To rehab.

DISCHARGE DIAGNOSIS:
1. Status post coronary artery bypass graft times four
including the LIMA to the LAD as well as saphenous vein graft
diagonal and in the oblique marginal sequentially in the
saphenous vein graft to the PDA with aortic tissue valve
repair not requiring anticoagulation.  The patient has a
history of coronary artery disease and unstable angina.
Additionally the patient has suffered postoperative acute
renal failure that has now improved and resolving. This was
non-oliguric and additional postoperative supraventricular
tachycardia as well as atrial fibrillation currently in sinus
rhythm and on Amiodarone therapy.

DISCHARGE MEDICATIONS:  Include
1.  Hydralazine 10 milligrams po q six.
2.  Lasix 20 milligrams po q day.
3.  Protonix 40 milligrams po q day.
4.  Amiodarone 400  mg po tid times seven days then change to
400 milligrams po bid times seven days then change to 400
milligrams po q day times 14 days and then stop.
5.  Percocet 5 325 one to two tablets po four to six prn.
6.  Synthroid 75 micrograms po q day.
7.  Lopressor 12.5 milligrams po bid.
8.  KCL 20 milliequivalents q day.
9.  Aspirin 325 milligrams po q day.
10. Lipitor 20 milligrams po q day.

DI[**Last Name (STitle) 408**]E INSTRUCTIONS: The patient will have follow up with
Dr. [**Last Name (Prefixes) **] in 30 days from discharge. Wound check in
seven days from discharge.  See his cardiologist or PCP in
three weeks from time of discharge.  No heavy lifting greater
than 10 lbs. times 30 days.  No driving times 30 days.  [**Month (only) 116**]
shower. Steri Strips stay intact will fall off on their own.



                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2172-12-14**]  11:21
T:  [**2172-12-14**]  11:26
JOB#:  [**Job Number 36922**]
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified disease of pericardium,Unspecified acquired hypothyroidism,Anemia, unspecified'}


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: Mr. [**Known lastname **] is a 73 year-old
male with known history of aortic stenosis had progressive
exertional dyspnea over the last two years now accompanied by
chest pain.  Echo in [**2168**] and [**2169**] had showed an aortic
stenosis greater than approximately 70 mm of mercury with a
cross sectional valvular area of 0.8 cm squared.
Catheterization done in [**2170-10-29**] as well showing mild
to moderate aortic stenosis at a gradient of only 20 mm of
mercury.  Echo re-performed on [**2172-10-17**] showed a gradient
of 72 mm of mercury followed a [**2172-11-6**]
catheterization showing severe as well as right coronary
artery to be 78% diseased. There was LAD irregularities and a
circumflex lesion of 60%. There was also a cross section
valvular area of the area involved measured 0.6 cm squared.
The patient was therefore evaluated for aortic valve
replacement and coronary artery bypass graft.

MEDICAL HISTORY: Otherwise negative.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Negative for tobacco, rare ethanol ingestion. 

### Response:
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified disease of pericardium,Unspecified acquired hypothyroidism,Anemia, unspecified'}
