CHIEF COMPLAINT: The patient presented for aortic
valvuloplasty.

PRESENT ILLNESS: The patient is an 89 year old
female with a history of aortic stenosis, who presented
recently with complaints consistent with congestive heart
failure, which included shortness of breath and increasing
lower extremity edema.  Cardiac catheterization revealed an
aortic valve peak gradient of 80 with estimated valve surface
area of 0.5 cm2 and severely elevated filling pressures with
prominent V waves.  Cardiac catheterization showed 30% ostial
left circumflex lesion with mild left anterior descending
artery and right coronary artery luminal irregularities.
Left ventriculogram showed a left ventricular ejection
fraction of 60%, 3+ mitral regurgitation and normal wall
motion.

MEDICAL HISTORY: 1.  Congestive heart failure.
2.  Atrial fibrillation.
3.  Severe aortic stenosis.
4.  Severe mitral regurgitation.
5.  Hypertension.
6.  Family history of coronary artery disease.
7.  Polymyalgia rheumatica.
8.  Osteoporosis.
9.  Bleeding colonic polyps.
10. Pseudogout.
11. Status post cholecystectomy.
12. Status post cystectomy with stoma.
13. History of gastrointestinal bleed, polyps versus aspirin
induced.

MEDICATION ON ADMISSION: Coumadin 1 mg p.o.q.h.s., Lasix 40
mg p.o.q.d., Lopressor 12.5 mg p.o.b.i.d., ferrous sulfate
325 mg p.o.q.d., Os-Cal p.o.q.d., Protonix 40 mg p.o.q.d.,
Prednisone 5 mg p.o.q.d., trazodone 50 mg p.o.q.h.s.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Osteoporosis, unspecified,Polymyalgia rheumatica,Other left bundle branch block,Unspecified essential hypertension
Mitral insuf/aort stenos,Rheumatic heart failure,Atrial fibrillation,Crnry athrscl natve vssl,Osteoporosis NOS,Polymyalgia rheumatica,Left bb block NEC,Hypertension NOS
Admission Date:  [**2130-5-22**]     Discharge Date:  [**2130-5-25**]


Service:  CCU

CHIEF COMPLAINT:  The patient presented for aortic
valvuloplasty.

HISTORY OF PRESENT ILLNESS:  The patient is an 89 year old
female with a history of aortic stenosis, who presented
recently with complaints consistent with congestive heart
failure, which included shortness of breath and increasing
lower extremity edema.  Cardiac catheterization revealed an
aortic valve peak gradient of 80 with estimated valve surface
area of 0.5 cm2 and severely elevated filling pressures with
prominent V waves.  Cardiac catheterization showed 30% ostial
left circumflex lesion with mild left anterior descending
artery and right coronary artery luminal irregularities.
Left ventriculogram showed a left ventricular ejection
fraction of 60%, 3+ mitral regurgitation and normal wall
motion.

The patient underwent scheduled aortic valvuloplasty on day
one of this admission, which showed a peak gradient of 60 mm
of mercury and a valve area of 0.4 cm2.  After valvuloplasty
the gradient was reduced to 30 mm of mercury and the valve
surface area increased to 0.6 cm2.  A new left bundle branch
block was noted on a post intervention electrocardiogram with
a heart rate of 75.

The patient was then taken back to the catheterization
laboratory for placement of a temporary ventricular pacing
wire.  A repeat electrocardiogram after this procedure showed
atrial fibrillation without left bundle branch block.  The
atrial fibrillation is chronic.  There were no pacer spikes
on this tracing.  The patient's pulmonary artery pressure was
61/22 with a mean of 40.  At this point, the patient was
transferred to the Coronary Care Unit for 24 hours of
observation.

PAST MEDICAL HISTORY:
1.  Congestive heart failure.
2.  Atrial fibrillation.
3.  Severe aortic stenosis.
4.  Severe mitral regurgitation.
5.  Hypertension.
6.  Family history of coronary artery disease.
7.  Polymyalgia rheumatica.
8.  Osteoporosis.
9.  Bleeding colonic polyps.
10. Pseudogout.
11. Status post cholecystectomy.
12. Status post cystectomy with stoma.
13. History of gastrointestinal bleed, polyps versus aspirin
induced.

MEDICATIONS ON ADMISSION:  Coumadin 1 mg p.o.q.h.s., Lasix 40
mg p.o.q.d., Lopressor 12.5 mg p.o.b.i.d., ferrous sulfate
325 mg p.o.q.d., Os-Cal p.o.q.d., Protonix 40 mg p.o.q.d.,
Prednisone 5 mg p.o.q.d., trazodone 50 mg p.o.q.h.s.

ALLERGIES:  The patient has no known drug allergies.

PHYSICAL EXAMINATION:  On physical examination on transfer to
the Coronary Care Unit, the patient had a pulse of 66,
respiratory rate 24, blood pressure 108/49 and oxygen
saturation 100% on two liters nasal cannula.  Neurologic
examination:  No focal neurological deficits, alert and
oriented times three.  Cardiovascular:  Irregular heart rate,
IV/VI harsh crescendo-decrescendo systolic murmur, mild
pitting pretibial edema.  Pulmonary:  Lungs clear to
auscultation bilaterally with bibasilar crackles.  Abdomen:
Soft, nontender, nondistended.  Extremities:  Temporary
pacing wire in right groin.

PERTINENT LABORATORY DATA:  Hematocrit 31.4, creatinine 1,
and INR 1.2.

HOSPITAL COURSE:  After transfer to the Coronary Care Unit,
the patient did not develop further conduction problems.
Several times she had brief bursts of a rapid atrial
fibrillation, which spontaneously resolved on their own.  Her
Coumadin was held for the procedure and it was restarted,
along with subcutaneous heparin 5,000 units twice a day until
the INR is therapeutic.  The patient tolerated the procedure
well and there were no complications.

The patient was to be discharged on [**2130-5-24**], but had a
low grade temperature of 100.1 in the morning and stated that
she did not feel well, more specifically that she was a
little bit dizzy.  Blood cultures were obtained, a chest
x-ray was obtained and the patient was held for a further 24
hours for observation.  On the morning of discharge, her
symptoms of dizziness had resolved.  She had no further
temperature spikes, with blood cultures showing no growth at
the time of discharge and a chest x-ray showing mild
congestive heart failure.

DISCHARGE STATUS:  The patient is stable for discharge home
with VNA services.  She will receive subcutaneous heparin
injections 5,000 units twice a day until her INR is
therapeutic.

FOLLOW-UP:  The patient will follow up Monday at the [**Hospital 197**]
Clinic for an INR check and Coumadin adjustment.  She will
follow up in two to three weeks with Dr. [**Last Name (STitle) **].  Since she
was having bursts of atrial fibrillation with rapid
ventricular response on her current Lopressor dose, she may
need an increase in the dose of this medication.  Because of
problems with bradycardia in the past, she may require a
pacer in order for this to happen.

DISCHARGE DIAGNOSIS:
1.  Critical aortic stenosis, status post valvuloplasty.
2.  Atrial fibrillation.

DISCHARGE MEDICATIONS:
Heparin 5,000 units s.c.q.12h. until INR therapeutic.
Coumadin 1 mg p.o.q.h.s.
Aspirin 325 mg p.o.q.d.
Lasix 40 mg p.o.q.d.
Ferrous sulfate 325 mg p.o.q.d.
Protonix 40 mg p.o.q.d.
Metoprolol 12.5 mg p.o.b.i.d.
Prednisone 5 mg p.o.q.d.
Trazodone 50 mg p.o.q.h.s.p.r.n.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1544**], M.D.  [**MD Number(1) 1545**]

Dictated By:[**Last Name (NamePattern1) 2582**]

MEDQUIST36

D:  [**2130-5-25**]  11:59
T:  [**2130-5-29**]  19:37
JOB#:  [**Job Number 99107**]
{'Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Osteoporosis, unspecified,Polymyalgia rheumatica,Other left bundle branch block,Unspecified essential hypertension'}


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: The patient presented for aortic
valvuloplasty.

PRESENT ILLNESS: The patient is an 89 year old
female with a history of aortic stenosis, who presented
recently with complaints consistent with congestive heart
failure, which included shortness of breath and increasing
lower extremity edema.  Cardiac catheterization revealed an
aortic valve peak gradient of 80 with estimated valve surface
area of 0.5 cm2 and severely elevated filling pressures with
prominent V waves.  Cardiac catheterization showed 30% ostial
left circumflex lesion with mild left anterior descending
artery and right coronary artery luminal irregularities.
Left ventriculogram showed a left ventricular ejection
fraction of 60%, 3+ mitral regurgitation and normal wall
motion.

MEDICAL HISTORY: 1.  Congestive heart failure.
2.  Atrial fibrillation.
3.  Severe aortic stenosis.
4.  Severe mitral regurgitation.
5.  Hypertension.
6.  Family history of coronary artery disease.
7.  Polymyalgia rheumatica.
8.  Osteoporosis.
9.  Bleeding colonic polyps.
10. Pseudogout.
11. Status post cholecystectomy.
12. Status post cystectomy with stoma.
13. History of gastrointestinal bleed, polyps versus aspirin
induced.

MEDICATION ON ADMISSION: Coumadin 1 mg p.o.q.h.s., Lasix 40
mg p.o.q.d., Lopressor 12.5 mg p.o.b.i.d., ferrous sulfate
325 mg p.o.q.d., Os-Cal p.o.q.d., Protonix 40 mg p.o.q.d.,
Prednisone 5 mg p.o.q.d., trazodone 50 mg p.o.q.h.s.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Osteoporosis, unspecified,Polymyalgia rheumatica,Other left bundle branch block,Unspecified essential hypertension'}
