CHIEF COMPLAINT: Weakness and fatigue

PRESENT ILLNESS: 86 year old male with history of
atrial fibrillation and aortic stenosis ([**Location (un) 109**] 1 on Cardiac
catheterization). Over the past 24 hours he presented to outside
hospital with complaint of chest pain, fatique, weakness and
mild
upper back pain. EKG with chronic ST segment changes,inferior
infarct, anterior ST changes, troponin 0.4.  His hematocrit was
found to be 17 and he was transfused with 2 units PRBC.
Additionally INR was elevated 5.7 related to coumadin for atrial
fibrillation and was treated 2 units FFP and Vitamin K 10mg po.
Due to recurrent chest pain he was transferred for further
evaluation due to known coronary artery disease and aortic
stenosis.  He was seen by cardiac surgery in [**Month (only) **] in evaluation
for cardiac surgery however declined surgery.

MEDICAL HISTORY: Hard of hearing
Rate Controlled Atrial fibrillation- on Coumadin previously
Coumadin discontinued due to GI bleed
Aortic valve disorder ([**Location (un) 109**] 1)
Arthritis
Anemia recieves IV Iron
Gastroesophageal reflux disease
Colon cancer s/p colon resection
Prostate cancer s/p radioactive seed implant

MEDICATION ON ADMISSION: Doxazosin 8 mg daily
Lasix 80 mg daily
Hydroxyurea 1000 mg wednesday and saturday
Prilosec 20 mg daily
Coumadin 5 mg mon-wed-fri-sun, 2.5 mg tues-thrus-sat - last dose

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:80's irreg, Resp: 14 O2 sat: 2l 98%
B/P  Right: 108/52   Left: 109/54
Height: 5'[**52**]"    Weight: 80.4kg

FAMILY HISTORY: None

SOCIAL HISTORY: Lives with: widowed, lives with daughter, [**Name (NI) 5627**]
Occupation:Retired
Tobacco: none- quit [**2113**]
ETOH: [**2-10**]+ beers/day
Coronary atherosclerosis of native coronary artery,Acute posthemorrhagic anemia,Aortic valve disorders,Atrial fibrillation,Long-term (current) use of anticoagulants,Esophageal reflux,Personal history of malignant neoplasm of large intestine,Personal history of malignant neoplasm of prostate,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Crnry athrscl natve vssl,Ac posthemorrhag anemia,Aortic valve disorder,Atrial fibrillation,Long-term use anticoagul,Esophageal reflux,Hx of colonic malignancy,Hx-prostatic malignancy,Abn react-anastom/graft
Admission Date:  [**2154-7-5**]              Discharge Date:   [**2154-7-12**]


Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Weakness and fatigue

Major Surgical or Invasive Procedure:
[**2154-7-5**] - 1. Aortic valve replacement (21-mm St. [**Hospital 923**] Medical
Biocor tissue valve). 2. Coronary artery bypass grafting x3 --
left internal mammary artery graft to left anterior descending
and reversed saphenous vein graft to the marginal branch and the
terminal circumflex coronary artery.


History of Present Illness:
86 year old male with history of
atrial fibrillation and aortic stenosis ([**Location (un) 109**] 1 on Cardiac
catheterization). Over the past 24 hours he presented to outside
hospital with complaint of chest pain, fatique, weakness and
mild
upper back pain. EKG with chronic ST segment changes,inferior
infarct, anterior ST changes, troponin 0.4.  His hematocrit was
found to be 17 and he was transfused with 2 units PRBC.
Additionally INR was elevated 5.7 related to coumadin for atrial
fibrillation and was treated 2 units FFP and Vitamin K 10mg po.
Due to recurrent chest pain he was transferred for further
evaluation due to known coronary artery disease and aortic
stenosis.  He was seen by cardiac surgery in [**Month (only) **] in evaluation
for cardiac surgery however declined surgery.


Past Medical History:
Hard of hearing
Rate Controlled Atrial fibrillation- on Coumadin previously
Coumadin discontinued due to GI bleed
Aortic valve disorder ([**Location (un) 109**] 1)
Arthritis
Anemia recieves IV Iron
Gastroesophageal reflux disease
Colon cancer s/p colon resection
Prostate cancer s/p radioactive seed implant

Social History:
Lives with: widowed, lives with daughter, [**Name (NI) 5627**]
Occupation:Retired
Tobacco: none- quit [**2113**]
ETOH: [**2-10**]+ beers/day


Family History:
None

Physical Exam:
Pulse:80's irreg, Resp: 14 O2 sat: 2l 98%
B/P  Right: 108/52   Left: 109/54
Height: 5'[**52**]"    Weight: 80.4kg

General: Hard of hearing, sitting up in chair no acute distress
denies any pain
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular [x]  Murmur [**2-10**] syst.
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] well healed mid-line scar s/p partial colectomy
Extremities: Warm [x], well-perfused [x]
Edema- none
Varicosities- minimal
Neuro: alert and oriented x3 nonfocal
Pulses:
Femoral      Right: 2+  Left:2+
DP           Right: 1+  Left:1+
PT           [**Name (NI) 167**]: Doppler  Left:doppler
Radial       Right: 2+  Left:2+

Carotid Bruit        Right: None   Left:None


Pertinent Results:
[**2154-7-5**] ECHO
PRE-CPB:
The left atrium is mildly dilated. Mild spontaneous echo
contrast is present in the left atrial appendage. The left
atrial appendage emptying velocity is depressed (<0.2m/s). A
left atrial appendage thrombus cannot be excluded. A patent
foramen ovale is present. A left-to-right shunt across the
interatrial septum is seen at rest.

Left ventricular wall thicknesses are normal. The left
ventricular cavity is moderately dilated. Overall left
ventricular systolic function is moderately depressed (LVEF= 35
%). Hypokinesis is most notable in the inferior and inferoseptal
segments. The mid-inferior wall segment also appears thinned.
Right ventricular chamber size and free wall motion are normal.

There are complex (>4mm) atheroma in the descending thoracic
aorta. No thoracic aortic dissection is seen.

There are three aortic valve leaflets. The aortic valve leaflets
are severely thickened/deformed. The left coronary cusp appears
to be the only one with good mobility. There is severe aortic
valve stenosis (valve area 0.8-1.0cm2). Mild (1+) aortic
regurgitation is seen.

The mitral valve leaflets are mildly thickened. [**Month/Day/Year **] (2+)
mitral regurgitation is seen. There is a central and an
eccentric component. Due to the eccentric nature of the
regurgitant jet, its severity may be significantly
underestimated (Coanda effect).

[**Month/Day/Year **] [2+] tricuspid regurgitation is seen.

POST-CPB:
A bioprosthetic valve is seen in the aortic position. The valve
appears well-seated with normal leaflet mobility. No
paravalvular leaks are seen. There is no AI. The peak gradient
across the aortic valve is 25mmHg, the mean gradient is 14mmHg
with CO of 4.

The MR [**First Name (Titles) 19947**] [**Last Name (Titles) 1192**] with an eccentric component. The TR
appears mild to [**Last Name (Titles) 1192**].

The LV systolic function appears similar to pre-op with
estimated EF = 35% on phenylephrine infusion only. Same regional
wall motion pattern is noted as preop.

There is no evidence of aortic dissection.

[**2154-7-12**] 04:23AM BLOOD WBC-11.8* RBC-3.30* Hgb-10.3* Hct-29.4*
MCV-89 MCH-31.4 MCHC-35.1* RDW-16.3* Plt Ct-234
[**2154-7-12**] 04:23AM BLOOD UreaN-32* Creat-1.0 Na-135 K-3.5 Cl-101
[**2154-7-11**] 04:30AM BLOOD Glucose-95 UreaN-34* Creat-0.9 Na-133
K-3.3 Cl-99 HCO3-23 AnGap-14

Brief Hospital Course:
Mr. [**Known lastname 5239**] was admitted to the [**Hospital1 18**] on [**2154-7-5**] for surgical
management of his cardiac disease. He was taken directly to the
operating room where he underwent coronary artery bypass
grafting to three vessels and an aortic valve replacement.
Please see operative note for details. Postoperatively he was
taken to the intensive care unit for monitoring. Within 48
hours, he awoke neurologically intact and was extubated. He was
a little slow to wake, however cleared by postoperative day two.
He was transfused for postoperative anemia. He remained in
atrial fibrillation however given his significant past GI bleed,
coumadin was not resumed. He was gently diuresed towards his
preoperative weight. The physical therapy service was consulted
for assistance with his care. On postoperative day five, he was
transferred to the step down unit for further recovery. He
continued to make steady progress and was discharged to [**Hospital 88766**]
rehab on [**2154-7-12**]. All follow-up appoinments were arranged.

Medications on Admission:
Doxazosin 8 mg daily
Lasix 80 mg daily
Hydroxyurea 1000 mg wednesday and saturday
Prilosec 20 mg daily
Coumadin 5 mg mon-wed-fri-sun, 2.5 mg tues-thrus-sat - last dose

Vitamin C 500mg daily
Leutin 1 tab in am and 1 tab in PM
Tylenol 650 mg twice a day
Ascorbic acid
Aspirin 81 mg daily
Ferrous sulfate 325 mg TID
Multivitamin


Discharge Medications:
1. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
3. hydroxyurea 500 mg Capsule Sig: Two (2) Capsule PO 2X/WEEK
(WE,SA).
4. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
6. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
7. doxazosin 4 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

8. lutein 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. ferrous sulfate 300  mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
10. multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
12. ascorbic acid 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day.
14. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain.
15. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheezes.
16. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO once a day.
17. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 30191**] Rehabilitation & Nursing Center - [**Location (un) 22287**]

Discharge Diagnosis:
Aortic stenosis/Coronary artery disease
Hard of hearing
Atrial fibrillation- on Coumadin
Aortic valve disorder ([**Location (un) 109**] 1)
Arthritis
Anemia recieves IV Iron
Gastroesophageal reflux disease
Colon cancer s/p colon resection
Prostate cancer s/p radioactive seed implant


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
1+ Edema


Discharge Instructions:
1) 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.
2) Please NO lotions, cream, powder, or ointments to incisions.
3) Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart provided.
4) No driving for approximately one month and while taking
narcotics. Driving will be discussed at follow up appointment
with surgeon when you will likely be cleared to drive.
5) No lifting more than 10 pounds for 10 weeks
6) 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:
Surgeon: [**Name6 (MD) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**], [**2154-8-14**] 1:00
Cardiologist: [**Month/Day/Year 5310**] on [**8-2**] at 2:20pm

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) **],PIOTR [**Telephone/Fax (1) 20264**] in [**3-12**] 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**



Completed by:[**2154-7-12**]
{'Coronary atherosclerosis of native coronary artery,Acute posthemorrhagic anemia,Aortic valve disorders,Atrial fibrillation,Long-term (current) use of anticoagulants,Esophageal reflux,Personal history of malignant neoplasm of large intestine,Personal history of malignant neoplasm of prostate,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Weakness and fatigue

PRESENT ILLNESS: 86 year old male with history of
atrial fibrillation and aortic stenosis ([**Location (un) 109**] 1 on Cardiac
catheterization). Over the past 24 hours he presented to outside
hospital with complaint of chest pain, fatique, weakness and
mild
upper back pain. EKG with chronic ST segment changes,inferior
infarct, anterior ST changes, troponin 0.4.  His hematocrit was
found to be 17 and he was transfused with 2 units PRBC.
Additionally INR was elevated 5.7 related to coumadin for atrial
fibrillation and was treated 2 units FFP and Vitamin K 10mg po.
Due to recurrent chest pain he was transferred for further
evaluation due to known coronary artery disease and aortic
stenosis.  He was seen by cardiac surgery in [**Month (only) **] in evaluation
for cardiac surgery however declined surgery.

MEDICAL HISTORY: Hard of hearing
Rate Controlled Atrial fibrillation- on Coumadin previously
Coumadin discontinued due to GI bleed
Aortic valve disorder ([**Location (un) 109**] 1)
Arthritis
Anemia recieves IV Iron
Gastroesophageal reflux disease
Colon cancer s/p colon resection
Prostate cancer s/p radioactive seed implant

MEDICATION ON ADMISSION: Doxazosin 8 mg daily
Lasix 80 mg daily
Hydroxyurea 1000 mg wednesday and saturday
Prilosec 20 mg daily
Coumadin 5 mg mon-wed-fri-sun, 2.5 mg tues-thrus-sat - last dose

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:80's irreg, Resp: 14 O2 sat: 2l 98%
B/P  Right: 108/52   Left: 109/54
Height: 5'[**52**]"    Weight: 80.4kg

FAMILY HISTORY: None

SOCIAL HISTORY: Lives with: widowed, lives with daughter, [**Name (NI) 5627**]
Occupation:Retired
Tobacco: none- quit [**2113**]
ETOH: [**2-10**]+ beers/day 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute posthemorrhagic anemia,Aortic valve disorders,Atrial fibrillation,Long-term (current) use of anticoagulants,Esophageal reflux,Personal history of malignant neoplasm of large intestine,Personal history of malignant neoplasm of prostate,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
