CHIEF COMPLAINT: 

PRESENT ILLNESS: This 71 year old female has a
history of critical aortic stenosis and mitral stenosis and
is preopped for an AVR.  She had a recent catheterization at
[**Hospital1 69**] on [**11-21**] which revealed
clean coronaries and she now presents for surgery.  She has
had increased shortness of breath and dyspnea on exertion.
Also, on her catheterization, she had an ejection fraction of
57%.  Her aortic valve had a 37 mm gradient and was .54 cm
squared.  Mitral valve had a 20 mm gradient and was 0.59 cm
square.  She had 1+ aortic insufficiency as well.  She is now
admitted for AVR/MVR.

MEDICAL HISTORY: Significant for a history of critical
aortic stenosis.  History of hypertension. History of
diabetes.  History of chronic atrial fibrillation and status
post hysterectomy.

MEDICATION ON ADMISSION: Vitamin E 400 units q. day.
Wolfram 7 mg p.o. q. day.
Spironolactone 25 mg p.o. three times a day.
Clochlor 10 meq p.o. q. day.
Glucotrol XL 10 mg p.o. q. day.
Furosemide 80 mg p.o. q. day.
Fosamax 7 mg subcutaneous q. week.

ALLERGIES: She is allergic to Quinine.  She gets welts.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone in [**Hospital3 4634**]. She does
not smoke cigarettes and does not drink alcohol.
Mitral valve stenosis and aortic valve stenosis,Atrial fibrillation,Rheumatic heart failure (congestive),Hemorrhage complicating a procedure,Acidosis,Acute kidney failure, unspecified
Mitral/aortic stenosis,Atrial fibrillation,Rheumatic heart failure,Hemorrhage complic proc,Acidosis,Acute kidney failure NOS
Admission Date:  [**2182-12-3**]       Discharge Date:  [**2183-1-10**]

Date of Birth:                    Sex:

Service:

HISTORY OF PRESENT ILLNESS:  This 71 year old female has a
history of critical aortic stenosis and mitral stenosis and
is preopped for an AVR.  She had a recent catheterization at
[**Hospital1 69**] on [**11-21**] which revealed
clean coronaries and she now presents for surgery.  She has
had increased shortness of breath and dyspnea on exertion.
Also, on her catheterization, she had an ejection fraction of
57%.  Her aortic valve had a 37 mm gradient and was .54 cm
squared.  Mitral valve had a 20 mm gradient and was 0.59 cm
square.  She had 1+ aortic insufficiency as well.  She is now
admitted for AVR/MVR.

PAST MEDICAL HISTORY:  Significant for a history of critical
aortic stenosis.  History of hypertension. History of
diabetes.  History of chronic atrial fibrillation and status
post hysterectomy.

MEDICATIONS ON ADMISSION:
Vitamin E 400 units q. day.
Wolfram 7 mg p.o. q. day.
Spironolactone 25 mg p.o. three times a day.
Clochlor 10 meq p.o. q. day.
Glucotrol XL 10 mg p.o. q. day.
Furosemide 80 mg p.o. q. day.
Fosamax 7 mg subcutaneous q. week.

ALLERGIES:  She is allergic to Quinine.  She gets welts.

SOCIAL HISTORY:  She lives alone in [**Hospital3 4634**]. She does
not smoke cigarettes and does not drink alcohol.

REVIEW OF SYSTEMS:  As above.

PHYSICAL EXAMINATION:  She is an elderly, white female in no
apparent distress.  Vital signs stable, afebrile.  HEAD,
EYES, EARS, NOSE AND THROAT:  Normal cephalic, atraumatic.
Extraocular movements intact.  Oropharynx benign.  Neck was
supple, full range of motion, no lymphadenopathy or
thyromegaly.  Carotids 2+ and equal bilaterally with
radiating murmurs.  Neck was supple.  Full range of motion.
No lymphadenopathy or thyromegaly.  Lungs had bibasilar
crackles.  Cardiovascular examination:  Irregular rate and
rhythm with a 3/6 systolic ejection murmur and a [**2-28**]
diastolic murmur.  Abdomen was soft, nontender, with positive
bowel sounds.  No masses or hepatosplenomegaly.  Extremities:
2+ pulses bilaterally throughout.  No clubbing, cyanosis or
edema.  Neurologic examination was nonfocal.

HOSPITAL COURSE:  On [**12-4**], she underwent a AVR/MVR Maze
procedure with stapling of the left atrial appendage.  Her
aortic valve was replaced with a 19 mm [**Last Name (un) 3843**]-[**Doctor Last Name **]
pericardial valve.  Her mitral valve was replaced with a 25
mm [**Last Name (un) 3843**]-[**Doctor Last Name **] pericardial valve.  Cross clamp time
was 175 minutes.  Total bypass time was 150 minutes. She was
transferred to the CSRU on Milrinone, Epinephrine and
Nitroglycerin.

She was extubated on postoperative day number one and
continued to have chest tube output.  She had increased PA
pressures and remained on the Milrinone.  Also, her white
count went up to 20,000.  She was started on Levofloxacin.
She remained on the Milrinone drip in the unit for quite some
time, with an elevated white count.  All her cultures were
negative.  She had an increased amylase and lipase eventually
and was n.p.o.  She also started to have a rising creatinine
and was seen by renal.  They recommended holding her
diuretics.  She still remained on the Milrinone and remained
in preoperative atrial fibrillation.  She was treated with
Vancomycin and Levo for awhile with no positive cultures.
She was seen by renal.  She also had hyponatremia of unknown
etiology. She went down as low as 116 and was treated with
hypertonic saline.  She has not had a recurrence of that.
She had a negative cortisol stimulation test.

She continued to remain in the unit with a white count around
20,000.  She was eventually weaned off her Milrinone on
postoperative day number 10.  She was very slow to progress
with any ambulation or physical activity.  She was beginning
to be stable until postoperative day number 12 when she
became hypothermic.  She had a profound acidosis and had to
get reintubated.  She again did not grow out any positive
cultures.  She had a head CT that was negative.  Neurology
saw her.  They did not feel that it was due to her correction
of her sodium because that was done over several days,
therefore, that was not the issue.  She remained intubated.
She was started on tube feeds.  She has had a chronic
elevated amylase of around 200 which does not change if we
feed her. She does not have abdominal pain with that. General
surgery feels that it is not a pancreatitis.

She remained intubated and was eventually treated with
Fluconazole, Flagyl, Levofloxacin.  She continued to have
chest tubes during this entire time, as she had continuous
serous drainage from those.  She was eventually extubated
again on postoperative day number 19. She was slowly
recovering and started eating.  She did have a few abdominal
ultrasounds and abdominal CT's which were negative for any
pancreatitis.  She did have large gallstones which is all she
had with that. She continued to remain in the unit and slowly
progressed.  She had a triple lumen catheter placed in her
right subclavian on postoperative day number 30.  She was
stable from the line. Her heparin was restarted and a day
later, her PTT was 78 and that evening she became diaphoretic
and tachypneic.  She became acidotic and was reintubated.
She was found to have a right hemothorax.

On postoperative day number 32, she had a right VAC procedure
with evacuation of a hemothorax.  She tolerated that well and
recovered from that.  On postoperative day number 33, she had
a tracheostomy. The next day, she had a percutaneous
endoscopic gastrostomy placed. She tolerated all of this
well. She also was treated with Natrecor for diuresis and was
followed by the heart failure service.  We discontinued the
Natrecor on postoperative day number 36 and switched her to
her preoperative Aldactone 25 mg three times a day and put
her on 60 of intravenous Lasix twice a day.  Upon discharge
to rehabilitation, she is on C-Pap with a pressure support of
12. She is tolerating that well. She is also on Pro-Balance
tube feeds at 50 an hour, tolerating that well.

MEDICATIONS ON DISCHARGE:
Tylenol prn.
Colace 100 mg p.o. twice a day.
Nystatin swish and swallow four times a day.
Glipizide 10 mg p.o. twice a day.
Glucotrol 10 mg p.o. q. day.
KCl 40 meq p.o. twice a day.
Lasix 60 mg intravenous twice a day.  This should remain
intravenous. She will not diurese well with p.o.
Spironolactone 25 mg p.o. three times a day.
Fosamax 70 mg subcutaneous q. week.
Coumadin .5 mg p.o. q h.s.
Subcutaneous heparin 5000 units subcutaneous twice a day.
She should have an INR goal of 2 to 2.5.

LA[**Last Name (STitle) **]RY DATA:  White count 7,200; hematocrit 29.2;
platelets 127.  Sodium 149; potassium 4; chloride 113; BUN
33; creatinine 0.5; blood sugar 146.  She will be followed by
Dr. [**Last Name (Prefixes) **] as soon as she is discharged from
rehabilitation and by Dr. [**Last Name (STitle) **] when she is discharged from
rehabilitation.  She needs to have her vent weaned and is to
work with physical therapy for ambulation.

She was discharged to [**Location (un) 4480**] [**Hospital 4094**] Rehabilitation on
postoperative day number 37.







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

Dictated By:[**Last Name (NamePattern1) 11726**]
MEDQUIST36

D:  [**2183-1-10**]  07:20
T:  [**2183-1-10**]  04:12
JOB#:  [**Job Number 54492**]
{'Mitral valve stenosis and aortic valve stenosis,Atrial fibrillation,Rheumatic heart failure (congestive),Hemorrhage complicating a procedure,Acidosis,Acute kidney failure, 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: This 71 year old female has a
history of critical aortic stenosis and mitral stenosis and
is preopped for an AVR.  She had a recent catheterization at
[**Hospital1 69**] on [**11-21**] which revealed
clean coronaries and she now presents for surgery.  She has
had increased shortness of breath and dyspnea on exertion.
Also, on her catheterization, she had an ejection fraction of
57%.  Her aortic valve had a 37 mm gradient and was .54 cm
squared.  Mitral valve had a 20 mm gradient and was 0.59 cm
square.  She had 1+ aortic insufficiency as well.  She is now
admitted for AVR/MVR.

MEDICAL HISTORY: Significant for a history of critical
aortic stenosis.  History of hypertension. History of
diabetes.  History of chronic atrial fibrillation and status
post hysterectomy.

MEDICATION ON ADMISSION: Vitamin E 400 units q. day.
Wolfram 7 mg p.o. q. day.
Spironolactone 25 mg p.o. three times a day.
Clochlor 10 meq p.o. q. day.
Glucotrol XL 10 mg p.o. q. day.
Furosemide 80 mg p.o. q. day.
Fosamax 7 mg subcutaneous q. week.

ALLERGIES: She is allergic to Quinine.  She gets welts.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone in [**Hospital3 4634**]. She does
not smoke cigarettes and does not drink alcohol. 

### Response:
{'Mitral valve stenosis and aortic valve stenosis,Atrial fibrillation,Rheumatic heart failure (congestive),Hemorrhage complicating a procedure,Acidosis,Acute kidney failure, unspecified'}
