CHIEF COMPLAINT: Syncope

PRESENT ILLNESS: This 72 year old white female was admitted to another
institution with a syncopal event.  She has had recent episodes
of standing up from wheelchair and feeling lightheaded.  One
episode with possible loss of consciousness for approximately 1
minute.  She denies other symptoms.  Echocardiogram in [**2108-1-14**]
showed aortic valve area of 0.6, EF 50-55%.  She was
catheterized at [**Hospital 5279**] Hospital today which revealed multivessel
disease and critical aortic stenosis.  She was transferred to
[**Hospital1 18**] for surgery.

MEDICAL HISTORY: Calcified AS with normal LV function
PVD with moderate Left carotid artery stenosis
Osteopenia
Depression
stroke in2003 with right sided hemiparesis residual
Hypercholesterolemia
Polio as child - wears right sided leg brace
Right foot surgery in [**2052**]
Left ankle surgery for fracture
Cholecystectomy

MEDICATION ON ADMISSION: Calcium with Vit D
Coumadin 4.5 mg daily for hx CVA - LD Friday [**3-30**]
Zocor 40 daily
HCTZ 12.5 daily
ASA 325 daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 98.2
Pulse:66 Resp:18  O2 sat: 98% RA
B/P  Right: 127/81    Left:
Height:5'1"     Weight:152#

FAMILY HISTORY: Family History: Parents both died in 60's
Race: Caucasian
Last Dental Exam: 2 months ago - upper dentures

SOCIAL HISTORY: Lives with: Husband - married 49 years
Occupation:
Tobacco: none
ETOH: none
Walks ~ 1 mile/day
Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Aortic valve disorders,Diseases of tricuspid valve,Other iatrogenic hypotension,Other nonspecific abnormal serum enzyme levels,Other fluid overload,Atherosclerosis of aorta,Other acquired deformities of ankle and foot,Late effects of acute poliomyelitis,Long-term (current) use of anticoagulants,Other specified peripheral vascular diseases,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pure hypercholesterolemia
Crnry athrscl natve vssl,Secundum atrial sept def,Urin tract infection NOS,Delirium d/t other cond,Late ef-hemplga side NOS,Aortic valve disorder,Tricuspid valve disease,Iatrogenc hypotnsion NEC,Abn serum enzy level NEC,Fluid overload NEC,Aortic atherosclerosis,Acq ankle-foot def NEC,Late effect acute polio,Long-term use anticoagul,Periph vascular dis NEC,Ocl crtd art wo infrct,Pure hypercholesterolem
Admission Date:  [**2108-4-3**]              Discharge Date:   [**2108-4-15**]

Date of Birth:  [**2035-6-2**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
coronary artery bypass grafts x 3(LIMA-LAD,SVG-OM,SVG-PDA),
closure patent foramen ovale, aortic valve replacement(21 CE
Magna Epic),Tricuspid valve repair(Annuloplasty ring) [**2108-4-9**]

History of Present Illness:
This 72 year old white female was admitted to another
institution with a syncopal event.  She has had recent episodes
of standing up from wheelchair and feeling lightheaded.  One
episode with possible loss of consciousness for approximately 1
minute.  She denies other symptoms.  Echocardiogram in [**2108-1-14**]
showed aortic valve area of 0.6, EF 50-55%.  She was
catheterized at [**Hospital 5279**] Hospital today which revealed multivessel
disease and critical aortic stenosis.  She was transferred to
[**Hospital1 18**] for surgery.

Past Medical History:
Calcified AS with normal LV function
PVD with moderate Left carotid artery stenosis
Osteopenia
Depression
stroke in2003 with right sided hemiparesis residual
Hypercholesterolemia
Polio as child - wears right sided leg brace
Right foot surgery in [**2052**]
Left ankle surgery for fracture
Cholecystectomy

Social History:
Lives with: Husband - married 49 years
Occupation:
Tobacco: none
ETOH: none
Walks ~ 1 mile/day

Family History:
Family History: Parents both died in 60's
Race: Caucasian
Last Dental Exam: 2 months ago - upper dentures

Physical Exam:
T 98.2
Pulse:66 Resp:18  O2 sat: 98% RA
B/P  Right: 127/81    Left:
Height:5'1"     Weight:152#

General:AAOx 3 in NAD, pleasant
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur IV/VI SEM
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x] Deformities of B/L feet
Neuro: Grossly intact, right sided strength 3/5 upper and lower
extremity, left sided 5/5 strength
Pulses:
Femoral      Right:minimal bleeding at cath site   Left:2+
DP           Right:1+   Left:1+
PT           [**Name (NI) 167**]:1+   Left:1+
Radial       Right:2+   Left:2+

Carotid Bruit   Transmitted murmur b/l

Pertinent Results:
[**4-9**] Echo: Prebypass: No spontaneous echo contrast is seen in
the body of the left atrium or left atrial appendage. No
spontaneous echo contrast is seen in the body of the right
atrium or right atrial appendage. A patent foramen ovale is
present with a left-to-right shunt seen at rest. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%). The right ventricular
cavity is dilated with borderline normal free wall function.
[Intrinsic right ventricular systolic function is likely more
depressed given the severity of tricuspid regurgitation.] The
ascending aorta is mildly dilated. There are simple atheroma in
the descending thoracic aorta. There are three aortic valve
leaflets. The aortic valve leaflets are severely
thickened/deformed. There is critical aortic valve stenosis
(valve area <0.8cm2). Mild to moderate ([**1-15**]+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is mild valvular mitral stenosis (area
1.5-2.0cm2) and moderate MAC. Trivial mitral regurgitation is
seen. The tricuspid valve leaflets are mildly thickened. Severe
[4+] tricuspid regurgitation is seen. There is no pericardial
effusion.
Postbypass: The patient is A paced and is on an infusion of
epinephrine. There is a bioprosthetic valve in the aortic
position which appears well-seated without evidence of
perivalvular leak. There is a trace amount of central aortic
regurgitation. Gradients are peak/mean 21/11 mmHg at a CO of 5
L/min. There is a ring around the tricuspid annulus. Tricuspid
regurgitation is now trace. Mitral regurgitation continues to be
trace. Biventricular systolic function is unchanged. The
thoracic aorta is intact post decannulation.
[**4-3**] Carotid U/S: Findings consistent with less than 40%
stenosis on the right and 60-69% stenosis on the left.
[**4-3**] Head CT: 1. Large chronic infarction in the left posterior
cerebral artery territory, which also involves the parasagittal
left parietal lobe, likely due to vascular variation. 2.
Numerous chronic microvascular infarcts in the supratentorial
white matter and deep [**Doctor Last Name 352**] nuclei. 3. No evidence of acute
intracranial abnormalities.
[**4-3**] Chest CT: 1. Extensive calcifications of the very proximal
ascending aorta with sparing of the rest of the anterior wall of
the ascending aorta and the proximal arch. 2. Severe aortic
valve calcifications. Severe coronary artery calcifications.
Papillary muscle calcifications that in conjunction with some
aneurysmatic configuration of the left ventricle would be
concerning prior myocardial infarction. 3. Several pulmonary
nodules that should be further followed in one year for
documentation of stability based on their size. 4. Several renal
lesions, one of them being hyperdense and eccentric that should
be correlated with renal ultrasound.
[**4-5**] Abd U/S: 1. Unremarkable pancreas; however, the
visualization of the pancreas is very limited due to overlying
bowel. 2. No biliary dilatation. 3. Simple bilateral renal
cysts. 4. Atherosclerotic aorta with no AAA.

[**2108-4-3**] 07:05PM BLOOD WBC-5.5 RBC-4.07* Hgb-12.7 Hct-37.6
MCV-93 MCH-31.1 MCHC-33.6 RDW-13.8 Plt Ct-156
[**2108-4-11**] 04:01AM BLOOD WBC-6.5 RBC-2.68* Hgb-8.3* Hct-23.2*
MCV-86 MCH-31.1 MCHC-36.0* RDW-17.4* Plt Ct-94*
[**2108-4-12**] 07:55PM BLOOD WBC-6.3 RBC-3.17* Hgb-9.8* Hct-28.2*
MCV-89 MCH-31.0 MCHC-34.8 RDW-16.8* Plt Ct-112*
[**2108-4-15**] 05:26AM BLOOD WBC-6.9 RBC-3.50* Hgb-10.9* Hct-31.2*
MCV-89 MCH-31.0 MCHC-34.8 RDW-16.7* Plt Ct-149*
[**2108-4-3**] 07:05PM BLOOD PT-14.9* PTT-26.6 INR(PT)-1.3*
[**2108-4-9**] 01:39PM BLOOD PT-18.3* PTT-117.9* INR(PT)-1.6*
[**2108-4-14**] 05:45AM BLOOD PT-14.5* INR(PT)-1.2*
[**2108-4-15**] 05:26AM BLOOD PT-20.7* PTT-29.1 INR(PT)-1.9*
[**2108-4-3**] 07:05PM BLOOD Glucose-107* UreaN-21* Creat-1.0 Na-142
K-3.7 Cl-106 HCO3-30 AnGap-10
[**2108-4-15**] 05:26AM BLOOD Glucose-104* UreaN-33* Creat-1.0 Na-139
K-3.9 Cl-104 HCO3-28 AnGap-11
[**2108-4-12**] 01:39AM BLOOD Calcium-8.1* Phos-2.3* Mg-1.8

Brief Hospital Course:
Following admission the usual preoperative workup was
undertaken. On [**4-9**] she went to the operating room where surgery
was performed as noted. She weaned from bypass on Propofol, Neo
Synephrine and Epinephrine in sinus rhythm. She was transferred
to the CVICU for invasive monitoring in stable condition. She
remained stable, was weaned from pressors and sedation, awoke
neurologically intact and extubated easily. Beta blockade was
resumed, she was diuresed towards her preoperative weight and
physical therapy was consulted. She had an orthostatic episode,
without loss of consciousness on post-op day four. One unit of
blood was transfused for a hematocrit of 28. Diuresis was
continued due to significant extravascular fluid overload.
Chest tubes and wires were removed per protocol. Follow up
appointments were made with surgery and cardiology.  She was
screened for rehab to allow further recovery prior to return
home. On post-op day six she was discharged to Colonial Poplin
in NH with the appropriate medications. She was restarted on
Coumadin post-op d/t history of CVA.

Medications on Admission:
Calcium with Vit D
Coumadin 4.5 mg daily for hx CVA - LD Friday [**3-30**]
Zocor 40 daily
HCTZ 12.5 daily
ASA 325 daily

Discharge Medications:
1. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
5. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain/temp.
6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
8. warfarin 1 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily) as
needed for CVA hx.
9. furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 10 days.
10. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO Q12H (every 12 hours) for 10
days.
11. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).

Discharge Disposition:
Extended Care

Facility:
Colonial Poplin Nursing

Discharge Diagnosis:
Coronary artery disease s/p Coronary artery bypass graft x 3
Aortic stenosis s/p Aortic valve replacement
Tricuspid regurgitation s/p Tricuspid valve repair
Closure of patent foramen ovale
Past medical history:
Peripheral vascular disease w/ moderate Left carotid artery
stenosis
Osteopenia
Depression
CVA [**2100**] with right sided hemiparesis residual
Hypercholesterolemia
Polio as child - wears right sided leg brace
s/p Right foot surgery in [**2052**]
s/p Left ankle surgery for fx
s/p Cholecystectomy several years ago

Discharge Condition:
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage

Discharge Instructions:
DISCHARGE INSTRUCTIONS:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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 approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
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**
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge

Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) 914**] ([**Telephone/Fax (1) 170**]) on [**4-24**] at 1:45pm
Cardiologist: Dr. [**Last Name (STitle) 39975**] on [**4-30**] at 11am

Please call to schedule appointments with your
Primary Care: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 83943**]) in [**4-17**] 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:[**2108-4-15**]
{'Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Aortic valve disorders,Diseases of tricuspid valve,Other iatrogenic hypotension,Other nonspecific abnormal serum enzyme levels,Other fluid overload,Atherosclerosis of aorta,Other acquired deformities of ankle and foot,Late effects of acute poliomyelitis,Long-term (current) use of anticoagulants,Other specified peripheral vascular diseases,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pure hypercholesterolemia'}


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: Syncope

PRESENT ILLNESS: This 72 year old white female was admitted to another
institution with a syncopal event.  She has had recent episodes
of standing up from wheelchair and feeling lightheaded.  One
episode with possible loss of consciousness for approximately 1
minute.  She denies other symptoms.  Echocardiogram in [**2108-1-14**]
showed aortic valve area of 0.6, EF 50-55%.  She was
catheterized at [**Hospital 5279**] Hospital today which revealed multivessel
disease and critical aortic stenosis.  She was transferred to
[**Hospital1 18**] for surgery.

MEDICAL HISTORY: Calcified AS with normal LV function
PVD with moderate Left carotid artery stenosis
Osteopenia
Depression
stroke in2003 with right sided hemiparesis residual
Hypercholesterolemia
Polio as child - wears right sided leg brace
Right foot surgery in [**2052**]
Left ankle surgery for fracture
Cholecystectomy

MEDICATION ON ADMISSION: Calcium with Vit D
Coumadin 4.5 mg daily for hx CVA - LD Friday [**3-30**]
Zocor 40 daily
HCTZ 12.5 daily
ASA 325 daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 98.2
Pulse:66 Resp:18  O2 sat: 98% RA
B/P  Right: 127/81    Left:
Height:5'1"     Weight:152#

FAMILY HISTORY: Family History: Parents both died in 60's
Race: Caucasian
Last Dental Exam: 2 months ago - upper dentures

SOCIAL HISTORY: Lives with: Husband - married 49 years
Occupation:
Tobacco: none
ETOH: none
Walks ~ 1 mile/day 

### Response:
{'Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Aortic valve disorders,Diseases of tricuspid valve,Other iatrogenic hypotension,Other nonspecific abnormal serum enzyme levels,Other fluid overload,Atherosclerosis of aorta,Other acquired deformities of ankle and foot,Late effects of acute poliomyelitis,Long-term (current) use of anticoagulants,Other specified peripheral vascular diseases,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pure hypercholesterolemia'}
