CHIEF COMPLAINT: Syncope x 2 over last 3 months and dyspnea on exertion

PRESENT ILLNESS: This is an 80yo male with known aortic stenosis followed by
serial echos over past 7 years. Presents with recurrent syncopal
episodes. His most recent was [**2156-9-30**]. Syncopal
episode prior to that was [**2156-8-11**]. He is now referred
for aortic valve replacement.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Basal Cell CA
Basal cell excision-leg and back

MEDICATION ON ADMISSION: Simvastatin 20mg daily
Multivitamin daily
Aspirin 81mg 3x/wk,
Metoprolol 50mg daily

ALLERGIES: Lactose

PHYSICAL EXAM: Pulse: 92 Resp: 18  O2 sat: 99%-RA
B/P  Right: 128/58   Left: 132/64
Height:  68"   Weight: 170 lbs

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death

SOCIAL HISTORY: Race: caucasian
Last Dental Exam:[**Month (only) 205**] or [**2156-7-4**]
Lives with: alone
Occupation: [**Hospital1 **]-security
Tobacco: Denies
ETOH: Rare glass of wine
Aortic valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified cardiac dysrhythmias,Personal history of other malignant neoplasm of skin,Examination of participant in clinical trial,First degree atrioventricular block
Aortic valve disorder,Hypertension NOS,Hyperlipidemia NEC/NOS,Cardiac dysrhythmias NEC,Hx-skin malignancy NEC,Exam-clincal trial,Atriovent block-1st degr
Admission Date:  [**2156-11-19**]              Discharge Date:   [**2156-11-23**]

Date of Birth:  [**2076-1-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lactose

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Syncope x 2 over last 3 months and dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2156-11-19**] Aortic valve replacement with 21-mm Biocor Epic tissue
valve

History of Present Illness:
This is an 80yo male with known aortic stenosis followed by
serial echos over past 7 years. Presents with recurrent syncopal
episodes. His most recent was [**2156-9-30**]. Syncopal
episode prior to that was [**2156-8-11**]. He is now referred
for aortic valve replacement.

Past Medical History:
Hypertension
Hyperlipidemia
Basal Cell CA
Basal cell excision-leg and back

Social History:
Race: caucasian
Last Dental Exam:[**Month (only) 205**] or [**2156-7-4**]
Lives with: alone
Occupation: [**Hospital1 **]-security
Tobacco: Denies
ETOH: Rare glass of wine

Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death

Physical Exam:
Pulse: 92 Resp: 18  O2 sat: 99%-RA
B/P  Right: 128/58   Left: 132/64
Height:  68"   Weight: 170 lbs

General: NAD
Skin: Warm[x] Dry [x] intact [x]
HEENT: NCAT[x] PERRLA [x] EOMI [x]  benign oropharynx
Neck:  Supple [x] Full ROM [x] no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]    Murmur: 3/6 SEM
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema: none
Varicosities: None
Neuro: A&O x3, MAE, nonfocal exam
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit- radiated murmur bilat

Pertinent Results:
[**2156-11-19**] Echo: PRE-BYPASS: The left atrium is mildly dilated. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium or left atrial appendage. No atrial septal defect is
seen by 2D or color Doppler. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. There are simple atheroma in the ascending aorta.
There are simple atheroma in the descending thoracic aorta. The
aortic valve leaflets are severely thickened/deformed. There is
severe aortic valve stenosis (valve area 0.8-1.0cm2). Moderate
to severe (3+) aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Mild (1+) mitral regurgitation is
seen. There is no pericardial effusion.
POST CPB: 1. Preserved biventricular systlic function 2.
Bioprosthetic valve in aortic position. Well seated and stable,
good leaflet excursion. 3.Peak Gradient = 39 mm Hg. Cardiac
Output = 6 litersw/min 4. No other change

Brief Hospital Course:
Mr. [**Known lastname **] was a same day admit after undergoing pre-operative
work-up prior to admission. On [**11-19**] he was brought directly to
the operating room where he underwent an aortic valve
replacement. Please see operative report for surgical details.
Following surgery he was transferred to the CVICU for invasive
monitoring. Within 24 hours he was weaned from sedation, awoke
neurologically intact and extubated. On post-op day one he was
transferred to the telemetry floor for further care. Beta
blockers and diuretics were started and he was gently diuresed
towards his pre-op weight. Chest tubes and epicardial pacing
wires were removed per protocol. On post-op day two he required
blood transfusion for low HCT (rose from 23 to 32). He worked
with physical therapy for strength and mobility during his
post-op period. On post-op day four he was discharged to rehab
(West Acres) with the appropriate medications and follow-up
appointments.

Medications on Admission:
Simvastatin 20mg daily
Multivitamin daily
Aspirin 81mg 3x/wk,
Metoprolol 50mg daily

Discharge Medications:
1. simvastatin 10 mg Tablet Sig: Two (2) 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. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
5. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
7. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
9. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days. Tablet(s)
10. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 7
days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Rehabilitation and Nursing Center - [**Location (un) 701**]

Discharge Diagnosis:
Aortic Stenosis s/p Aortic valve replacement
Past medical history:
Hypertension
Hyperlipidemia
Basal Cell CA
Basal cell excision-leg and back

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Trace edema


Discharge Instructions:
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
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**

Followup Instructions:
You are scheduled for the following appointment
Surgeon: Dr. [**Last Name (STitle) **] on [**2156-12-16**] at 1:30pm
Please call and schedule an appointment to be see by your
Cardiologist: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10543**] in 4 weeks [**Telephone/Fax (1) 4475**]

Please call to schedule appointments with your
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 15942**] in [**3-8**] 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:[**2156-12-1**]
{'Aortic valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified cardiac dysrhythmias,Personal history of other malignant neoplasm of skin,Examination of participant in clinical trial,First degree atrioventricular block'}


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 x 2 over last 3 months and dyspnea on exertion

PRESENT ILLNESS: This is an 80yo male with known aortic stenosis followed by
serial echos over past 7 years. Presents with recurrent syncopal
episodes. His most recent was [**2156-9-30**]. Syncopal
episode prior to that was [**2156-8-11**]. He is now referred
for aortic valve replacement.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Basal Cell CA
Basal cell excision-leg and back

MEDICATION ON ADMISSION: Simvastatin 20mg daily
Multivitamin daily
Aspirin 81mg 3x/wk,
Metoprolol 50mg daily

ALLERGIES: Lactose

PHYSICAL EXAM: Pulse: 92 Resp: 18  O2 sat: 99%-RA
B/P  Right: 128/58   Left: 132/64
Height:  68"   Weight: 170 lbs

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death

SOCIAL HISTORY: Race: caucasian
Last Dental Exam:[**Month (only) 205**] or [**2156-7-4**]
Lives with: alone
Occupation: [**Hospital1 **]-security
Tobacco: Denies
ETOH: Rare glass of wine 

### Response:
{'Aortic valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified cardiac dysrhythmias,Personal history of other malignant neoplasm of skin,Examination of participant in clinical trial,First degree atrioventricular block'}
