CHIEF COMPLAINT: 

PRESENT ILLNESS: An 80-year-old female, with a
history of aortic stenosis, had recently had increase in
dyspnea on exertion.  The patient had a cath today which
revealed severe AS with [**Location (un) 109**] 0.59, 1+ AR and a left
ventricular ejection fraction of 65%, with normal coronaries.
The patient was referred to the cardiac surgery service for
AVR.  The patient had an echo in [**2100-11-20**] that showed
AS, [**Location (un) 109**] of 0.4, 2+ TR, 1+ MR, AV gradual peak at 93.

MEDICAL HISTORY: 1. Hospitalized in [**2096**] with ?pneumonia versus CHF, and the
patient was intubated at that time.  The patient had a
question of a history of AFIB at that time, and the patient
was on Coumadin for a brief period of time.
2. Status post tonsillectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: The patient is a healthy appearing
80-year-old female.  Neurologically, the patient was grossly
intact without carotid bruits.  Examination of the lungs
revealed clear to auscultation bilaterally.  Examination of
the heart revealed a IV/VI systolic ejection murmur with S1
and S2.  Abdomen was soft, nontender, nontender.  Examination
of the extremities revealed warm with positive peripheral
pulses without any edema.

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking history.  The patient denies
drinking alcohol.  The patient is married and lives with
husband.
Aortic valve disorders,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Unspecified essential hypertension
Aortic valve disorder,Surg compl-heart,Urin tract infection NOS,Hypertension NOS
Admission Date:  [**2101-2-25**]       Discharge Date:  [**2101-3-3**]


Service:  CARDIAC SURGERY

HISTORY OF PRESENT ILLNESS:  An 80-year-old female, with a
history of aortic stenosis, had recently had increase in
dyspnea on exertion.  The patient had a cath today which
revealed severe AS with [**Location (un) 109**] 0.59, 1+ AR and a left
ventricular ejection fraction of 65%, with normal coronaries.
The patient was referred to the cardiac surgery service for
AVR.  The patient had an echo in [**2100-11-20**] that showed
AS, [**Location (un) 109**] of 0.4, 2+ TR, 1+ MR, AV gradual peak at 93.

PAST MEDICAL HISTORY:
1. Hospitalized in [**2096**] with ?pneumonia versus CHF, and the
patient was intubated at that time.  The patient had a
question of a history of AFIB at that time, and the patient
was on Coumadin for a brief period of time.
2. Status post tonsillectomy.

SOCIAL HISTORY:  No smoking history.  The patient denies
drinking alcohol.  The patient is married and lives with
husband.

MEDICATIONS:
1. Atenolol 25 qd.
2. Multivitamins 1 tablet qd.

LABS ON ADMISSION:  White count 5.9, hematocrit 35.2,
platelets 181, INR 1.1, sodium 137, potassium 3.3, chloride
104, bicarb 23, BUN 28, creatinine 0.6, glucose 132.  UA was
negative.  LFTs were normal.

REVIEW OF SYSTEMS:  The patient denied TIAs, CVA, seizures,
no PND, no palpitations, no cough, no wheezes.  The patient
states that she has occasional heartburn relieved with Tums.
The patient has a rare history of diarrhea, some hemorrhoids.
The patient denies claudication.  Denies diabetes, thyroid
disease, or heme issues.

PHYSICAL EXAM:  The patient is a healthy appearing
80-year-old female.  Neurologically, the patient was grossly
intact without carotid bruits.  Examination of the lungs
revealed clear to auscultation bilaterally.  Examination of
the heart revealed a IV/VI systolic ejection murmur with S1
and S2.  Abdomen was soft, nontender, nontender.  Examination
of the extremities revealed warm with positive peripheral
pulses without any edema.

HOSPITAL COURSE:  The patient was admitted to the cardiac
surgery service and underwent aortic valve replacement with a
#19 tissue valve.  The patient was extubated and transferred
to the CSRU.  The patient was on perioperative Kefzol,
remained afebrile with pulse at 100, and blood pressure
133/56, otherwise doing well.  The patient's white count was
21.9, hematocrit 36.9.  The patient was put on low dose
Lopressor 12.5 [**Hospital1 **], and the patient's Swan was switched to a
CVL.

On postop day #2, the patient was started on lasix for low
urine output.  The patient remained afebrile with pulse
around 90, blood pressure 130s/40s, otherwise doing well.
The patient still had the chest tube, wires and Foley.  The
chest tubes were removed.  Lopressor was increased to 25 mg
[**Hospital1 **].

On postop day #3, the patient continued to remain afebrile.
Pulse was running around 88, normal sinus, blood pressure
120s/40s, otherwise doing well.  Taking in good POs and
making good urine.  White count was down to 13.  The patient
was transferred to the floor in stable condition.

On postop day #4, the patient had no complaints.  The
patient's Lopressor was at 50 [**Hospital1 **].  The patient had a
low-grade fever of 100.3, otherwise remained stable, pulse
around 87, and blood pressure 110s/60s.  She was taking good
POs and making good urine.  White count at 13.  The patient's
wire was removed and had worked with physical therapist.

On postop day #5, the patient remained afebrile with stable
vital signs.  Pulse still running around 90.  The patient
worked with physical therapist and passed level 5, and it was
safe for the patient to return home.

On postop day #6, the patient had no complaints.  The patient
was on Lopressor 100 [**Hospital1 **] for systemic ventricular
tachycardia.  The patient's T-max was 100.1, pulse remained
at 99, and blood pressure 116/51.  The patient was taking
good POs and making good urine.  The patient was switched to
Lopressor 75 mg tid, and the patient was doing well.
Pressure and heart rate were better controlled.  The patient
was discharged home in good condition.

CONDITION ON DISCHARGE:  Good.

DISPOSITION:  Home with services.

FINAL DIAGNOSES:
1. Status post aortic valve replacement.
2. Severe aortic stenosis.
3. Pneumonia.
4. Status post tonsillectomy.

FO[**Last Name (STitle) **]P PLANS:
1. Please follow-up with Dr. [**Last Name (Prefixes) **] in 4 weeks; please
call his office for follow-up appointment.
2. Please follow-up with Dr. [**Last Name (STitle) 26191**], the PCP, [**Last Name (NamePattern4) **] [**1-21**]
weeks; please call for a follow-up appointment.

DISCHARGE MEDICATIONS:
1. Lasix 20 mg po bid for 7 days.
2. Potassium 20 mEq po q 12 h for 7 days.
3. Colace 100 mg po bid.
4. Metoprolol 75 mg po tid.
5. Aspirin 325 mg po qd.
6. Percocet 1-2 tabs po q 4 h prn pain.




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

Dictated By:[**Name8 (MD) 26192**]
MEDQUIST36

D:  [**2101-3-3**]  08:52
T:  [**2101-3-3**]  09:37
JOB#:  [**Job Number 26193**]


Name:  [**Known lastname 4432**], [**Known firstname **]                   Unit No:  [**Numeric Identifier 4433**]

Admission Date:  [**2101-2-25**]     Discharge Date:  [**2101-3-4**]

Date of Birth:   [**2020-6-18**]     Sex:  F

Service:

ADDENDUM:  This is an Addendum to the hospital course.  The
patient continued aggressive physical therapy and was cleared
for discharge home.  She was sent home tolerating a regular
diet and with adequate pain control on by mouth pain
medications.  She had no complaints.

MEDICATIONS ON DISCHARGE:
1.  Lasix 20 mg by mouth once per day (times 10 days).
2.  Potassium chloride 20 mEq by mouth once per day (times 10
days).
3.  Aspirin 325 mg by mouth once per day.
4.  Percocet 5/325-mg tablets one to two tablets by mouth
q.4h. as needed (for pain).
5.  Levaquin 500 mg once per day (times seven days).
6.  Lopressor 100 mg by mouth three times per day.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with Dr. [**First Name (STitle) **]
[**Last Name (Prefixes) **] in four weeks' time.
2.  The patient was instructed to follow up Cardiology in one
to two weeks' time.
3.  The patient was instructed to avoid heavy lifting or
strenuous activities.
4.  Should the patient have any complaints of fever, wound
infection, erythema, or discharge the patient was instructed
to immediately call Dr. [**First Name4 (NamePattern1) 255**] [**Last Name (NamePattern1) **] [**Last Name (Prefixes) 4522**] office or come to
the Emergency Department.





                          [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Last Name (NamePattern1) 4523**]

MEDQUIST36

D:  [**2101-3-4**]  16:03
T:  [**2101-3-5**]  01:03
JOB#:  [**Job Number 4524**]


Name:  [**Known lastname 4432**], [**Known firstname **]                   Unit No:  [**Numeric Identifier 4433**]

Admission Date:  [**2101-2-25**]     Discharge Date:  [**2101-3-5**]

Date of Birth:   [**2020-6-18**]     Sex:  F

Service:

ADDENDUM:  This is an Addendum to a previously dictated
Discharge Summary.

On postoperative day six, the patient had several bouts of
sinus tachycardia to the 120s.  Thus, the patient was kept in
the hospital.

On postoperative day seven, the patient's Lopressor was
increased.  On postoperative day seven, the patient continued
to have high sinus tachycardia.  The patient's Lopressor was
increased once again to 100 mg three times per day which
controlled her heart rate without any difficulties.   The
patient also complained of some dysuria.  A urinalysis was
sent which showed that she had many bacteria, several white
blood cells, and positive nitrites; identifying that the
patient had a urinary tract infection.  The patient was
placed on levofloxacin for seven days to treat the urinary
tract infection.

On postoperative day eight, the patient remained afebrile
with stable vital signs.  The patient's heart rate in the 80s
with Lopressor 100 mg three times per day.

DISCHARGE STATUS:  The patient's discharge status was to
home.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was good.

MEDICATIONS ON DISCHARGE:
1.  Lasix 20 mg by mouth once per day (for 10 days).
2.  Potassium chloride 20 mEq by mouth once per day (for 10
days).
3.  Aspirin 325 mg by mouth once per day.
4.  Percocet one to two tablets by mouth q.4h. as needed (for
pain).
5.  Levofloxacin 500 mg by mouth q.24h. (for seven days).
6.  Lopressor 100 mg by mouth three times per day.






                          [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Last Name (NamePattern1) 360**]

MEDQUIST36

D:  [**2101-3-5**]  08:12
T:  [**2101-3-5**]  08:35
JOB#:  [**Job Number 4434**]
{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,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: 

PRESENT ILLNESS: An 80-year-old female, with a
history of aortic stenosis, had recently had increase in
dyspnea on exertion.  The patient had a cath today which
revealed severe AS with [**Location (un) 109**] 0.59, 1+ AR and a left
ventricular ejection fraction of 65%, with normal coronaries.
The patient was referred to the cardiac surgery service for
AVR.  The patient had an echo in [**2100-11-20**] that showed
AS, [**Location (un) 109**] of 0.4, 2+ TR, 1+ MR, AV gradual peak at 93.

MEDICAL HISTORY: 1. Hospitalized in [**2096**] with ?pneumonia versus CHF, and the
patient was intubated at that time.  The patient had a
question of a history of AFIB at that time, and the patient
was on Coumadin for a brief period of time.
2. Status post tonsillectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: The patient is a healthy appearing
80-year-old female.  Neurologically, the patient was grossly
intact without carotid bruits.  Examination of the lungs
revealed clear to auscultation bilaterally.  Examination of
the heart revealed a IV/VI systolic ejection murmur with S1
and S2.  Abdomen was soft, nontender, nontender.  Examination
of the extremities revealed warm with positive peripheral
pulses without any edema.

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking history.  The patient denies
drinking alcohol.  The patient is married and lives with
husband. 

### Response:
{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,Unspecified essential hypertension'}
