CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: This is a [**Age over 90 **] year old female with aortic stenosis which is a
relatively new diagnosis from [**2190**]. Approximately two months
ago, she began developing dyspnea and chest pressure with
walking upstairs, as well as intermittent mild pedal edema. A
recent echocardiogram revealed severe aortic stenosis with an
aortic
valve area of <0.8cm2 and a mean gradient of 37mmHg. She has
been referred for possible aortic valve replacement surgery. If
surgery was deemed too high risk, Dr. [**Last Name (STitle) 171**] would like her
evaluated for CoreValve trial of percutaneous aortic valve
replacement. There was mention of a calcified aorta on a
previous note.

MEDICAL HISTORY: HTN
Hyperlipidemia
Spinal stenosis
osteoarthritis
Osteoporosis
CAD
PVD
s/p cholecystectomy
s/p L4/5 laminectomy

MEDICATION ON ADMISSION: aspirin 81 mg/day, atenolol 100 mg/day, amlodipine 10 mg/day,
Lasix 20 mg/day, allopurinol 200 mg/day, Losartan 25mg/day,
Actonel, Omeprazole 20mg/day, Trusopt, Percocet, Xalantan,
simvastatin 20mg/day, Calcium and vitamin D

ALLERGIES: Fosamax

PHYSICAL EXAM: Pulse: 62 SR Resp: 18  O2 sat: 97/RA
B/P  Right: 148/68  Left:149/60
Height: 63inches    Weight: 143lbs

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives at home with son.  [**Name (NI) **] tobacco/ETOH
Aortic valve disorders,Acidosis,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Chronic kidney disease, unspecified,Other chronic pulmonary heart diseases,Atherosclerosis of native arteries of the extremities, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Osteoporosis, unspecified,Esophageal reflux,Hip joint replacement
Aortic valve disorder,Acidosis,CHF NOS,Crnry athrscl natve vssl,Atrial fibrillation,Iatrogenc hypotnsion NEC,Chronic kidney dis NOS,Chr pulmon heart dis NEC,Athscl extrm ntv art NOS,Hy kid NOS w cr kid I-IV,Hyperlipidemia NEC/NOS,Hx-ven thrombosis/embols,Osteoporosis NOS,Esophageal reflux,Joint replaced hip
Admission Date:  [**2192-5-1**]              Discharge Date:   [**2192-5-7**]


Service: CARDIOTHORACIC

Allergies:
Fosamax

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2192-5-1**] - Coronary artery bypass grafting to three vessels. AVR
(19mm [**Doctor Last Name **] Pericardial Valve)


History of Present Illness:
This is a [**Age over 90 **] year old female with aortic stenosis which is a
relatively new diagnosis from [**2190**]. Approximately two months
ago, she began developing dyspnea and chest pressure with
walking upstairs, as well as intermittent mild pedal edema. A
recent echocardiogram revealed severe aortic stenosis with an
aortic
valve area of <0.8cm2 and a mean gradient of 37mmHg. She has
been referred for possible aortic valve replacement surgery. If
surgery was deemed too high risk, Dr. [**Last Name (STitle) 171**] would like her
evaluated for CoreValve trial of percutaneous aortic valve
replacement. There was mention of a calcified aorta on a
previous note.

Past Medical History:
HTN
Hyperlipidemia
Spinal stenosis
osteoarthritis
Osteoporosis
CAD
PVD
s/p cholecystectomy
s/p L4/5 laminectomy

Social History:
Lives at home with son.  [**Name (NI) **] tobacco/ETOH


Family History:
Non contributory

Physical Exam:
Pulse: 62 SR Resp: 18  O2 sat: 97/RA
B/P  Right: 148/68  Left:149/60
Height: 63inches    Weight: 143lbs

General: WDWN in NAD. Elderly
Skin: Warm, dry and intact. Well healed abdominal incision.
HEENT: NCAT, OD bind, OP benign, Teeth in fair repair. Upper
dentures and lower native.
Neck:  Supple [X] Full ROM [X] No JVD
Chest: Lungs clear bilaterally [X]
Heart: RRR, IV/VI SEM
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X] 1+ non pitting Edema
Varicosities: one small varicose vein on the left calf
Neuro: Grossly intact
Pulses:
Femoral      Right:2   Left:2
DP           Right:1   Left:1
PT           [**Name (NI) 167**]:1   Left:1
Radial       Right:2   Left:2

Carotid Bruit       Transmitted vs. Bruit


Pertinent Results:
ECHO [**2192-5-1**]
Prebypass
The left atrium is dilated. 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. No atrial septal defect is seen by 2D or color Doppler.
Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Regional left ventricular
wall motion is normal. Overall left ventricular systolic
function is low normal (LVEF 50-55%). The estimated cardiac
index is borderline low (2.0-2.5L/min/m2). Tissue Doppler
imaging suggests an increased left ventricular filling pressure
(PCWP>18mmHg). Right ventricular chamber size and free wall
motion are normal. There are simple atheroma in the aortic arch.
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). Trace aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. Moderate
(2+) mitral regurgitation is seen. There is no pericardial
effusion.

Postbypass
The patient is on a phenylephrine infusion and is A-paced.
Biventricular systolic function remains normal. There is a new
bioprosthetic valve in the aortic position. The valve is
well-seated and there is trace aortic regurgitation without
evidence of perivalvular leak. The mean gradient across the
valve is 8 mmHg at a cardiac output 4.0 L/min. The mitral
regurgitation is now mild-moderate. Tricuspid regurgitation
remains trace. The thoracic aorta is intact post-decannulation.

[**2192-5-7**] 05:55AM BLOOD WBC-8.4 RBC-3.56* Hgb-11.0* Hct-33.6*
MCV-95 MCH-31.0 MCHC-32.8 RDW-16.3* Plt Ct-224
[**2192-5-6**] 04:52AM BLOOD WBC-8.4 RBC-3.42* Hgb-10.6* Hct-32.4*
MCV-95 MCH-31.1 MCHC-32.8 RDW-16.0* Plt Ct-179
[**2192-5-6**] 04:52AM BLOOD PT-13.9* PTT-25.7 INR(PT)-1.2*
[**2192-5-3**] 03:36AM BLOOD PT-14.8* PTT-31.3 INR(PT)-1.3*
[**2192-5-7**] 05:55AM BLOOD Glucose-116* UreaN-28* Creat-1.3* Na-140
K-4.9 Cl-105 HCO3-26 AnGap-14
[**2192-5-6**] 04:52AM BLOOD Glucose-116* UreaN-31* Creat-1.4* Na-141
K-4.4 Cl-104 HCO3-28 AnGap-13
[**2192-5-4**] 03:10PM BLOOD Glucose-117* UreaN-32* Creat-1.6* Na-138
K-3.9 Cl-104 HCO3-24 AnGap-14
[**2192-5-7**] 05:55AM BLOOD Mg-2.2
[**2192-5-4**] 03:10PM BLOOD Mg-2.6

Brief Hospital Course:
Ms. [**Known lastname 16251**] was admitted to the [**Hospital1 18**] on [**2192-5-1**] for
surgical management of her aortic valve and coronary artery
disease. She was taken directly to the operating room where she
underwent three vessel coronary artery bypass grafting and an
aortic valve replacement using a 19mm [**Doctor Last Name **] pericardial valve.
Please see operative note for details. Postoperatively she was
taken to the intensive care unit for monitoring. Over the next
several hours, she awoke neurologically intact and was
extubated. Beta blockade, aspirin and a statin were resumed. On
postoperative day two, she was transferred to the step down unit
for further recovery. She was gently diuresed towards her
preoperative weight. She had brief episodes of afib and her
betablocker was titrated up with good effect. Pacing wires were
remove POD#5 without incident. The physical therapy service was
consulted for assistance with her postoperative strength and
mobility and they are recommending rehab. On POD 6 she was
cleared for discharge to [**Hospital 100**] Rehab. All follow up
appointments were advised.


Medications on Admission:
aspirin 81 mg/day, atenolol 100 mg/day, amlodipine 10 mg/day,
Lasix 20 mg/day, allopurinol 200 mg/day, Losartan 25mg/day,
Actonel, Omeprazole 20mg/day, Trusopt, Percocet, Xalantan,
simvastatin 20mg/day, Calcium and vitamin D


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID (3
times a day).
6. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
7. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
8. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
9. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
10. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
11. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain.
12. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
13. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x 1 week, then 400mg daily x 1 week, then
200mg daily.
14. metipranolol 0.3 % Drops Sig: One (1)  Ophthalmic [**Hospital1 **] (2
times a day).
15. bimatoprost 0.03 % Drops Sig: One (1) Drop Ophthalmic QHS
(once a day (at bedtime)).
16. sodium chloride 0.65 % Aerosol, Spray Sig: [**12-4**] Sprays Nasal
QID (4 times a day) as needed for nasal dryness.
17. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day
for 1 weeks.
18. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO DAILY (Daily) for 1 weeks.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
-Severe calcific aortic stenosis and CAD
-Calcified Aorta
-Hypertension
-Dyslipidemia
-Secondary pulmonary hypertension
-Chronic Renal Insufficiency Creat 1.7
-Recent Pneumonia
-Osteoarthritis and Gout
-Right shoulder impingement syndrome and rotator cuff
tendinosis,
s/p subacromial corticosteroid injection
-Chronic urine/stool incontinence, requires adult briefs
-History of positive PPD - received BCG in the past
-History of bilateral LE DVT following
laminectomies/diskectomies
-Osteoporosis
-Nephrolithiasis
-Right eye blindness
-Glaucoma


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


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**]

*Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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 appointments
Surgeon: Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**], [**2192-5-31**] 1:15
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2192-6-25**] 10:40

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 250**] in [**3-6**] weeks

Previously Scheduled Appointments:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2192-6-6**] 10:50
[**Name6 (MD) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 2226**] Date/Time:[**2192-9-6**] 10:30

**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:[**2192-5-7**]

Name:  [**Known lastname 2563**],[**Known firstname 2564**]             Unit No:   [**Numeric Identifier 2565**]

Admission Date:  [**2192-5-1**]              Discharge Date:   [**2192-5-7**]

Date of Birth:  [**2101-11-6**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Fosamax

Attending:[**First Name3 (LF) 741**]
Addendum:
Lopressor increased to 25 mg [**Hospital1 **] for better BP control/HR
control

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 609**] for the Aged - [**Location (un) 1409**]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2192-5-7**]
{'Aortic valve disorders,Acidosis,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Chronic kidney disease, unspecified,Other chronic pulmonary heart diseases,Atherosclerosis of native arteries of the extremities, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Osteoporosis, unspecified,Esophageal reflux,Hip joint replacement'}


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: Dyspnea on exertion

PRESENT ILLNESS: This is a [**Age over 90 **] year old female with aortic stenosis which is a
relatively new diagnosis from [**2190**]. Approximately two months
ago, she began developing dyspnea and chest pressure with
walking upstairs, as well as intermittent mild pedal edema. A
recent echocardiogram revealed severe aortic stenosis with an
aortic
valve area of <0.8cm2 and a mean gradient of 37mmHg. She has
been referred for possible aortic valve replacement surgery. If
surgery was deemed too high risk, Dr. [**Last Name (STitle) 171**] would like her
evaluated for CoreValve trial of percutaneous aortic valve
replacement. There was mention of a calcified aorta on a
previous note.

MEDICAL HISTORY: HTN
Hyperlipidemia
Spinal stenosis
osteoarthritis
Osteoporosis
CAD
PVD
s/p cholecystectomy
s/p L4/5 laminectomy

MEDICATION ON ADMISSION: aspirin 81 mg/day, atenolol 100 mg/day, amlodipine 10 mg/day,
Lasix 20 mg/day, allopurinol 200 mg/day, Losartan 25mg/day,
Actonel, Omeprazole 20mg/day, Trusopt, Percocet, Xalantan,
simvastatin 20mg/day, Calcium and vitamin D

ALLERGIES: Fosamax

PHYSICAL EXAM: Pulse: 62 SR Resp: 18  O2 sat: 97/RA
B/P  Right: 148/68  Left:149/60
Height: 63inches    Weight: 143lbs

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives at home with son.  [**Name (NI) **] tobacco/ETOH 

### Response:
{'Aortic valve disorders,Acidosis,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Chronic kidney disease, unspecified,Other chronic pulmonary heart diseases,Atherosclerosis of native arteries of the extremities, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Osteoporosis, unspecified,Esophageal reflux,Hip joint replacement'}
