CHIEF COMPLAINT: Asymptomatic

PRESENT ILLNESS: 52 year old gentleman with known bicuspid aortic valve and
dilated ascending aorta followed by monthly echocardiograms. His
bicuspid aortic valve was diagnosed in the 7th grade. Most
recent echocardiogram revealed progression of his aortic
stenosis and aortic aneurysm. A CT scan was performed which
showed his ascending aorta to now measure 5.2cm. Echo showed the
ascending aorta to be 5.4cm up from 5.0cm 6 months ago. His
aortic root measures 4.6cm. Given the progression of his
disease, he has been referred for surgical management.

MEDICAL HISTORY: Complete Heart Block(PPM)
Postop DVT in LUE [**2104-3-12**] following lead extraction
Hyperlipidemia
s/p Dual chamber pacemaker placement in [**2087**]
s/p replacement of PM generator [**2096**]
s/p Lead extraction and reimplantation of PPM [**3-/2104**]
Hernia repair as child

MEDICATION ON ADMISSION: Aspirin
COzaar 50mg QD
Zocor 40mg QD

ALLERGIES: Penicillins

PHYSICAL EXAM: Pulse: 80 SR    Resp: 16    O2 sat: 98% RA
B/P  Right: 120/70 Left: 122/73
Height:71"     Weight:265 lbs

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Native bottom teeth/Upper plate. Clearance
faxed to Cardiac surgery office
Lives with: Wife in [**Name2 (NI) 1727**]
Occupation: Production manager on ship yard
Tobacco: Quit 1.5 years ago. 40 pack year history
ETOH: [**12-14**] drinks per week
Aortic valve disorders,Congenital insufficiency of aortic valve,Unspecified pleural effusion,Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Fitting and adjustment of cardiac pacemaker,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Anemia, unspecified
Aortic valve disorder,Cong aorta valv insuffic,Pleural effusion NOS,Thoracic aortic aneurysm,Crnry athrscl natve vssl,Ftng cardiac pacemaker,Hyperlipidemia NEC/NOS,Hx-ven thrombosis/embols,Anemia NOS
Admission Date:  [**2105-2-3**]              Discharge Date:   [**2105-2-7**]

Date of Birth:  [**2052-9-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Asymptomatic

Major Surgical or Invasive Procedure:
[**2105-2-3**] Ascending aorta and hemi-arch replacement and Aortic
Valve Replacement

History of Present Illness:
52 year old gentleman with known bicuspid aortic valve and
dilated ascending aorta followed by monthly echocardiograms. His
bicuspid aortic valve was diagnosed in the 7th grade. Most
recent echocardiogram revealed progression of his aortic
stenosis and aortic aneurysm. A CT scan was performed which
showed his ascending aorta to now measure 5.2cm. Echo showed the
ascending aorta to be 5.4cm up from 5.0cm 6 months ago. His
aortic root measures 4.6cm. Given the progression of his
disease, he has been referred for surgical management.

Past Medical History:
Complete Heart Block(PPM)
Postop DVT in LUE [**2104-3-12**] following lead extraction
Hyperlipidemia
s/p Dual chamber pacemaker placement in [**2087**]
s/p replacement of PM generator [**2096**]
s/p Lead extraction and reimplantation of PPM [**3-/2104**]
Hernia repair as child

Social History:
Race: Caucasian
Last Dental Exam: Native bottom teeth/Upper plate. Clearance
faxed to Cardiac surgery office
Lives with: Wife in [**Name2 (NI) 1727**]
Occupation: Production manager on ship yard
Tobacco: Quit 1.5 years ago. 40 pack year history
ETOH: [**12-14**] drinks per week

Family History:
non-contributory

Physical Exam:
Pulse: 80 SR    Resp: 16    O2 sat: 98% RA
B/P  Right: 120/70 Left: 122/73
Height:71"     Weight:265 lbs

General: WDWN in NAD
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X] OP benign, Teeth in fair repair. OP
Benign.
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X] Left lateral upper chest PPM
Pocket.
Heart: RRR, II/VI SEM, Nl S1-S2
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X] Trace-1+ Edema
Varicosities: None [X]. (B) lower leg venous stasis changes.
Neuro: Grossly intact
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   Faintly transmitted murmur vs bruit bilaterally

Pertinent Results:
[**2105-2-3**] Echo: No atrial septal defect is seen by 2D or color
Doppler. Left ventricular wall thicknesses and cavity size are
normal. Right ventricular chamber size and free wall motion are
normal. The aortic root is moderately dilated at the sinus
level. The ascending aorta is moderately dilated. There are
complex (>4mm) atheroma in the ascending aorta. There are
complex (>4mm) atheroma in the aortic arch. There are complex
(>4mm) atheroma in the descending thoracic aorta. The aortic
valve is bicuspid. The aortic valve leaflets are severely
thickened/deformed. Significant aortic stenosis is present (not
quantified). Trace aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no pericardial
effusion. POST CPB: 1. Preserved [**Hospital1 **]-ventricular systolic
function is normal. 2. A prosthetic valve is identified in the
aortic position. Well seated and stable and with good leaflet
excursion. 3. Minimal gradient acorss the prosthetic valve. 4.
Intact aorta. 5. No other change.
[**2105-2-7**] 06:55AM BLOOD WBC-6.3 RBC-2.56* Hgb-7.4*  MCV-85
MCH-28.7 MCHC-33.6 RDW-13.3 Plt Ct-193, repeat HCT PND
[**2105-2-3**] 01:32PM BLOOD WBC-13.1* RBC-3.36* Hgb-9.5*# Hct-29.6*
MCV-88 MCH-28.2 MCHC-32.0 RDW-13.1 Plt Ct-167
[**2105-2-7**] 06:55AM BLOOD PT-22.7* PTT-39.4* INR(PT)-2.1*
[**2105-2-3**] 12:21PM BLOOD PT-15.5* PTT-31.9 INR(PT)-1.4*
[**2105-2-7**] 06:55AM BLOOD Glucose-100 UreaN-14 Creat-0.6 Na-139
K-4.3 Cl-103 HCO3-27 AnGap-13
[**2105-2-4**] 02:43AM BLOOD Glucose-133* UreaN-14 Creat-0.7 Na-138
K-4.9 Cl-108 HCO3-23 AnGap-12

Brief Hospital Course:
Mr. [**Known lastname **] was a same day admit after undergoing pre-operative
work-up as an outpatient. On [**2-3**] he was brought to the
operating room where he underwent an aortic valve replacement
and replacement of his ascending aorta and hemi-arch. Please see
operative report for surgical details. Following surgery he was
transferred to the CVICU for invasive monitoring in stable
condition. Within 24 hours he was weaned from sedation, awoke
neurologically intact and extubated. EP followed up
postoperatively to interrogate Mr.[**Name13 (STitle) 83776**] PPM. On post-op day one
he was transferred to the telemetry floor for further
management. Chest tubes and epicardial pacing wires were removed
per protocol. Beta-Blocker, Statin, Aspirin, and diuretics were
initiated. The patient was evaluated by the physical therapy
service for assistance with post-operative strength and
mobility.  He was started on coumadin with a heparin bridge for
his mechanical aortic valve with a goal INR 2.5-3.5 (per ACC/AHA
guidelines, given his history of DVT). POD#4 Mr.[**Known lastname **] was
transfused 2 units of packed red blood cells for anemia. CXR
confirmed no hemothorax. Dr.[**Last Name (STitle) 914**] cleared Mr.[**Name13 (STitle) 83776**] for
discharge to home with a repeat HCT of_____. INR/Coumadin dosing
will be followed by his PCP, [**Last Name (NamePattern4) **].[**Last Name (STitle) 28272**]. All follow up
appointments were advised.

Medications on Admission:
Aspirin
COzaar 50mg QD
Zocor 40mg QD

Discharge Medications:
1. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily). Tablet(s)
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
5. Outpatient Lab Work
Serial PT/INR
dx: mechanical aortic valve (+ h/o DVT)
goal INR 2.5-3.5
6. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day:
**dose will change daily for goal INR 2.5-3.5, Dr. [**Last Name (STitle) 28272**] to
manage**.
Disp:*60 Tablet(s)* Refills:*2*
7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 5 days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*2*
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
11. Furosemide 40 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA of Southern [**State 1727**]

Discharge Diagnosis:
Aortic Aneurysm/Aortic Valve stenosis s/p Ascending aorta and
hemi-arch replacement and Aortic Valve Replacement
Past medical history:
Complete Heart Block(PPM)
Postop DVT in LUE [**2104-3-12**] following lead extraction
Hyperlipidemia
s/p Dual chamber pacemaker placement in [**2087**]
s/p replacement of PM generator [**2096**]
s/p Lead extraction and reimplantation of PPM [**3-/2104**]
Hernia repair as child

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with percocet prn

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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Recommended Follow-up:Please call to schedule appointments
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 28272**] in [**12-13**] weeks [**Telephone/Fax (1) 83777**]
Dr. [**Last Name (STitle) 28272**] will continue to follow coumadin
First INR draw [**2105-2-9**] results to Dr. [**Last Name (STitle) 28272**] fax [**Telephone/Fax (1) 83778**]
(confirmed with [**Doctor First Name **])
Cardiologist Dr. [**Known firstname 487**] [**Last Name (NamePattern1) 80724**] in [**12-13**] weeks
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will
Provider: [**Name10 (NameIs) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2105-3-12**] 1:00
VNA to draw [**2-8**] AM HCT and call lab results to F6 #[**Telephone/Fax (1) 3071**]


Completed by:[**2105-2-7**]
{'Aortic valve disorders,Congenital insufficiency of aortic valve,Unspecified pleural effusion,Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Fitting and adjustment of cardiac pacemaker,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Anemia, 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: Asymptomatic

PRESENT ILLNESS: 52 year old gentleman with known bicuspid aortic valve and
dilated ascending aorta followed by monthly echocardiograms. His
bicuspid aortic valve was diagnosed in the 7th grade. Most
recent echocardiogram revealed progression of his aortic
stenosis and aortic aneurysm. A CT scan was performed which
showed his ascending aorta to now measure 5.2cm. Echo showed the
ascending aorta to be 5.4cm up from 5.0cm 6 months ago. His
aortic root measures 4.6cm. Given the progression of his
disease, he has been referred for surgical management.

MEDICAL HISTORY: Complete Heart Block(PPM)
Postop DVT in LUE [**2104-3-12**] following lead extraction
Hyperlipidemia
s/p Dual chamber pacemaker placement in [**2087**]
s/p replacement of PM generator [**2096**]
s/p Lead extraction and reimplantation of PPM [**3-/2104**]
Hernia repair as child

MEDICATION ON ADMISSION: Aspirin
COzaar 50mg QD
Zocor 40mg QD

ALLERGIES: Penicillins

PHYSICAL EXAM: Pulse: 80 SR    Resp: 16    O2 sat: 98% RA
B/P  Right: 120/70 Left: 122/73
Height:71"     Weight:265 lbs

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Native bottom teeth/Upper plate. Clearance
faxed to Cardiac surgery office
Lives with: Wife in [**Name2 (NI) 1727**]
Occupation: Production manager on ship yard
Tobacco: Quit 1.5 years ago. 40 pack year history
ETOH: [**12-14**] drinks per week 

### Response:
{'Aortic valve disorders,Congenital insufficiency of aortic valve,Unspecified pleural effusion,Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Fitting and adjustment of cardiac pacemaker,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Anemia, unspecified'}
