CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 65 year old female with a history of diabetes, hypertension, and
known aortic stenosis-followed by serial echocardiograms- was
found to be in atrial fibrillation with worsening Aortic
stenosis and decreased LVEF of 45% during
an echo on [**9-22**]. She was told to go tho the ED and presented to
OSH complaining of worsening dyspnea on exertion, fatigue and
lower extremity edema. Cardiac cath revealed multivessel
coronary disease. She was transferred to [**Hospital1 18**] for cardiac
surgery evaluation of operative candidacy for Aortic Valve
replacement/
coronary artery revascularization.

MEDICAL HISTORY: DMII, dyslipidemia, hypertension, Aortic stenosis, PAF since
[**2121-9-22**], scarlet fever, migraines

MEDICATION ON ADMISSION: Lisinopril 40(1), Glyburide 5(2), ASA 81(1), Simvastatin that
she recently stopped 2' cost, Vit D/Calcium, Prilosec 20 (1)

ALLERGIES: Tuberculin,Ppd,Multi-Puncture

PHYSICAL EXAM: Pulse: 54 Resp:18   O2 sat: 99% R/A
B/P  Right:113/64    Left:
Height: 66     Weight: 270

FAMILY HISTORY: Father +MI->deceased 75yo, Mother->AAA, sister->Dibetes/leukemia

SOCIAL HISTORY: Last Dental Exam:1 year ago
Lives with:alone
Occupation:RN->med/[**Doctor First Name **]
Tobacco:denies
ETOH:denies
Aortic valve disorders,Atrial flutter,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anemia, unspecified,Other and unspecified hyperlipidemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Obesity, unspecified,Other specified complications of procedures not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution
Aortic valve disorder,Atrial flutter,Urin tract infection NOS,Crnry athrscl natve vssl,Dental caries NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Anemia NOS,Hyperlipidemia NEC/NOS,Migrne unsp wo ntrc mgrn,Depressive disorder NEC,History of tobacco use,Obesity NOS,Oth spcf cmplc procd NEC,Abn react-anastom/graft,Accid in resident instit
Admission Date:  [**2121-9-26**]              Discharge Date:   [**2121-10-8**]

Date of Birth:  [**2056-5-1**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Tuberculin,Ppd,Multi-Puncture

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2121-9-30**] - Coronary artery bypass grafting to one vessel, Aortic
valve replacement (21mm St. [**Male First Name (un) 923**] Mechanical valve)


History of Present Illness:
65 year old female with a history of diabetes, hypertension, and
known aortic stenosis-followed by serial echocardiograms- was
found to be in atrial fibrillation with worsening Aortic
stenosis and decreased LVEF of 45% during
an echo on [**9-22**]. She was told to go tho the ED and presented to
OSH complaining of worsening dyspnea on exertion, fatigue and
lower extremity edema. Cardiac cath revealed multivessel
coronary disease. She was transferred to [**Hospital1 18**] for cardiac
surgery evaluation of operative candidacy for Aortic Valve
replacement/
coronary artery revascularization.


Past Medical History:
DMII, dyslipidemia, hypertension, Aortic stenosis, PAF since
[**2121-9-22**], scarlet fever, migraines

Social History:
Last Dental Exam:1 year ago
Lives with:alone
Occupation:RN->med/[**Doctor First Name **]
Tobacco:denies
ETOH:denies


Family History:
Father +MI->deceased 75yo, Mother->AAA, sister->Dibetes/leukemia


Physical Exam:
Pulse: 54 Resp:18   O2 sat: 99% R/A
B/P  Right:113/64    Left:
Height: 66     Weight: 270

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmurx- SEM IV/VI
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right:   Left:
DP           Right:2+   Left:2+
PT           [**Name (NI) 167**]:   Left:
Radial       Right:   Left:

Carotid Bruit -SEM transmitted   Right:  2+  Left:2+


Pertinent Results:
[**2121-9-27**] ECHO
The left atrium is moderately dilated. The right atrium is
moderately dilated. There is mild symmetric left ventricular
hypertrophy with normal cavity size and regional/global systolic
function (LVEF>55%). Right ventricular chamber size and free
wall motion are normal. The aortic arch is mildly dilated. The
aortic valve leaflets are severely thickened/deformed. There is
critical aortic valve stenosis (valve area <0.8cm2). Mild (1+)
aortic regurgitation is seen. The mitral valve leaflets are
moderately thickened. There is severe mitral annular
calcification with moderate thickening of the valve chordae.
There is mild functional mitral stenosis (mean gradient 3 mmHg)
due to mitral annular calcification. The pulmonary artery
systolic pressure could not be determined. There is no
pericardial effusion.

IMPRESSION: Symmetric LVH with normal global and regional
biventricular systolic function. Critical calcific aortic
stenosis. Mild calcific mitral stenosis.

[**2121-10-7**] 04:30AM BLOOD WBC-10.1 RBC-3.50* Hgb-10.8* Hct-31.7*
MCV-90 MCH-30.9 MCHC-34.2 RDW-13.9 Plt Ct-277
[**2121-10-8**] 04:54AM BLOOD PT-37.4* INR(PT)-3.9*
[**2121-10-7**] 04:30AM BLOOD Glucose-142* UreaN-18 Creat-0.6 Na-135
K-3.9 Cl-97 HCO3-36* AnGap-6*

Brief Hospital Course:
Ms. [**Known lastname 87383**] was admitted to the [**Hospital1 18**] on [**2121-9-26**] for surgical
management of her coronary artery disease and aortic valve
stenosis. She was worked-up in the usual preoperative manner.
Dental clearance was obtained. Heparin was continued as she was
in atrial fibrillation. She had a urinary tract infection for
which ciprofloxacin was started. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 387**] diabetes consult was
obtained as her hemoglobin A1c was 10.8%. On [**2121-9-30**], Ms.
[**Known lastname 87383**] was taken to the operating room where she underwent
coronary artery bypass grafting to her right coronary artery and
an aortic valve replacement using a 21mm St. [**Male First Name (un) 923**] mechanical
valve. Please see operative note for details. Postoperatively
she was taken to the intensive care unit for monitoring. On
postoperative day one, she awoke neurologically intact and was
extubated. She had atrial fibrillation and was placed on
amiodarone.  Coumadin was started for her mechanical AVR and
atrial fibrillation.  Her chest tubes were removed and she was
transferred to the surgical step down floor.  Her epicardial
wires were removed.  She was seen in consultation by the
physical therapy service. She continued to make steady progress
and was discharged to home on postoperative day eight.  INR was
arranged to be followed by Dr. [**Last Name (STitle) 84113**].  All follow-up
appointments were advised.

Medications on Admission:
Lisinopril 40(1), Glyburide 5(2), ASA 81(1), Simvastatin that
she recently stopped 2' cost, Vit D/Calcium, Prilosec 20 (1)


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. simvastatin 40 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
4. glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
5. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 10
days.
Disp:*10 Tablet(s)* Refills:*2*
6. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 10
days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*
7. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
take 400mg daily for 1 week, then decrease to 200mg daily
ongoing.
Disp:*60 Tablet(s)* Refills:*2*
8. Zofran 4 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*
9. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
10. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*2*
11. Coumadin 2.5 mg Tablet Sig: One (1) Tablet PO once a day: or
as directed by the office of Dr. [**Last Name (STitle) 84113**]. .
Disp:*30 Tablet(s)* Refills:*2*
12. Outpatient Lab Work
Labs: PT/INR for Coumadin for Mechanical AVR and atrial
fibrillation
Goal INR [**1-29**]
First draw [**10-9**]
Results to Dr. [**Last Name (STitle) 84113**] at ([**2121**]


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Aortic stenosis
Coronary artery disease
Diabetes
Dyslipidemia
Hypertension
Paroxysmal atrial fibrillation
Obesity


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


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**]
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:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2121-10-23**] 1:30

Cardiologist: Dr. [**Last Name (STitle) 4922**] on [**10-31**] at 1:15pm

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) **],[**First Name8 (NamePattern2) 251**] [**Doctor Last Name **] [**0-0-**] in [**3-31**] 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**

Labs: PT/INR for Coumadin for Mechanical AVR and atrial
fibrillation
Goal INR [**1-29**]
First draw [**10-9**]
Results to Dr. [**Last Name (STitle) 84113**] at ([**2121**]



Completed by:[**2121-10-8**]

Name:  [**Known lastname 13861**],[**Known firstname 13862**]                 Unit No:   [**Numeric Identifier 13863**]

Admission Date:  [**2121-9-26**]              Discharge Date:   [**2121-10-8**]

Date of Birth:  [**2056-5-1**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Tuberculin,Ppd,Multi-Puncture

Attending:[**First Name3 (LF) 741**]
Addendum:
Pt also prescribed 40 units Lantus q AM for better BS control.
At the time of discharge blood sugar was ranging 72-185.
Patient was instructed about the importance of strict blood
sugar control.

Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 1066**], [**First Name3 (LF) **]

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

Completed by:[**2121-10-8**]
{'Aortic valve disorders,Atrial flutter,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anemia, unspecified,Other and unspecified hyperlipidemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Obesity, unspecified,Other specified complications of procedures not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}


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: Shortness of breath

PRESENT ILLNESS: 65 year old female with a history of diabetes, hypertension, and
known aortic stenosis-followed by serial echocardiograms- was
found to be in atrial fibrillation with worsening Aortic
stenosis and decreased LVEF of 45% during
an echo on [**9-22**]. She was told to go tho the ED and presented to
OSH complaining of worsening dyspnea on exertion, fatigue and
lower extremity edema. Cardiac cath revealed multivessel
coronary disease. She was transferred to [**Hospital1 18**] for cardiac
surgery evaluation of operative candidacy for Aortic Valve
replacement/
coronary artery revascularization.

MEDICAL HISTORY: DMII, dyslipidemia, hypertension, Aortic stenosis, PAF since
[**2121-9-22**], scarlet fever, migraines

MEDICATION ON ADMISSION: Lisinopril 40(1), Glyburide 5(2), ASA 81(1), Simvastatin that
she recently stopped 2' cost, Vit D/Calcium, Prilosec 20 (1)

ALLERGIES: Tuberculin,Ppd,Multi-Puncture

PHYSICAL EXAM: Pulse: 54 Resp:18   O2 sat: 99% R/A
B/P  Right:113/64    Left:
Height: 66     Weight: 270

FAMILY HISTORY: Father +MI->deceased 75yo, Mother->AAA, sister->Dibetes/leukemia

SOCIAL HISTORY: Last Dental Exam:1 year ago
Lives with:alone
Occupation:RN->med/[**Doctor First Name **]
Tobacco:denies
ETOH:denies 

### Response:
{'Aortic valve disorders,Atrial flutter,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Dental caries, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anemia, unspecified,Other and unspecified hyperlipidemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Depressive disorder, not elsewhere classified,Personal history of tobacco use,Obesity, unspecified,Other specified complications of procedures not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}
