CHIEF COMPLAINT: chest discomfort with activity

PRESENT ILLNESS: 59 yo male with history of angina with activity over the past
month. Cath revealed severe AS, mild MR and 40% RCA lesion.
Referred for surgery.

MEDICAL HISTORY: AS
elev. lipids
obesity
spastic colon ( aysmptomatic on fiber supplement)

MEDICATION ON ADMISSION: toprol Xl 50 mg daily
lipitor 10 mg daily
ASA 81 mg daily
glucosamine
alprazolam 0.25 mg prn
MVI
ibuprofen prn
fish oil

ALLERGIES: Iodine

PHYSICAL EXAM: HR 64  RR 20   right 160/100   left 150/100
5'6"   210#
NAD, skin/HEENT unremarkable
neck supple, full ROM,murmur bilat. to carotids
CTAB
RRR with 4/6 Systolic murmur
soft, NT, ND, + BS
warm, well-perfused; no edema or varicosities
neuro grossly intact
2+ bil. fems/DP/PT/radials
right groin ecchymotic post- cath

FAMILY HISTORY: father died of MI at 68

SOCIAL HISTORY: truck driver
few ETOH per day
remote tobacco
lives with wife
Aortic valve disorders,Thoracic aneurysm without mention of rupture,Other and unspecified alcohol dependence, continuous
Aortic valve disorder,Thoracic aortic aneurysm,Alcoh dep NEC/NOS-contin
Admission Date:  [**2107-12-19**]              Discharge Date:   [**2107-12-25**]

Date of Birth:  [**2048-7-22**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Iodine

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
chest discomfort with activity

Major Surgical or Invasive Procedure:
[**2107-12-19**] Aortic valve replacement (27 mm CE pericardial valve) &
replacement of ascending aorta ( 26 mm Gelweave graft)


History of Present Illness:
59 yo male with history of angina with activity over the past
month. Cath revealed severe AS, mild MR and 40% RCA lesion.
Referred for surgery.

Past Medical History:
AS
elev. lipids
obesity
spastic colon ( aysmptomatic on fiber supplement)

Social History:
truck driver
few ETOH per day
remote tobacco
lives with wife

Family History:
father died of MI at 68

Physical Exam:
HR 64  RR 20   right 160/100   left 150/100
5'6"   210#
NAD, skin/HEENT unremarkable
neck supple, full ROM,murmur bilat. to carotids
CTAB
RRR with 4/6 Systolic murmur
soft, NT, ND, + BS
warm, well-perfused; no edema or varicosities
neuro grossly intact
2+ bil. fems/DP/PT/radials
right groin ecchymotic post- cath

Pertinent Results:
[**2107-12-25**] 03:55AM BLOOD WBC-5.6 RBC-2.62* Hgb-8.8* Hct-24.8*
MCV-95 MCH-33.6* MCHC-35.5* RDW-13.9 Plt Ct-163
[**2107-12-25**] 03:55AM BLOOD PT-13.2* PTT-27.8 INR(PT)-1.2*
[**2107-12-25**] 03:55AM BLOOD Plt Ct-163
[**2107-12-25**] 03:55AM BLOOD Glucose-114* UreaN-10 Creat-0.9 Na-137
K-3.8 Cl-101 HCO3-25 AnGap-15
[**2107-12-25**] 03:55AM BLOOD Calcium-8.9 Phos-5.0* Mg-2.2

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 71173**] (Complete)
Done [**2107-12-19**] at 10:27:38 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Last Name (Prefixes) 413**], [**First Name3 (LF) 412**]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2048-7-22**]
Age (years): 59 M  Hgt (in): 66
BP (mm Hg): 111/77  Wgt (lb): 210
HR (bpm): 74  BSA (m2): 2.04 m2
Indication: Aortic valve disease. Intra-op TEE for AVR, Asc.
Aorta replacement
ICD-9 Codes: 440.0, 441.2, V43.3, 424.1
Test Information
Date/Time: [**2107-12-19**] at 10:27    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 929**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2007AW01-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.4 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  4.1 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.3 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.3 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  3.5 cm
Left Ventricle - Fractional Shortening:  *0.19  >= 0.29
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Annulus:  2.4 cm  <= 3.0 cm
Aorta - Sinus Level:  *3.8 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  *3.4 cm  <= 3.0 cm
Aorta - Ascending:  *4.5 cm  <= 3.4 cm
Aorta - Arch:  2.8 cm  <= 3.0 cm
Aorta - Descending Thoracic:  *2.8 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *3.9 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *62 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  32 mm Hg
Aortic Valve - LVOT pk vel:  0.50 m/sec
Aortic Valve - LVOT diam:  2.3 cm
Aortic Valve - Valve Area:  *0.7 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Mild LA enlargement. Good (>20 cm/s) LAA ejection
velocity.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. No
ASD by 2D or color Doppler.

LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size.
Overall normal LVEF (>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Mildly dilated aortic sinus. Focal calcifications in
aortic root. Moderately dilated ascending aorta. Focal
calcifications in ascending aorta. Normal aortic arch diameter.
Simple atheroma in aortic arch. Mildly dilated descending aorta.
Simple atheroma in descending aorta.

AORTIC VALVE: Bicuspid aortic valve. Moderately thickened aortic
valve leaflets. Severe AS (AoVA <0.8cm2). No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MS.
Physiologic MR (within normal limits).

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. No TEE related complications. The patient was under
general anesthesia throughout the procedure. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient. See Conclusions for post-bypass data

Conclusions
PRE-BYPASS:
1. The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or color Doppler.
2. There is mild symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
3. Right ventricular chamber size and free wall motion are
normal.
4. The aortic root is mildly dilated at the sinus level. The
ascending aorta is moderately dilated. There are simple atheroma
in the aortic arch. The descending thoracic aorta is mildly
dilated. There are simple atheroma in the descending thoracic
aorta.
5. The aortic valve is bicuspid. The aortic valve leaflets are
moderately thickened. There is severe aortic valve stenosis
(area <0.8cm2). No aortic regurgitation is seen.
6. The mitral valve leaflets are mildly thickened. Physiologic
mitral regurgitation is seen (within normal limits).

POST-BYPASS: Pt is in sinus rhythm and is on an infusion of
phenylephrine
1. A Bioprosthesis is well seated in the aortic position.
Leaflets open well. Trace central AI is seen.
2. A ascending aortic prosthesis is seen.
3. Other findings are unchanged.
I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD, Interpreting
physician



Brief Hospital Course:
Admitted [**12-19**] and underwent AVR/replacement. ascending aorta
with Dr. [**Last Name (STitle) 1290**]. Extubated that evening and transferred to
the floor on POD #1 to begin increasing his activity level.
Chest tubes and pacing wires removed without incidient.
Vancomycin started for sternal drainage on POD #3. Had periods
of disorientation and psych. evaluated pt.with noted probable
alcohol dependence/withdrawal.Delirium resolved over the next
several days and he was cleared for discharge to home with
services on POD #6. Pt. to make all follow-up appts. as per
discharge instructions.

Medications on Admission:
toprol Xl 50 mg daily
lipitor 10 mg daily
ASA 81 mg daily
glucosamine
alprazolam 0.25 mg prn
MVI
ibuprofen prn
fish oil

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
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.
4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
10. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO
DAILY (Daily) for 5 days.
Disp:*5 Packet(s)* Refills:*0*
11. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4-6H (every 4 to 6 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
13. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO every [**3-2**]
hours as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
14. Keflex 500 mg Tablet Sig: One (1) Tablet PO every six (6)
hours for 14 days.
Disp:*56 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
1. Severe aortic stenosis
2. anxiety
3. EtOH dependence
4. Acending aortic aneursym
5. obesity
6.spastic colon
7. elev. lipids


Discharge Condition:
good


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more then 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.
No heavy lifting or driving until follow up with surgeon.


Followup Instructions:
1. Return to [**Hospital Ward Name 121**] 2 for wound check in 1 week
2. Provider: [**Last Name (Prefixes) **]  Follow-up appointment should be in 1
month [**Telephone/Fax (1) 170**]
3. Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 900**] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 37064**]  Follow-up appointment
should be in 2 weeks



Completed by:[**2107-12-26**]
{'Aortic valve disorders,Thoracic aneurysm without mention of rupture,Other and unspecified alcohol dependence, continuous'}


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: chest discomfort with activity

PRESENT ILLNESS: 59 yo male with history of angina with activity over the past
month. Cath revealed severe AS, mild MR and 40% RCA lesion.
Referred for surgery.

MEDICAL HISTORY: AS
elev. lipids
obesity
spastic colon ( aysmptomatic on fiber supplement)

MEDICATION ON ADMISSION: toprol Xl 50 mg daily
lipitor 10 mg daily
ASA 81 mg daily
glucosamine
alprazolam 0.25 mg prn
MVI
ibuprofen prn
fish oil

ALLERGIES: Iodine

PHYSICAL EXAM: HR 64  RR 20   right 160/100   left 150/100
5'6"   210#
NAD, skin/HEENT unremarkable
neck supple, full ROM,murmur bilat. to carotids
CTAB
RRR with 4/6 Systolic murmur
soft, NT, ND, + BS
warm, well-perfused; no edema or varicosities
neuro grossly intact
2+ bil. fems/DP/PT/radials
right groin ecchymotic post- cath

FAMILY HISTORY: father died of MI at 68

SOCIAL HISTORY: truck driver
few ETOH per day
remote tobacco
lives with wife 

### Response:
{'Aortic valve disorders,Thoracic aneurysm without mention of rupture,Other and unspecified alcohol dependence, continuous'}
