CHIEF COMPLAINT: Dizziness and dyspnea

PRESENT ILLNESS: Mr. [**Known lastname 81493**] is a 70 year old male with known aortic stenosis. He
admits to a several month history of worsening dyspnea. He
presented to outside hospital with several hours of dizziness.
He ruled out for myocardial infarction. Echocardiogram was
notable for worsening aortic stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.6 cm2
with mild to moderate aortic insufficiency. His ejection
fraction was normal at 65-70%. Cardiac catheterization confirmed
severe aortic stenosis while coronary angiography showed
significant disease in the ramus branch and first obtuse
marginal arteries. Given the above findings, he was transferred
to the [**Hospital1 18**] for cardiac surgical intervention.

MEDICAL HISTORY: Aortic Stenosis, Aortic Insufficiency
Coronary Artery Disease
History of Myocardial Infarction [**2182**]
Hypertension
Dyslipidemia
Atrial Fibrillation
Diverticular Disease
Interstitial Lung Disease
Prior Colonic Resection
s/p Appendectomy

MEDICATION ON ADMISSION: Aspirin 81 qd, Zocor 20 qd, Metoprolol 150 [**Hospital1 **], Cartia 120 qd,
Zestril 5 qd, Tikosyn 0.5 [**Hospital1 **], Celebrex 200 qd, Protonix 40 qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS - 114/74, 60, 24
Gen: well developed well nourished elderly male in NAD. Oriented
x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa.
Neck: Supple, No LAD, no JVP appreciated
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.

FAMILY HISTORY: Two sons died of heart attacks.

SOCIAL HISTORY: Retired mechanical engineer. Quit tobacco over 18 years ago.
Admits to only social ETOH. Lives with wife.
Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Postinflammatory pulmonary fibrosis,Swelling, mass, or lump in chest,Dizziness and giddiness,Emphysematous bleb,Hypoxemia,Unspecified essential hypertension,Old myocardial infarction,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia
Aortic valve disorder,Crnry athrscl natve vssl,Atrial fibrillation,Postinflam pulm fibrosis,Chest swelling/mass/lump,Dizziness and giddiness,Emphysematous bleb,Hypoxemia,Hypertension NOS,Old myocardial infarct,Dvrtclo colon w/o hmrhg,Hyperlipidemia NEC/NOS
Admission Date:  [**2188-12-9**]              Discharge Date:   [**2188-12-19**]

Date of Birth:  [**2118-4-1**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dizziness and dyspnea

Major Surgical or Invasive Procedure:
[**2188-12-12**] Aortic Valve Replacement(23mm St. [**Male First Name (un) 923**] Epic Supra
Porcine) and Single Vessel Coronary Artery Bypass Grafting(vein
graft to ramus intermedius).

History of Present Illness:
Mr. [**Known lastname 81493**] is a 70 year old male with known aortic stenosis. He
admits to a several month history of worsening dyspnea. He
presented to outside hospital with several hours of dizziness.
He ruled out for myocardial infarction. Echocardiogram was
notable for worsening aortic stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.6 cm2
with mild to moderate aortic insufficiency. His ejection
fraction was normal at 65-70%. Cardiac catheterization confirmed
severe aortic stenosis while coronary angiography showed
significant disease in the ramus branch and first obtuse
marginal arteries. Given the above findings, he was transferred
to the [**Hospital1 18**] for cardiac surgical intervention.

Past Medical History:
Aortic Stenosis, Aortic Insufficiency
Coronary Artery Disease
History of Myocardial Infarction [**2182**]
Hypertension
Dyslipidemia
Atrial Fibrillation
Diverticular Disease
Interstitial Lung Disease
Prior Colonic Resection
s/p Appendectomy

Social History:
Retired mechanical engineer. Quit tobacco over 18 years ago.
Admits to only social ETOH. Lives with wife.

Family History:
Two sons died of heart attacks.

Physical Exam:
VS - 114/74, 60, 24
Gen: well developed well nourished elderly male in NAD. Oriented
x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa.
Neck: Supple, No LAD, no JVP appreciated
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.

Chest: decreased breath sounds bilaterally
Abd: Soft, NT, ND. No abdominial bruits appreciated.
Ext: Warm. No edema or cyanosis.
Skin: multiple nevi on face and head
Pulses: 1+ bilaterally, no carotid or femoral bruits noted

Pertinent Results:
[**2188-12-10**] Trans-thoracic ECHO: The left atrium is moderately
dilated. The estimated right atrial pressure is 0-5 mmHg. There
is mild symmetric left ventricular hypertrophy with normal
cavity size. There is mild regional left ventricular systolic
dysfunction with thinning/akinesis of the inferolateral wall and
hypokinesis of the inferior wall. The remaining segments
contract well (LVEF 45%). Right ventricular chamber size and
free wall motion are normal. The ascending aorta is mildly
dilated. The aortic valve leaflets are severely
thickened/deformed. There is severe aortic valve stenosis (area
<0.8cm2). Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. The pulmonary artery systolic pressure
could not be quantified. There is an anterior space which most
likely represents a fat pad.
[**2188-12-10**] Carotid US:
1. No significant stenosis of the right ICA.
2. Less than 40% stenosis of the left ICA.

[**2188-12-11**]:
SPIROMETRY 12:43 PM Pre drug Post drug
    Actual Pred %Pred Actual %Pred %chg
FVC   4.37 4.23 103 4.30 102 -2
FEV1   2.75 2.85 97 2.70 95 -2
MMF   1.11 2.61 42 1.23 47 +11
FEV1/FVC   63 67 93 63 93 0

LUNG VOLUMES 12:43 PM Pre drug Post drug
    Actual Pred %Pred Actual %Pred
TLC   6.55 6.71 98
FRC   2.95 3.82 77
RV   2.17 2.48 88
VC   4.52 4.23 107
IC   3.60 2.89 125
ERV   0.78 1.34 58
RV/TLC   33 37 90
He Mix Time   3.38

DLCO 12:43 PM
    Actual Pred %Pred
DSB   15.16 24.79 61
VA(sb)   6.22 6.71 93
HB   15.20
DSB(HB)   14.91 24.79 60
DL/VA   2.40 3.70 65

[**2188-12-12**] Intraop TEE:
Pre Bypass: The left atrium is normal in size. There is mild
symmetric left ventricular hypertrophy. Right ventricular
chamber size and free wall motion are normal. There are complex
(>4mm) atheroma in the aortic arch. The descending thoracic
aorta is mildly dilated. There are simple atheroma in the
descending thoracic aorta. The aortic valve leaflets are
severely thickened/deformed. There is severe aortic valve
stenosis (area <0.8cm2). Mild to moderate ([**1-23**]+) aortic
regurgitation is seen. The mitral valve leaflets are moderately
thickened. Mild to moderate ([**1-23**]+) mitral regurgitation is seen.
There is no pericardial effusion.
Post bypass: Preserved biventricular function LVEF 45%. Mid
inferior hypokinesis is unchanged. MR remains 1+. Aortic
bioprosthesis is insitu (#23 [**Doctor Last Name **]) Peak gradient 17, mean
gradient 5 mm hg. No perivalvular leaks or insufficiency. Aortic
contours intact. Remaining exam is unchanged. All findings
discussed with surgeons at the time of the exam.

[**Known lastname **],[**Known firstname **] C [**Medical Record Number 81494**] M  70  [**2118-4-1**]

Radiology Report CHEST (PA & LAT) Study Date of [**2188-12-15**] 9:05 AM



[**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG FA6A [**2188-12-15**] SCHED
CHEST (PA & LAT)   Clip # [**0-0-**]
Reason: pleural effusions
Final Report
PA AND LATERAL CHEST RADIOGRAPH

HISTORY: 70-year-old man status post AVR and CABG. Evaluate for
pleural
effusions.

COMPARISON: Chest radiograph from [**12-13**] dating back to
[**2188-12-9**].

FINDINGS: Small bilateral pleural effusions are present and
unchanged.
Bilateral pleural densities may be due to subpleural adipose
tissue or pleural
thickening. In the right apex, there is an ill-defined
spiculated nodule
which is either in the lung parenchyma or abuts the pleura. This
nodule is
unchanged since [**2188-12-9**].

The patient is status post median sternotomy and CABG with
appropriately
positioned cerclage wires. The cardiac silhouette is normal in
size. The
aorta is mildly tortuous but unchanged. The hilar and
mediastinal contours
appear unremarkable. A Swan-Ganz catheter has been removed.

IMPRESSION:
1. Unchanged bilateral pleural effusions with slight improvement
in the left
basilar atelectasis.
2. Right apical spiculated nodule will require further
investigation with
chest CT when the patient is clinically stable.

The study and the report were reviewed by the staff radiologist.


DR. [**First Name (STitle) 13879**] [**Name (STitle) 13880**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: MON [**2188-12-15**] 4:18 PM
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2188-12-17**] 05:15AM    8.2 3.13* 9.6* 27.5* 88 30.8 35.0 14.3
182#
Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2188-12-19**] 06:05AM      26* 1.4* 139 3.9


Brief Hospital Course:
Mr. [**Known lastname 81493**] was admitted to the cardiac surgical service and
underwent routine preoperative evaluation which included repeat
echocardiogram, carotid ultrasound and pulmonary function
testing - please see result section for details. He remained
stable on medical therapy. Prior to surgery, he was cleared by
the dental service. His preoperative course was otherwise
uneventful. Given his hospital stay was greater than 24 hours
prior to surgery, Vancomycin was used for perioperative
coverage.

On [**12-12**], Dr. [**Last Name (STitle) **] performed an aortic valve
replacement and coronary artery bypass grafting surgery. For
surgical details, please see separate dictated operative note.
Following the operation, he was brought to the CVICU for
invasive monitoring. Within 24 hours, he awoke neurologically
intact and was extubated without incident. His CVICU course was
uneventful and he transferred to the step down floor on
postoperative day two. Chest tubes and pacing wires were
discontinued without complication.  The patient made excellent
progress with physical therapy, showing good strength and
balance prior to discharge.  He did require meclizine for
vertigo, which was diagnosed pre-operatively.  The patient
required supplemental oxygen throughout his post-operative
course. A blood gas was drawn on room air on [**12-17**] and
reavealed a PO2 of 49. He was diuresed aggressively and treated
with inhalers and his oxygenation improved with room air
saturations above 90% with ambulation.  There was a right upper
lobe nodule found on CXR and he had a chest CT which revealed
bullous emphysema and a right upper lobe pleural based mass
which could represent scarring, inflamation, or neoplasm.  He
was evaluated by Dr. [**Last Name (STitle) **] from thoracic surgery and will
follow up with him.  He should obtain a PET CT and head CT prior
to that visit.  He was discharged to home in stable condition on
POD#7.

Medications on Admission:
Aspirin 81 qd, Zocor 20 qd, Metoprolol 150 [**Hospital1 **], Cartia 120 qd,
Zestril 5 qd, Tikosyn 0.5 [**Hospital1 **], Celebrex 200 qd, Protonix 40 qd

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:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Dofetilide 250 mcg Capsule Sig: One (1) Capsule PO Q12H
(every 12 hours).
Disp:*60 Capsule(s)* Refills:*0*
4. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
5. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) as needed for vertigo symptoms.
Disp:*90 Tablet(s)* Refills:*0*
6. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
7. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
9. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation every six (6) hours.
Disp:*1 vial* Refills:*2*
10. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 vial* Refills:*2*
11. Potassium Chloride 20 mEq Packet Sig: One (1)  PO BID (2
times a day) for 10 days.
Disp:*20 tabs* Refills:*0*
12. Lasix 20 mg Tablet Sig: One (1) Tablet PO three times a day
for 10 days.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Hospice and VNA

Discharge Diagnosis:
aortic stenosis
emphysema
paroxysmal atrial fibrillation
hypertension
hyperlipidemia


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
1) Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for
appointment
2) Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] N [**Telephone/Fax (1) 72189**]  in 1 week () please call
for appointment *follow up with Dr. [**Last Name (STitle) 70216**] re: right apical
nodule on cxr [**12-15**]*
3) Dr. [**Last Name (STitle) 656**] in [**2-24**] weeks please call for appointment
4) Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3071**])
5)Make an appointment with Dr. [**Last Name (STitle) **] for 4 weeks.  Obtain
PET CT and head CT prior to visit.



Completed by:[**2188-12-19**]
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Postinflammatory pulmonary fibrosis,Swelling, mass, or lump in chest,Dizziness and giddiness,Emphysematous bleb,Hypoxemia,Unspecified essential hypertension,Old myocardial infarction,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia'}


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: Dizziness and dyspnea

PRESENT ILLNESS: Mr. [**Known lastname 81493**] is a 70 year old male with known aortic stenosis. He
admits to a several month history of worsening dyspnea. He
presented to outside hospital with several hours of dizziness.
He ruled out for myocardial infarction. Echocardiogram was
notable for worsening aortic stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.6 cm2
with mild to moderate aortic insufficiency. His ejection
fraction was normal at 65-70%. Cardiac catheterization confirmed
severe aortic stenosis while coronary angiography showed
significant disease in the ramus branch and first obtuse
marginal arteries. Given the above findings, he was transferred
to the [**Hospital1 18**] for cardiac surgical intervention.

MEDICAL HISTORY: Aortic Stenosis, Aortic Insufficiency
Coronary Artery Disease
History of Myocardial Infarction [**2182**]
Hypertension
Dyslipidemia
Atrial Fibrillation
Diverticular Disease
Interstitial Lung Disease
Prior Colonic Resection
s/p Appendectomy

MEDICATION ON ADMISSION: Aspirin 81 qd, Zocor 20 qd, Metoprolol 150 [**Hospital1 **], Cartia 120 qd,
Zestril 5 qd, Tikosyn 0.5 [**Hospital1 **], Celebrex 200 qd, Protonix 40 qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS - 114/74, 60, 24
Gen: well developed well nourished elderly male in NAD. Oriented
x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa.
Neck: Supple, No LAD, no JVP appreciated
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.

FAMILY HISTORY: Two sons died of heart attacks.

SOCIAL HISTORY: Retired mechanical engineer. Quit tobacco over 18 years ago.
Admits to only social ETOH. Lives with wife. 

### Response:
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Postinflammatory pulmonary fibrosis,Swelling, mass, or lump in chest,Dizziness and giddiness,Emphysematous bleb,Hypoxemia,Unspecified essential hypertension,Old myocardial infarction,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia'}
