CHIEF COMPLAINT: chest discomfort

PRESENT ILLNESS: 80 yo male with known AS being
followed by serial echos.  Has become symptomatic in past few
months and was referred for AVR. He presents today for surgical
management of his aortic valve stenosis.

MEDICAL HISTORY: aortic stenosis
avascular necrosis R hip
hypertension
hyperlipidemia
gastroesophageal reflux disease
prior ETOH dependen

MEDICATION ON ADMISSION: ASA 325 mg daily
metoprolol XL 50 mg daily
MVI daily
fish oil
simvastatin 10 mg daily
quinapril 5 mg daily
zolpidem 10 mg daily
omeprazole 20 mg [**Hospital1 **]
percocet 5/325 mg prn TID

ALLERGIES: Differin / Coumadin / Adhesive Tape

PHYSICAL EXAM: Pulse: 61 Resp: 16  O2 sat: 95%
B/P Left: 123/72
Height:  5'6"   Weight: 175lb

FAMILY HISTORY: no FH of CAD

SOCIAL HISTORY: Lives with: wife
Occupation: works at supermarket deli 20h/week
Tobacco: quit 30 yrs. ago (20 pack year hx)
ETOH: 4 beers/day
Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Long-term (current) use of aspirin,Hip joint replacement,Other iatrogenic hypotension
Aortic valve disorder,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Long-term use of aspirin,Joint replaced hip,Iatrogenc hypotnsion NEC
Admission Date:  [**2124-8-30**]              Discharge Date:   [**2124-9-5**]

Date of Birth:  [**2044-1-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Differin / Coumadin / Adhesive Tape

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

Major Surgical or Invasive Procedure:
[**2124-8-30**] Aortic valve replacement 25-mm Mosaic
tissue valve.


History of Present Illness:
80 yo male with known AS being
followed by serial echos.  Has become symptomatic in past few
months and was referred for AVR. He presents today for surgical
management of his aortic valve stenosis.


Past Medical History:
aortic stenosis
avascular necrosis R hip
hypertension
hyperlipidemia
gastroesophageal reflux disease
prior ETOH dependen

Social History:
Lives with: wife
Occupation: works at supermarket deli 20h/week
Tobacco: quit 30 yrs. ago (20 pack year hx)
ETOH: 4 beers/day


Family History:
no FH of CAD

Physical Exam:
Pulse: 61 Resp: 16  O2 sat: 95%
B/P Left: 123/72
Height:  5'6"   Weight: 175lb

General: NAD, WGWN, appears stated age
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur 3/6 SEM
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:  2+ (closure device s/p cath) Left: 2+
DP           Right:  2+  Left: 2+
PT           [**Name (NI) 167**]:  2+  Left: 2+
Radial       Right:  2+  Left: 2+

Carotid Bruit    radiation of cardiac murmur vs. bruit


Pertinent Results:
[**2124-9-1**] 05:38AM BLOOD WBC-12.4* RBC-3.46* Hgb-11.1* Hct-31.6*
MCV-91 MCH-32.0 MCHC-35.0 RDW-13.5 Plt Ct-119*
[**2124-8-31**] 05:13AM BLOOD WBC-17.6*# RBC-3.75* Hgb-12.2* Hct-34.0*
MCV-91 MCH-32.5* MCHC-35.9* RDW-13.7 Plt Ct-147*
[**2124-8-30**] 01:10PM BLOOD PT-13.4 PTT-38.9* INR(PT)-1.1
[**2124-9-1**] 05:38AM BLOOD Glucose-117* UreaN-13 Creat-1.0 Na-135
K-4.0 Cl-101 HCO3-28 AnGap-10

PREBYPASS
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 or right atrial appendage.
No atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%). Right ventricular
chamber size is normal with normal free wall contractility. The
descending thoracic aorta is mildly dilated. There are complex
(>4mm) atheroma in the proximal descending thoracic aorta/distal
aortic arch. 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. Mild (1+) mitral regurgitation is seen. There
is no pericardial effusion.

POSTBYPASS

The patient is A-paced on a phenylephrine infusion.There is a
bioprosthetic aortic valve which appears well seated. The
peak/mean gradients across the valve are 19/8 mmHg at a CO of
3.91 L/min. The aorta is intact post decannulation. Dr.[**Last Name (STitle) **]
was notified in person of the results at the time of the study.


[**2124-9-5**] 04:30AM BLOOD WBC-6.4 RBC-3.21* Hgb-10.3* Hct-29.9*
MCV-93 MCH-31.9 MCHC-34.3 RDW-13.3 Plt Ct-286
[**2124-9-4**] 05:45AM BLOOD WBC-6.7 RBC-3.25* Hgb-10.5* Hct-30.1*
MCV-93 MCH-32.2* MCHC-34.8 RDW-13.4 Plt Ct-218
[**2124-9-5**] 04:30AM BLOOD Glucose-96 UreaN-21* Creat-1.0 Na-139
K-4.0 Cl-103 HCO3-27 AnGap-13

Brief Hospital Course:
The patient was brought to the operating room on [**2124-8-30**] where
the patient underwent aortic valve replacement with a 25mm
tissue valve.  Overall the patient tolerated the procedure well
and post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.  Cefazolin was
used for surgical antibiotic prophylaxis.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.  The patient
was transferred to the telemetry floor for further recovery.  He
did develop post-op a-fib briefly and converted to sinus rhythm
with amiodarone.  Chest tubes and pacing wires were discontinued
without complication.  The patient was evaluated by the physical
therapy service for assistance with strength and mobility.  By
the time of discharge on POD 6 the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.  The patient was discharged to rehab (TCU, [**Hospital 1474**]
Hospital) in good condition with appropriate follow up
instructions.

Medications on Admission:
ASA 325 mg daily
metoprolol XL 50 mg daily
MVI daily
fish oil
simvastatin 10 mg daily
quinapril 5 mg daily
zolpidem 10 mg daily
omeprazole 20 mg [**Hospital1 **]
percocet 5/325 mg prn TID


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. omega-3 fatty acids     Capsule Sig: One (1) Capsule PO DAILY
(Daily).
4. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain/temp.
10. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
11. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x 7 days, then 400mg daily x 7 days, then
200mg daily until further instructed.
12. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
13. oxycodone-acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
14. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
15. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day
for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
16. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 1
weeks.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
17. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
18. diphenhydramine HCl 25 mg Capsule Sig: [**11-27**] Capsules PO Q6H
(every 6 hours) as needed for itching.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 1474**] Hospital  TCU (Signature)

Discharge Diagnosis:
Aortic Stenosis
PMH:
avascular necrosis R hip
hypertension
hyperlipidemia
gastroesophageal reflux disease
prior ETOH dependency

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, [**Known lastname **], 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**]
**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:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2124-9-28**] 1:00
Cardiologist Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **]  [**10-2**] @ 12:20 pm
Please call to schedule the following:
Primary Care Dr.[**Last Name (STitle) **],[**First Name3 (LF) **] H. [**Telephone/Fax (1) 14331**]  in [**2-28**] weeks



Completed by:[**2124-9-5**]
{'Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Long-term (current) use of aspirin,Hip joint replacement,Other iatrogenic hypotension'}


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

PRESENT ILLNESS: 80 yo male with known AS being
followed by serial echos.  Has become symptomatic in past few
months and was referred for AVR. He presents today for surgical
management of his aortic valve stenosis.

MEDICAL HISTORY: aortic stenosis
avascular necrosis R hip
hypertension
hyperlipidemia
gastroesophageal reflux disease
prior ETOH dependen

MEDICATION ON ADMISSION: ASA 325 mg daily
metoprolol XL 50 mg daily
MVI daily
fish oil
simvastatin 10 mg daily
quinapril 5 mg daily
zolpidem 10 mg daily
omeprazole 20 mg [**Hospital1 **]
percocet 5/325 mg prn TID

ALLERGIES: Differin / Coumadin / Adhesive Tape

PHYSICAL EXAM: Pulse: 61 Resp: 16  O2 sat: 95%
B/P Left: 123/72
Height:  5'6"   Weight: 175lb

FAMILY HISTORY: no FH of CAD

SOCIAL HISTORY: Lives with: wife
Occupation: works at supermarket deli 20h/week
Tobacco: quit 30 yrs. ago (20 pack year hx)
ETOH: 4 beers/day 

### Response:
{'Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Long-term (current) use of aspirin,Hip joint replacement,Other iatrogenic hypotension'}
