CHIEF COMPLAINT: SOB/DOE

PRESENT ILLNESS: 73 year old male with a history of
lymphoma treated with radiation and chemotherapy and Aortic
Aneurysm followed with serial CT scans. He reported to
DR.[**Last Name (STitle) 6512**]
that he's noticed increasing shortness of breath and dyspnea on
exertion  over a week ago. CTA [**12-3**] revealed increasing Thoracic
aortic aneurysm and coronary and aortic valve calcifications.
[**2187-11-14**] TTE revealed severe Aortic stenosis/Ascending aorta and
transverse aorta are dilated measuring 4.9-5.1 cm and 3.3cm/
LVEF=50%. Cath did not reveal significant CAD. Referred

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
Lymphoma
Aortic aneurysm
Hypertension
Dyslipidemia

MEDICATION ON ADMISSION: allopurinol 100 mg Tablet 2 Tablet(s) by
mouth once a day,enalapril maleate 20 mg Tablet1 Tablet(s) by
mouth once a day ,omeprazole 20 mg Capsule, Delayed
Release(E.C.)

ALLERGIES: Lipitor / Lactose

PHYSICAL EXAM: Pulse:72 Resp:18  O2 sat: 94%
B/P  Right: 131/88   Left: 126/91
Height:     Weight:

FAMILY HISTORY: Mother: CAD,
Father: [**Name (NI) **] cancer

SOCIAL HISTORY: Lives with wife. Retired social worker.
-Tobacco history: remote history, occasional cigar
-ETOH: occasional
-Illicit drugs: denies
Aortic valve disorders,Acidosis,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Thoracic aneurysm without mention of rupture,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Gout, unspecified,Thrombocytopenia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Chronic kidney disease, unspecified
Aortic valve disorder,Acidosis,Oth lymp unsp xtrndl org,Thoracic aortic aneurysm,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Asthma NOS,Gout NOS,Thrombocytopenia NOS,Cor ath unsp vsl ntv/gft,Chronic kidney dis NOS
Admission Date:  [**2187-12-13**]              Discharge Date:   [**2187-12-18**]

Date of Birth:  [**2114-4-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lipitor / Lactose

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
SOB/DOE

Major Surgical or Invasive Procedure:
[**2187-12-13**] Aortic valve replacement with a 27-mm [**Company 1543**]
Mosaic     aortic valve bioprosthesis. Replacement of ascending
aorta using a 28-mm Vascutek Dacron tube graft using deep
hypothermic circulatory arrest. Epiaortic duplex scanning.


History of Present Illness:
73 year old male with a history of
lymphoma treated with radiation and chemotherapy and Aortic
Aneurysm followed with serial CT scans. He reported to
DR.[**Last Name (STitle) 6512**]
that he's noticed increasing shortness of breath and dyspnea on
exertion  over a week ago. CTA [**12-3**] revealed increasing Thoracic
aortic aneurysm and coronary and aortic valve calcifications.
[**2187-11-14**] TTE revealed severe Aortic stenosis/Ascending aorta and
transverse aorta are dilated measuring 4.9-5.1 cm and 3.3cm/
LVEF=50%. Cath did not reveal significant CAD. Referred


Past Medical History:
1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
Lymphoma
Aortic aneurysm
Hypertension
Dyslipidemia


Social History:
Lives with wife. Retired social worker.
-Tobacco history: remote history, occasional cigar
-ETOH: occasional
-Illicit drugs: denies


Family History:
Mother: CAD,
Father: [**Name (NI) **] cancer


Physical Exam:
Pulse:72 Resp:18  O2 sat: 94%
B/P  Right: 131/88   Left: 126/91
Height:     Weight:

General:A&Ox 3, NAD
Skin: Warm[x] Dry [x] intact x[]
HEENT: NCAT[x] PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [ x]
Heart: RRR []  Irregular []  Murmur [x] SEM IV/V loudest along
LSB
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: Grossly intact

Pulses:
Femoral      Right:   Left:
DP           Right:   Left:
PT           [**Name (NI) 167**]:   Left:
Radial       Right:  2+ Left:2+
Carotid Bruit   none    pulses Right: 2+   Left:2+


Pertinent Results:
POST BYPASS There is low normal right ventricular systolic
function. The left ventricle displays mild global hypokinesis
with an ejection fraction of about 40 to 45%. There is a
bioprosthesis in the aortic position. It appears well seated.
The leaflets can not be seen very well. There are two trace jets
of aortic regurgitation that are likely perivalvular but image
quality makes definitive diagnosis extremely difficult. The
maximum gradient through the valve is 12 mm Hg with a mean
gradient of 7 mm Hg at a cardiac output of about 4
liters/minute. The effective orifice area of the valve is about
1.7 cm2. There is trace mitral regurgitation. The ascending
aortic gradft can not be well seen. The rest of the thoracic
aorta appears intact after decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD, Interpreting physician
[**Last Name (NamePattern4) **] [**2187-12-13**] 14:50

[**2187-12-18**] 03:50AM BLOOD WBC-7.2 RBC-3.25* Hgb-9.4* Hct-27.6*
MCV-85 MCH-28.9 MCHC-34.1 RDW-16.3* Plt Ct-171
[**2187-12-18**] 03:50AM BLOOD Plt Ct-171
[**2187-12-18**] 03:50AM BLOOD PT-13.9* INR(PT)-1.2*
[**2187-12-13**] 11:10AM BLOOD Fibrino-302
[**2187-12-18**] 03:50AM BLOOD Glucose-114* UreaN-37* Creat-1.4* Na-135
K-4.1 Cl-99 HCO3-28 AnGap-12
[**2187-12-13**] 11:22PM BLOOD ALT-16 AST-45* AlkPhos-43 Amylase-72
TotBili-0.6
[**2187-12-18**] 03:50AM BLOOD Calcium-8.4 Phos-3.3 Mg-2.3

Brief Hospital Course:
Admitted [**12-13**] and underwent surgery with Dr. [**Last Name (STitle) 914**].
Transferred to the CVICU in stable condition on titrated
phenylephrine and propofol drips. Extubated the next morning.
PICC placed for access on POD #2.Transferred to the floor on POD
#3 to begin increasing his activity level. Gently diuresed
toward his preop weight. Chest tubes and pacing wires removed
per protocol.Loaded with amiodarone for A fib.He continued to
make good progress and was cleared for discharge to home with
VNA on POD #5.All f/u appts were advised.

Medications on Admission:
allopurinol 100 mg Tablet 2 Tablet(s) by
mouth once a day,enalapril maleate 20 mg Tablet1 Tablet(s) by
mouth once a day ,omeprazole 20 mg Capsule, Delayed
Release(E.C.)

1 Capsule(s) by mouth once a day,pravastatin 20 mg Tablet
1 Tablet(s) by mouth once a day
* OTCs *
aspirin 81 mg Tablet, Delayed Release (E.C.)
1 Tablet(s) by mouth once a day ,calcium carbonate-vitamin D3
500 mg (1,250 mg)-400 unit Tablet 1 Tablet(s) by mouth twice a
day    multivitamin Tablet 1 Tablet(s) by mouth once a day


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. 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*
3. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. 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:*0*
6. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2)  Inhalation every six (6) hours as needed for shortness
of breath or wheezing.
Disp:*qs qs* Refills:*0*
7. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): please take 400 mg twice a day for 7 days then decrease
to 400 mg once a day for 7 days then decrease to 200 mg until
seen by Dr [**Last Name (STitle) **] .
Disp:*63 Tablet(s)* Refills:*0*
8. warfarin 2 mg Tablet Sig: goal INR 2.0-2.5 Tablets PO once a
day: dose to be adjusted based on INR with goal 2.0-2.5 - being
followed by [**Hospital3 **] [**Hospital1 **] .
Disp:*60 Tablet(s)* Refills:*0*
9. warfarin 5 mg Tablet Sig: goal INR 2.0-2.5 Tablets PO once a
day: dose to be adjusted based on INR .
Disp:*60 Tablet(s)* Refills:*0*
10. Coumadin
You have received two different doses of coumadin/warfarin - 5
mg tablets and 2 mg tablets to allow adjust of your dose of
coumadin with goal INR 2.0-2.5 for atrial fibrillation
[**Hospital3 271**] will be following your INR and speaking
with you in relation to what dose to take
You have received 2.5 mg today at the hospital - the VNA will
see you [**12-19**] and draw your lab - from there the [**Hospital 3052**] will tell you how much coumadin/warfarin to take
11. allopurinol 100 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*0*
12. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
PO DAILY (Daily) as needed for constipation.
13. Lopressor 100 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*
14. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Aortic stenosis s/p AVR
Dilated ascending aorta s/p Ascending Aorta Replacement
Postoperative atrial fibrillation
Asthma
Gout
Arthritis
Diverticulosis


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with Percocet
Incisions:
Sternal - healing well, no erythema or drainage
Edema +1 bilateral lower extremities


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**]

**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: Dr [**Last Name (STitle) 914**] [**Telephone/Fax (1) 170**] [**2188-1-1**] 2:30 pm
Cardiologist: Dr [**Last Name (STitle) **] [**1-11**] at 9:50 am

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) **] in [**5-7**] weeks [**Telephone/Fax (1) 31019**]

**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 ?????? indication Atrial Fibrillation
Goal INR 2.0-2.5
First draw [**2187-12-19**]
Results to Anticoagulation management services
phone [**Telephone/Fax (1) 31020**]  fax  [**Telephone/Fax (1) 31021**]
Please draw INR monday, wednesday, and friday for minimum of 2
weeks



Completed by:[**2187-12-21**]
{'Aortic valve disorders,Acidosis,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Thoracic aneurysm without mention of rupture,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Gout, unspecified,Thrombocytopenia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Chronic kidney disease, 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: SOB/DOE

PRESENT ILLNESS: 73 year old male with a history of
lymphoma treated with radiation and chemotherapy and Aortic
Aneurysm followed with serial CT scans. He reported to
DR.[**Last Name (STitle) 6512**]
that he's noticed increasing shortness of breath and dyspnea on
exertion  over a week ago. CTA [**12-3**] revealed increasing Thoracic
aortic aneurysm and coronary and aortic valve calcifications.
[**2187-11-14**] TTE revealed severe Aortic stenosis/Ascending aorta and
transverse aorta are dilated measuring 4.9-5.1 cm and 3.3cm/
LVEF=50%. Cath did not reveal significant CAD. Referred

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
Lymphoma
Aortic aneurysm
Hypertension
Dyslipidemia

MEDICATION ON ADMISSION: allopurinol 100 mg Tablet 2 Tablet(s) by
mouth once a day,enalapril maleate 20 mg Tablet1 Tablet(s) by
mouth once a day ,omeprazole 20 mg Capsule, Delayed
Release(E.C.)

ALLERGIES: Lipitor / Lactose

PHYSICAL EXAM: Pulse:72 Resp:18  O2 sat: 94%
B/P  Right: 131/88   Left: 126/91
Height:     Weight:

FAMILY HISTORY: Mother: CAD,
Father: [**Name (NI) **] cancer

SOCIAL HISTORY: Lives with wife. Retired social worker.
-Tobacco history: remote history, occasional cigar
-ETOH: occasional
-Illicit drugs: denies 

### Response:
{'Aortic valve disorders,Acidosis,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Thoracic aneurysm without mention of rupture,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Gout, unspecified,Thrombocytopenia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Chronic kidney disease, unspecified'}
