CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 76F w h/o aortic stenosis and CAD, s/p LAD stent in [**2104**].  Echo
in [**2106-7-14**] revealed [**Location (un) 109**] 0.8-1cm2 with EF 75%.  Further workup
was delayed at this time, as there was some question of GI
bleed. Endoscopy and colonoscopy have been performed in the
meantime, and were both negative.  She has developed shortness
of breath with moderate exertion recently.  Cardiac cath today
reveals moderate CAD.  The patient is referred for cardiac
surgery evaluation.

MEDICAL HISTORY: Aortic Stenosis
Coronary artery disease s/p stent to LAD [**2104**]
Hypertension
Hypercholesterolemia
Osteopenia/Osteoarthritis
Anemia
Gastroesophageal reflux disease
s/p hernia repair
s/p tonsillectomy
s/p right shoulder surgery

MEDICATION ON ADMISSION: fosamax 70 q wednesday
atenolol 25'
lisinopril 20'
omeprazole 20'
simvastatin 80'
aspirin 162'
calcium
vitamin D
MVI
ibuprofen prn

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Pulse: 73SR Resp: 18  O2 sat: 100%RA
B/P  Right: 177/63   Left:
Height: 5'6"    Weight: 61.7kg

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race: caucasian
Last Dental Exam: 2 weeks ago
Lives with: husband
Occupation: retired, office work
Tobacco: none
ETOH: approx 3/week
Coronary atherosclerosis of native coronary artery,Alkalosis,Chronic diastolic heart failure,Cardiac complications, not elsewhere classified,Aortic valve disorders,Thrombocytopenia, unspecified,Oliguria and anuria,Unspecified essential hypertension,Pure hypercholesterolemia,Disorder of bone and cartilage, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Esophageal reflux,Percutaneous transluminal coronary angioplasty status,Atrial fibrillation,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,Other iatrogenic hypotension
Crnry athrscl natve vssl,Alkalosis,Chr diastolic hrt fail,Surg compl-heart,Aortic valve disorder,Thrombocytopenia NOS,Oliguria & anuria,Hypertension NOS,Pure hypercholesterolem,Bone & cartilage dis NOS,Osteoarthros NOS-unspec,Anemia NOS,Esophageal reflux,Status-post ptca,Atrial fibrillation,Abn react-anastom/graft,Iatrogenc hypotnsion NEC
Admission Date:  [**2107-4-14**]              Discharge Date:   [**2107-4-19**]

Date of Birth:  [**2030-7-21**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
1. Aortic valve replacement with a size 19 [**First Name9 (NamePattern2) 12640**] [**Last Name (un) 3843**]-
[**Doctor Last Name **] tissue valve.
2. Coronary artery bypass graft x3, left internal mammary artery
to left anterior descending artery and saphenous vein grafts to
obtuse marginal and posterior descending arteries

History of Present Illness:
76F w h/o aortic stenosis and CAD, s/p LAD stent in [**2104**].  Echo
in [**2106-7-14**] revealed [**Location (un) 109**] 0.8-1cm2 with EF 75%.  Further workup
was delayed at this time, as there was some question of GI
bleed. Endoscopy and colonoscopy have been performed in the
meantime, and were both negative.  She has developed shortness
of breath with moderate exertion recently.  Cardiac cath today
reveals moderate CAD.  The patient is referred for cardiac
surgery evaluation.

Past Medical History:
Aortic Stenosis
Coronary artery disease s/p stent to LAD [**2104**]
Hypertension
Hypercholesterolemia
Osteopenia/Osteoarthritis
Anemia
Gastroesophageal reflux disease
s/p hernia repair
s/p tonsillectomy
s/p right shoulder surgery

Social History:
Race: caucasian
Last Dental Exam: 2 weeks ago
Lives with: husband
Occupation: retired, office work
Tobacco: none
ETOH: approx 3/week

Family History:
non-contributory

Physical Exam:
Pulse: 73SR Resp: 18  O2 sat: 100%RA
B/P  Right: 177/63   Left:
Height: 5'6"    Weight: 61.7kg

General:
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 [] no edema or varicosities
Neuro: Grossly intact  x
Pulses:
Femoral      Right: cath site   Left: 2+
DP           Right: 1+   Left: 1+
PT           [**Name (NI) 167**]: 1+  Left: 1+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right:    Left:  no bruits appreciated

Pertinent Results:
[**2107-4-14**] Echo: PRE-BYPASS: The left atrium is dilated. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. No atrial septal defect is seen
by 2D or color Doppler. 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. There are focal calcifications in the
aortic arch. The aortic valve leaflets are severely
hickened/deformed. There is critical aortic valve stenosis
(valve area <0.8cm2). The peak and mean gradients are 60 and 35
m of Hg. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse. Trivial mitral regurgitation is seen. There is no
pericardial effusion. Dr. [**First Name (STitle) **] was notified in person of the
results on Mrs [**Known lastname **] [**Name (STitle) 60351**]: Preserved biventricular
systolic function. LVEF 55%. Normal RV systolic function. Aortic
prosthesis is stable and functioning well with residual peak and
means of 30 and 12 mm of Hg. Mild to Moderate TR. Intact
thoracic aorta. Trivial MR.

Brief Hospital Course:
Mrs. [**Known lastname **] was a same day admit and on [**4-14**] she was brought to
the operating room and underwent an aortic valve replacement and
coronary artery bypass graft. Please see operative report for
surgical details. Following surgery she was transferred to the
CVICU for invasive monitoring in stable condition. Within 24
hours she was weaned from sedation, awoke neurologically intact
and extubated. Amiodarone was started for premature atrial
contractions and eventually discontinued. Chest tubes were
removed on post-op day two and she was transferred to the
telemetry floor for further care. She started on having episodes
of atrial fibrillation and amiodarone was re-started.
Epicardial pacing wires were removed and she worked with
physical therapy for strength and mobility.  By the time of
discharge on POD 5 the patient was ambulating freely, the wound
was healing and pain was controlled with oral analgesics.  The
patient was discharged to rehab in good condition with
appropriate follow up instructions.

Medications on Admission:
fosamax 70 q wednesday
atenolol 25'
lisinopril 20'
omeprazole 20'
simvastatin 80'
aspirin 162'
calcium
vitamin D
MVI
ibuprofen prn

Discharge Medications:
1. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
2. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
9. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x5days then decrease to 400mg daily x7days
then 200 daily ongoing.
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Fosamax 70 mg Tablet Sig: One (1) Tablet PO once a week.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] Of [**Location (un) 620**]

Discharge Diagnosis:
Aortic Stenosis/Coronary artery disease s/p Aortic valve
replacement and coronary artery bypass graft x 3
Past medical history:
Hypertension
Hypercholesterolemia
s/p stent to LAD [**2104**]
Osteopenia/Osteoarthritis
Anemia
Gastroesophageal reflux disease
s/p hernia repair
s/p tonsillectomy
s/p right shoulder surgery
post operative afib


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with percocet prn

Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions

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 until follow up with
surgeon
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

Followup Instructions:
Please call to schedule appointments
Surgeon Dr. [**First Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Primary Care Dr. [**Last Name (STitle) **] in [**1-15**] weeks
Cardiologist Dr. [**Last Name (STitle) **] in [**1-15**] weeks


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2107-4-19**]
{'Coronary atherosclerosis of native coronary artery,Alkalosis,Chronic diastolic heart failure,Cardiac complications, not elsewhere classified,Aortic valve disorders,Thrombocytopenia, unspecified,Oliguria and anuria,Unspecified essential hypertension,Pure hypercholesterolemia,Disorder of bone and cartilage, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Esophageal reflux,Percutaneous transluminal coronary angioplasty status,Atrial fibrillation,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,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: Shortness of breath

PRESENT ILLNESS: 76F w h/o aortic stenosis and CAD, s/p LAD stent in [**2104**].  Echo
in [**2106-7-14**] revealed [**Location (un) 109**] 0.8-1cm2 with EF 75%.  Further workup
was delayed at this time, as there was some question of GI
bleed. Endoscopy and colonoscopy have been performed in the
meantime, and were both negative.  She has developed shortness
of breath with moderate exertion recently.  Cardiac cath today
reveals moderate CAD.  The patient is referred for cardiac
surgery evaluation.

MEDICAL HISTORY: Aortic Stenosis
Coronary artery disease s/p stent to LAD [**2104**]
Hypertension
Hypercholesterolemia
Osteopenia/Osteoarthritis
Anemia
Gastroesophageal reflux disease
s/p hernia repair
s/p tonsillectomy
s/p right shoulder surgery

MEDICATION ON ADMISSION: fosamax 70 q wednesday
atenolol 25'
lisinopril 20'
omeprazole 20'
simvastatin 80'
aspirin 162'
calcium
vitamin D
MVI
ibuprofen prn

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Pulse: 73SR Resp: 18  O2 sat: 100%RA
B/P  Right: 177/63   Left:
Height: 5'6"    Weight: 61.7kg

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race: caucasian
Last Dental Exam: 2 weeks ago
Lives with: husband
Occupation: retired, office work
Tobacco: none
ETOH: approx 3/week 

### Response:
{'Coronary atherosclerosis of native coronary artery,Alkalosis,Chronic diastolic heart failure,Cardiac complications, not elsewhere classified,Aortic valve disorders,Thrombocytopenia, unspecified,Oliguria and anuria,Unspecified essential hypertension,Pure hypercholesterolemia,Disorder of bone and cartilage, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Esophageal reflux,Percutaneous transluminal coronary angioplasty status,Atrial fibrillation,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,Other iatrogenic hypotension'}
