CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 60 y/o male with known bicuspid aortic valve who continues to
experience progressive dyspnea on exertion. Most recent echo
revealed severe aortic stenosis with preserved LVEF. He had an
abnormal ETT and then underwent cardiac cath. Cath revealed
single vessel coronary artery disease and was then referred for
surgery.

MEDICAL HISTORY: Aortic Stenosis/Bicuspid Aortic Valve, Hypertension,
Hypercholesterolemia, Gastroesophageal Reflux Disease, h/o
Pericarditis, s/p T&A

MEDICATION ON ADMISSION: Zoloft 100mg qd, Lipitor 10mg qd, Lisinopril 10mg qd, Protonix
40mg qd, Excedrin [**2-4**]/d, Sinex nasal inh

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 76 12 142/80 149/73 67" 178#
General: WDWN male in NAD
Skin: Warm, dry -lesions
HEENT: EOMI, PERRL, NCAER, OP benign, sclera anicteric
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, 4/6 SEM w/ transmitted murmur to carotids
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: A&O x 3, CN2-12 intact, MAE, non-focal

FAMILY HISTORY: Father did of MI at age 52.

SOCIAL HISTORY: Office worker, Quit smoking 12 years ago. Drinks 1-2 beers/wk.
Live with wife.
Aortic valve disorders,Congenital insufficiency of aortic valve,Hemorrhage complicating a procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux
Aortic valve disorder,Cong aorta valv insuffic,Hemorrhage complic proc,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Esophageal reflux
Admission Date:  [**2126-7-30**]              Discharge Date:   [**2126-8-4**]

Date of Birth:  [**2066-3-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2126-7-30**] Coronary Artery Bypas Graft x 1 (SVG to RCA), Aortic
Valve Replacement with 29mm CE Pericardial Tissue Valve

History of Present Illness:
60 y/o male with known bicuspid aortic valve who continues to
experience progressive dyspnea on exertion. Most recent echo
revealed severe aortic stenosis with preserved LVEF. He had an
abnormal ETT and then underwent cardiac cath. Cath revealed
single vessel coronary artery disease and was then referred for
surgery.

Past Medical History:
Aortic Stenosis/Bicuspid Aortic Valve, Hypertension,
Hypercholesterolemia, Gastroesophageal Reflux Disease, h/o
Pericarditis, s/p T&A

Social History:
Office worker, Quit smoking 12 years ago. Drinks 1-2 beers/wk.
Live with wife.

Family History:
Father did of MI at age 52.

Physical Exam:
VS: 76 12 142/80 149/73 67" 178#
General: WDWN male in NAD
Skin: Warm, dry -lesions
HEENT: EOMI, PERRL, NCAER, OP benign, sclera anicteric
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, 4/6 SEM w/ transmitted murmur to carotids
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: A&O x 3, CN2-12 intact, MAE, non-focal

Pertinent Results:
Echo [**7-30**]: Pre Bypass: There is a tiny pfo with left to right
flow. There is mild symmetric left ventricular hypertrophy with
normal cavity size. Overall left ventricular systolic function
is normal (LVEF>55%). There are simple atheroma in the aortic
arch. The descending thoracic aorta is mildly dilated. There are
complex (>4mm) atheroma in the descending thoracic aorta. The
aortic valve is bicuspid. The aortic valve leaflets are severely
thickened/deformed. There is moderate aortic valve stenosis.
Mild (1+) aortic regurgitation is seen. The aortic regurgitation
jet is eccentric, directed toward the anterior mitral leaflet.
There is mild anterior leaflet mitral valve partial prolapse.
Trivial mitral regurgitation is seen. The main pulmonary artery
is borderline dilated. Post Bypass: Biventricular function is
preserved, LVEF >55% no wall motion abnormalities. There is a 29
mm bioprosthetic valve in place. There is trace Aortic
insufficiency originating between the left and right coronary
cusps. There is no Aortic stenosis (peak gradient 8 mm Hg,
calculated [**Location (un) 109**] 3.6 cm2). There are no perivalvular leaks.
CXR [**8-1**]: Persistent left lower lobe atelectasis with possible
small left pleural effusion.
[**2126-7-30**] 12:16PM BLOOD WBC-17.6*# RBC-3.15*# Hgb-9.9*#
Hct-27.2*# MCV-86 MCH-31.6 MCHC-36.6*# RDW-13.8 Plt Ct-136*#
[**2126-8-2**] 06:14AM BLOOD WBC-15.0* RBC-2.57* Hgb-7.9* Hct-22.5*
MCV-88 MCH-31.0 MCHC-35.3* RDW-14.3 Plt Ct-170
[**2126-7-30**] 12:16PM BLOOD PT-16.1* PTT-39.8* INR(PT)-1.5*
[**2126-8-2**] 06:14AM BLOOD PT-12.3 PTT-26.3 INR(PT)-1.1
[**2126-7-30**] 12:58PM BLOOD UreaN-19 Creat-0.8 Cl-112* HCO3-25
[**2126-8-2**] 06:14AM BLOOD Glucose-122* UreaN-25* Creat-0.9 Na-136
K-4.3 Cl-99 HCO3-31 AnGap-10

Brief Hospital Course:
Mr. [**Known lastname **] was a same day admit after undergoing all
pre-operative work-up as an outpatient. On [**7-30**] he was brought to
the operating room where he underwent a coronary artery bypass
graft x 1 and an aortic valve replacement. Please see op report
for surgical details. Patient tolerated the procedure well and
was tranferred to the CSRU for invasive monitoring in stable
condition. Later on op day patient was weaned from sedation,
awoke neurologically intact and then extubated. He did require
multiple transfusions post-operatively with FFP and RBC's
secondary to bleeding. He was transferred to the cardiac surgery
telemetry floor on post-op day one. He was also started on beta
blockers and diuretics and he was gently diuresed towards his
pre-op weight. Chest tubes were removed on post-op day two. A
PICC line was also placed on this day d/t poor venous access. On
post-op day five his epicardial pacing wires were removed. He
was discharged home on POD 5 tolerating a regualr diet,
ambulating with physical therapy, and his pain well controlled
with po pain medication.

Medications on Admission:
Zoloft 100mg qd, Lipitor 10mg qd, Lisinopril 10mg qd, Protonix
40mg qd, Excedrin [**2-4**]/d, Sinex nasal inh

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. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
3. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*1*
6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*2*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
8. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO BID (2 times a day) for 10
days.
Disp:*40 Capsule, Sustained Release(s)* Refills:*0*
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
10. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
11. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
12. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypas Graft x 1
Aortic Stenosis/Bicuspid Aortic Valve s/p Aortic Valve
Replacement
PMH: Hypertension, Hypercholesterolemia, Gastroesophageal Reflux
Disease, h/o Pericarditis, s/p T&A

Discharge Condition:
Good

Discharge Instructions:
You may take shower. Wash incisions and gently pat dry. Do not
take bath. Do not apply lotion, creams, ointments or powders to
incisions.
Do not lift more than 10 pounds for 2 months.
Do not drive for 1 month.
If you develop a fever or notice drainage from chest incision,
or redness around incision, please contact office immediately.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) **] (cardiologist) in [**2-1**] weeks
Dr. [**Last Name (STitle) 410**] (PCP) in [**12-31**] weeks
{'Aortic valve disorders,Congenital insufficiency of aortic valve,Hemorrhage complicating a procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux'}


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: Dyspnea on exertion

PRESENT ILLNESS: 60 y/o male with known bicuspid aortic valve who continues to
experience progressive dyspnea on exertion. Most recent echo
revealed severe aortic stenosis with preserved LVEF. He had an
abnormal ETT and then underwent cardiac cath. Cath revealed
single vessel coronary artery disease and was then referred for
surgery.

MEDICAL HISTORY: Aortic Stenosis/Bicuspid Aortic Valve, Hypertension,
Hypercholesterolemia, Gastroesophageal Reflux Disease, h/o
Pericarditis, s/p T&A

MEDICATION ON ADMISSION: Zoloft 100mg qd, Lipitor 10mg qd, Lisinopril 10mg qd, Protonix
40mg qd, Excedrin [**2-4**]/d, Sinex nasal inh

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 76 12 142/80 149/73 67" 178#
General: WDWN male in NAD
Skin: Warm, dry -lesions
HEENT: EOMI, PERRL, NCAER, OP benign, sclera anicteric
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, 4/6 SEM w/ transmitted murmur to carotids
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: A&O x 3, CN2-12 intact, MAE, non-focal

FAMILY HISTORY: Father did of MI at age 52.

SOCIAL HISTORY: Office worker, Quit smoking 12 years ago. Drinks 1-2 beers/wk.
Live with wife. 

### Response:
{'Aortic valve disorders,Congenital insufficiency of aortic valve,Hemorrhage complicating a procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux'}
