CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 40 year old
gentleman with known bicuspid aortic valve and hepatitis A.
The patient had an echocardiogram previously done in [**2125**]
which showed mild aortic stenosis and no aortic
insufficiency.  On a recent visit with his primary care
physician he was noted to have a new heart murmur.  The
patient had an echocardiogram done at an outside hospital on
[**2132-9-12**] which demonstrated a moderately dilated
left aorta and left ventricle with an ejection fraction of
approximately 60%.  The patient also had moderately severe
aortic insufficiency and mild aortic stenosis.  As a result
of this echocardiogram the patient underwent a cardiac
magnetic resonance imaging scan on [**2132-11-12**].  The
results of the study were as follows:  1.  Bicuspid aortic
valve with moderate severe aortic regurgitation; 2.  Moderate
dilation of aortic root and ascending aorta; 3.  Severely
dilated left ventricular cavity size with normal regional and
global left ventricular systolic function; 4.  Left
ventricular ejection fraction normal at 66%; 5.  Normal right
ventricular cavity size and function; 6.  Moderately dilated
main pulmonary artery; 7.  Bilateral enlargement.  This study
was ordered by Dr. [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **].  The patient was referred
for a cardiac catheterization to determine the central need
for surgery.  On [**2133-1-6**], the patient underwent a
cardiac catheterization.  The cardiac catheterization
revealed normal coronary arteries; severe aortic
regurgitation with aortic root dilation; mild aortic
stenosis; preserved systolic ventricular function.  Following
the cardiac catheterization the patient was referred to Dr.
[**Last Name (STitle) **] for aortic valve replacement.

MEDICAL HISTORY: 1.  The patient's past medical history is significant for
aortic valve disease.
2.  Hepatitis A.
3.  Allergic rhinitis.
4.  Status post vasectomy.

MEDICATION ON ADMISSION: 1.  Zestril 10 mg q.d.
2.  Multivitamin q.d.

ALLERGIES: The patient is allergic to Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married, lives with his wife
three children.  The patient works as a medical technician at
[**Hospital6 2910**].
Aortic valve disorders,Atrial fibrillation,Congenital insufficiency of aortic valve,Viral hepatitis A without mention of hepatic coma,Thoracic aneurysm without mention of rupture
Aortic valve disorder,Atrial fibrillation,Cong aorta valv insuffic,Hepatitis A w/o coma,Thoracic aortic aneurysm
Admission Date:  [**2133-1-12**]       Discharge Date:  [**2133-1-17**]

Date of Birth:   [**2092-2-26**]       Sex:  M

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 40 year old
gentleman with known bicuspid aortic valve and hepatitis A.
The patient had an echocardiogram previously done in [**2125**]
which showed mild aortic stenosis and no aortic
insufficiency.  On a recent visit with his primary care
physician he was noted to have a new heart murmur.  The
patient had an echocardiogram done at an outside hospital on
[**2132-9-12**] which demonstrated a moderately dilated
left aorta and left ventricle with an ejection fraction of
approximately 60%.  The patient also had moderately severe
aortic insufficiency and mild aortic stenosis.  As a result
of this echocardiogram the patient underwent a cardiac
magnetic resonance imaging scan on [**2132-11-12**].  The
results of the study were as follows:  1.  Bicuspid aortic
valve with moderate severe aortic regurgitation; 2.  Moderate
dilation of aortic root and ascending aorta; 3.  Severely
dilated left ventricular cavity size with normal regional and
global left ventricular systolic function; 4.  Left
ventricular ejection fraction normal at 66%; 5.  Normal right
ventricular cavity size and function; 6.  Moderately dilated
main pulmonary artery; 7.  Bilateral enlargement.  This study
was ordered by Dr. [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **].  The patient was referred
for a cardiac catheterization to determine the central need
for surgery.  On [**2133-1-6**], the patient underwent a
cardiac catheterization.  The cardiac catheterization
revealed normal coronary arteries; severe aortic
regurgitation with aortic root dilation; mild aortic
stenosis; preserved systolic ventricular function.  Following
the cardiac catheterization the patient was referred to Dr.
[**Last Name (STitle) **] for aortic valve replacement.

PAST MEDICAL HISTORY:
1.  The patient's past medical history is significant for
aortic valve disease.
2.  Hepatitis A.
3.  Allergic rhinitis.
4.  Status post vasectomy.

SOCIAL HISTORY:  The patient is married, lives with his wife
three children.  The patient works as a medical technician at
[**Hospital6 2910**].

ALLERGIES:  The patient is allergic to Penicillin.

MEDICATIONS ON ADMISSION:
1.  Zestril 10 mg q.d.
2.  Multivitamin q.d.

REVIEW OF SYSTEMS:  The patient denied any visual changes,
dysphagia, shortness of breath, hematochezia, melena,
dysuria, transient ischemic attack symptoms.  The patient did
describe feeling palpitations with exertion.

PHYSICAL EXAMINATION:  On presentation the patient's physical
examination revealed that he was a pleasant male in no
apparent distress who was alert and oriented times three.  He
was afebrile.  The heart rate was 76 in sinus rhythm.  Blood
pressure was 89/53.  Respiratory, breathing 20 breaths/minute
with a saturation of 100% on room air.  The patient's head,
eyes, ears, nose and throat examination, pupils equal, round
and reactive to light, extraocular movements intact,
oropharynx was clear with good dentition, no jugulovenous
distension, no bruits.  Neck was supple.  Carotid artery
pulses were 2+ bilaterally.  The patient's lung examination
was even and unlabored, clear to auscultation bilaterally.
The patient's cardiac examination revealed a regular rate and
rhythm with a III/VI systolic ejection murmur; the patient's
abdominal examination revealed positive bowel sounds, soft,
nontender, nondistended.  The patient's extremity examination
showed 2+ bilateral pulses, dorsalis pedis and posterior
tibialis.  The patient's extremities were not erythematous or
edematous.  Neurological examination, the patient was alert
and oriented times three.  Cranial nerves II through XII were
grossly intact.

HOSPITAL COURSE:  The patient was admitted and underwent an
aortic root and transverse arch replacement with aortic valve
replacement with aortic valve replacement on [**2133-1-12**].
An aortic valve replacement was done with a 29 mm CV
pericardial valve.  The aortic root and transverse arch
replacement was done with 28 mm gel-weave graft.  The
procedure was done by Dr. [**Last Name (STitle) **] and assisted by Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 12373**], MD [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], PA Cardiac.  The patient was
placed on a pulmonary bypass time of 185 minutes and a
crossclamp time of 139 minutes.  The patient was under
complete circulatory arrest for 14 minutes.  The patient
tolerated the procedure well and was transferred to the
Intensive Care Unit with Levophed, Epinephrine, and Propofol
drips.  The patient also had two atrial and two ventricular
pacing wires.

Over the postoperative night the patient was extubated
without complications and remained on Levophed and
Epinephrine drips to keep the systolic blood pressure 95 to
110.  That evening was only complicated by one small run of
atrial fibrillation which converted without any intervention.
Following expiration the patient's lung fields were clear
with diminished bases bilaterally but was able to maintain
oxygen saturations at 100% while on 2 liters of nasal
cannula.  The patient's chest tube had minimal serosanguinous
drainage and no air leak noted.

On postoperative day #1 the patient was successfully weaned
off of his Levophed and Epinephrine drips.  The patient's
pulmonary status continued to improve, he was able to
maintain oxygen saturation while being weaned off of 2 liters
of nasal cannula.  The patient was transferred out of the
Cardiac Surgery Recovery Unit to the Surgical Floor.  The
patient was transferred with two atrial and two ventricular
pacing wires as well as two [**Doctor Last Name 406**] chest Tubes.  The chest
tubes were draining a small amount of serosanguinous fluids.

The patient continued to have an uncomplicated postoperative
course.  Both of his chest tubes were removed on
postoperative day #2.  The patient tolerated the procedure
well.  The patient was seen and evaluated by physical therapy
and it was determined that after one more session the patient
would be cleared to go home.  The patient had her pacing
wires discontinued on postoperative day #3.  The patient
remains in sinus rhythm with a rate of approximately 70 to
90.

The patient had a serial hematocrit performed throughout his
postoperative course and noticed that hematocrit level had
dropped to a nadir of 19.6.  The patient was offered the
choice of transfusion versus medication with iron and Vitamin
C.  The patient refused the transfusion, having concerns over
the transition of hepatitis.  The patient was started on
SeFO4 325 mg p.o. q.d. and ascorbic acid 500 mg p.o. b.i.d.
Hematocrit levels taken the following day showed an increase
of 21.4.  The patient stated that he felt considerably
better, less lethargic, and more energetic.  By postoperative
day #5, it was felt that the patient was ready and stable to
be discharged to home for further continuation of recovery of
the cardiac surgery.

The remainder of this dictation will be completed when the
patient leaves in the morning.


                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 846**]
MEDQUIST36

D:  [**2133-1-16**]  14:41
T:  [**2133-1-16**]  15:42
JOB#:  [**Job Number 12374**]


Name:  [**Known lastname 1810**], [**Known firstname 1811**]           Unit No:  [**Numeric Identifier 1812**]

Admission Date: [**2133-1-12**]      Discharge Date: [**2133-1-17**]

Date of Birth: [**2092-2-26**]       Sex:  M

Service:  Cardiothoracic Surgery Service

ADDENDUM:  Please erase the last paragraph of the previous
dictation and place the following.

PHYSICAL EXAMINATION ON DISCHARGE:  The patient's discharge
examination revealed his vital signs to be stable with a
temperature of 99.9 degrees Fahrenheit, his heart rate was 86
(in sinus), his blood pressure was 114/64, his respiratory
rate was 18 breaths per minute, and his oxygen saturation was
94% on room air.  The patient was alert and oriented times
three and in no apparent distress.  Cardiovascular
examination revealed a regular rate and rhythm.  His wounds
were clean, dry, and intact.  The lungs were clear to
auscultation bilaterally.  His breathing was even and
unlabored.  The abdomen was soft, nontender, and
nondistended.  The patient's legs revealed no clubbing,
cyanosis, or edema.

PERTINENT LABORATORY VALUES ON DISCHARGE:  The patient's
white blood cell count was 10.7, his hematocrit was 21.6, and
his platelets were 221,000.  The patient's sodium was 138,
potassium was 4.2, chloride was 101, bicarbonate was 30,
blood urea nitrogen was 14, creatinine was 0.8, and the
patient's blood glucose was 99.

DISCHARGE DISPOSITION:   The patient was to be discharged to
home.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was good.

MEDICATIONS ON DISCHARGE:  (The patient was to be discharged
on the following medications)
1.  Colace 100 mg by mouth twice per day as needed (for
constipation).
2.  Aspirin 325 mg by mouth once per day.
3.  Percocet one to two tablets by mouth q.4-6h. as needed
(for pain).
4.  Ferrous sulfate 325 mg by mouth twice per day.
5.  Ascorbic acid 500 mg by mouth twice per day.
6.  Metoprolol 50 mg by mouth twice per day.

DISCHARGE DIAGNOSES:
1.  Status post aortic root replacement with a 28-mm
Gelweave.
2.  Status post transverse arch replacement with a 28-mm
Gelweave.
3.  Status post aortic valve replacement with a 29-mm CE
pericardial valve.
4.  Aortic insufficiency.
5.  Hepatitis A.
6.  Aortic stenosis.
7.  Allergic rhinitis.
8.  Status post vasectomy.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to please follow up with his
primary care physician (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1813**]) in one to two weeks.
2.  The patient was additionally asked to follow up with Dr.
[**Last Name (STitle) 1814**] (Cardiology) in two to three weeks.
3.  The patient was instructed to follow up with Dr. [**First Name (STitle) **] [**Last Name (Prefixes) 1815**] (cardiac surgeon) in four weeks.
4.  The patient was additionally instructed not to lift heavy
objects greater than 10 pounds for the next month.
5.  The patient was instructed not to take a bath or go
swimming until further instructed by a physician.
6.  The patient was also instructed not to apply any creams,
powders, salves, or ointments to his sternal wounds.



                          [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Name8 (MD) 1816**]

MEDQUIST36

D:  [**2133-1-16**]  15:43
T:  [**2133-1-17**]  07:15
JOB#:  [**Job Number 1817**]
{'Aortic valve disorders,Atrial fibrillation,Congenital insufficiency of aortic valve,Viral hepatitis A without mention of hepatic coma,Thoracic aneurysm without mention of rupture'}


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: 

PRESENT ILLNESS: The patient is a 40 year old
gentleman with known bicuspid aortic valve and hepatitis A.
The patient had an echocardiogram previously done in [**2125**]
which showed mild aortic stenosis and no aortic
insufficiency.  On a recent visit with his primary care
physician he was noted to have a new heart murmur.  The
patient had an echocardiogram done at an outside hospital on
[**2132-9-12**] which demonstrated a moderately dilated
left aorta and left ventricle with an ejection fraction of
approximately 60%.  The patient also had moderately severe
aortic insufficiency and mild aortic stenosis.  As a result
of this echocardiogram the patient underwent a cardiac
magnetic resonance imaging scan on [**2132-11-12**].  The
results of the study were as follows:  1.  Bicuspid aortic
valve with moderate severe aortic regurgitation; 2.  Moderate
dilation of aortic root and ascending aorta; 3.  Severely
dilated left ventricular cavity size with normal regional and
global left ventricular systolic function; 4.  Left
ventricular ejection fraction normal at 66%; 5.  Normal right
ventricular cavity size and function; 6.  Moderately dilated
main pulmonary artery; 7.  Bilateral enlargement.  This study
was ordered by Dr. [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **].  The patient was referred
for a cardiac catheterization to determine the central need
for surgery.  On [**2133-1-6**], the patient underwent a
cardiac catheterization.  The cardiac catheterization
revealed normal coronary arteries; severe aortic
regurgitation with aortic root dilation; mild aortic
stenosis; preserved systolic ventricular function.  Following
the cardiac catheterization the patient was referred to Dr.
[**Last Name (STitle) **] for aortic valve replacement.

MEDICAL HISTORY: 1.  The patient's past medical history is significant for
aortic valve disease.
2.  Hepatitis A.
3.  Allergic rhinitis.
4.  Status post vasectomy.

MEDICATION ON ADMISSION: 1.  Zestril 10 mg q.d.
2.  Multivitamin q.d.

ALLERGIES: The patient is allergic to Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married, lives with his wife
three children.  The patient works as a medical technician at
[**Hospital6 2910**]. 

### Response:
{'Aortic valve disorders,Atrial fibrillation,Congenital insufficiency of aortic valve,Viral hepatitis A without mention of hepatic coma,Thoracic aneurysm without mention of rupture'}
