CHIEF COMPLAINT: asymptomatic/past avr now followed by serial echos, now with
worsening stenosis/gradients

PRESENT ILLNESS: 57yoM s/p AVR/CABG in '[**40**] followed by echo now presents with
worsening stenosis

MEDICAL HISTORY: AS s/p AVR(tissue), CAD s/p CABG(SVG-OM), HTN, ^chol, GERD,
Schizophrenia, Depression, Tonsillectomy

MEDICATION ON ADMISSION: Lipitor 40'
Digoxin 0.25'
Depakote 250'
Lisinopril 2.5'
Lopressor 50"
ASA 81'
Clozapine 200'Omepprazole 20'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
VS HR 76  BP Rt104/60 Lft 100/64  RR 12    Ht 5'8"  Wt 195lbs
Gen NAD
Neuro A&Ox3 MAE, nonfocal exam
Pulm CTA bilat
CV RRR 4/6 SEM
Abdm soft, NT/+BS
Ext warm, well perfused. No edema. Rt LE incision mid thigh to
ankle-clean. No varicosities
Palpable pulses throughout

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives alone. Does not work.
Remote tobbacco- quit 30 years ago
Rare ETOH
Aortic valve disorders,Delirium due to conditions classified elsewhere,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Schizoaffective disorder, unspecified,Depressive disorder, not elsewhere classified,Anemia, unspecified,Aortocoronary bypass status
Aortic valve disorder,Delirium d/t other cond,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem,Esophageal reflux,Schizoaffective dis NOS,Depressive disorder NEC,Anemia NOS,Aortocoronary bypass
Admission Date:  [**2150-4-7**]              Discharge Date:   [**2150-4-13**]

Date of Birth:  [**2092-3-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
asymptomatic/past avr now followed by serial echos, now with
worsening stenosis/gradients

Major Surgical or Invasive Procedure:
AVR(#23 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] Epic Supra)[**4-7**]


History of Present Illness:
57yoM s/p AVR/CABG in '[**40**] followed by echo now presents with
worsening stenosis

Past Medical History:
AS s/p AVR(tissue), CAD s/p CABG(SVG-OM), HTN, ^chol, GERD,
Schizophrenia, Depression, Tonsillectomy

Social History:
Lives alone. Does not work.
Remote tobbacco- quit 30 years ago
Rare ETOH

Family History:
noncontributory

Physical Exam:
Admission:
VS HR 76  BP Rt104/60 Lft 100/64  RR 12    Ht 5'8"  Wt 195lbs
Gen NAD
Neuro A&Ox3 MAE, nonfocal exam
Pulm CTA bilat
CV RRR 4/6 SEM
Abdm soft, NT/+BS
Ext warm, well perfused. No edema. Rt LE incision mid thigh to
ankle-clean. No varicosities
Palpable pulses throughout

Discharge:
VS


Pertinent Results:
[**2150-4-12**] 05:35AM BLOOD

WBC-10.8 RBC-3.49* Hgb-10.6* Hct-29.7* MCV-85 MCH-30.3
MCHC-35.5* RDW-14.3 Plt Ct-342

[**2150-4-8**] 01:18PM

URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.016
URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG
Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG

[**2150-4-8**] 10:44 am URINE      Source: Catheter.

URINE CULTURE (Final [**2150-4-9**]):    NO GROWTH.

[**2150-4-12**] 05:35AM BLOOD

Glucose-112* UreaN-17 Creat-0.9 Na-138 K-4.2 Cl-105 HCO3-24
AnGap-13

[**2150-4-11**] 2:57 PM

CHEST (PA & LAT)

Cardiomediastinal contours are stable in the post-operative
period. Bibasilar atelectatic changes have nearly resolved.
Calcified granuloma is incidentally noted within the right mid
lung. No definite pleural effusions are evident, and there is no
evidence of pneumothorax. Right hemidiaphragm remains mildly
elevated.

IMPRESSION: Resolving bibasilar atelectasis

[**2150-4-10**] 10:39 AM

FEMORAL VASCULAR US RIGHT; FEMORAL VASCULAR US RIGHT PORT

FINDINGS: Sagittal and transverse son[**Name (NI) 493**] analysis of the
right groin demonstrate a 5 x 5 x 2 cm hematoma in the
subcutaneous tissues. There are small branch vessels around the
hematoma but there is no evidence of pseudoaneurysm or fistula
formation. Doppler analysis of the common femoral artery and
vein shows normal waveforms.

IMPRESSION: Right groin hematoma with no evidence of
pseudoaneurysm or fistula formation.


Brief Hospital Course:
Mr [**Known lastname 1313**] was a direct admission to the operating room on [**4-7**].
At that time he had an AVR, please see OR report for details. In
summary he had an AVR with #23 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] Supra valve, his bypass
time was 98 minutes with a crossclaamp time of 68 minutes. He
did well in the immediate post-op period, and he was extubated
on the day of surgery. On POD1 he remained hemodynamically
stable and was transferred to the floors for continued care.
Once on the floors he had an uneventful post-op course. His
chest tubes and Epicardial wires were removed on POD 3 His
activity level was advanced medicationsd tittrated and on POD 5
it was decided he was ready for discharge home with visiting
nurses.

Medications on Admission:
Lipitor 40'
Digoxin 0.25'
Depakote 250'
Lisinopril 2.5'
Lopressor 50"
ASA 81'
Clozapine 200'Omepprazole 20'

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day. Capsule, Delayed
Release(E.C.)(s)
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. 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:*2*
5. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Clozapine 100 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. Divalproex 250 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO DAILY (Daily).
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
9. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
11. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for
7 days.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
12. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
13. Divalproex 250 mg Tablet Sustained Release 24 hr Sig: One
(1) Tablet Sustained Release 24 hr PO HS (at bedtime).
14. Clozapine 100 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
15. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
16. Guaifenesin 600 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO bid ().
17. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed: prn.
Disp:*30 Tablet(s)* Refills:*0*
18. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*2*
19. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
20. [**Last Name (un) 1724**]
lipitor 40', digoxin .25', depakote 250', lisinopril 25',
lopressor 50'', asa 81', clozapine 200', omeprazole 20'.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA, [**Hospital1 1559**]

Discharge Diagnosis:
s/p redo sternotomy AVR(#23 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] Epic Supra)[**4-7**]


Discharge Condition:
stable


Discharge Instructions:
Keep wounds clean and dry. OK to shower, no bathing or swimming.
Take all medications as prescribed.
Call for any fever, redness or drainage from wounds.

Followup Instructions:
[**Hospital 409**] clinic in 2 weeks
Dr [**Last Name (STitle) **] in 4 weeks
Dr [**First Name (STitle) 1726**] or [**Doctor Last Name 99504**] in [**3-17**] weeks



Completed by:[**2150-4-12**]
{'Aortic valve disorders,Delirium due to conditions classified elsewhere,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Schizoaffective disorder, unspecified,Depressive disorder, not elsewhere classified,Anemia, unspecified,Aortocoronary bypass status'}


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: asymptomatic/past avr now followed by serial echos, now with
worsening stenosis/gradients

PRESENT ILLNESS: 57yoM s/p AVR/CABG in '[**40**] followed by echo now presents with
worsening stenosis

MEDICAL HISTORY: AS s/p AVR(tissue), CAD s/p CABG(SVG-OM), HTN, ^chol, GERD,
Schizophrenia, Depression, Tonsillectomy

MEDICATION ON ADMISSION: Lipitor 40'
Digoxin 0.25'
Depakote 250'
Lisinopril 2.5'
Lopressor 50"
ASA 81'
Clozapine 200'Omepprazole 20'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
VS HR 76  BP Rt104/60 Lft 100/64  RR 12    Ht 5'8"  Wt 195lbs
Gen NAD
Neuro A&Ox3 MAE, nonfocal exam
Pulm CTA bilat
CV RRR 4/6 SEM
Abdm soft, NT/+BS
Ext warm, well perfused. No edema. Rt LE incision mid thigh to
ankle-clean. No varicosities
Palpable pulses throughout

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives alone. Does not work.
Remote tobbacco- quit 30 years ago
Rare ETOH 

### Response:
{'Aortic valve disorders,Delirium due to conditions classified elsewhere,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Schizoaffective disorder, unspecified,Depressive disorder, not elsewhere classified,Anemia, unspecified,Aortocoronary bypass status'}
