CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 44 year old male with history of MSSA aortic valve enodcarditis.
He completed his 6 week course of IV Oxacillin in [**2108-4-6**].
Follow up echocardiogram showed mod-severe aortic stenosis with
mild aortic insufficiency. His aortic valve is likely bicuspid
and findings showed a 2-4mm vegetation on the posterior AV
leaflet in [**2108-4-6**]. In preperation for aortic valve
replacement, he underwent cardiac catheterization which revealed
single vessel coronary artery disease of the right coronary/PDA.
He was evaluated by Dr. [**Last Name (STitle) **] in [**Month (only) **] for surgery and returns
today for surgery.

MEDICAL HISTORY: Aortic valve enodcarditis, Aortic stenosis and insufficiency,
probable bicuspid AV
Coronary Artery Disease with evidence of prior MI
Congestive Heart Failure
History of MRSA Hand Infection, [**2107-11-7**]
Diabetes Mellitus, on Insulin Pump
TIA
Obesity
ADHD
Asthma
Acute renal failure [**1-16**]
Bipolar Disorder
Chronic low back pain
History of Kidney Infections
Psoriasis
Gastroesophageal reflux disease
Past Surgical History:
Left Hand Surgery x 2
Vasectomy
Adenoidectomy

MEDICATION ON ADMISSION: Humalog Insulin Pump
Lipitor 80 mg QHS
Protonix 40mg Daily
Lithium 300mg three times day Currently weaning off and has not
taken in >1 week.
Adderall 30mg daily
Neurontin 600mg three times daily
Seroquel 100mg daily
Cymbalta 90mg daily
Aspirin 325mg daily
Xanax 2mg twice daily
Colace 100mg twice daily
Advair 500/50 twice daily
Albuterol 2 puffs twice daily
Vicodin 10mg three times daily
Fish oil l1200mg daily
Vitamin B complex daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 76 SR   Resp: 14
B/P  Right: 118/80    Left: 106/70
Height: 72 inches    Weight: 265 lbs
General: WDWN in NAD
Skin: Dry [X] intact [X] no C/C/E. Multiple areas of psoriasis.
?ringworm on back.
HEENT: PERRLA [X] EOMI [X] OP benign
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR, III/VI SEM
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  No Edema
Pt has fungal infection in both groins (left much worse than
right)
Varicosities: None []
Neuro: Grossly intact
Pulses:
Femoral      Right: 1  Left: 1
DP           Right: trace  Left: trace
PT           [**Name (NI) 167**]: 1  Left: 1
Radial       Right: 2  Left: 2
Carotid Bruit     Murmur radiates to (B) carotids

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Occupation: still disabled
Lives with: friends  ([**Name2 (NI) **]), he is divorced with 3 kids
Insulin pump status,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Bipolar disorder, unspecified,Congestive heart failure, unspecified,Attention deficit disorder with hyperactivity,Esophageal reflux,Tobacco use disorder,Congenital insufficiency of aortic valve,Delirium due to conditions classified elsewhere,Aortic valve disorders,Obesity, unspecified,Dermatophytosis of groin and perianal area,Other psoriasis,Obstructive sleep apnea (adult)(pediatric)
Insulin pump status,Crnry athrscl natve vssl,DMI wo cmp nt st uncntrl,Bipolar disorder NOS,CHF NOS,Attn deficit w hyperact,Esophageal reflux,Tobacco use disorder,Cong aorta valv insuffic,Delirium d/t other cond,Aortic valve disorder,Obesity NOS,Dermatophytosis of groin,Other psoriasis,Obstructive sleep apnea
Admission Date:  [**2108-8-8**]              Discharge Date:   [**2108-8-13**]

Date of Birth:  [**2064-5-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2108-8-8**] Aortic valve replacement with a [**Street Address(2) 11688**]. [**Hospital 923**] Medical
Biocor tissue valve. Xenograft reconstruction of pericardium
with core matrix patch.

History of Present Illness:
44 year old male with history of MSSA aortic valve enodcarditis.
He completed his 6 week course of IV Oxacillin in [**2108-4-6**].
Follow up echocardiogram showed mod-severe aortic stenosis with
mild aortic insufficiency. His aortic valve is likely bicuspid
and findings showed a 2-4mm vegetation on the posterior AV
leaflet in [**2108-4-6**]. In preperation for aortic valve
replacement, he underwent cardiac catheterization which revealed
single vessel coronary artery disease of the right coronary/PDA.
He was evaluated by Dr. [**Last Name (STitle) **] in [**Month (only) **] for surgery and returns
today for surgery.

Past Medical History:
Aortic valve enodcarditis, Aortic stenosis and insufficiency,
probable bicuspid AV
Coronary Artery Disease with evidence of prior MI
Congestive Heart Failure
History of MRSA Hand Infection, [**2107-11-7**]
Diabetes Mellitus, on Insulin Pump
TIA
Obesity
ADHD
Asthma
Acute renal failure [**1-16**]
Bipolar Disorder
Chronic low back pain
History of Kidney Infections
Psoriasis
Gastroesophageal reflux disease
Past Surgical History:
Left Hand Surgery x 2
Vasectomy
Adenoidectomy

Social History:
Occupation: still disabled
Lives with: friends  ([**Name2 (NI) **]), he is divorced with 3 kids

Tobacco: 30PYH, smokes 4 cigs/day currently

ETOH: 2 drinks per week

Family History:
noncontributory

Physical Exam:
Pulse: 76 SR   Resp: 14
B/P  Right: 118/80    Left: 106/70
Height: 72 inches    Weight: 265 lbs
General: WDWN in NAD
Skin: Dry [X] intact [X] no C/C/E. Multiple areas of psoriasis.
?ringworm on back.
HEENT: PERRLA [X] EOMI [X] OP benign
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR, III/VI SEM
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  No Edema
Pt has fungal infection in both groins (left much worse than
right)
Varicosities: None []
Neuro: Grossly intact
Pulses:
Femoral      Right: 1  Left: 1
DP           Right: trace  Left: trace
PT           [**Name (NI) 167**]: 1  Left: 1
Radial       Right: 2  Left: 2
Carotid Bruit     Murmur radiates to (B) carotids

Pertinent Results:
[**2108-8-8**] Echo: Pre bypass: The left atrium is elongated. No
spontaneous echo contrast is seen in the body of the left
atrium. There are focal calcifications in the aortic arch. There
are simple atheroma in the descending thoracic aorta. There are
three aortic valve leaflets, although the right and non coronary
cusps appear partially fused. There is a large mass on the non
coronary cusp with some mobile components. There is mild aortic
valve stenosis (valve area 1.2-1.9cm2). Moderate (2+) aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. No mitral regurgitation is seen. There is
no pericardial effusion.
Post bypass: preserved biventricular function LVEF 55%. A
bioprosthetic aortic valve is insitu with no AI or perivalvular
leaks. Peak graident 19, mean 11 mm hg. Aortic contours intact.
Remainging exam is unchanged. All findings discussed surgeons at
the time of the exam.
[**2108-8-11**] 05:40AM BLOOD WBC-5.9 RBC-3.09* Hgb-9.5* Hct-28.2*
MCV-91 MCH-30.6 MCHC-33.6 RDW-13.3 Plt Ct-113*
[**2108-8-8**] 09:15AM BLOOD WBC-6.9 RBC-5.13 Hgb-15.8 Hct-44.5 MCV-87
MCH-30.8 MCHC-35.6* RDW-13.5 Plt Ct-212
[**2108-8-13**] 04:40AM BLOOD Plt Ct-156
[**2108-8-11**] 05:40AM BLOOD PT-11.8 PTT-23.6 INR(PT)-1.0
[**2108-8-8**] 01:07PM BLOOD PT-13.3 PTT-23.3 INR(PT)-1.1
[**2108-8-8**] 09:15AM BLOOD Plt Ct-212
[**2108-8-13**] 10:35AM BLOOD K-5.1
[**2108-8-13**] 04:40AM BLOOD Glucose-162* UreaN-27* Creat-1.2 Na-141
K-5.2* Cl-104 HCO3-29 AnGap-13
[**2108-8-8**] 09:15AM BLOOD Glucose-150* UreaN-20 Creat-1.0 Na-134
K-3.8 Cl-97 HCO3-25 AnGap-16
[**2108-8-13**] 04:40AM BLOOD Calcium-8.3* Phos-5.1* Mg-2.3
]
[**2108-8-8**] 11:30 am TISSUE      AORTIC VALVE.

   GRAM STAIN (Final [**2108-8-8**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.

   TISSUE (Final [**2108-8-11**]):    NO GROWTH.

   ANAEROBIC CULTURE (Preliminary):    NO GROWTH.


Brief Hospital Course:
Admitted same day surgery and brought directly to the operating
room where he underwent a aortic valve replacement. Please see
operative report for surgical details. He received cefazolin for
perioperative antibiotics.  Postoperatively he was transferred
to the intensive care unit for hemodynamic management.  In the
first twenty four hours he was weaned from sedation, awoke
neurologically intact and was extubated without complications.
He was noted for apnea and was placed on autoCPAP and sleep was
consulted ith plan for him to follow up in sleep clinic.  [**Last Name (un) **]
was consulted due to elevated hgba1c on insulin pump, insulin
was adjusted and he was started on lantus.  He remained in the
intensive care unit an extra day to manage his blood glucose.
Post operative day two he was transferred to the floor for the
remainder of his care.  Physical therapy worked with him on
strength and mobility.  Psychiatry was consulted in relation to
his medications due to him stopping lithium preoperatively.
Plan for follow up with outpatient psychiatrist and do not
restart lithium at this time.  He was ready for discharge to
rehab on postoperative day five.

Medications on Admission:
Humalog Insulin Pump
Lipitor 80 mg QHS
Protonix 40mg Daily
Lithium 300mg three times day Currently weaning off and has not
taken in >1 week.
Adderall 30mg daily
Neurontin 600mg three times daily
Seroquel 100mg daily
Cymbalta 90mg daily
Aspirin 325mg daily
Xanax 2mg twice daily
Colace 100mg twice daily
Advair 500/50 twice daily
Albuterol 2 puffs twice daily
Vicodin 10mg three times daily
Fish oil l1200mg daily
Vitamin B complex daily

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day). Capsule(s)
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO TID (3
times a day).
4. Quetiapine 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Three
(3) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
6. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
7. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
8. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
9. Alprazolam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for anxiety.
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Insulin Glargine 100 unit/mL Solution Sig: One Hundred (100)
units Subcutaneous once a day.
12. insulin sliding scale
Humalog sliding scale
Insulin SC Sliding Scale
     Breakfast       Lunch      Dinner     Bedtime
0-65   mg/dL 4 oz. Juice 4 oz. Juice 4 oz. Juice 4 oz. Juice
66-80   mg/dL 0   Units 0   Units 0   Units 0   Units
81-160   mg/dL 10   Units 10   Units 10   Units 0   Units
161-280   mg/dL 22   Units 22   Units 22   Units 6   Units
281-319   mg/dL 26   Units 26   Units 26   Units 7   Units
320-359   mg/dL 28   Units 28   Units 28   Units 8   Units
360-400   mg/dL 30   Units 30   Units 30   Units 10   Units
  Instructons for NPO Patients: use bedtime scale when NPO


Discharge Disposition:
Extended Care

Facility:
[**Doctor First Name **] healthcare center

Discharge Diagnosis:
Aortic stenosis and insufficiency s/p Aortic Valve Replacement
AV Endocarditis(MSSA)- probable bicuspid AV
Coronary Artery Disease with evidence of prior MI
History of MRSA Hand Infection [**2107-11-7**]
Diabetes Mellitus
TIA
Obesity
ADHD
Asthma
Acute renal failure [**1-16**]
Bipolar Disorder
Chronic low back pain
History of Kidney Infections
Psoriasis
Gastroesophageal reflux disease
Past Surgical History:
Left Hand Surgery x 2
Vasectomy
Adenoidectomy


Discharge Condition:
Good

Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain. Please report any and all wound
issues to your surgeon at ([**Telephone/Fax (1) 1504**].
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
4) Please wash incision with soap and water daily and gently pat
dry. No lotions, creams or powders to incisions until they have
healed. No bathing or submerging incisions for 1 month.
5) No lifting greater then 10 pounds for 10 weeks from date of
surgery.
6) No driving for 1 month.
7) Please call with any questions or concerns [**Telephone/Fax (1) 170**]
8) Please follow up with outpatient psychiatrist
9) Please continue with sliding scale insulin and lantus no
further insulin pump [**First Name8 (NamePattern2) **] [**Last Name (un) **] diabetes recommendations
10) Autocpap for apnea - follow up with sleep clinic

Followup Instructions:
Please call to schedule appointments
Sleep clinic in [**12-9**] weeks ([**Telephone/Fax (1) 9525**]
Dr. [**Last Name (STitle) **] in [**1-10**] weeks at [**Hospital1 **] heart center [**Telephone/Fax (2) 6256**]
Dr. [**Last Name (STitle) 14334**] after discharge from rehab [**Telephone/Fax (1) 6256**]
Dr. [**Last Name (STitle) **] after discharge from rehab [**Telephone/Fax (1) 50679**]
Please follow up with outpatient psychiatrist



Completed by:[**2108-8-13**]
{'Insulin pump status,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Bipolar disorder, unspecified,Congestive heart failure, unspecified,Attention deficit disorder with hyperactivity,Esophageal reflux,Tobacco use disorder,Congenital insufficiency of aortic valve,Delirium due to conditions classified elsewhere,Aortic valve disorders,Obesity, unspecified,Dermatophytosis of groin and perianal area,Other psoriasis,Obstructive sleep apnea (adult)(pediatric)'}


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: 44 year old male with history of MSSA aortic valve enodcarditis.
He completed his 6 week course of IV Oxacillin in [**2108-4-6**].
Follow up echocardiogram showed mod-severe aortic stenosis with
mild aortic insufficiency. His aortic valve is likely bicuspid
and findings showed a 2-4mm vegetation on the posterior AV
leaflet in [**2108-4-6**]. In preperation for aortic valve
replacement, he underwent cardiac catheterization which revealed
single vessel coronary artery disease of the right coronary/PDA.
He was evaluated by Dr. [**Last Name (STitle) **] in [**Month (only) **] for surgery and returns
today for surgery.

MEDICAL HISTORY: Aortic valve enodcarditis, Aortic stenosis and insufficiency,
probable bicuspid AV
Coronary Artery Disease with evidence of prior MI
Congestive Heart Failure
History of MRSA Hand Infection, [**2107-11-7**]
Diabetes Mellitus, on Insulin Pump
TIA
Obesity
ADHD
Asthma
Acute renal failure [**1-16**]
Bipolar Disorder
Chronic low back pain
History of Kidney Infections
Psoriasis
Gastroesophageal reflux disease
Past Surgical History:
Left Hand Surgery x 2
Vasectomy
Adenoidectomy

MEDICATION ON ADMISSION: Humalog Insulin Pump
Lipitor 80 mg QHS
Protonix 40mg Daily
Lithium 300mg three times day Currently weaning off and has not
taken in >1 week.
Adderall 30mg daily
Neurontin 600mg three times daily
Seroquel 100mg daily
Cymbalta 90mg daily
Aspirin 325mg daily
Xanax 2mg twice daily
Colace 100mg twice daily
Advair 500/50 twice daily
Albuterol 2 puffs twice daily
Vicodin 10mg three times daily
Fish oil l1200mg daily
Vitamin B complex daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 76 SR   Resp: 14
B/P  Right: 118/80    Left: 106/70
Height: 72 inches    Weight: 265 lbs
General: WDWN in NAD
Skin: Dry [X] intact [X] no C/C/E. Multiple areas of psoriasis.
?ringworm on back.
HEENT: PERRLA [X] EOMI [X] OP benign
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR, III/VI SEM
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  No Edema
Pt has fungal infection in both groins (left much worse than
right)
Varicosities: None []
Neuro: Grossly intact
Pulses:
Femoral      Right: 1  Left: 1
DP           Right: trace  Left: trace
PT           [**Name (NI) 167**]: 1  Left: 1
Radial       Right: 2  Left: 2
Carotid Bruit     Murmur radiates to (B) carotids

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Occupation: still disabled
Lives with: friends  ([**Name2 (NI) **]), he is divorced with 3 kids 

### Response:
{'Insulin pump status,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Bipolar disorder, unspecified,Congestive heart failure, unspecified,Attention deficit disorder with hyperactivity,Esophageal reflux,Tobacco use disorder,Congenital insufficiency of aortic valve,Delirium due to conditions classified elsewhere,Aortic valve disorders,Obesity, unspecified,Dermatophytosis of groin and perianal area,Other psoriasis,Obstructive sleep apnea (adult)(pediatric)'}
