CHIEF COMPLAINT: Syncope

PRESENT ILLNESS: 62 year old female with known Aortic Stenosis, [**Location (un) 109**] 0.6cm2, peak
gradient 73, scheduled for AVR later this month with Dr.
[**Last Name (STitle) 1290**].  Patient was taken to [**Hospital6 **] ED after
three syncopal episodes, one with loc of 5-10min. She was also
complaining of cough productive of green sputum, chills x3 days.
She further complained of chest pressure and shortness of
breath.

MEDICAL HISTORY: NIDDM
Hypertension
Asthma
Critical Aortic stenosis
Lupus - off steroids since 5 years ago
Congestive Heart Failure
Gout
Hypercholesteremia

MEDICATION ON ADMISSION: Atrovent 12.5
Albuterol
Allopurinol 300'
Plaquenil 200'
Prozac 20'
Lasix 20'
Glyburide 25/Metformin 500''
Lantus 24hs
ASA 81'
Benicar 20'
Lipitor 10'
Humalog [**3-29**] SSI
Neurontin 400 tid
Maxair prn

ALLERGIES: Penicillins / Iodine; Iodine Containing

PHYSICAL EXAM: HEENT: conjunctiva erythematous left>right, no jvd, transmitted
murmur Bilateral carotids, trachea midline
Chest:B/C CTAB anteriorly, RRR SEM II/VI loudest RSB 2ICS
ABD: S/NT/protuberant/BS +
EXT:trace edema, distal pulses 2+
Neuro:nonfocal

FAMILY HISTORY: NC

SOCIAL HISTORY: Smoked ~3 cigs/day X 15 years, quit 30 years ago.
Aortic valve disorders,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Primary pulmonary hypertension,Systemic lupus erythematosus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Pure hypercholesterolemia,Personal history of tobacco use,Asthma, unspecified type, unspecified
Aortic valve disorder,CHF NOS,Urin tract infection NOS,Prim pulm hypertension,Syst lupus erythematosus,DMII wo cmp nt st uncntr,Gout NOS,Pure hypercholesterolem,History of tobacco use,Asthma NOS
Admission Date:  [**2161-3-21**]              Discharge Date:   [**2161-3-24**]

Date of Birth:  [**2098-9-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Iodine; Iodine Containing

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Syncope

Major Surgical or Invasive Procedure:
None


History of Present Illness:
62 year old female with known Aortic Stenosis, [**Location (un) 109**] 0.6cm2, peak
gradient 73, scheduled for AVR later this month with Dr.
[**Last Name (STitle) 1290**].  Patient was taken to [**Hospital6 **] ED after
three syncopal episodes, one with loc of 5-10min. She was also
complaining of cough productive of green sputum, chills x3 days.
She further complained of chest pressure and shortness of
breath.

Past Medical History:
NIDDM
Hypertension
Asthma
Critical Aortic stenosis
Lupus - off steroids since 5 years ago
Congestive Heart Failure
Gout
Hypercholesteremia


Social History:
Smoked ~3 cigs/day X 15 years, quit 30 years ago.


Family History:
NC

Physical Exam:
HEENT: conjunctiva erythematous left>right, no jvd, transmitted
murmur Bilateral carotids, trachea midline
Chest:B/C CTAB anteriorly, RRR SEM II/VI loudest RSB 2ICS
ABD: S/NT/protuberant/BS +
EXT:trace edema, distal pulses 2+
Neuro:nonfocal

Pertinent Results:
Cardiology Report ECHO Study Date of [**2161-3-23**]



PATIENT/TEST INFORMATION:
Indication: Aortic valve disease. Left ventricular function.
Preoperative assessment.
Height: (in) 68
Weight (lb): 230
BSA (m2): 2.17 m2
BP (mm Hg): 85/40
HR (bpm): 90
Status: Inpatient
Date/Time: [**2161-3-23**] at 11:03
Test: Portable TTE (Focused views)
Doppler: Full Doppler and color Doppler
Contrast: Definity
Tape Number: 2006W000-0:00
Test Location: West MICU
Technical Quality: Suboptimal




REFERRING DOCTOR: DR. [**First Name (STitle) 412**] [**Last Name (Prefixes) 413**]

MEASUREMENTS:
Left Atrium - Four Chamber Length: *6.1 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: 4.4 cm (nl <= 5.0 cm)
Left Ventricle - Ejection Fraction: 55% to 60% (nl >=55%)
Aortic Valve - Peak Velocity: *5.3 m/sec (nl <= 2.0 m/sec)
Aortic Valve - Peak Gradient: 113 mm Hg
Aortic Valve - Mean Gradient: 78 mm Hg
Aortic Valve - LVOT Peak Vel: 1.00 m/sec
Aortic Valve - LVOT Diam: 2.0 cm
Aortic Valve - Valve Area: *0.6 cm2 (nl >= 3.0 cm2)
Mitral Valve - E Wave: 1.0 m/sec
Mitral Valve - A Wave: 1.2 m/sec
Mitral Valve - E/A Ratio: 0.83
Mitral Valve - E Wave Deceleration Time: 259 msec
TR Gradient (+ RA = PASP): *47 mm Hg (nl <= 25 mm Hg)

INTERPRETATION:

Findings:

LEFT ATRIUM: Elongated LA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
systolic function
(LVEF>55%). Suboptimal technical quality, a focal LV wall motion
abnormality
cannot be fully excluded. No LV mass/thrombus.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTIC VALVE: ?# aortic valve leaflets. Severely
thickened/deformed aortic
valve leaflets. Severe AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
mitral annular
calcification. Mild thickening of mitral valve chordae. Mild
(1+) MR. LV
inflow pattern c/w impaired relaxation.

TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. Mild
[1+] TR.
Moderate PA systolic hypertension.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with
physiologic PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.
Suboptimal
image quality - body habitus.

Conclusions:
The left atrium is elongated. There is an echodensity within the
posterior [**Name Prefix (Prefixes) **]
[**Last Name (Prefixes) **] that likely represents the ridge betweeen the left atrial
appendage and
the [**Doctor Last Name **] pulmonary vein (warfarin ridge). Left ventricular wall
thickness,
cavity size, and systolic function are normal (LVEF>55%). Due to
suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded.
No masses or thrombi are seen in the left ventricle. Right
ventricular chamber
size and free wall motion are normal. The number of aortic valve
leaflets
cannot be determined. The aortic valve leaflets are severely
thickened/deformed. There is severe aortic valve stenosis. No
aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild
(1+) mitral regurgitation is seen. The left ventricular inflow
pattern
suggests impaired relaxation. The tricuspid valve leaflets are
mildly
thickened. There is moderate pulmonary artery systolic
hypertension. There is
no pericardial effusion.

IMPRESSION: Severe aortic stenosis. Moderate pulmonary
hypertension. Normal
LVEF.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD on [**2161-3-23**] 14:34.
[**Location (un) **] PHYSICIAN: [**Name10 (NameIs) **],[**First Name3 (LF) **]

   RADIOLOGY   Preliminary Report

CAROTID SERIES COMPLETE PORT  [**2161-3-23**] 3:15 PM

CAROTID SERIES COMPLETE PORT

Reason: syncope

[**Hospital 93**] MEDICAL CONDITION:
62 year old woman with AS, syncope, preop
REASON FOR THIS EXAMINATION:
syncope
CAROTID SERIES COMPLETE.

REASON: Aortic stenosis.

FINDINGS: Duplex evaluation was performed of both carotid
arteries. Minimal plaque was identified.

On the right, peak systolic velocities are 51, 64, 37 in the
ICA, CCA, ECA respectively. The ICA to CCA ratio is 0.8. This is
consistent with no stenosis.

On the left, peak systolic velocities are 60, 75, 51 in the ICA,
CCA, ECA respectively. The ICA to CCA ratio is 0.8. This is
consistent with no stenosis.

There is antegrade flow in both vertebral arteries.

IMPRESSION: No evidence of stenosis in either carotid artery.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

   RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2161-3-22**] 7:31 AM

CHEST (PORTABLE AP)

Reason: r/o effusion

[**Hospital 93**] MEDICAL CONDITION:
62 year old woman with AS
REASON FOR THIS EXAMINATION:
r/o effusion
CHEST ONE VIEW PORTABLE.

INDICATION: 62-year-old woman with AS.

COMMENTS: Portable erect AP radiograph of the chest is reviewed.
No previous study is available for comparison.

There is mild congestive heart failure with cardiomegaly. There
is marked tortuosity of the thoracic aorta, which is consistent
with patient's history of aortic stenosis. No evidence of
pneumothorax is identified.

IMPRESSION: Mild congestive heart failure.

DR. [**First Name (STitle) 7204**] [**Name (STitle) 7205**]
Approved: SUN [**2161-3-22**] 11:34 AM

Cardiology Report ECG Study Date of [**2161-3-21**]  11:51:56 PM


Sinus rhythm
Early transition
Since previous tracing, no significant change


Read by: [**Last Name (LF) **],[**First Name3 (LF) **] J.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
86 164 100 398/441.28 41 6 93


[**2161-3-21**] 08:55PM   GLUCOSE-180* UREA N-50* CREAT-2.0* SODIUM-136
POTASSIUM-4.3 CHLORIDE-104 TOTAL CO2-20* ANION GAP-16
[**2161-3-21**] 08:55PM   ALT(SGPT)-12 AST(SGOT)-19 LD(LDH)-143 ALK
PHOS-119* TOT BILI-0.2
[**2161-3-21**] 08:55PM   WBC-14.9* RBC-3.15* HGB-8.9* HCT-27.2* MCV-86
MCH-28.1 MCHC-32.6 RDW-16.0*
[**2161-3-21**] 07:40PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-SM
[**2161-3-21**] 07:40PM URINE  RBC-0-2 WBC-0-2 BACTERIA-MOD YEAST-NONE
EPI-<1

Brief Hospital Course:
Mrs. [**Known lastname 106519**] was admitted after presentation to OSH ED for
syncopal episodes associated with a loss of consciousness and
CHF.  She was admitted for diuresis and cardiac monitoring.
Cardiology was consulted for management of CHF in the setting of
Aortic stenosis.  She was empirically placed on levaquin for
possible pneumonia.  Blood Cultures were negative after 72hours.
 She was gently diuresed toward her baseline weight.  Urine
culture showed a E. Coli UTI, sensitivities pending.  On
hospital day 4 Mrs. [**Known lastname 106519**] was 1.5kg below her baseline
weight, able to walk up two flights of stairs without distress,
denying any chest discomfort or shortness of breath at rest.
She has dental follow up scheduled with her dentist as an
outpatient for filling of two dental carries prior to AVR on
[**2161-4-10**] with Dr. [**Last Name (STitle) 1290**].  She was  instructed to minimize her
trips out of her apartment (3 story walk up) and to call 911 and
come to [**Hospital1 18**] if she has further episodes of CP, DOE, SOB, or
syncope.  She is to keep her PAT appointment on [**2161-4-1**] for her
AVR.

Medications on Admission:
Atrovent 12.5
Albuterol
Allopurinol 300'
Plaquenil 200'
Prozac 20'
Lasix 20'
Glyburide 25/Metformin 500''
Lantus 24hs
ASA 81'
Benicar 20'
Lipitor 10'
Humalog [**3-29**] SSI
Neurontin 400 tid
Maxair prn


Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Hydroxychloroquine 200 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*2*
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. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Erythromycin 5 mg/g Ointment Sig: One (1)  Ophthalmic  QID (4
times a day).
Disp:*qs qs* Refills:*2*
7. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
Disp:*3 Tablet(s)* Refills:*0*
8. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
9. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: One (1)
Inhalation four times a day.
Disp:*qs qs* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Aortic stenosis, Asthma, DM, HTN, Lupus, Gout,
Hypercholesteremia


Discharge Condition:
Good


Discharge Instructions:
Resume your previous medications.  Limit your physical exertion,
as tolerated.  If you experience persistent shortness of breath,
chest pain, or further fainting episodes, call 911 and come to
[**Hospital1 18**] ED.  Call [**Telephone/Fax (1) 170**] with any routine questions
regarding your upcoming surgery

Followup Instructions:
Follow up with your dentist regarding treatment for two dental
carries prior to your surgery on [**2161-4-10**].

You will be admitted to [**Hospital1 18**] on [**2161-4-10**] the AM of your surgery



Completed by:[**2161-3-24**]
{'Aortic valve disorders,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Primary pulmonary hypertension,Systemic lupus erythematosus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Pure hypercholesterolemia,Personal history of tobacco use,Asthma, unspecified type, unspecified'}


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: Syncope

PRESENT ILLNESS: 62 year old female with known Aortic Stenosis, [**Location (un) 109**] 0.6cm2, peak
gradient 73, scheduled for AVR later this month with Dr.
[**Last Name (STitle) 1290**].  Patient was taken to [**Hospital6 **] ED after
three syncopal episodes, one with loc of 5-10min. She was also
complaining of cough productive of green sputum, chills x3 days.
She further complained of chest pressure and shortness of
breath.

MEDICAL HISTORY: NIDDM
Hypertension
Asthma
Critical Aortic stenosis
Lupus - off steroids since 5 years ago
Congestive Heart Failure
Gout
Hypercholesteremia

MEDICATION ON ADMISSION: Atrovent 12.5
Albuterol
Allopurinol 300'
Plaquenil 200'
Prozac 20'
Lasix 20'
Glyburide 25/Metformin 500''
Lantus 24hs
ASA 81'
Benicar 20'
Lipitor 10'
Humalog [**3-29**] SSI
Neurontin 400 tid
Maxair prn

ALLERGIES: Penicillins / Iodine; Iodine Containing

PHYSICAL EXAM: HEENT: conjunctiva erythematous left>right, no jvd, transmitted
murmur Bilateral carotids, trachea midline
Chest:B/C CTAB anteriorly, RRR SEM II/VI loudest RSB 2ICS
ABD: S/NT/protuberant/BS +
EXT:trace edema, distal pulses 2+
Neuro:nonfocal

FAMILY HISTORY: NC

SOCIAL HISTORY: Smoked ~3 cigs/day X 15 years, quit 30 years ago. 

### Response:
{'Aortic valve disorders,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Primary pulmonary hypertension,Systemic lupus erythematosus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Pure hypercholesterolemia,Personal history of tobacco use,Asthma, unspecified type, unspecified'}
