CHIEF COMPLAINT: Chest pain and syncope

PRESENT ILLNESS: This 84WF presented to [**Hospital1 18**] [**Location (un) 620**] [**2150-1-19**] with CP and was in
AF.  She was treated with Lopressor and Dilt and became
asystolic. She was resuscitated and transferred to [**Hospital1 18**].  She
was found to have aortic stenosis and is now admitted for AVR.

MEDICAL HISTORY: Aortic stenosis
recent Afib
HTN
Pseudogout of R knee
Hypothyroidism
GERD, EGD [**2144**]
Breast Cancer [**2102**] s/p left mastectomy
s/p Hysterectomy
Osteoporosis on Evista
Aortic Stenosis
DJD Hand
Iron Deficiency Anemia [**2146**]
Left Shoulder Impingement Syndrome
Spinal Stenosis: MRI [**10-26**] showed severe stenosis of spinal
canal and recesses at L4-L5
Osteoarthritis: Right lower extremity pain and lower back pain
Paronychia
Actinic keratosis on R face

MEDICATION ON ADMISSION: Thyroid 15mg PO 5x/week.
ASA 81 mg PO daily
Ascorbic acid 500 mg PO BID
Calcium carbonate 1500mg PO TID
Vitamin D3 400 mg PO daily
Raloxifene 60 mg PO daily
Prilosec 20 mg PO daily
Lopressor 12.5 mg PO daily
Hexavitamin 1 PO daily
Simvistatin 40 mg PO daily
Lisinopril 5 mg PO daily

ALLERGIES: Promethazine/Codeine

PHYSICAL EXAM: Elderly WF in NAD
AVSS
HEENT: NC/AT, oropharynx benign
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+ bilat. with rad murmur
Lungs: Clear to A+P
CV: RRR w/ III/VI SEM
Abd: +BS, soft, nontender, without masses or hepatosplenomegaly
Ext: without C/C/E, pulses 2+= bilat. throughout
Neuro: nonfocal

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use.  She previously smoked 1 ppd, but quit 40 years ago. There
is no history of alcohol abuse. She lives at home with a
boarder.
Congestive heart failure, unspecified,Aortic valve disorders,Atrial fibrillation,Atherosclerosis of aorta,Stricture and stenosis of esophagus,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Iron deficiency anemia, unspecified,Candidiasis of skin and nails,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Postmastectomy lymphedema syndrome,Personal history of irradiation, presenting hazards to health
CHF NOS,Aortic valve disorder,Atrial fibrillation,Aortic atherosclerosis,Esophageal stricture,Hypertension NOS,Hypothyroidism NOS,Osteoporosis NOS,Iron defic anemia NOS,Cutaneous candidiasis,Hx of breast malignancy,Acq absnce breast/nipple,Postmastect lymphedema,Hx of irradiation
Admission Date:  [**2150-2-3**]              Discharge Date:   [**2150-2-16**]


Service: CARDIOTHORACIC

Allergies:
Promethazine/Codeine

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest pain and syncope

Major Surgical or Invasive Procedure:
s/p AVR(19mm Mosaic porcine valve)/Aortic endarterctomy [**2-3**]
s/p pacer placement [**2-10**]


History of Present Illness:
This 84WF presented to [**Hospital1 18**] [**Location (un) 620**] [**2150-1-19**] with CP and was in
AF.  She was treated with Lopressor and Dilt and became
asystolic. She was resuscitated and transferred to [**Hospital1 18**].  She
was found to have aortic stenosis and is now admitted for AVR.

Past Medical History:
Aortic stenosis
recent Afib
HTN
Pseudogout of R knee
Hypothyroidism
GERD, EGD [**2144**]
Breast Cancer [**2102**] s/p left mastectomy
s/p Hysterectomy
Osteoporosis on Evista
Aortic Stenosis
DJD Hand
Iron Deficiency Anemia [**2146**]
Left Shoulder Impingement Syndrome
Spinal Stenosis: MRI [**10-26**] showed severe stenosis of spinal
canal and recesses at L4-L5
Osteoarthritis: Right lower extremity pain and lower back pain
Paronychia
Actinic keratosis on R face

Social History:
Social history is significant for the absence of current tobacco
use.  She previously smoked 1 ppd, but quit 40 years ago. There
is no history of alcohol abuse. She lives at home with a
boarder.


Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
Elderly WF in NAD
AVSS
HEENT: NC/AT, oropharynx benign
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+ bilat. with rad murmur
Lungs: Clear to A+P
CV: RRR w/ III/VI SEM
Abd: +BS, soft, nontender, without masses or hepatosplenomegaly
Ext: without C/C/E, pulses 2+= bilat. throughout
Neuro: nonfocal

Pertinent Results:
[**2150-2-14**] 07:15AM BLOOD WBC-13.2* RBC-3.61* Hgb-11.0* Hct-32.2*
MCV-89 MCH-30.4 MCHC-34.0 RDW-14.0 Plt Ct-294
[**2150-2-14**] 09:04AM BLOOD PT-24.2* INR(PT)-2.4*
[**2150-2-14**] 07:15AM BLOOD Glucose-99 UreaN-19 Creat-1.1 Na-139
K-4.1 Cl-99 HCO3-34* AnGap-10
RADIOLOGY   Preliminary Report

CHEST (PA & LAT)  [**2150-2-13**] 6:12 PM

CHEST (PA & LAT)

Reason: eval for pleural effusions

[**Hospital 93**] MEDICAL CONDITION:
84 year old woman s/p AVR
REASON FOR THIS EXAMINATION:
eval for pleural effusions
CHEST

HISTORY: AVR.

Two views. Comparison with the previous study done [**2150-2-11**].
Small bilateral pleural effusions and subsegmental atelectasis
or scarring at the right base are again demonstrated. The
patient is status post median sternotomy and AVR as before. A
bipolar transvenous pacemaker remains in place. Aorta is mildly
tortuous and calcified. Mediastinal structures are unchanged.
The bony thorax is grossly intact. There are degenerative
arthritic changes in the spine.

IMPRESSION: Small pleural effusions. Status post AVR. No
significant change.

DR. [**First Name (STitle) **] [**Doctor Last Name 4391**]
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4392**]





Brief Hospital Course:
The pt. was admitted [**2150-2-3**] and underwent elective AVR(19mm
Mosaic porcine valve)/Aortic endarterectomy.  The cross-clamp
time was 52 mins., total bypass timewas 72 mins.  The pt.
tolerated the procedure well and was transferred to the CVICU in
stable condition on Propofol and Neo.  She had a stable post op
night and was extubated on POD#1.  She was quite lethargic but
eventually was more alert.  Her chest tubes were d/c'd on POD#2
and was transferred to the floor on POD#4.  She had intermittent
AF and was treated with beta blockers.  On POD#5 she had a 10
second pause and was paced with her temporary epicardial wires.
EP was consulted and on POD#7 she underwent permanent pacer
placement.  She was restarted on coumadin for afib. She
continued to have intermittent rapid a fib and her beta blocker
was increased. Her INR became supratherapeutic and her coumadin
was held. Her INR came down and she was discharged on 1 mg
daily.  She was discharged to rehab in stable condition on
POD#11.

Medications on Admission:
Thyroid 15mg PO 5x/week.
ASA 81 mg PO daily
Ascorbic acid 500 mg PO BID
Calcium carbonate 1500mg PO TID
Vitamin D3 400 mg PO daily
Raloxifene 60 mg PO daily
Prilosec 20 mg PO daily
Lopressor 12.5 mg PO daily
Hexavitamin 1 PO daily
Simvistatin 40 mg PO daily
Lisinopril 5 mg PO daily

Discharge Medications:
1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 5 days.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Raloxifene 60 mg Tablet Sig: One (1) Tablet PO daily ().
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Hydrocortisone 2.5 % Cream Sig: One (1) Appl Rectal TID (3
times a day).
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days.
10. Thyroid 30 mg Tablet Sig: 0.5 Tablet PO 5X/WEEK
([**Doctor First Name **],MO,WE,TH,SA).
11. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO QID (4 times a day) as needed.
12. CefazoLIN 1 g IV Q12H pacer Duration: 3 Days
13. Hydralazine 10 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
14. Metoprolol Tartrate 50 mg Tablet Sig: 2.5 Tablets PO TID (3
times a day).
15. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 3 days: Then decrease dose to 400 mg PO daily for 7
days, then decrease to 200 mg PO daily.
16. Coumadin 1 mg Tablet Sig: One (1) Tablet PO once a day:
Check daily PT, dose for INR goal of [**2-21**].5.
17. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Aortic stenosis
HTN
hypothyroidism
GERD
s/p breast ca, s/p L mastectomy
s/p TAH
osteoporosis
iron deficiency anemia
spinal stenosis


Discharge Condition:
Good.


Discharge Instructions:
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs for 2 months.
After pacer dressing is off (7 days), shower daily, let water
flow over wounds.
Do not use lotions, powders, or creams on wounds.
Call our office for temp. >101.5, sternal drainage.

Followup Instructions:
Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2150-2-17**]
9:00
Make an appointment with Dr. [**Last Name (STitle) 4390**] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) **] for 4 weeks.



Completed by:[**2150-2-14**]
{'Congestive heart failure, unspecified,Aortic valve disorders,Atrial fibrillation,Atherosclerosis of aorta,Stricture and stenosis of esophagus,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Iron deficiency anemia, unspecified,Candidiasis of skin and nails,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Postmastectomy lymphedema syndrome,Personal history of irradiation, presenting hazards to health'}


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: Chest pain and syncope

PRESENT ILLNESS: This 84WF presented to [**Hospital1 18**] [**Location (un) 620**] [**2150-1-19**] with CP and was in
AF.  She was treated with Lopressor and Dilt and became
asystolic. She was resuscitated and transferred to [**Hospital1 18**].  She
was found to have aortic stenosis and is now admitted for AVR.

MEDICAL HISTORY: Aortic stenosis
recent Afib
HTN
Pseudogout of R knee
Hypothyroidism
GERD, EGD [**2144**]
Breast Cancer [**2102**] s/p left mastectomy
s/p Hysterectomy
Osteoporosis on Evista
Aortic Stenosis
DJD Hand
Iron Deficiency Anemia [**2146**]
Left Shoulder Impingement Syndrome
Spinal Stenosis: MRI [**10-26**] showed severe stenosis of spinal
canal and recesses at L4-L5
Osteoarthritis: Right lower extremity pain and lower back pain
Paronychia
Actinic keratosis on R face

MEDICATION ON ADMISSION: Thyroid 15mg PO 5x/week.
ASA 81 mg PO daily
Ascorbic acid 500 mg PO BID
Calcium carbonate 1500mg PO TID
Vitamin D3 400 mg PO daily
Raloxifene 60 mg PO daily
Prilosec 20 mg PO daily
Lopressor 12.5 mg PO daily
Hexavitamin 1 PO daily
Simvistatin 40 mg PO daily
Lisinopril 5 mg PO daily

ALLERGIES: Promethazine/Codeine

PHYSICAL EXAM: Elderly WF in NAD
AVSS
HEENT: NC/AT, oropharynx benign
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+ bilat. with rad murmur
Lungs: Clear to A+P
CV: RRR w/ III/VI SEM
Abd: +BS, soft, nontender, without masses or hepatosplenomegaly
Ext: without C/C/E, pulses 2+= bilat. throughout
Neuro: nonfocal

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use.  She previously smoked 1 ppd, but quit 40 years ago. There
is no history of alcohol abuse. She lives at home with a
boarder. 

### Response:
{'Congestive heart failure, unspecified,Aortic valve disorders,Atrial fibrillation,Atherosclerosis of aorta,Stricture and stenosis of esophagus,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Iron deficiency anemia, unspecified,Candidiasis of skin and nails,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Postmastectomy lymphedema syndrome,Personal history of irradiation, presenting hazards to health'}
