CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: This is a a 66 year old male with dyspnea on exertion and
history of aortic stenosis. While being evaluated for radical
prostatectomy he had a stress test showing subendocardial
ischemia and underwent cardiac cath which showed coronary artery
disease and aortic valve pathology. He is now referred for
surgical evaluation.

MEDICAL HISTORY: Coronary artery disease
Aortic stenosis
Hyperlipidemia
Prostate cancer
Sclerotic rib lesion ( not metastatic per urology)
Arthritis
Bilateral cataract surgery

MEDICATION ON ADMISSION: Zocor 40mg daily, Aspirin 81mg daily, Amoxicillin prn dental

ALLERGIES: Pollen Extracts

PHYSICAL EXAM: admission:

FAMILY HISTORY: Notable for lung cancer in his father. [**Name (NI) **] history of premature
coronary artery disease or valve disease.

SOCIAL HISTORY: Race: Asian American
Last Dental Exam: 6 months ago
Lives with: Wife
Occupation: Retired electrical engineer
Tobacco: Denies
ETOH: Denies
Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Malignant neoplasm of prostate,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Arthropathy, unspecified, site unspecified,Disorder of bone and cartilage, unspecified,Examination of participant in clinical trial,Family history of malignant neoplasm of trachea, bronchus, and lung
Aortic valve disorder,Crnry athrscl natve vssl,Malign neopl prostate,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem,Arthropathy NOS-unspec,Bone & cartilage dis NOS,Exam-clincal trial,Fm hx-trach/bronchog mal
Admission Date:  [**2100-11-8**]              Discharge Date:   [**2100-11-12**]

Date of Birth:  [**2034-1-2**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Pollen Extracts

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
s/p Coronary Artery Bypass Grafting x 1 (left internal artery
grafted to left anterior descending)/Aortic Valve Replacement
(#23 mm Tissue valve) on [**2100-11-8**]


History of Present Illness:
This is a a 66 year old male with dyspnea on exertion and
history of aortic stenosis. While being evaluated for radical
prostatectomy he had a stress test showing subendocardial
ischemia and underwent cardiac cath which showed coronary artery
disease and aortic valve pathology. He is now referred for
surgical evaluation.

Past Medical History:
Coronary artery disease
Aortic stenosis
Hyperlipidemia
Prostate cancer
Sclerotic rib lesion ( not metastatic per urology)
Arthritis
Bilateral cataract surgery

Social History:
Race: Asian American
Last Dental Exam: 6 months ago
Lives with: Wife
Occupation: Retired electrical engineer
Tobacco: Denies
ETOH: Denies

Family History:
Notable for lung cancer in his father. [**Name (NI) **] history of premature
coronary artery disease or valve disease.

Physical Exam:
admission:

Pulse:72 Resp:  O2 sat: 100% RA
B/P  Right:140/51    Left: 142/59
Height:5'8"   Weight:151  (68.4 kg)

General:NAD, well-appearing
Skin: Warm[x] Dry [x] intact [x]
HEENT: NCAT[x] PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur: 4/6 SEM radiates to
carotids
Abdomen: Soft [x] non-distended [x] non-tender [x]
bowel sounds +[x]
Extremities: Warm [x], well-perfused [x]  Edema-none
ecchymosis Right groin/thigh at cath site
Varicosities: None []
Neuro: Grossly intact, nonfocal exam,MAE [**5-12**] strengths

Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+   Left: 2+

Carotid Bruit: murmur radiates to  carotids

Pertinent Results:
[**2100-11-8**] Intraop TEE:
PRE-CPB: 1. The left atrium is mildly dilated. No thrombus is
seen in the left atrial appendage. 2. No atrial septal defect is
seen by 2D or color Doppler. 3. There is moderate symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). 4. Right ventricular chamber size and free wall
motion are normal. 5. There are simple atheroma in the ascending
aorta. There are simple atheroma in the aortic arch. There are
simple atheroma in the descending thoracic aorta. 6. There are
three aortic valve leaflets. The aortic valve leaflets are
severely thickened/deformed. There is severe aortic valve
stenosis (valve area 0.8-1.0cm2). Moderate to severe (3) aortic
regurgitation is seen. 7. The mitral valve leaflets are mildly
thickened. Mild (1) mitral regurgitation is seen.
Post-CPB: 1. Well-seated bioprosthetic valve in the aortic
position. 2. Preserved biventricular systolic function. 3.
Aortic contour normal post-decannulation.

[**2100-11-8**] 11:30AM BLOOD WBC-7.5 RBC-3.03*# Hgb-8.2*# Hct-24.6*#
MCV-81* MCH-27.2 MCHC-33.4 RDW-13.9 Plt Ct-115*
[**2100-11-10**] 04:40AM BLOOD WBC-12.3* RBC-3.43* Hgb-9.5* Hct-28.1*
MCV-82 MCH-27.6 MCHC-33.8 RDW-14.1 Plt Ct-118*
[**2100-11-8**] 11:30AM BLOOD PT-13.9* PTT-45.8* INR(PT)-1.2*
[**2100-11-8**] 12:43PM BLOOD UreaN-11 Creat-0.7 Na-141 K-3.9 Cl-113*
HCO3-24 AnGap-8
[**2100-11-12**] 04:50AM BLOOD UreaN-25* Creat-1.0 Na-134 K-4.3 Cl-96

Brief Hospital Course:
Mr. [**Known lastname **] was admitted and underwent single vessel coronary artery
bypass grafting and aortic valve replacement surgery by Dr.
[**Last Name (STitle) **]. For surgical details, please see operative note.
Following the operation, he was brought to the CVICU for
invasive monitoring. Within 24 hours, he awoke neurologically
intact and was extubated without incident. His CVICU course was
uneventful and he transferred to the floor on postoperative day
one. He experienced a brief bout of atrial fibrillation but
converted back to a normal sinus rhythm with the administration
of IV amiodarone and then oral dosing. He was begun on a beta
blocker, diuresed towards his preoperative weight and progressed
well. Chest tubes were removed on post-op day one and pacing
wires on post-op day 3. Physical Therapy worked with him for
mobility and strength. He appeared to be doing well on post-op
day 4 and was discharged home with VNA services.

Medications on Admission:
Zocor 40mg daily, Aspirin 81mg daily, Amoxicillin prn dental

Discharge Medications:
1. 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*
2. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
4. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. docusate sodium 100 mg Tablet Sig: One (1) Tablet PO twice a
day.
Disp:*60 Tablet(s)* Refills:*2*
7. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
8. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 2 weeks.
Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
9. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Take to two 200 mg tablets twice daily for 1 week. Then
one 200 mg tablets twice daily for 1 week. Then 1 200 mg tablet
daily until stopped by cardiologist.
Disp:*60 Tablet(s)* Refills:*2*

Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary artery disease and Aortic Stenosis s/p Coronary Artery
Bypass Grafting x 1(LIMA-LAD)/Aortic Valve Replacement (#23 mm
Tissue valve)
Past medical history:
Hyperlipidemia
Cataracts s/p Bilateral cataract surgery
Prostate cancer
Sclerotic rib lesion (not metastatic per urology)
Arthritis

Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Edema: none

Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) on [**2100-12-9**] at 1:45pm
Cardiologist:Dr.[**Last Name (STitle) 14522**] on [**2100-12-14**] at 3;15pm

Please call to schedule appointments with:
Primary Care: Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 30837**]) in [**1-9**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Completed by:[**2100-11-12**]
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Malignant neoplasm of prostate,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Arthropathy, unspecified, site unspecified,Disorder of bone and cartilage, unspecified,Examination of participant in clinical trial,Family history of malignant neoplasm of trachea, bronchus, and lung'}


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: Dyspnea on exertion

PRESENT ILLNESS: This is a a 66 year old male with dyspnea on exertion and
history of aortic stenosis. While being evaluated for radical
prostatectomy he had a stress test showing subendocardial
ischemia and underwent cardiac cath which showed coronary artery
disease and aortic valve pathology. He is now referred for
surgical evaluation.

MEDICAL HISTORY: Coronary artery disease
Aortic stenosis
Hyperlipidemia
Prostate cancer
Sclerotic rib lesion ( not metastatic per urology)
Arthritis
Bilateral cataract surgery

MEDICATION ON ADMISSION: Zocor 40mg daily, Aspirin 81mg daily, Amoxicillin prn dental

ALLERGIES: Pollen Extracts

PHYSICAL EXAM: admission:

FAMILY HISTORY: Notable for lung cancer in his father. [**Name (NI) **] history of premature
coronary artery disease or valve disease.

SOCIAL HISTORY: Race: Asian American
Last Dental Exam: 6 months ago
Lives with: Wife
Occupation: Retired electrical engineer
Tobacco: Denies
ETOH: Denies 

### Response:
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Malignant neoplasm of prostate,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Arthropathy, unspecified, site unspecified,Disorder of bone and cartilage, unspecified,Examination of participant in clinical trial,Family history of malignant neoplasm of trachea, bronchus, and lung'}
