CHIEF COMPLAINT: significant dyspnea on exertion and fatigue

PRESENT ILLNESS: 81yo female with a history of aortic stenosis followed by echo.
Symptoms of dyspnea and fatigue have progressed recently.  By
echo she now has critical aortic stenosis with [**Location (un) 109**] 0.7cm2, peak
gradient 69mmHg and mean gradient 43mmHg.  She is referred for
surgical evaluation.

MEDICAL HISTORY: aortic stenosis
hypertension
hyperlipidemia
GI bleed (on naprosyn 12 yrs ago)
bilateral breast cysts
bronchitis
left lower extremity claudication
varicose veins
transient ischemic attack [**2185**]

MEDICATION ON ADMISSION: Dyazide 37.5/25 daily
omeprazole 20 daily
ECASA 81 mg daily
Centrum Silver daily

ALLERGIES: Demerol / Codeine / Statins-Hmg-Coa Reductase Inhibitors

PHYSICAL EXAM: Pulse: 82 Resp: 16  O2 sat: 99%
B/P  Right: 136/80   Left: 144/79
Height:  62"  Weight: 142lb

FAMILY HISTORY: brother with CABG at age 76 and CVA 84yo
brother with CABG at age 60
brother with MI at age 66
mother died at 83 with h/o CHF

SOCIAL HISTORY: Lives with: widowed, alone
Occupation: home maker
Tobacco: never
ETOH: none
Aortic valve disorders,Acute posthemorrhagic anemia,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Other disorders of bone and cartilage,Other and unspecified angina pectoris,Unspecified essential hypertension,Atherosclerosis of aorta,Other and unspecified hyperlipidemia,Unspecified late effects of cerebrovascular disease,Esophageal reflux,Personal history of peptic ulcer disease,Personal history of allergy to narcotic agent,Personal history of allergy to other specified medicinal agents,Family history of ischemic heart disease,Family history of other cardiovascular diseases
Aortic valve disorder,Ac posthemorrhag anemia,Surg compl-heart,Crnry athrscl natve vssl,Atrial fibrillation,Iatrogenc hypotnsion NEC,Bone & cartilage dis NEC,Angina pectoris NEC/NOS,Hypertension NOS,Aortic atherosclerosis,Hyperlipidemia NEC/NOS,Late effect CV dis NOS,Esophageal reflux,Prsnl hst peptic ulcr ds,Hx-narcotic allergy,Hx-drug allergy NEC,Fam hx-ischem heart dis,Fam hx-cardiovas dis NEC
Admission Date:  [**2190-7-15**]              Discharge Date:   [**2190-7-20**]

Date of Birth:  [**2109-4-20**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Demerol / Codeine / Statins-Hmg-Coa Reductase Inhibitors

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
significant dyspnea on exertion and fatigue

Major Surgical or Invasive Procedure:
[**2190-7-15**]
1. Aortic valve replacement with a 21 mm Magna aortic valve
    bioprosthesis.
2. Coronary bypass grafting x2, left internal mammary
    artery to left anterior descending coronary; reverse
    saphenous vein single graft from aorta to distal right
    coronary artery.
3. Epiaortic Duplex scanning.
4. Endoscopic vein harvesting.
5. Repair of sternal separation with placement of
the Talon system.


History of Present Illness:
81yo female with a history of aortic stenosis followed by echo.
Symptoms of dyspnea and fatigue have progressed recently.  By
echo she now has critical aortic stenosis with [**Location (un) 109**] 0.7cm2, peak
gradient 69mmHg and mean gradient 43mmHg.  She is referred for
surgical evaluation.


Past Medical History:
aortic stenosis
hypertension
hyperlipidemia
GI bleed (on naprosyn 12 yrs ago)
bilateral breast cysts
bronchitis
left lower extremity claudication
varicose veins
transient ischemic attack [**2185**]


Social History:
Lives with: widowed, alone
Occupation: home maker
Tobacco: never
ETOH: none


Family History:
brother with CABG at age 76 and CVA 84yo
brother with CABG at age 60
brother with MI at age 66
mother died at 83 with h/o CHF


Physical Exam:
Pulse: 82 Resp: 16  O2 sat: 99%
B/P  Right: 136/80   Left: 144/79
Height:  62"  Weight: 142lb

General: NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur 3/6 SEM
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  no Edema, moderate
Varicosities (left worse than right)
Neuro: Grossly intact  x
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        Right:    Left:
radiation of cardiac murmur


Pertinent Results:
[**2190-7-20**] 05:25AM BLOOD WBC-9.9 RBC-3.14* Hgb-9.7* Hct-29.0*
MCV-92 MCH-31.1 MCHC-33.6 RDW-14.7 Plt Ct-159
[**2190-7-19**] 05:10AM BLOOD WBC-11.9* RBC-3.05* Hgb-9.4* Hct-28.2*
MCV-92 MCH-30.9 MCHC-33.5 RDW-15.1 Plt Ct-139*
[**2190-7-20**] 05:25AM BLOOD UreaN-27* Creat-1.1 Na-140 K-3.8 Cl-101
[**2190-7-19**] 05:10AM BLOOD Glucose-83 UreaN-35* Creat-1.1 Na-139
K-3.5 Cl-102 HCO3-26 AnGap-15
[**2190-7-18**] 02:20AM BLOOD Glucose-106* UreaN-32* Creat-1.5* Na-137
K-4.1 Cl-104 HCO3-22 AnGap-15

[**2190-7-15**] Intra-op Echo
Pre Bypass: The left atrium is mildly dilated and elongated.
There is mild symmetric left ventricular hypertrophy. Regional
left ventricular wall motion is normal (LVEF>55%). The right
ventricular cavity is mildly dilated There are complex (>4mm)
atheroma in the aortic arch and descending aorta as a flat sheet
of calcification 4-5 mm thick. Epiaortic scan of the ascending
aorta reveals no significant plaque at the proposed site of
cross clamp and cannulation. The descending thoracic aorta is
mildly dilated. There are complex (>4mm) . There are three
aortic valve leaflets. The aortic valve leaflets are severely
thickened/deformed. There is critical aortic valve stenosis
(valve area <0.8cm2). Mild (1+) aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen with no mitral stenosis.

Post Bypass: Preserved biventricular function LVEF >55%. A
bioprosthetic valve is seen in the aortic position (#21 manga
[**Doctor Last Name **] per surgeons) Mean gradient 16, mean 25 mm hg, no
perivavular leaks. Aortic contours intact. Remaining exam is
unchanged. All findings discussed with surgeons at the time of
the exam.

Brief Hospital Course:
The patient was admitted to the hospital and brought to the
operating room on [**2190-7-15**] where the patient underwent AVR, CABG
as detailed in the operative report.  Overall the patient
tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring.  Cefazolin was used for surgical antibiotic
prophylaxis.  POD 1 found the patient extubated, alert and
oriented and breathing comfortably.  The patient was
neurologically intact and hemodynamically stable on no inotropic
or vasopressor support.  She did develop post-op atrial
fibrillation for which she was successfully cardioverted to
sinus rhythm.  Amiodarone was initiated.  Beta blocker was
initiated and the patient was gently diuresed toward the
preoperative weight.  The patient was transferred to the
telemetry floor for further recovery.  Chest tubes and pacing
wires were discontinued without complication.  The patient was
evaluated by the physical therapy service for assistance with
strength and mobility.  By the time of discharge on POD 5 the
patient was ambulating freely, the wound was healing and pain
was controlled with oral analgesics.  The patient was discharged
to [**Hospital 100**] Rehab in good condition with appropriate follow up
instructions.

Medications on Admission:
Dyazide 37.5/25 daily
omeprazole 20 daily
ECASA 81 mg daily
Centrum Silver daily


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
7. Tramadol 50 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours)
as needed for pain.
8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x 1 week, then 400mg daily x  week, then 200mg
daily until further instructed.
9. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
10. Triamterene-Hydrochlorothiazid 37.5-25 mg Capsule Sig: One
(1) Capsule PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
aortic stenosis
coronary artery disease
s/p aortic valve replacement and coronary artery bypass [**2190-7-15**]
PMH:
hypertension
hyperlipidemia
GI bleed (on naprosyn 12 yrs ago)
bilateral breast cysts
bronchitis
left lower extremity claudication
varicose veins
transient ischemic attack [**2185**]


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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 until follow up with
surgeon
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**
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge

Followup Instructions:
Please call to schedule appointments
Primary Care Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] J [**Telephone/Fax (1) 14328**] in [**2-6**] weeks
Cardiologist Dr. [**Last Name (STitle) **] in [**2-6**] 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**
Provider: [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2190-8-24**] 1:30
Provider: [**Name10 (NameIs) **] LAB Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2190-10-21**]
10:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 2625**]
Date/Time:[**2190-10-21**] 10:30



Completed by:[**2190-7-20**]
{'Aortic valve disorders,Acute posthemorrhagic anemia,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Other disorders of bone and cartilage,Other and unspecified angina pectoris,Unspecified essential hypertension,Atherosclerosis of aorta,Other and unspecified hyperlipidemia,Unspecified late effects of cerebrovascular disease,Esophageal reflux,Personal history of peptic ulcer disease,Personal history of allergy to narcotic agent,Personal history of allergy to other specified medicinal agents,Family history of ischemic heart disease,Family history of other cardiovascular diseases'}


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: significant dyspnea on exertion and fatigue

PRESENT ILLNESS: 81yo female with a history of aortic stenosis followed by echo.
Symptoms of dyspnea and fatigue have progressed recently.  By
echo she now has critical aortic stenosis with [**Location (un) 109**] 0.7cm2, peak
gradient 69mmHg and mean gradient 43mmHg.  She is referred for
surgical evaluation.

MEDICAL HISTORY: aortic stenosis
hypertension
hyperlipidemia
GI bleed (on naprosyn 12 yrs ago)
bilateral breast cysts
bronchitis
left lower extremity claudication
varicose veins
transient ischemic attack [**2185**]

MEDICATION ON ADMISSION: Dyazide 37.5/25 daily
omeprazole 20 daily
ECASA 81 mg daily
Centrum Silver daily

ALLERGIES: Demerol / Codeine / Statins-Hmg-Coa Reductase Inhibitors

PHYSICAL EXAM: Pulse: 82 Resp: 16  O2 sat: 99%
B/P  Right: 136/80   Left: 144/79
Height:  62"  Weight: 142lb

FAMILY HISTORY: brother with CABG at age 76 and CVA 84yo
brother with CABG at age 60
brother with MI at age 66
mother died at 83 with h/o CHF

SOCIAL HISTORY: Lives with: widowed, alone
Occupation: home maker
Tobacco: never
ETOH: none 

### Response:
{'Aortic valve disorders,Acute posthemorrhagic anemia,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Other disorders of bone and cartilage,Other and unspecified angina pectoris,Unspecified essential hypertension,Atherosclerosis of aorta,Other and unspecified hyperlipidemia,Unspecified late effects of cerebrovascular disease,Esophageal reflux,Personal history of peptic ulcer disease,Personal history of allergy to narcotic agent,Personal history of allergy to other specified medicinal agents,Family history of ischemic heart disease,Family history of other cardiovascular diseases'}
