CHIEF COMPLAINT: decreased energy

PRESENT ILLNESS: 55 year old man with a known childhood murmur who was echoed
during a recent admission
for pneumonia and found to have severe aortic stenosis. Referred
for AVR after cath showed clean coronaries.

MEDICAL HISTORY: bicuspid aortic valve, aortic stenosis,
aortic insufficiency, valvular induced cardiomyopathy, moderate
pulmonary hypertension (52/23), recent pneumonia

MEDICATION ON ADMISSION: lasix 20mg daily
zocor 40mg daily
KCL 20mEq daily
coreg 3.125mg daily
Amox 500mg (cont. after dental d/t symptoms from pna)
ASA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 82 O2 sat: 96%
B/P Left: 96/57
Height: 73"  Weight: 90.9kg

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Last Dental Exam: 2 years ago
Lives with: fiance
Occupation: teamster trucker
Tobacco: none
ETOH: rarely
Aortic valve disorders,Congenital insufficiency of aortic valve,Other primary cardiomyopathies,Chronic combined systolic and diastolic heart failure,Other chronic pulmonary heart diseases
Aortic valve disorder,Cong aorta valv insuffic,Prim cardiomyopathy NEC,Chr syst/diastl hrt fail,Chr pulmon heart dis NEC
Admission Date:  [**2156-3-16**]              Discharge Date:   [**2156-3-20**]

Date of Birth:  [**2100-10-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
decreased energy

Major Surgical or Invasive Procedure:
[**2156-3-16**] AVR ( [**Street Address(2) 11688**]. [**Male First Name (un) 923**] Regent mechanical)


History of Present Illness:
55 year old man with a known childhood murmur who was echoed
during a recent admission
for pneumonia and found to have severe aortic stenosis. Referred
for AVR after cath showed clean coronaries.

Past Medical History:
bicuspid aortic valve, aortic stenosis,
aortic insufficiency, valvular induced cardiomyopathy, moderate
pulmonary hypertension (52/23), recent pneumonia


Social History:
Last Dental Exam: 2 years ago
Lives with: fiance
Occupation: teamster trucker
Tobacco: none
ETOH: rarely


Family History:
non-contributory

Physical Exam:
Pulse: 82 O2 sat: 96%
B/P Left: 96/57
Height: 73"  Weight: 90.9kg

General: Well-developed male in no acute distress
Skin: Dry [x] intact [xx]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur II/VI SEM radiating to
carotids and across precordium
Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds
+
[x]
Extremities: Warm [x], well-perfused [x]  Edema/Varicosities:
None [x]
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:-


Pertinent Results:
Conclusions
PRE-CPB:1. The left atrium is moderately dilated. No spontaneous
echo contrast is seen in the left atrial appendage. 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 is moderately dilated. Doppler
parameters are most consistent with Grade II (moderate) left
ventricular diastolic dysfunction.
4. Right ventricular chamber size and free wall motion are
normal.
5. There are simple atheroma in the descending thoracic aorta.
6. The aortic valve is bicuspid. There is severe aortic valve
stenosis (valve area 0.8-1.0cm2). Moderate (2+) aortic
regurgitation is seen. The severity of aortic regurgitation may
be underestimated. The aortic regurgitation jet is eccentric,
directed toward the anterior mitral leaflet.
7. The mitral valve appears structurally normal with trivial
mitral regurgitation. There is bilateral retraction of the
mitral valve.
8. There is a small to moderate sized pericardial effusion.
9. A moderate left pleural effusion is seen.
Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) **] were notified in person of the
results.

POST-CPB: On infusions of epi, neo. AV pacing , then a pacing.
Well-seated mechanical valve in the aortic position. Coronary
flow seen in LMCA and RCA. Trace AI consistent with washing
jets. Preserved ventricular function on inotropic support. LVEF
is now 40%. Trace MR. Aortic contour is normal post
decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2156-3-16**] 14:13



Brief Hospital Course:
Mr. [**Known lastname 30814**] was admitted on [**2156-3-16**] and underwent AVR( mech AVR
#23 St. [**Male First Name (un) 923**]) with Dr. [**Last Name (STitle) **]. See operative note for details.
Post operatively he remained intubated and was transferred to
the CVICU in stable condition on epinephrine, phenylephrine,
propofol, and lidocaine drips. He awoke neurologically intact,
was weaned from the ventilator and extubated. Vasoactive
medications were weaned after hemodynamic stability was
achieved. Betablockers, diuretics and statin therapies were
initiated and titrated. Chest tubes and temporary pacing wires
were removed per protocol. Coumadin therpay was intiated for
mechanical AVR. He was evaluated and treated by physical therapy
for strength and conditioning. Mr. [**Known lastname 30814**] was cleared for
discharge to home on POD#4 with an INR of 2.0 by Dr. [**Last Name (STitle) **].

Medications on Admission:
lasix 20mg daily
zocor 40mg daily
KCL 20mEq daily
coreg 3.125mg daily
Amox 500mg (cont. after dental d/t symptoms from pna)
ASA


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
7. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
10. Coumadin 2.5 mg Tablet Sig: as directed Tablet PO once a
day: goal INR 2.5-3.0 for mechcanical aortic valve.
take 2.5 mg on sunday then as directed by Dr. [**Last Name (STitle) 83774**].
Disp:*60 Tablet(s)* Refills:*2*
11. Outpatient [**Name (NI) **] Work
PT/INR for coumadin dosing indication mechanical aortic valve -
goal INR 2.5-3.0 with results to [**Hospital1 **] heart center coumadin
clinic fax # [**Telephone/Fax (1) 31080**] attn coumadin clinic and Dr [**Last Name (STitle) 6254**] -
first draw monday [**2156-3-22**]


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
Aortic stenosis, aortic insufficiency s/p Aortic valve
replacement (Mech -#23mm St. [**Male First Name (un) 923**])
valvular-induced cardiomyopathy
pulmonary hypertension
recent Pneumonia
chronic systolic/diastolic heart failure


Discharge Condition:
alert and oriented
ambulating with steady gait
Sternal pain managed with dilaudid


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**]


Followup Instructions:
Surgeon Dr. [**Last Name (STitle) **] at [**Hospital1 **] [**4-8**] @ 9:00 AM [**Telephone/Fax (1) 6256**]
Please call to schedule appointments
Primary Care Dr. [**First Name (STitle) **] in [**1-31**] weeks
Cardiologist Dr. [**Last Name (STitle) 6254**] in [**1-31**] weeks
Labs: PT/INR for coumadin dosing indication mechanical aortic
valve - goal INR 2.5-3.0 with results to [**Hospital1 **] heart center
coumadin clinic fax # [**Telephone/Fax (1) 31080**] attn coumadin clinic and Dr
[**Last Name (STitle) 6254**] - first draw monday [**2156-3-22**]



Completed by:[**2156-3-20**]
{'Aortic valve disorders,Congenital insufficiency of aortic valve,Other primary cardiomyopathies,Chronic combined systolic and diastolic heart failure,Other chronic pulmonary heart 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: decreased energy

PRESENT ILLNESS: 55 year old man with a known childhood murmur who was echoed
during a recent admission
for pneumonia and found to have severe aortic stenosis. Referred
for AVR after cath showed clean coronaries.

MEDICAL HISTORY: bicuspid aortic valve, aortic stenosis,
aortic insufficiency, valvular induced cardiomyopathy, moderate
pulmonary hypertension (52/23), recent pneumonia

MEDICATION ON ADMISSION: lasix 20mg daily
zocor 40mg daily
KCL 20mEq daily
coreg 3.125mg daily
Amox 500mg (cont. after dental d/t symptoms from pna)
ASA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 82 O2 sat: 96%
B/P Left: 96/57
Height: 73"  Weight: 90.9kg

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Last Dental Exam: 2 years ago
Lives with: fiance
Occupation: teamster trucker
Tobacco: none
ETOH: rarely 

### Response:
{'Aortic valve disorders,Congenital insufficiency of aortic valve,Other primary cardiomyopathies,Chronic combined systolic and diastolic heart failure,Other chronic pulmonary heart diseases'}
