CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 47 year old female with known aortic stenosis was seen at OSH ED
for recent development of shortness of breath.  In the days
preceding her ED visit the patient developed shortness of breath
when walking distances or up stairs.  Her SOB was associated
with chest tightness, dizziness, changes in vision, and on one
occurence, loss of urine.  There has not been any syncope with
these episodes.  She saw her PCP the day of her admission where
CXR showed CHF and she was then sent to the ED for further work
up and diuresis.  ECHO in the ED showed critical aortic
stenosis.  Patient was transferred to [**Hospital1 18**] for cardiac cath in
preparation for future valve surgery.  Cath showed mild disease
in coronaries and critical AS with an aortic valve area of 0.27
and gradient of 26.63.  She was also noted to have [**1-10**]+MR,
severe pulmonary HTN, LV diastolic heart failure with LVEF of
45-50%.  Pressures: RA - 14, RV - 71/19, PA - 71/37, PCWP - 32,
AO - 100/54, CO - 2.29, CI - 1.19.

MEDICAL HISTORY: Anxiety
Alcohol abuse
Back pain
Anemia secondary to chronic alcohol use
Aortic stenosis

MEDICATION ON ADMISSION: Folate
MVI
Remeron
ASA 81 mg
Vit B12 shots

ALLERGIES: Amoxicillin / Sulfa (Sulfonamides)

PHYSICAL EXAM: Vit:  T  97.3   HR 85    BP 136/59    RR 20   PO2 95%RA 2L
Gen: milddle aged woman, lying flat on bed, in NAD
HEENT: MM slightly dry, PERRLA, EOMI
Neck: soft, + JVD
CV: RR, [**3-13**] blowing holosystolic murmur radiating to the
carotids, early diastolic murmur
Pulm: CTAB anteriorly, no w/c/r
Abd: + BS, soft, NT, ND
Ext: no peripheral edema
Skin: + telangectasias on face
Neuro: AAO x 3, CN II-XII grossly intact

FAMILY HISTORY: Father - aortic stenosis, bovine valve replacement, multiple
CABGs, CHF, CEA
Mother - hx of silent MI
3 Siblings - healthy

SOCIAL HISTORY: Patient lives with her husband and two sons. She has a 30 ppy
tobacco hx, and recurrent alcohol abuse.  She has presenty been
sober for 8 months, is involved in AA and therapy.
Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Diseases of tricuspid valve,Hemorrhage complicating a procedure,Alcohol abuse, unspecified,Other chronic pulmonary heart diseases,Anemia of other chronic disease,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Tachycardia, unspecified,Anxiety state, unspecified,Lumbago,Other and unspecified hyperlipidemia,Disorders of magnesium metabolism,Hypopotassemia
Mitr/aortic mult involv,Rheumatic heart failure,Tricuspid valve disease,Hemorrhage complic proc,Alcohol abuse-unspec,Chr pulmon heart dis NEC,Anemia-other chronic dis,Hypertension NOS,Crnry athrscl natve vssl,Tachycardia NOS,Anxiety state NOS,Lumbago,Hyperlipidemia NEC/NOS,Dis magnesium metabolism,Hypopotassemia
Admission Date:  [**2168-7-19**]              Discharge Date:   [**2168-8-2**]

Date of Birth:  [**2121-6-20**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Amoxicillin / Sulfa (Sulfonamides)

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

Major Surgical or Invasive Procedure:
Cardiac cath

History of Present Illness:
47 year old female with known aortic stenosis was seen at OSH ED
for recent development of shortness of breath.  In the days
preceding her ED visit the patient developed shortness of breath
when walking distances or up stairs.  Her SOB was associated
with chest tightness, dizziness, changes in vision, and on one
occurence, loss of urine.  There has not been any syncope with
these episodes.  She saw her PCP the day of her admission where
CXR showed CHF and she was then sent to the ED for further work
up and diuresis.  ECHO in the ED showed critical aortic
stenosis.  Patient was transferred to [**Hospital1 18**] for cardiac cath in
preparation for future valve surgery.  Cath showed mild disease
in coronaries and critical AS with an aortic valve area of 0.27
and gradient of 26.63.  She was also noted to have [**1-10**]+MR,
severe pulmonary HTN, LV diastolic heart failure with LVEF of
45-50%.  Pressures: RA - 14, RV - 71/19, PA - 71/37, PCWP - 32,
AO - 100/54, CO - 2.29, CI - 1.19.


Past Medical History:
Anxiety
Alcohol abuse
Back pain
Anemia secondary to chronic alcohol use
Aortic stenosis

Social History:
Patient lives with her husband and two sons. She has a 30 ppy
tobacco hx, and recurrent alcohol abuse.  She has presenty been
sober for 8 months, is involved in AA and therapy.

Family History:
Father - aortic stenosis, bovine valve replacement, multiple
CABGs, CHF, CEA
Mother - hx of silent MI
3 Siblings - healthy

Physical Exam:
Vit:  T  97.3   HR 85    BP 136/59    RR 20   PO2 95%RA 2L
Gen: milddle aged woman, lying flat on bed, in NAD
HEENT: MM slightly dry, PERRLA, EOMI
Neck: soft, + JVD
CV: RR, [**3-13**] blowing holosystolic murmur radiating to the
carotids, early diastolic murmur
Pulm: CTAB anteriorly, no w/c/r
Abd: + BS, soft, NT, ND
Ext: no peripheral edema
Skin: + telangectasias on face
Neuro: AAO x 3, CN II-XII grossly intact


Pertinent Results:

[**2168-8-2**] 06:10AM BLOOD WBC-7.7 RBC-3.50* Hgb-11.3* Hct-33.9*
MCV-97 MCH-32.2* MCHC-33.3 RDW-15.6* Plt Ct-104*
[**2168-8-2**] 06:10AM BLOOD PT-21.3* PTT-74.9* INR(PT)-3.0
[**2168-8-2**] 06:10AM BLOOD UreaN-11 Creat-0.8 K-4.3

Brief Hospital Course:
Taken to OR on [**2168-7-21**] for AVR (mechanical), found to have
significant MAC, therefore, MVR was also done at that time.
Post-op course stable, transferred to telemetry floor on POD #
2, started on Coumadin, lopressor and lasix.  Heparin gtt
initiated on POD # 3.  On POD # 6, INR was elevated to 3.5 (from
1.8), but on the following day, she dropped to < 2.0, and
heparin was restarted.  She remained in the hospital waiting for
therapeutic INR.  During that time, her lasix and KCl were
d/c'd, she progressed with PT, and she is now [**Last Name (un) **] to be
discharged home.  Her INR today is 3.0.  SHe will receive 5 mg
on Coumadin today and tomorrow, then have her INR checked, and
called to Dr. [**Last Name (STitle) 656**] who will continue dosing for a target INR
3.0-3.5.



Medications on Admission:
Folate
MVI
Remeron
ASA 81 mg
Vit B12 shots

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
4. Mirtazapine 30 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*90 Tablet(s)* Refills:*2*
7. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO once a day
for 2 days: 5 mg on [**8-2**] & [**8-3**],then INR to be checked and
called to Dr.[**Name (NI) 42421**] office for continued dosing (target INR
3.0-3.5).
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Gentiva

Discharge Diagnosis:
Severe AS, MAC
s/p AVR(), MVR()-mechanical
Etoh abuse
anxiety


Discharge Condition:
Good.

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 2 lbs in one
day or five in one week
Call with temperature greater than 100.5, redness or drainage
froim incision.
No driving or lifting more than 10 pounds until follow up
appointment.
[**Month (only) 116**] shower, wash incision with mild soap and water, pat dry, do
not aply lotions, creams or powders, no baths, keep out of the
sun.
Adhere to 2 gm sodium diet

Followup Instructions:
Dr. [**Last Name (STitle) **] 4 weeks
Dr. [**Last Name (STitle) 656**] 2 weeks
Dr. [**Last Name (STitle) **] 2 weeks



Completed by:[**2168-8-2**]
{'Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Diseases of tricuspid valve,Hemorrhage complicating a procedure,Alcohol abuse, unspecified,Other chronic pulmonary heart diseases,Anemia of other chronic disease,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Tachycardia, unspecified,Anxiety state, unspecified,Lumbago,Other and unspecified hyperlipidemia,Disorders of magnesium metabolism,Hypopotassemia'}


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: SOB

PRESENT ILLNESS: 47 year old female with known aortic stenosis was seen at OSH ED
for recent development of shortness of breath.  In the days
preceding her ED visit the patient developed shortness of breath
when walking distances or up stairs.  Her SOB was associated
with chest tightness, dizziness, changes in vision, and on one
occurence, loss of urine.  There has not been any syncope with
these episodes.  She saw her PCP the day of her admission where
CXR showed CHF and she was then sent to the ED for further work
up and diuresis.  ECHO in the ED showed critical aortic
stenosis.  Patient was transferred to [**Hospital1 18**] for cardiac cath in
preparation for future valve surgery.  Cath showed mild disease
in coronaries and critical AS with an aortic valve area of 0.27
and gradient of 26.63.  She was also noted to have [**1-10**]+MR,
severe pulmonary HTN, LV diastolic heart failure with LVEF of
45-50%.  Pressures: RA - 14, RV - 71/19, PA - 71/37, PCWP - 32,
AO - 100/54, CO - 2.29, CI - 1.19.

MEDICAL HISTORY: Anxiety
Alcohol abuse
Back pain
Anemia secondary to chronic alcohol use
Aortic stenosis

MEDICATION ON ADMISSION: Folate
MVI
Remeron
ASA 81 mg
Vit B12 shots

ALLERGIES: Amoxicillin / Sulfa (Sulfonamides)

PHYSICAL EXAM: Vit:  T  97.3   HR 85    BP 136/59    RR 20   PO2 95%RA 2L
Gen: milddle aged woman, lying flat on bed, in NAD
HEENT: MM slightly dry, PERRLA, EOMI
Neck: soft, + JVD
CV: RR, [**3-13**] blowing holosystolic murmur radiating to the
carotids, early diastolic murmur
Pulm: CTAB anteriorly, no w/c/r
Abd: + BS, soft, NT, ND
Ext: no peripheral edema
Skin: + telangectasias on face
Neuro: AAO x 3, CN II-XII grossly intact

FAMILY HISTORY: Father - aortic stenosis, bovine valve replacement, multiple
CABGs, CHF, CEA
Mother - hx of silent MI
3 Siblings - healthy

SOCIAL HISTORY: Patient lives with her husband and two sons. She has a 30 ppy
tobacco hx, and recurrent alcohol abuse.  She has presenty been
sober for 8 months, is involved in AA and therapy. 

### Response:
{'Multiple involvement of mitral and aortic valves,Rheumatic heart failure (congestive),Diseases of tricuspid valve,Hemorrhage complicating a procedure,Alcohol abuse, unspecified,Other chronic pulmonary heart diseases,Anemia of other chronic disease,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Tachycardia, unspecified,Anxiety state, unspecified,Lumbago,Other and unspecified hyperlipidemia,Disorders of magnesium metabolism,Hypopotassemia'}
