CHIEF COMPLAINT: Increasing chest tightness with shortness
of breath and dyspnea on exertion during rest.

PRESENT ILLNESS: The patient is a 58-year-old
woman first told that she had a murmur 15 years ago following
a dental visit and was found to have endocarditis and a
pericardial effusion.  She had pericardiocentesis at that
time followed by serial echocardiograms.

MEDICAL HISTORY: Endocarditis with pericardial
effusion.  Aortic stenosis.  Congestive heart failure.
Noninsulin dependent diabetes mellitus.
Hypercholesterolemia.  Anemia.  Peripheral neuropathy.
Chronic low back pain.  Bilateral lower extremity
varicosities.

MEDICATION ON ADMISSION: 

ALLERGIES: Felpine causes acute shortness of breath.

PHYSICAL EXAM: Vital signs:  Temperature 98.1,
heart rate 77 in sinus rhythm, blood pressure 122/60,
respirations 18, oxygen saturation 96 percent on room air,
weight preoperatively 207 lbs, on discharge 195 lbs.
General:  She was alert and oriented times three.  She moves
all extremities.  She follows commands.  Respiratory:
Bibasilar crackles.  Cardiovascular:  Regular rate and rhythm
with mechanical click.  Sternum stable.  Incision open to
air, clean and dry.  Abdomen:  Soft, nontender, nondistended.
Positive bowel sounds.  Extremities:  Warm and well perfused.
She had [**11-15**]+ edema bilaterally, right greater than left.
Lower extremity incision open to air, clean and dry.

FAMILY HISTORY: Mother is alive at 83 with anemia and
congestive heart failure.  Father died at 77 of an myocardial
infarction.

SOCIAL HISTORY: The patient lives with her husband and four
children.  She has a remote tobacco history; quit in [**2172**].
Rare alcohol, only on social occasions.  She denied any other
drug use.
Aortic valve disorders,Congestive heart failure, unspecified,Acidosis,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Obesity, unspecified,Pure hypercholesterolemia,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere
Aortic valve disorder,CHF NOS,Acidosis,Crnry athrscl natve vssl,Chr pulmon heart dis NEC,Obesity NOS,Pure hypercholesterolem,DMII renl nt st uncntrld,Nephritis NOS in oth dis
Admission Date: [**2183-3-18**]        Discharge Date: [**2183-4-7**]

Date of Birth:  [**2124-12-30**]        Sex:  F

Service:  CSU


CHIEF COMPLAINT:  Increasing chest tightness with shortness
of breath and dyspnea on exertion during rest.

HISTORY OF PRESENT ILLNESS:  The patient is a 58-year-old
woman first told that she had a murmur 15 years ago following
a dental visit and was found to have endocarditis and a
pericardial effusion.  She had pericardiocentesis at that
time followed by serial echocardiograms.

She underwent cardiac catheterization on [**2183-3-4**].  At
that time, cardiac catheterization showed an ejection
fraction of 50 percent, left main with 60 percent ostial
stenosis, left anterior descending coronary artery with 50
percent midvessel stenosis, and mild luminal irregularity,
circumflex with a 60 percent ostial stenosis, and right
coronary artery with mild luminal irregularities, and a
distal 50-60 percent lesion at the origin of the  .

Th[**Last Name (STitle) 1050**] was ultimately discharged to home following
cardiac catheterization and referred to Cardiac Surgery.  She
was seen by Dr. [**Last Name (Prefixes) **] and accepted for aortic valve
replacement and scheduled as an outpatient admission.

The patient was admitted to [**Hospital6 2018**] on [**3-18**] to have her surgery; however, this had to be
postponed due to an emergency with another patient, and she
was therefore rescheduled to undergo aortic valve replacement
on [**3-19**].

PAST MEDICAL HISTORY:  Endocarditis with pericardial
effusion.  Aortic stenosis.  Congestive heart failure.
Noninsulin dependent diabetes mellitus.
Hypercholesterolemia.  Anemia.  Peripheral neuropathy.
Chronic low back pain.  Bilateral lower extremity
varicosities.

PAST SURGICAL HISTORY:  Cesarean section times four.
Laparoscopic cholecystectomy.

MEDICATIONS PRIOR TO ADMISSION:  Procrit once a week,
Glyburide 10 mg b.i.d., Aspirin 325 q.d., Atenolol 25 b.i.d.,
Imdur 60 q.d., Lipitor 20 q.d., Lisinopril 5 q.d., Metformin
1000 b.i.d., Centrum Silver 1 q.d., Calcium Carbonate no dose
provided, Betacarotene, Vitamin B12 no dose provided, Folic
Acid 1 mg q.d., Lasix no dose provided.

ALLERGIES:  Felpine causes acute shortness of breath.

FAMILY HISTORY:  Mother is alive at 83 with anemia and
congestive heart failure.  Father died at 77 of an myocardial
infarction.

SOCIAL HISTORY:  The patient lives with her husband and four
children.  She has a remote tobacco history; quit in [**2172**].
Rare alcohol, only on social occasions.  She denied any other
drug use.

REVIEW OF SYMPTOMS:  Angina with activity, no palpitations or
syncope.  Shortness of breath at rest and with activity.
Positive paroxysmal nocturnal dyspnea.  Positive PNA.  No
asthma.  Positive bronchitis.  Positive congestive heart
failure.  Positive constipation.  No melena.  Positive
claudication and bilateral varicosities.  Positive peripheral
neuropathy of the hands and legs.  Positive diabetes.  No
thyroid problems.  Positive anemia.

PHYSICAL EXAMINATION:  Vital signs:  Heart rate 72 and
regular, blood pressure 142/68, respirations 20, height 5 ft
0 in, weight 207 lbs.  General:  The patient was very obese.
Skin:  Birth mark of the right face and tongue.  HEENT:
Normal mucosa.  Nonicteric.  Neck:  Supple.  No jugular
venous distension.  Murmur radiating bilaterally to the
carotids.  Chest:  Clear to auscultation bilaterally.  Heart:
Regular rate and rhythm.  S1 and S2.  There was a 4/6
systolic ejection murmur throughout.  Abdomen:  Soft and
nontender.  No CVA tenderness.  Extremities:  Warm and well
perfused.  No clubbing or cyanosis.  There was 1+ bilateral
edema.  There were bilateral varicosities of the right thigh
greater than left thigh, left calf greater than the right
calf.  Neurologic:  Cranial nerves II-XII grossly intact.
Nonfocal examination.  She had 4/5 strength in all four
extremities.  Pulses:  Femoral 2+ bilaterally, dorsalis pedis
2+ bilaterally, posterior tibial 2+ bilaterally, radial 2+
bilaterally.

LABORATORY DATA:  White count 6.8, hematocrit 36.2, platelet
count 175; sodium 136, potassium 4.4, chloride 108, CO2 22,
BUN 28, creatinine 12.1, glucose 129.

Chest x-ray showed no congestive heart failure or pneumonia,
positive cardiomegaly.

Electrocardiogram was in sinus rhythm with a rate of 67 beats
per minute, nonspecific ST wave changes.

Carotid ultrasound showed scattered areas of focal calcific
plague at the origin of the left right coronary artery and
beyond the origin of the right internal carotid artery.
There was normal antegrade flow within both vertebral
arteries, no associated significant internal carotid artery
or common carotid artery stenosis.

HOSPITAL COURSE:  On [**3-19**], the patient was brought to the
Operating Room at which time she underwent an aortic valve
replacement with a number 19 St. [**Male First Name (un) 923**] mechanical valve.
Please see the operative report for full details.

In summary, the patient had an aortic valve replacement.  She
tolerated the operation well.  Her bypass time was 122 min
with a cross-clamp time of 66 min.  She was transferred from
the Operating Room to the Cardiothoracic Intensive Care Unit.
At the time of transfer, the patient was in sinus rhythm at a
rate of 81 beats per minute.  Her mean arterial pressure was
70 with a CVP of 15 and PAD of 24.  She had Dopamine at 2.5
mcg/kg/min, Propofol at 10 mcg/kg/min, and Nitroglycerin at
0.3 mcg/kg/min.

The patient remained hemodynamically stable in the immediate
postoperative period.  An initial attempt to awaken and wean
the patient from the ventilator was unsuccessful.  She was
therefore resedated and remained sedated throughout the night
of the operative day.

On postoperative day 1, the patient's Dobutamine infusion was
weaned to off, which she tolerated well.  An additional
attempt was made to wean and extubate the patient from the
vent; however, she became increasingly dyspneic and had mild
respiratory acidosis.  She therefore remained on the
ventilator following which a bronchoscopy was done which
showed minimal secretions and generally clear airway.

On postoperative day 2, the patient was again weaned from the
ventilator and successfully extubated.  Additionally, she
remained hemodynamically stable and was weaned from her Neo-
Synephrine infusion.

On postoperative day 3, the patient continued to make slow
progress.  She remained extubated; however, her creatinine
had begun to rise.  Attempts were made to diurese with both
Lasix and Diuril.  The patient's temporary pacing wires were
removed, and the patient was begun on a heparin infusion.

On postoperative day 4, the patient continued to be
hemodynamically stable.  She was begun on Coumadin, and was
transfused with 1 U packed red blood cells for a hematocrit
of 24.

On postoperative day 5, the patient continued to make slow
progress.  A sputum culture from prior bronchoscopy showed
Staphylococcus aureus, and she was begun on Levaquin and
transferred to FAR2 for continuing postoperative care and
cardiac rehabilitation.

Once on the floor, the patient made extremely slow progress
in her physical activity.  Her Coumadin doses were adjusted
to a target INR of 2.5-3.0, at which time her heparin
infusion was weaned to off.

On postoperative day 10, the patient complained of blurred
vision with diplopia at that time.  The Ophthalmology Service
was consulted which reported horizontal diplopia with mild
distant vision disturbances that they felt were due likely to
small microvascular infarcts which would resolve with time.
The patient was informed to schedule an outpatient clinic
appointment with the Ophthalmology Department.

On postoperative day 12, the patient remained hemodynamically
stable.  Her creatinine remained in the 1.3-1.5 range;
however, she seemed to be having less response to her
diuresis.  She was therefore started on Natrecor drip at that
time with good affect.  Additionally, the patient continued
to have mildly elevated blood glucose levels, and the [**Last Name (un) **]
was consulted to assist with glucose control.

Over the next several days, the patient remained
hemodynamically stable.  She continued to have good diuresis
to the Natrecor infusion.  She continued to make exceedingly
slow progress in advancing her physical activity.  On
postoperative day 6, the Natrecor infusion was discontinued.
She was again maintained with Lasix for diuresis.

She was monitored for three additional days to be sure that
she would not have an increase4 in her creatinine and that
her fluid balance would remain stable, and on postoperative
day 18, it was decided that the patient was stable and ready
to be discharged to home.

DISCHARGE PHYSICAL EXAM:  Vital signs:  Temperature 98.1,
heart rate 77 in sinus rhythm, blood pressure 122/60,
respirations 18, oxygen saturation 96 percent on room air,
weight preoperatively 207 lbs, on discharge 195 lbs.
General:  She was alert and oriented times three.  She moves
all extremities.  She follows commands.  Respiratory:
Bibasilar crackles.  Cardiovascular:  Regular rate and rhythm
with mechanical click.  Sternum stable.  Incision open to
air, clean and dry.  Abdomen:  Soft, nontender, nondistended.
Positive bowel sounds.  Extremities:  Warm and well perfused.
She had [**11-15**]+ edema bilaterally, right greater than left.
Lower extremity incision open to air, clean and dry.

DISCHARGE MEDICATIONS:  Aspirin 81 mg q.d., Glyburide 10 mg
b.i.d., Prilosec 40 mg q.d., Folate 1 mg q.d., Ferrous
Sulfate 325 mg q.d., Vitamin C 500 mg b.i.d., Metoprolol 50
mg b.i.d., Furosemide 20 mg b.i.d., Insulin Lantus 13 U
q.p.m., regular Insulin sliding scale, Lipitor 20 mg q.d.,
Warfarin as directed, the patient is to receive 1 mg on the
day of discharge, she is to have an INR check on [**4-8**] with
the results called to Dr. [**Last Name (STitle) 38610**] in [**Hospital1 3597**], [**Location (un) 3844**].
Additionally, the patient is to receive Dilaudid 1-2 mg q.4-6
hours p.r.n.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  She is to be discharged to home with VNA.

FO[**Last Name (STitle) 996**]P:  She is to follow-up with Dr. [**Last Name (STitle) 38610**] in one week,
follow-up with Dr. [**Last Name (Prefixes) **] in four weeks, follow-up with
Dr. [**Last Name (STitle) 410**] in [**12-17**] weeks, follow-up with Ophthalmology six
weeks following discharge; the patient is to make an
appointment in the outpatient clinic.

DISCHARGE DIAGNOSIS:
1. Aortic stenosis status post aortic valve replacement with
   a 19 St. [**Male First Name (un) 923**] mechanical valve.
2. Obesity.
3. Noninsulin dependent diabetes mellitus.
4. Hypercholesterolemia.
5. Anemia.
6. Chronic low back pain.
7. Bilateral varicosities.
8. Peripheral neuropathy.
9. Status post cesarean section times four.
10.      Status post laparoscopic cholecystectomy.


DISCHARGE LABORATORY DATA:  Hematocrit 35; PT 18, PTT 2.2;
sodium 136, potassium 4.4, chloride 100, CO2 29, BUN 23,
creatinine 1.0, glucose 164.



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2183-4-8**] 09:03:31
T:  [**2183-4-8**] 10:13:34
Job#:  [**Job Number 38611**]
{'Aortic valve disorders,Congestive heart failure, unspecified,Acidosis,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Obesity, unspecified,Pure hypercholesterolemia,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}


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: Increasing chest tightness with shortness
of breath and dyspnea on exertion during rest.

PRESENT ILLNESS: The patient is a 58-year-old
woman first told that she had a murmur 15 years ago following
a dental visit and was found to have endocarditis and a
pericardial effusion.  She had pericardiocentesis at that
time followed by serial echocardiograms.

MEDICAL HISTORY: Endocarditis with pericardial
effusion.  Aortic stenosis.  Congestive heart failure.
Noninsulin dependent diabetes mellitus.
Hypercholesterolemia.  Anemia.  Peripheral neuropathy.
Chronic low back pain.  Bilateral lower extremity
varicosities.

MEDICATION ON ADMISSION: 

ALLERGIES: Felpine causes acute shortness of breath.

PHYSICAL EXAM: Vital signs:  Temperature 98.1,
heart rate 77 in sinus rhythm, blood pressure 122/60,
respirations 18, oxygen saturation 96 percent on room air,
weight preoperatively 207 lbs, on discharge 195 lbs.
General:  She was alert and oriented times three.  She moves
all extremities.  She follows commands.  Respiratory:
Bibasilar crackles.  Cardiovascular:  Regular rate and rhythm
with mechanical click.  Sternum stable.  Incision open to
air, clean and dry.  Abdomen:  Soft, nontender, nondistended.
Positive bowel sounds.  Extremities:  Warm and well perfused.
She had [**11-15**]+ edema bilaterally, right greater than left.
Lower extremity incision open to air, clean and dry.

FAMILY HISTORY: Mother is alive at 83 with anemia and
congestive heart failure.  Father died at 77 of an myocardial
infarction.

SOCIAL HISTORY: The patient lives with her husband and four
children.  She has a remote tobacco history; quit in [**2172**].
Rare alcohol, only on social occasions.  She denied any other
drug use. 

### Response:
{'Aortic valve disorders,Congestive heart failure, unspecified,Acidosis,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Obesity, unspecified,Pure hypercholesterolemia,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}
