CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 60939**] is a 52-year-old
gentleman with a history of aortic valve endocarditis, and he
was hospitalized approximately 6 weeks. The cause was
unknown, and the organism was unknown, but he had recovered
well until about 7 to 8 months ago. He had been starting to
experience worsening shortness of breath and dyspnea on
exertion. Echocardiography showed LVH, an ejection fraction
of 55% to 60%, a calcified aortic valve with aortic stenosis
and aortic insufficiency. He was referred to Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **].
[**Last Name (NamePattern1) **] for aortic valve replacement.

MEDICAL HISTORY: 1. Diverticulosis.
2. Status post colon resection in [**2179**] due to diverticulitis.
3. Hypertension.
4. Psoriasis on his lower extremities.
5. Aortic valve endocarditis.

MEDICATION ON ADMISSION: Enalapril 20 mg p.o. once a day,
aspirin 81 mg p.o. once a day, Afrin nasal spray p.r.n., and
over-the-counter medication for psoriasis.

ALLERGIES: He had no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Aortic valve disorders,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension
Aortic valve disorder,CHF NOS,Surg compl-heart,Atriovent block complete,Crnry athrscl natve vssl,Hypertension NOS
Admission Date: [**2194-5-28**]        Discharge Date: [**2194-6-8**]

Date of Birth:  [**2141-12-19**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 60939**] is a 52-year-old
gentleman with a history of aortic valve endocarditis, and he
was hospitalized approximately 6 weeks. The cause was
unknown, and the organism was unknown, but he had recovered
well until about 7 to 8 months ago. He had been starting to
experience worsening shortness of breath and dyspnea on
exertion. Echocardiography showed LVH, an ejection fraction
of 55% to 60%, a calcified aortic valve with aortic stenosis
and aortic insufficiency. He was referred to Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **].
[**Last Name (NamePattern1) **] for aortic valve replacement.

PAST MEDICAL HISTORY:
1. Diverticulosis.
2. Status post colon resection in [**2179**] due to diverticulitis.
3. Hypertension.
4. Psoriasis on his lower extremities.
5. Aortic valve endocarditis.


ALLERGIES:  He had no known allergies.

MEDICATIONS ON ADMISSION:  Enalapril 20 mg p.o. once a day,
aspirin 81 mg p.o. once a day, Afrin nasal spray p.r.n., and
over-the-counter medication for psoriasis.

RADIOLOGIC AND OTHER STUDIES:  Preoperative carotid studies
showed a 30% to 49% right internal carotid stenosis and less
than 30% on the left.

A preoperative chest x-ray showed no evidence of any acute
cardiopulmonary abnormality. Please refer to the official
report dated [**2194-5-28**].

A preoperative EKG showed a sinus rhythm at 83 with some LVH
and secondary ST-T changes. Please refer to the official
report dated [**2194-5-28**].

A preoperative cardiac catheterization report was not
available at the time of this dictation. Per the patient, he
had right coronary artery disease.

PREOPERATIVE LABORATORY DATA:  White count was 8.1,
hematocrit was 34.9, and platelet count was 348.000. PT was
13.4, PTT was 28.7, and INR was 1.1. Urinalysis was negative.
Sodium was 140, K was 4.6, chloride was 106, bicarbonate was
30, BUN was 17, creatinine was 1.1, with a blood sugar of
112. ALT was 42, AST was 20, alkaline phosphatase was 63,
amylase was 53, total bilirubin was 0.4, lipase was 30.
Magnesium was 2.0. HbA1C was 5.6%. Urine culture was also
negative.

HABITS:  He denied any tobacco use and rare use of alcohol.
His last dental visit was approximately 1 year prior with no
problems.

PHYSICAL EXAMINATION ON ADMISSION:  He was in sinus
tachycardia at 105, with a temperature of 99.2, a blood
pressure of 132/74, a respiratory rate of 18, and saturating
94 percent on room air. He was awake, and anxious, and
oriented x 3. He had a grossly nonfocal neurologic exam. His
heart was regular in rate and rhythm with a harsh grade 4/6
systolic ejection murmur that radiated to his carotids. His
lungs were clear with faint wheezes. He had positive bowel
sounds. His abdomen was soft, nontender, and nondistended,
and obese, with a well-healed surgical scar from his
colectomy. His extremities had 1+ edema with right lower
extremity psoriatic plaques. He had 2+ femoral pulses
bilaterally without any bruits heard on his right side, 2+
popliteal, 2+ DP and PT and radial pulses on the right, and
1+ DP and PT pulses on the left, with 2+ radial on the left.
On exam later in the day he was noted to have mild bilateral
rales as well as the elevated blood sugar that Dr. [**Last Name (STitle) **]
deemed to be undiagnosed diabetes.

HOSPITAL COURSE:  He was admitted for management of his
congestive heart failure with a plan to do surgery the
following morning. On [**5-29**], he underwent aortic valve
replacement with Dr. [**Last Name (STitle) **] with a 25-mm St. [**Male First Name (un) 923**] mechanical
valve. The right coronary artery was nondominant and unable
to be grafted. Postoperative TEE showed an ejection fraction
of 50%, no AI, and 1+ MR. [**Name13 (STitle) **] did go to the cardiothoracic ICU
on a nitroglycerin drip at 0.2 mcg/kg per minute, a propofol
drip at 15 mcg/kg per minute, and an insulin drip at 2 units
per hour. He was AV paced at the time.

On postoperative day 1, he had a cardiac index of 2.7, in
sinus rhythm at 93, with a blood pressure of 124/76. He was
alert and oriented. He had been extubated. His Swan was
removed. His chest tubes were removed. His Lopressor beta
blockade was begun. He remained on an insulin drip as well as
nitroglycerin at 1.25.

On postoperative day 2, the patient showed third-degree AV
block. His Lopressor was stopped. He continued to be
hemodynamically stable. He was started on captopril at 12.5
and began Lasix diuresis. The electrophysiology service was
consulted. He had an underlying sinus rhythm with junctional
rate also. He alternated between sinus and a junctional rate
at approximately 40 beats per minute.

On postoperative day 4, his Lasix was increased. His Foley
catheter was discontinued. He started a heparin drip. His
Coumadin was held pending his EP consult in case it was
determined that he would need a pacemaker, and he was
transferred out to the floor to begin working with nurses and
the physical therapist. EP evaluated him and determined that
his third-degree heart block and junctional rhythm would
require a pacemaker. His heparin was turned off on the
morning on postoperative day 5. He continued on captopril and
continued with aspirin and Imdur. His exam was unremarkable,
and he continued to have a temporary pacemaker prior to his
pacemaker placement on the 25th in the catheterization
laboratory which he had done successfully.

On postoperative day 6, he seemed to have tolerated his
pacemaker well. His temporary pacing wires were removed. He
was restarted on his heparin as well as Lopressor. He was
seen by case management and continued to work with the nurse
and physical therapist on increasing his exercise tolerance
and ambulating activity. The pacemaker was checked and
interrogated by the EP service with a confirmatory chest x-
ray also. He was receiving Percocet for sternal incisional
pain. His heparin was increased on postoperative day 6. He
received his first dose of Coumadin on [**6-4**]. He continued
with beta blockade with metoprolol 25 twice a day, and his
creatinine was stable at 0.9. His baseline INR was 1.1 prior
to his first dose of Coumadin. His sternum was stable. The
incisions were clean, dry, and intact. His pacer incision was
clean, dry, and intact. He had no extremity edema. He was
encouraged to increase his activity level with physical
therapy and that he would be able to be discharged to home
with VNA services as soon as his INR was therapeutic. Over
the course of the next several days he continued his
ambulation and continued to improve. He was dosed with
Coumadin every evening.

On postoperative day 8, his INR rose to 1.2. His Imdur was
discontinued as well as captopril being changed over to
lisinopril. His heparin was increased to 1400 units per hour
when his INR only rose from 1.1 to 1.2.

On postoperative day 9 and postoperative day 4 from his
pacemaker, he did a level V and was cleared by physical
therapy. He had a short run of a question of SVT versus AFib
which self terminated. He had scattered rhonchi and a sharp
click from his mechanical valve. His pacer site had no
hematoma. His Coumadin was increased to 7.5 mg that evening.
His enalapril was increased to 10 mg. On the 1st, Dr. [**Last Name (STitle) **]
determined that once his INR reached 1.8 he could be
discharged home on his Coumadin with followup with his
primary care physician. [**Name10 (NameIs) **] postoperative day 9, his INR rose
to 1.7.

On [**6-8**], on the day of discharge, his PT rose to 16.7 with
an INR of 1.8; and it was determined that he could be
discharged to home with VNA services with follow-up blood
draws at [**Hospital3 35813**] Center in [**Location (un) 37361**], [**Doctor Last Name **],
his home town, the following Monday.

DISCHARGE DIAGNOSES:
1. Status post aortic valve replacement with a 25-mm St. [**Male First Name (un) 923**]
   mechanical valve.
2. Status post pacemaker placement.
3. Diverticulosis.
4. Status post colectomy in [**2179**].
5. Hypertension.
6. Lower extremity psoriasis.


MEDICATIONS ON DISCHARGE:
1. Percocet 5/325 1 to 2 tablets p.o. q.4h. p.r.n. (for
   pain).
2. Enteric coated aspirin 81 mg p.o. once daily.
3. Colace 100 mg p.o. twice a day.
4. Lasix 40 mg p.o. once daily (for 7 days).
5. Metoprolol 50 mg p.o. twice a day.
6. Enalapril 20 mg p.o. once a day.
7. Coumadin 7.5 mg on the evening of discharge only and then
   following doses to be taken as directed by Dr. [**Last Name (STitle) 60940**] for
   an INR goal of 2 up to 3.5. The patient was instructed to
   follow up with Dr. [**Last Name (STitle) 60940**] and have his lab work drawn the
   following Monday at [**Hospital3 35813**] Center in [**Doctor Last Name **]
   Island.
8. Zantac 150 mg p.o. twice a day.
9. Potassium chloride 20 mEq p.o. once a day (for 7 days).


DISCHARGE INSTRUCTIONS:  The patient was also instructed to
have a follow-up appointment with Dr. [**Last Name (STitle) 60940**] in 1 to 2 weeks
post discharge and to make an appointment with Dr. [**Last Name (STitle) **],
his surgeon, for a postoperative visit in the office in 4
weeks.

DISCHARGE DISPOSITION:  He was discharged to home with VNA
services on [**2194-6-8**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2194-7-10**] 09:15:37
T:  [**2194-7-11**] 10:23:29
Job#:  [**Job Number 60941**]
{'Aortic valve disorders,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname 60939**] is a 52-year-old
gentleman with a history of aortic valve endocarditis, and he
was hospitalized approximately 6 weeks. The cause was
unknown, and the organism was unknown, but he had recovered
well until about 7 to 8 months ago. He had been starting to
experience worsening shortness of breath and dyspnea on
exertion. Echocardiography showed LVH, an ejection fraction
of 55% to 60%, a calcified aortic valve with aortic stenosis
and aortic insufficiency. He was referred to Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **].
[**Last Name (NamePattern1) **] for aortic valve replacement.

MEDICAL HISTORY: 1. Diverticulosis.
2. Status post colon resection in [**2179**] due to diverticulitis.
3. Hypertension.
4. Psoriasis on his lower extremities.
5. Aortic valve endocarditis.

MEDICATION ON ADMISSION: Enalapril 20 mg p.o. once a day,
aspirin 81 mg p.o. once a day, Afrin nasal spray p.r.n., and
over-the-counter medication for psoriasis.

ALLERGIES: He had no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Aortic valve disorders,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}
