CHIEF COMPLAINT: Presyncopal episodes and dyspnea on exertion

PRESENT ILLNESS: 80 y/o female with long h/o PSVT and AS followed by serial
echo's who has been having pre-syncopal episodes along with
dyspnea on exertion. Most recent echo and cath showed severe
Aortic Stenosis.

MEDICAL HISTORY: Aortic Stenosis, Hepatitis C, PSVT, Varicose veins s/p
stripping, Macular degeneration, Osteoporosis, s/p
Tonsillectomy, s/p Total abdominal hysterectomy, s/p Umbilical
hernia repair and abdominoplasty, s/p Spinal fusion and
laminectomy, s/p Bilateral cataract surgery

MEDICATION ON ADMISSION: Atenolol 12.5mg qd, Protonix 40mg qd, Calcium 600 + D [**Hospital1 **],
Selenium 200 qd, Vit B6, Vit C, Magnesium, Ocuvite, Zinc,
[**Last Name (LF) 106379**], [**First Name3 (LF) **]-3

ALLERGIES: Ampicillin

PHYSICAL EXAM: VS: 76 130/70 5'2" 113#
Gen: NAD
Skin: Ecchymosis right leg/groin
HEENT: PERRLA, EOMI, OP benign
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 3/6 SEM w/ radiation to carotids
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 2+ edema
Neuro: Grossly intact, MAE, right foot drop

FAMILY HISTORY: Brother died of CHF at age 75.

SOCIAL HISTORY: Retired lab tech. Denies tobacco use. Also denies ETOH use in 20
yrs.
Aortic valve disorders,Unspecified viral hepatitis C without hepatic coma,Other specified cardiac dysrhythmias,Macular degeneration (senile), unspecified,Osteoporosis, unspecified,Arthrodesis status,Other acquired deformities of ankle and foot,Anemia, unspecified,Other iatrogenic hypotension
Aortic valve disorder,Hpt C w/o hepat coma NOS,Cardiac dysrhythmias NEC,Macular degeneration NOS,Osteoporosis NOS,Arthrodesis status,Acq ankle-foot def NEC,Anemia NOS,Iatrogenc hypotnsion NEC
Name:  [**Last Name (LF) 8268**],[**Known firstname 1911**]                    Unit No:   [**Numeric Identifier 17330**]

Admission Date:  [**2146-7-4**]              Discharge Date:   [**2146-7-10**]

Date of Birth:  [**2066-2-24**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Ampicillin

Attending:[**First Name3 (LF) 741**]
Addendum:
Pt did not go to rehab on Percocet, but on Ultram instead.

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg twice a day for 7 days then decrease to 400mg
daily for 7 days then decrease to 200mg daily until follow up
with cardiologist.
Disp:*60 Tablet(s)* Refills:*2*
4. Pantoprazole 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*
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 3 days.
Disp:*6 Tablet(s)* Refills:*0*
7. Potassium Chloride 20 mEq Packet Sig: One (1)  PO twice a day
for 3 days.
Disp:*6 * Refills:*0*
8. Ultram 50 mg Tablet Sig: One (1) Tablet PO every six (6)
hours for 7 days.
Disp:*28 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital of [**Location (un) 776**] & Islands - [**Location (un) 777**]

Discharge Diagnosis:
Aortic Stenosis s/p Aortic Valve Replacement
PMH: Hepatitis C, PSVT, Varicose veins s/p stripping, Macular
degeneration, Osteoporosis, s/p Tonsillectomy, s/p Total
abdominal hysterectomy, s/p Umbilical hernia repair and
abdominoplasty, s/p Spinal fusion and laminectomy, s/p Bilateral
cataract surgery


Discharge Condition:
Good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 1477**]

Followup Instructions:
Please call to schedule all appointments
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) **] in [**1-23**] weeks
Dr. [**Last Name (STitle) 2283**] after discharge from rehab
**Staples to be dc'd on Wed [**7-13**] or Thurs [**7-14**] by
VNA/Rehab


                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2146-7-10**]

Admission Date:  [**2146-7-4**]              Discharge Date:   [**2146-7-10**]

Date of Birth:  [**2066-2-24**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Ampicillin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Presyncopal episodes and dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2146-7-4**] Aortic Valve Replacement w/ 19mm St. [**Male First Name (un) 923**] Porcine

History of Present Illness:
80 y/o female with long h/o PSVT and AS followed by serial
echo's who has been having pre-syncopal episodes along with
dyspnea on exertion. Most recent echo and cath showed severe
Aortic Stenosis.

Past Medical History:
Aortic Stenosis, Hepatitis C, PSVT, Varicose veins s/p
stripping, Macular degeneration, Osteoporosis, s/p
Tonsillectomy, s/p Total abdominal hysterectomy, s/p Umbilical
hernia repair and abdominoplasty, s/p Spinal fusion and
laminectomy, s/p Bilateral cataract surgery

Social History:
Retired lab tech. Denies tobacco use. Also denies ETOH use in 20
yrs.

Family History:
Brother died of CHF at age 75.

Physical Exam:
VS: 76 130/70 5'2" 113#
Gen: NAD
Skin: Ecchymosis right leg/groin
HEENT: PERRLA, EOMI, OP benign
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 3/6 SEM w/ radiation to carotids
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 2+ edema
Neuro: Grossly intact, MAE, right foot drop

Pertinent Results:
[**7-4**] Echo: PREBYPASS: No atrial septal defect is seen by 2D or
color Doppler. The left ventricular cavity size is normal.
Regional left ventricular wall motion is normal. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. There
are complex (>4mm) atheroma in the descending thoracic aorta.
The aortic valve leaflets are severely thickened/deformed. There
is severe aortic valve stenosis (area <0.8cm2). Mild to moderate
([**12-22**]+) aortic regurgitation is seen. The mitral valve leaflets
are mildly thickened. Mild (1+) mitral regurgitation is seen.
POSTBYPASS: LV systolic function appears hyperdynamic. RV
systolic function remains normal. There is a well seated, well
functioning bioprosthesis in the aortic position. There is trace
valvular AI. MR now appears trace. Otherwise no changes compared
to prebypass.

[**2146-7-4**] 02:00PM BLOOD WBC-9.2# RBC-3.11*# Hgb-9.6*# Hct-28.9*#
MCV-93 MCH-31.0 MCHC-33.4 RDW-15.1 Plt Ct-199
[**2146-7-7**] 06:55AM BLOOD WBC-4.6 RBC-2.98* Hgb-9.4* Hct-27.9*
MCV-94 MCH-31.5 MCHC-33.6 RDW-15.5 Plt Ct-160
[**2146-7-4**] 02:00PM BLOOD PT-14.3* PTT-83.9* INR(PT)-1.2*
[**2146-7-4**] 03:19PM BLOOD PT-14.7* PTT-92.3* INR(PT)-1.3*
[**2146-7-4**] 03:19PM BLOOD UreaN-12 Creat-0.4 Cl-117* HCO3-23
[**2146-7-7**] 06:55AM BLOOD Glucose-105 UreaN-12 Creat-0.4 Na-133
K-5.1 Cl-100 HCO3-32 AnGap-6*
[**2146-7-8**] 06:35AM BLOOD WBC-5.4 RBC-3.14* Hgb-    [**Last Name (LF) **],[**Known firstname **]
[**Medical Record Number 106377**] F  80  [**2066-2-24**]

Radiology Report CHEST (PORTABLE AP) Study Date of [**2146-7-6**] 3:19
PM


[**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG FA6A [**2146-7-6**] SCHED
CHEST (PORTABLE AP)   Clip # [**Clip Number (Radiology) 106378**]
Reason: r/o ptx after chest tube removal



[**Hospital 93**] MEDICAL CONDITION:
   80 year old woman with s/p avr
REASON FOR THIS EXAMINATION:
   r/o ptx after chest tube removal



Final Report
HISTORY: Chest tube removal, to evaluate for pneumothorax.

FINDINGS: In comparison with the study of [**7-4**], the various
tubes have been
removed. Specifically, there is no evidence of pneumothorax.
Atelectatic
changes persist at the left base.

DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**]
Approved: WED [**2146-7-6**] 5:09 PM

  Imaging Lab

9.8* Hct-29.8* MCV-95 MCH-31.1 MCHC-32.7 RDW-15.7* Plt Ct-177

[**2146-7-8**] 10:25AM BLOOD PT-12.6 PTT-27.5 INR(PT)-1.1
[**2146-7-8**] 06:35AM BLOOD Glucose-131* UreaN-12 Creat-0.4 Na-132*
K-4.5 Cl-99 HCO3-26 AnGap-12

Brief Hospital Course:
Mrs.[**Known lastname **] was a same day admit after undergoing all
pre-operative work-up as an outpatient. On [**7-4**] she was brought
to the operating room were she underwent a aortic valve
replacement. Please see operative report for surgical details.
Following surgery she was transferred to the CVICU in stable
condition. Within 24 hours she was weaned from sedation, awoke
neurologically intact and extubated. On post-op day one
beta-blockers and diuretics were initiated and she was
transferred to the telemetry floor for further care. On post-op
day two she had an episode of atrial fibrillation which
appropriately responded to beta blockers and she converted to
normal sinus rhythm.  She had further episodes of atrial
fibrillation and amiodarone and coumadin were initiated,INR GOAL
2-2.5, however, she converted to normal sinus rhythm and coumdin
was stopped upon discharge with INR 1.1.  Physical therapy
worked with her on strength and mobility.  She was ready for
discharge to rehab on POD 6. She has been instructed on follow
up with her PCP, [**Name10 (NameIs) **] and Dr.[**Last Name (STitle) **] after her discharge
from rehab.

Medications on Admission:
Atenolol 12.5mg qd, Protonix 40mg qd, Calcium 600 + D [**Hospital1 **],
Selenium 200 qd, Vit B6, Vit C, Magnesium, Ocuvite, Zinc,
[**Last Name (LF) 106379**], [**First Name3 (LF) **]-3

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg twice a day for 7 days then decrease to 400mg
daily for 7 days then decrease to 200mg daily until follow up
with cardiologist.
Disp:*60 Tablet(s)* Refills:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
5. Pantoprazole 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*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 3 days.
Disp:*6 Tablet(s)* Refills:*0*
8. Potassium Chloride 20 mEq Packet Sig: One (1)  PO twice a day
for 3 days.
Disp:*6 * Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Location 106380**]

Discharge Diagnosis:
Aortic Stenosis s/p Aortic Valve Replacement
PMH: Hepatitis C, PSVT, Varicose veins s/p stripping, Macular
degeneration, Osteoporosis, s/p Tonsillectomy, s/p Total
abdominal hysterectomy, s/p Umbilical hernia repair and
abdominoplast, s/p Spinal fusion and laminectomy, s/p Bilateral
cataract surgery

Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Please call to schedule all appointments
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 9751**] in [**1-23**] weeks
Dr. [**Last Name (STitle) 2696**] after discharge from rehab
**Staples to be dc'd on Wed [**7-13**] or Thurs [**7-14**] by
VNA/Rehab
{'Aortic valve disorders,Unspecified viral hepatitis C without hepatic coma,Other specified cardiac dysrhythmias,Macular degeneration (senile), unspecified,Osteoporosis, unspecified,Arthrodesis status,Other acquired deformities of ankle and foot,Anemia, unspecified,Other iatrogenic hypotension'}


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: Presyncopal episodes and dyspnea on exertion

PRESENT ILLNESS: 80 y/o female with long h/o PSVT and AS followed by serial
echo's who has been having pre-syncopal episodes along with
dyspnea on exertion. Most recent echo and cath showed severe
Aortic Stenosis.

MEDICAL HISTORY: Aortic Stenosis, Hepatitis C, PSVT, Varicose veins s/p
stripping, Macular degeneration, Osteoporosis, s/p
Tonsillectomy, s/p Total abdominal hysterectomy, s/p Umbilical
hernia repair and abdominoplasty, s/p Spinal fusion and
laminectomy, s/p Bilateral cataract surgery

MEDICATION ON ADMISSION: Atenolol 12.5mg qd, Protonix 40mg qd, Calcium 600 + D [**Hospital1 **],
Selenium 200 qd, Vit B6, Vit C, Magnesium, Ocuvite, Zinc,
[**Last Name (LF) 106379**], [**First Name3 (LF) **]-3

ALLERGIES: Ampicillin

PHYSICAL EXAM: VS: 76 130/70 5'2" 113#
Gen: NAD
Skin: Ecchymosis right leg/groin
HEENT: PERRLA, EOMI, OP benign
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 3/6 SEM w/ radiation to carotids
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 2+ edema
Neuro: Grossly intact, MAE, right foot drop

FAMILY HISTORY: Brother died of CHF at age 75.

SOCIAL HISTORY: Retired lab tech. Denies tobacco use. Also denies ETOH use in 20
yrs. 

### Response:
{'Aortic valve disorders,Unspecified viral hepatitis C without hepatic coma,Other specified cardiac dysrhythmias,Macular degeneration (senile), unspecified,Osteoporosis, unspecified,Arthrodesis status,Other acquired deformities of ankle and foot,Anemia, unspecified,Other iatrogenic hypotension'}
