CHIEF COMPLAINT: aortic stenosis

PRESENT ILLNESS: This 85 year old female has known aortic stenosis. She has
undergone serial echocardiograms with worsening aortic stenosis,
the last demonstrating severe stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] 0.6cm2.

MEDICAL HISTORY: Aortic Stenosis
Hypercholesterolemia
Hypertension
gastroesophageal reflux
s/p Appendectomy
s/p TAH/BSO

MEDICATION ON ADMISSION: AMLODIPINE 5 mg daily
NEXIUM 40 mg daily
LOSARTAN 50 mg daily
SIMVASTATIN 20 mg daily
ASPIRIN (Not Taking as Prescribed: ran out 3 days ago) 81 mg
daily
CALCIUM CARBONATE-VITAMIN D3- 500 mg calcium (1,250mg)-200 unit
Tablet) daily
CHOLECALCIFEROL (VITAMIN D3)400 unit daily
FLAXSEED OIL 1,000 mg daily
CENTRUM SILVER MVI 1 tablet daily

ALLERGIES: Fosamax

PHYSICAL EXAM: Pulse:80 Resp:14 O2 sat: 97%/RA
B/P  Right:151/56    Left:142/63
Height: 60"    Weight: 137 lbs

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: [**9-21**]
Lives: alone
Contact:[**Name (NI) 2092**] (son)    Phone #[**Telephone/Fax (1) 91389**]
Occupation: Retired postal worker
Cigarettes: Smoked no [X] yes []
Other Tobacco use: denies
ETOH: < 1 drink/week [X]
Illicit drug use: denies
Aortic valve disorders,Acute respiratory failure following trauma and surgery,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Acute venous embolism and thrombosis of superficial veins of upper extremity,Urinary complications, not elsewhere classified,Other fluid overload,Other iatrogenic hypotension,Hypoxemia,Other secondary thrombocytopenia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Long-term (current) use of anticoagulants,Surgical or other procedure not carried out because of contraindication,Family history of other cardiovascular diseases
Aortic valve disorder,Ac resp flr fol trma/srg,Ac kidny fail, tubr necr,Ac posthemorrhag anemia,Ac embl suprfcl up ext,Surg compl-urinary tract,Fluid overload NEC,Iatrogenc hypotnsion NEC,Hypoxemia,Sec thrombocytpenia NEC,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Esophageal reflux,Long-term use anticoagul,No proc/contraindication,Fam hx-cardiovas dis NEC
Admission Date:  [**2179-12-14**]              Discharge Date:   [**2179-12-29**]

Date of Birth:  [**2094-9-21**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Fosamax

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
aortic stenosis

Major Surgical or Invasive Procedure:
[**2179-12-14**]
Aortic valve replacement(19-mm [**Doctor Last Name **] Magna Ease) Model number
3300TFX. Serial number [**Serial Number 91388**] & Patch aortoplasty with a bovine
pericardium.

Insertion of tunnelled dialysis catheter

[**2179-12-14**]
Aortic valve replacement(19-mm [**Doctor Last Name **] Magna Ease)  Model number
3300TFX. Serial  number [**Serial Number 91388**] &  Patch aortoplasty with a
bovine pericardium.

Insertion of tunnelled dialysis catheter

[**2179-12-14**]
Aortic valve replacement(19-mm [**Doctor Last Name **] Magna Ease)  Model number
3300TFX. Serial  number [**Serial Number 91388**] &  Patch aortoplasty with a
bovine pericardium.

Insertion of tunnelled dialysis catheter

[**2179-12-14**]
Aortic valve replacement(19-mm [**Doctor Last Name **] Magna Ease)  Model number
3300TFX. Serial  number [**Serial Number 91388**] &  Patch aortoplasty with a
bovine pericardium.

Insertion of tunnelled dialysis catheter


History of Present Illness:
This 85 year old female has known aortic stenosis. She has
undergone serial echocardiograms with worsening aortic stenosis,
the last demonstrating severe stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] 0.6cm2.

She states she is mostly asymptomatic but develops mild dyspnea
on exertion. In addition, has experienced some lightheadedness.
.


Past Medical History:
Aortic Stenosis
Hypercholesterolemia
Hypertension
gastroesophageal reflux
s/p Appendectomy
s/p TAH/BSO


Social History:
Race: Caucasian
Last Dental Exam: [**9-21**]
Lives: alone
Contact:[**Name (NI) 2092**] (son)    Phone #[**Telephone/Fax (1) 91389**]
Occupation: Retired postal worker
Cigarettes: Smoked no [X] yes []
Other Tobacco use: denies
ETOH: < 1 drink/week [X]
Illicit drug use: denies


Family History:
No premature coronary artery disease


Physical Exam:
Pulse:80 Resp:14 O2 sat: 97%/RA
B/P  Right:151/56    Left:142/63
Height: 60"    Weight: 137 lbs

General: Well-developed female in no acute distress
Skin: Warm [X] Dry [X] intact [X]
HEENT: NCAT [X] PERRLA [X] EOMI [X]
Neck: Supple [X] Full ROM [X] JVD [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] soft systolic ejection Murmur grade [**2-15**] with
radiation to the L carotid area
Abdomen: Soft [X] non-distended [X] non-tender [X] + BS [X]
Extremities: Warm [X], well-perfused [X] min Edema, no
varicosities
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      soft (likely radiating cardiac murmur)


Pertinent Results:
[**2179-12-27**] 09:00AM BLOOD WBC-13.4* RBC-3.34* Hgb-9.9* Hct-30.5*
MCV-91 MCH-29.7 MCHC-32.6 RDW-15.0 Plt Ct-299
[**2179-12-26**] 06:00AM BLOOD WBC-15.0* RBC-3.45* Hgb-10.4* Hct-31.6*
MCV-92 MCH-30.1 MCHC-32.8 RDW-15.0 Plt Ct-294
[**2179-12-19**] 02:54AM BLOOD WBC-13.3* RBC-3.89* Hgb-11.4* Hct-34.6*
MCV-89 MCH-29.4 MCHC-33.0 RDW-15.2 Plt Ct-75*
[**2179-12-20**] 01:41AM BLOOD WBC-11.1* RBC-3.83* Hgb-11.3* Hct-34.4*
MCV-90 MCH-29.4 MCHC-32.7 RDW-15.4 Plt Ct-96*
[**2179-12-27**] 09:00AM BLOOD Glucose-111* UreaN-104* Creat-2.5* Na-145
K-3.4 Cl-105 HCO3-27 AnGap-16
[**2179-12-26**] 06:00AM BLOOD Glucose-111* UreaN-107* Creat-3.1* Na-138
K-3.3 Cl-98 HCO3-26 AnGap-17
[**2179-12-25**] 05:55AM BLOOD Glucose-125* UreaN-103* Creat-3.6* Na-141
K-3.6 Cl-99 HCO3-26 AnGap-20
[**2179-12-24**] 02:34AM BLOOD Glucose-113* UreaN-87* Creat-3.8* Na-141
K-3.8 Cl-98 HCO3-27 AnGap-20
[**2179-12-20**] 01:41AM BLOOD Glucose-144* UreaN-120* Creat-5.9* Na-140
K-4.3 Cl-101 HCO3-22 AnGap-21*
[**2179-12-19**] 02:54AM BLOOD Glucose-120* UreaN-90* Creat-5.2* Na-138
K-4.2 Cl-101 HCO3-22 AnGap-19
[**2179-12-18**] 02:59PM BLOOD Glucose-124* UreaN-74* Creat-4.8* Na-138
K-4.2 Cl-102 HCO3-21* AnGap-19
[**2179-12-18**] 05:07AM BLOOD UreaN-60* Creat-4.6* Na-139 K-4.1 Cl-103
HCO3-23 AnGap-17
[**2179-12-15**] 01:20PM BLOOD Glucose-126* UreaN-20 Creat-1.5* Na-141
K-3.8 Cl-110* HCO3-22 AnGap-13
[**2179-12-24**] 02:34AM BLOOD T4-5.6 T3-59*
[**2179-12-29**] 04:30AM BLOOD WBC-13.7* RBC-3.38* Hgb-10.1* Hct-30.7*
MCV-91 MCH-29.8 MCHC-32.8 RDW-15.6* Plt Ct-323
[**2179-12-29**] 04:30AM BLOOD Glucose-155* UreaN-69* Creat-1.8* Na-146*
K-4.4 Cl-109* HCO3-25 AnGap-16

Brief Hospital Course:
This 85 year old white female with known aortic stenosis was a
same day admission to the Operating Room for aortic valve
replacement by Dr. [**Last Name (STitle) 914**] on [**2179-12-14**]. Please see the operative
report for details. She underwent aortic valve replacement with
a 19-mm [**Doctor Last Name **] Magna Ease aortic valve bioprosthesis and patch
aortoplasty with a bovine pericardial patch. Her bypass time was
84 minutes with a crossclamp time of 69 minutes.
Post-operatively she was transferred to the cardiac surgery ICU
on Neosynephrine and Propofol infusions.

 Her cardiac function was suboptimal and she was subsequently
started on Milrinone to support her cardiac function.
Additionally she was somewhat hypoxic and she was kept sedated
through POD 1. On POD 2 her sedation was stopped, her Milrinone
was weaned off and diuretics were started. She failed to respond
to Lasix infusion. Her platelet count fell and a Heparin
antibody test was negative.  She remianed profoundly oliguric
and her creatinine rose to 6. The Lasix infusion at 20mg/hour
was continued and CVVH was instituted. Her urine output improved
and diuretics were continued with CVVH. She remained
hemodynamically stable.  She took several days to awaken, but
when her BUN was below 100 she awoke and was intact.  She was
subsequently extubated and after a couple of days was able to
swallow food and her medications.  She required hemodialysis and
as the renal function deteriorated again despite good urine
output.  A tunnelled dialysis line was placed by Interventional
Radiology.  She improved and her creatinne fell, she remained
alert and intact.

Her renal numbers improved daily with good urine output off any
diuretics.  On [**12-29**] her BUN and creatinine were 69 and 1.8
repectively.   The dialysis catheter was removed easily and the
site was clean.

Physical Therapy worked with her and a rehabilitation screen was
performed for discharge as she remained very weak.  CTs and
wires were removed in the ICU in a timely fashion without
problem.  Tube feedings were administered for a few days when
she was sedated and intubated.

On [**12-29**], POD 15, her BUN and creatinine had fallen to 69 and
1.8.  The dialysis catheter was removed sterilely with local
anesthesia.  She was discharged to [**Hospital1 **] for further
recovery and rehabilitation.  The renal numbers will be repeated
there.


Medications on Admission:
AMLODIPINE 5 mg daily
NEXIUM 40 mg daily
LOSARTAN 50 mg daily
SIMVASTATIN 20 mg daily
ASPIRIN (Not Taking as Prescribed: ran out 3 days ago) 81 mg
daily
CALCIUM CARBONATE-VITAMIN D3- 500 mg calcium (1,250mg)-200 unit
Tablet) daily
CHOLECALCIFEROL (VITAMIN D3)400 unit daily
FLAXSEED OIL 1,000 mg daily
CENTRUM SILVER MVI 1 tablet daily


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
3. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever, pain.
6. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
7. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
8. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
9. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
10. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection three times a day: discontinue when fully ambulatory.



Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital for Continuing Medical Care - [**Location (un) 1121**]
([**Hospital3 1122**] Center)

Discharge Diagnosis:
Aortic stenosis
s/p aortic valve replacement(19-mm [**Doctor Last Name **] Magna Ease)
postoperative renal failure
Hypercholesterolemia
Hypertension
gastroesophageal reflux
s/p Appendectomy
s/p TAH/BSO
s/p Tunnelled dialysis catheter implant


Discharge Condition:
Alert and oriented x3, nonfocal
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Edema:trace


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments:

Surgeon: Dr. [**Last Name (STitle) 914**]([**Telephone/Fax (1) 170**]) on [**2180-1-24**] at 1:45pm
Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 8421**] on [**2180-1-19**] at 10;30am


Please call to schedule appointments with your
Primary Care Dr.[**First Name11 (Name Pattern1) 569**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 1968**] ([**Telephone/Fax (1) 91390**]) in [**3-16**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**




Completed by:[**2179-12-29**]
{'Aortic valve disorders,Acute respiratory failure following trauma and surgery,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Acute venous embolism and thrombosis of superficial veins of upper extremity,Urinary complications, not elsewhere classified,Other fluid overload,Other iatrogenic hypotension,Hypoxemia,Other secondary thrombocytopenia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Long-term (current) use of anticoagulants,Surgical or other procedure not carried out because of contraindication,Family history of other cardiovascular 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: aortic stenosis

PRESENT ILLNESS: This 85 year old female has known aortic stenosis. She has
undergone serial echocardiograms with worsening aortic stenosis,
the last demonstrating severe stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] 0.6cm2.

MEDICAL HISTORY: Aortic Stenosis
Hypercholesterolemia
Hypertension
gastroesophageal reflux
s/p Appendectomy
s/p TAH/BSO

MEDICATION ON ADMISSION: AMLODIPINE 5 mg daily
NEXIUM 40 mg daily
LOSARTAN 50 mg daily
SIMVASTATIN 20 mg daily
ASPIRIN (Not Taking as Prescribed: ran out 3 days ago) 81 mg
daily
CALCIUM CARBONATE-VITAMIN D3- 500 mg calcium (1,250mg)-200 unit
Tablet) daily
CHOLECALCIFEROL (VITAMIN D3)400 unit daily
FLAXSEED OIL 1,000 mg daily
CENTRUM SILVER MVI 1 tablet daily

ALLERGIES: Fosamax

PHYSICAL EXAM: Pulse:80 Resp:14 O2 sat: 97%/RA
B/P  Right:151/56    Left:142/63
Height: 60"    Weight: 137 lbs

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: [**9-21**]
Lives: alone
Contact:[**Name (NI) 2092**] (son)    Phone #[**Telephone/Fax (1) 91389**]
Occupation: Retired postal worker
Cigarettes: Smoked no [X] yes []
Other Tobacco use: denies
ETOH: < 1 drink/week [X]
Illicit drug use: denies 

### Response:
{'Aortic valve disorders,Acute respiratory failure following trauma and surgery,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Acute venous embolism and thrombosis of superficial veins of upper extremity,Urinary complications, not elsewhere classified,Other fluid overload,Other iatrogenic hypotension,Hypoxemia,Other secondary thrombocytopenia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Esophageal reflux,Long-term (current) use of anticoagulants,Surgical or other procedure not carried out because of contraindication,Family history of other cardiovascular diseases'}
