CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: The patient is a 45 year old male with a history of aortic
stenosis (unknown valve area) with reported bicuspid aortic
valve (no history of rheumatic heart disease), "rapid heart
rate" for which he takes atenolol and 1 ppd x 15-17 years of
tobacco who presented to [**Hospital 26580**] hospital with the chief
complaint of shortness of breath worsening over the past [**3-23**]
months. The patient initially presented to his PCP in
[**Name9 (PRE) 404**]/[**2141-3-21**] with the chief complaint of a runny
nose, clear to yellowish productive cough with blood-tinged
sputum and shortness of breath. His CXR at the time, per the
patient, was clear but he was treated empirically for a
pneumonia for a 2 week course. However, his symptoms did not
resolve. A repeat CXR was taken which showed no pneumonia but he
was treated again with Levoquin again with no improvement. Also
at this time, he noted that he was unable to lie supine at night
to sleep and thus sat upright while sleeping. In addition, he
noted increased night sweats and chills and reports a 50 pound
weight loss in the past 10 years with increased exercise but no
decreased appetite.  At baseline, the patient is able to
exercise a high degree (ie. jogs 1/2 hour with 50 pound weight
around waist, does aerobics daily). With his AS, the patient
denies any history of syncope or angina.

MEDICAL HISTORY: Aortic stenosis with h/o bicuspid aortic valve
h/o "rapid heart rate" into 300s now on atenolol

MEDICATION ON ADMISSION: Atenolol 25 mg PO QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile, HR 99, BP 86/42
NAD, alert, pale and ill-appearing
Neck: supple, no JVD, no bruits
Chest: RRR, + SEM; bibasilar rales
Abd: soft, NT, ND
Ext: no edema

FAMILY HISTORY: Mother in 60s with CHF
Father with prostate cancer
Father's brother with CAD s/p CABG in 50s
No family history of sudden cardiac death or MI before age 50

SOCIAL HISTORY: The patient is an auto-body mechanic. He does not drink EtOh and
denies any IV or illicit drug use. He does admit to a h/o
tobacco 1 ppd x 15-17 years ago, he quit 10-15 years ago.
Aortic valve disorders,Cardiogenic shock,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Congenital insufficiency of aortic valve,Atrial fibrillation,Coronary atherosclerosis of native coronary artery
Aortic valve disorder,Cardiogenic shock,CHF NOS,Acute kidney failure NOS,Cong aorta valv insuffic,Atrial fibrillation,Crnry athrscl natve vssl
Admission Date:  [**2141-5-7**]              Discharge Date:   [**2141-5-17**]

Date of Birth:  [**2095-10-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 14964**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
1. AVR (25mm CE pericardial)
2. CABG x1 (SVG-PDA)


History of Present Illness:
The patient is a 45 year old male with a history of aortic
stenosis (unknown valve area) with reported bicuspid aortic
valve (no history of rheumatic heart disease), "rapid heart
rate" for which he takes atenolol and 1 ppd x 15-17 years of
tobacco who presented to [**Hospital 26580**] hospital with the chief
complaint of shortness of breath worsening over the past [**3-23**]
months. The patient initially presented to his PCP in
[**Name9 (PRE) 404**]/[**2141-3-21**] with the chief complaint of a runny
nose, clear to yellowish productive cough with blood-tinged
sputum and shortness of breath. His CXR at the time, per the
patient, was clear but he was treated empirically for a
pneumonia for a 2 week course. However, his symptoms did not
resolve. A repeat CXR was taken which showed no pneumonia but he
was treated again with Levoquin again with no improvement. Also
at this time, he noted that he was unable to lie supine at night
to sleep and thus sat upright while sleeping. In addition, he
noted increased night sweats and chills and reports a 50 pound
weight loss in the past 10 years with increased exercise but no
decreased appetite.  At baseline, the patient is able to
exercise a high degree (ie. jogs 1/2 hour with 50 pound weight
around waist, does aerobics daily). With his AS, the patient
denies any history of syncope or angina.

Around Thursday, the patient noted increased lower extremity
edema, increased orthopnea, and increased shortness of breath
and thus went to [**Hospital3 3583**] on Saturday [**2141-5-6**]. In
addition, he has noticed increased hemoptysis with now up to a
teaspoon at a time of blood in his sputum. He denies any recent
travel and had a PPD placed by his PCP that was reportedly
negative.

 At [**Hospital 26580**] hospital, he was felt to be in CHF and diuresed with
20 mg IV lasix x 2 with no effect and then 100 mg IV lasix with
900 cc out. He was transferred to [**Hospital1 18**] for cath, aortic
stenosis management.

ROS: Denies any chest pain, melena/hematuria. Denies any fevers
but notes night sweats and chills. Denies any palpitations.


Past Medical History:
Aortic stenosis with h/o bicuspid aortic valve
h/o "rapid heart rate" into 300s now on atenolol

Social History:
The patient is an auto-body mechanic. He does not drink EtOh and
denies any IV or illicit drug use. He does admit to a h/o
tobacco 1 ppd x 15-17 years ago, he quit 10-15 years ago.

Family History:
Mother in 60s with CHF
Father with prostate cancer
Father's brother with CAD s/p CABG in 50s
No family history of sudden cardiac death or MI before age 50

Physical Exam:
Afebrile, HR 99, BP 86/42
NAD, alert, pale and ill-appearing
Neck: supple, no JVD, no bruits
Chest: RRR, + SEM; bibasilar rales
Abd: soft, NT, ND
Ext: no edema

Brief Hospital Course:
The patient is a 45 year old male with a history of tobacco 1
ppd x 10-15 years, remarkable weight loss over past 10 years in
setting of exercise, nights sweats, chills, and increased
shortness of breath with bloody sputum x 2-3 months as well as
aortic stenosis with h/o bicuspid aortic valve who was
transferred from [**Hospital3 **] for management of his presumed
CHF and aortic stenosis.

Upon day of transfer, the pt steadily declined clinically, going
into cardiogenic shock.  He was taken emergently to the cardiac
cath lab where he was found to have wide open AI with
[**Hospital1 **]-ventricular dysfunction.  His EF was 15%, cardiac index of 1,
and SV02 of 24%.  He was consented on the cath table for
emergent surgery.  He went to the OR [**2141-5-9**] for emergent AVR
(25mm pericardial) and CABG x1 (SVG-PDA).  For more detailed
account, please see operative report.  Post-op, he was
transferred to the CSRU on multiple vasopressors and inotropes,
as well as an IABP.  Over the next several days, vasopressors
and IABP were weaned to off or removed, repectively.  He was
extubated on POD 2.  Chest tubes and wires were removed per
protocol over the next couple of days.  During CSRU stay, pt did
remarkably well with cardiac index from > 2.5 and SVO2 of
60-70%.  Echo on POD 5 showed an EF 20-25%.  He was transferred
to the floor on POD 5.  The remainder of his hospital stay was
unremarkable.

Medications on Admission:
Atenolol 25 mg PO QD

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. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
Disp:*60 Tablet(s)* Refills:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
6. 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*
7. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours).
Disp:*60 Packet(s)* Refills:*2*
8. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day:
take lisinopril and coreg at staggered times.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
1. Aortic stenosis
2. Aortic insufficiency
3. Bicuspid aortic valve
4. Hypertension
5. [**Hospital1 **]-ventricular dysfunction


Discharge Condition:
Good

Discharge Instructions:
1. Resume medications as directed.
2. Follow up as directed.
3. Call office or go to ER if fever/chills, drainage from
sternal incision, chest pain, shortness of breath.

Followup Instructions:
PCP, 2 weeks, please call for appointment.

Dr. [**Last Name (STitle) **], 2 weeks, please call for appointment.

Dr. [**Last Name (STitle) 70**], 6 weeks, please call for appointment.
{'Aortic valve disorders,Cardiogenic shock,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Congenital insufficiency of aortic valve,Atrial fibrillation,Coronary atherosclerosis of native coronary artery'}


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: Shortness of breath

PRESENT ILLNESS: The patient is a 45 year old male with a history of aortic
stenosis (unknown valve area) with reported bicuspid aortic
valve (no history of rheumatic heart disease), "rapid heart
rate" for which he takes atenolol and 1 ppd x 15-17 years of
tobacco who presented to [**Hospital 26580**] hospital with the chief
complaint of shortness of breath worsening over the past [**3-23**]
months. The patient initially presented to his PCP in
[**Name9 (PRE) 404**]/[**2141-3-21**] with the chief complaint of a runny
nose, clear to yellowish productive cough with blood-tinged
sputum and shortness of breath. His CXR at the time, per the
patient, was clear but he was treated empirically for a
pneumonia for a 2 week course. However, his symptoms did not
resolve. A repeat CXR was taken which showed no pneumonia but he
was treated again with Levoquin again with no improvement. Also
at this time, he noted that he was unable to lie supine at night
to sleep and thus sat upright while sleeping. In addition, he
noted increased night sweats and chills and reports a 50 pound
weight loss in the past 10 years with increased exercise but no
decreased appetite.  At baseline, the patient is able to
exercise a high degree (ie. jogs 1/2 hour with 50 pound weight
around waist, does aerobics daily). With his AS, the patient
denies any history of syncope or angina.

MEDICAL HISTORY: Aortic stenosis with h/o bicuspid aortic valve
h/o "rapid heart rate" into 300s now on atenolol

MEDICATION ON ADMISSION: Atenolol 25 mg PO QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile, HR 99, BP 86/42
NAD, alert, pale and ill-appearing
Neck: supple, no JVD, no bruits
Chest: RRR, + SEM; bibasilar rales
Abd: soft, NT, ND
Ext: no edema

FAMILY HISTORY: Mother in 60s with CHF
Father with prostate cancer
Father's brother with CAD s/p CABG in 50s
No family history of sudden cardiac death or MI before age 50

SOCIAL HISTORY: The patient is an auto-body mechanic. He does not drink EtOh and
denies any IV or illicit drug use. He does admit to a h/o
tobacco 1 ppd x 15-17 years ago, he quit 10-15 years ago. 

### Response:
{'Aortic valve disorders,Cardiogenic shock,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Congenital insufficiency of aortic valve,Atrial fibrillation,Coronary atherosclerosis of native coronary artery'}
