CHIEF COMPLAINT: Dyspnea on Exertion

PRESENT ILLNESS: 79 y/o male with known AS diagnosed 1 year ago. Recent Echo
revealed severe AS with a normal EF. Progressive DOE over the
past 6 months and past two Echo's have shown an increase in AS.

MEDICAL HISTORY: Aortic Stenosis
s/p Pneumonia [**2130**]
s/p Bilat. Inguinal hernia repair
s/p Deviated septum repair
s/p Tonsillectomy
s/p Bilat. saphenous vein stripping

MEDICATION ON ADMISSION: 1. ASA 81mg qd
2. Toprol XL 12.5mg qd
3. Lisinopril 10mg qd
4. MVI qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: P 64 Reg Ht 6' Wt 145
General: WD/WN male, NAD, appears stated age
Skin: W/D -lesion or rashes
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, +S1S2 w/ harsh 4/6 SEM with radtion to carotids and
occassional skipped beat
Abd: Soft, NT/ND, +BS. Well healed inguinal hernia scar
Ext: Warm, well-perfused, -c/c/e, superficial varicosities on
rt.
Neuro: A&Ox3, [**3-20**] strengths, -focal deficits
Pulses: 2+ throughout

FAMILY HISTORY: No known cardiopulmonary disease. His parents lived until they
reached ages greater than 90.

SOCIAL HISTORY: He lives alone in [**Hospital1 8**], MA. He is a retired physics
professor. He never smoked, drank ETOH or used illicit drugs.
Aortic valve disorders,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified,Pure hypercholesterolemia
Aortic valve disorder,Hemorrhage complic proc,Surg compl-heart,Atrial fibrillation,Pneumonia, organism NOS,Crnry athrscl natve vssl,Hypertension NOS,Anemia NOS,Pure hypercholesterolem
Admission Date:  [**2132-3-25**]              Discharge Date:   [**2132-4-7**]

Date of Birth:  [**2052-11-16**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Dyspnea on Exertion

Major Surgical or Invasive Procedure:
Aortic Valve Replacement w/ 23mm CE Pericardial Tissie Valve on
[**2132-3-25**]
Coronary Artery Diseas s/p PCI/Stent on [**2132-4-2**]

History of Present Illness:
79 y/o male with known AS diagnosed 1 year ago. Recent Echo
revealed severe AS with a normal EF. Progressive DOE over the
past 6 months and past two Echo's have shown an increase in AS.

Past Medical History:
Aortic Stenosis
s/p Pneumonia [**2130**]
s/p Bilat. Inguinal hernia repair
s/p Deviated septum repair
s/p Tonsillectomy
s/p Bilat. saphenous vein stripping

Social History:
He lives alone in [**Hospital1 8**], MA. He is a retired physics
professor. He never smoked, drank ETOH or used illicit drugs.

Family History:
No known cardiopulmonary disease. His parents lived until they
reached ages greater than 90.

Physical Exam:
P 64 Reg Ht 6' Wt 145
General: WD/WN male, NAD, appears stated age
Skin: W/D -lesion or rashes
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, +S1S2 w/ harsh 4/6 SEM with radtion to carotids and
occassional skipped beat
Abd: Soft, NT/ND, +BS. Well healed inguinal hernia scar
Ext: Warm, well-perfused, -c/c/e, superficial varicosities on
rt.
Neuro: A&Ox3, [**3-20**] strengths, -focal deficits
Pulses: 2+ throughout

Pertinent Results:
[**2132-4-4**] 05:40AM BLOOD WBC-6.6 RBC-3.60* Hgb-10.8* Hct-31.9*
MCV-89 MCH-30.0 MCHC-33.9 RDW-13.1 Plt Ct-284
[**2132-4-4**] 05:40AM BLOOD Plt Ct-284
[**2132-4-5**] 05:20AM BLOOD Glucose-107* UreaN-22* Creat-1.4* Na-136
K-3.7 Cl-102 HCO3-22 AnGap-16

Brief Hospital Course:
Pt. was originally seen in clinic on [**2132-2-28**]. After PAT, pt was
directly admitted to [**Hospital1 18**] on [**2132-3-25**] and went to the OR and
underwent a AVR with a 23mm CE pericardial tissue valve. He was
also planned to have a CABGx1, but did not receive this b/c pt.
had b/l saphenous vein stripping. He would receive PCI/stent
later during hospital course. Please see op note for full
surgical details. Pt. tolerated the procedure well and had total
bypass time of 90 minutes and cross-clamp time of 72 minutes. He
was transferred to CSRU in stable condition with a MAP of 75,
CVP 14, PAD 15, [**Doctor First Name 1052**] 25, HR 84 A-paced and being titrated on
Propofol and Neo. Once in the OR, Neo was off and NTG and
Nipride were started secondary to hypertension. He continued to
have adequate amount of chest tube output despite deligent
efforts with products(FFP/Cryo/platelets/Protamine/PRBC). Do to
this continued postoperative hemorrhage, he was brought back to
the OR and re explored for bleeding. Please see op note. Pt was
then brought back to the CSRU in stable condition. He remained
on mechanical ventilation until early POD #1 when propofol and
ventilation were weaned and he was extubated. He was awake,
[**Last Name (LF) 3584**], [**First Name3 (LF) 2995**], and following all commands at time of extubation. On
this day, diuresis and B-blockade were started and he remained
on a Nitro gtt. Throughout day pt cont. to have slightly tenuous
respiratory status and required repeated alb/Atrovent nebs,
Lasix, IS and coughing exercises. POD #2 pt's chest tubes were
removed and his was now weaned off of Nitro. Had some course
breath sounds and cont. to receive diuretics. On early POD #3,
despite repeated CPT, nebs, OOB, and diuretics pt had to be re
intubated for pending respiratory failure. Pt. also went into
AFIB, and after Lopressor dose and Amio bolus pt converted to
SR. An Amio drip was started. Sputum, Blood, Urine, and CVL
cultures were taken and Levo was started due to increased WBC
(12,000). ABX were changed to Zosyn and Vanco. CXR revealed LUL
infiltrate. Pt. remained on ventilatory support until POD #5
when he was successfully weaned from vent. support. Pacing wires
were removed and tube feeds began on POD #4. On POD #6 a swallow
eval was done secondary to difficulty taking meds. Pt passed
swallow. POD #7 he was given a Plavix load for preparation of
cardiac cath the next day and was also transferred to telemetry
floor. POD #8 he was brought for a cath and had PCI/stenting to
RCA. Lasix was held due to increased Creatinine but was started
again on POD#9, creatinine 1.2. He continued to be
hemodynamically stable and was encouraged to get OOB and
ambulate. On POD #10, his lasix was discontinued as he was below
his pre operative weight and his creatinine was elevated to 1.4.
 On POD#12 his antibiotics were discontinued, he remained
afebrile and was cleared for discharge to rehab on POD#13.

Medications on Admission:
1. ASA 81mg qd
2. Toprol XL 12.5mg qd
3. Lisinopril 10mg qd
4. MVI qd

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
4. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 1 months.
5. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours).
6. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Amlodipine Besylate 2.5 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Aortic Stenosis s/p Aortic Valve Replacement on [**2132-3-25**]
Coronary Artery Disease s/p PCI/Stent to Right Coronary Artery
Post-operative Pneumonia
Post-operative Atrial Fibrillation
s/p Pneumonia [**2130**]
s/p Bilat. Inguinal hernia repair
s/p Deviated septum repair
s/p Tonsillectomy
s/p Bilat. saphenous vein stripping

Discharge Condition:
Good

Discharge Instructions:
Can take shower. Wash incisions with warm water and gentle soap.
Gently pat dry.
Do not bath or swim.
Do not apply lotions, creams, ointments to incisions.
Do not lift greater than 10 pounds for 2 months.
Do not drive for 1 month.
Make/keep follow-up appointments

[**Last Name (NamePattern4) 2138**]p Instructions:
Follow-up with Dr. [**Last Name (Prefixes) **] in 4 weeks.
Follow-up with Dr. [**First Name (STitle) **] in [**11-18**] weeks.
Follow-up with Dr. [**Last Name (STitle) **] in [**12-20**] weeks.


Completed by:[**2132-4-7**]
{'Aortic valve disorders,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified,Pure hypercholesterolemia'}


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: Dyspnea on Exertion

PRESENT ILLNESS: 79 y/o male with known AS diagnosed 1 year ago. Recent Echo
revealed severe AS with a normal EF. Progressive DOE over the
past 6 months and past two Echo's have shown an increase in AS.

MEDICAL HISTORY: Aortic Stenosis
s/p Pneumonia [**2130**]
s/p Bilat. Inguinal hernia repair
s/p Deviated septum repair
s/p Tonsillectomy
s/p Bilat. saphenous vein stripping

MEDICATION ON ADMISSION: 1. ASA 81mg qd
2. Toprol XL 12.5mg qd
3. Lisinopril 10mg qd
4. MVI qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: P 64 Reg Ht 6' Wt 145
General: WD/WN male, NAD, appears stated age
Skin: W/D -lesion or rashes
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR, +S1S2 w/ harsh 4/6 SEM with radtion to carotids and
occassional skipped beat
Abd: Soft, NT/ND, +BS. Well healed inguinal hernia scar
Ext: Warm, well-perfused, -c/c/e, superficial varicosities on
rt.
Neuro: A&Ox3, [**3-20**] strengths, -focal deficits
Pulses: 2+ throughout

FAMILY HISTORY: No known cardiopulmonary disease. His parents lived until they
reached ages greater than 90.

SOCIAL HISTORY: He lives alone in [**Hospital1 8**], MA. He is a retired physics
professor. He never smoked, drank ETOH or used illicit drugs. 

### Response:
{'Aortic valve disorders,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified,Pure hypercholesterolemia'}
