CHIEF COMPLAINT: fatigue

PRESENT ILLNESS: This is a 60yo male with history of
dilated aortic root and aortic insufficiency. Serial
echocardiograms have shown worsening aortic insufficiency and
increasing left ventricular dimensions. Based upon
echocardiogram
findings, he has been referred for cardiac surgical evaluation.
He presents to [**Hospital1 18**] today for cardiac cath preop Bentall on
[**2138-7-15**] with Dr.[**Last Name (STitle) **].

MEDICAL HISTORY: - Short term memory loss s/p MVA
- Dilated Aortic Root with Aortic Insufficiency
- Hypertension
- Dyslipidemia
- Prostatism
- PTSD with Anxiety/Depression
- Obesity
- Sleep Apnea, wears CPAP
- Chronic Low Back Pain
- History of MVA
- History of renal stones
Past Surgical History
- Ureter surgery s/p renal stones.

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. butalbital-acetaminophen-caff *NF* 50-325-40 mg Oral q4h prn
headache
2. modafinil *NF* 100 mg Oral [**Hospital1 **]
3. Metoprolol Tartrate 50 mg PO DAILY
4. Fluticasone Propionate NASAL 2 SPRY NU [**Hospital1 **]:PRN prn
5. Multivitamins 1 TAB PO DAILY
6. Ibuprofen 800 mg PO Q8H:PRN pain
7. Pantoprazole 40 mg PO Q24H
8. Cetirizine *NF* 10 mg Oral daily
9. Tamsulosin 0.4 mg PO HS
10. Fluoxetine 20 mg PO DAILY

ALLERGIES: Sulfa(Sulfonamide Antibiotics) / Wellbutrin

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: 

SOCIAL HISTORY: 
Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Posttraumatic stress disorder,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Obesity, unspecified,Obstructive sleep apnea (adult)(pediatric),Lumbago
Aortic valve disorder,Crnry athrscl natve vssl,Thoracic aortic aneurysm,Hypertension NOS,Hyperlipidemia NEC/NOS,Posttraumatic stress dis,Anxiety state NOS,Depressive disorder NEC,Obesity NOS,Obstructive sleep apnea,Lumbago
Admission Date:  [**2138-7-14**]              Discharge Date:   [**2138-7-19**]

Date of Birth:  [**2078-3-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa(Sulfonamide Antibiotics) / Wellbutrin

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
fatigue

Major Surgical or Invasive Procedure:
[**2138-7-15**] CABG X2(LIMA->mLAD,SVG->PDA)AVR(mechanical 25 mm)


History of Present Illness:
This is a 60yo male with history of
dilated aortic root and aortic insufficiency. Serial
echocardiograms have shown worsening aortic insufficiency and
increasing left ventricular dimensions. Based upon
echocardiogram
findings, he has been referred for cardiac surgical evaluation.
He presents to [**Hospital1 18**] today for cardiac cath preop Bentall on
[**2138-7-15**] with Dr.[**Last Name (STitle) **].


Past Medical History:
- Short term memory loss s/p MVA
- Dilated Aortic Root with Aortic Insufficiency
- Hypertension
- Dyslipidemia
- Prostatism
- PTSD with Anxiety/Depression
- Obesity
- Sleep Apnea, wears CPAP
- Chronic Low Back Pain
- History of MVA
- History of renal stones
Past Surgical History
- Ureter surgery s/p renal stones.


Physical Exam:
Physical Exam

BP: 134/59 Heart Rate: 64 Resp. Rate: 18  O2 Saturation%: 97.
Height: 70.5inches    Weight: 214 lbs

General: NAD, alert and oriented x 3, sitting in a chair.
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [x] grade III/VI diastolic
murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+
[x].
Extremities: Warm [x], well-perfused [x]  Edema - none
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right:   Left:
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right:   Left:

Carotid Bruit        Right:  +  Left: +


Pertinent Results:
[**2138-7-14**] 03:19PM   GLUCOSE-128* UREA N-20 CREAT-0.9 SODIUM-141
POTASSIUM-3.9 CHLORIDE-105 TOTAL CO2-29 ANION GAP-11
[**2138-7-14**] 03:19PM   WBC-6.7 RBC-4.84 HGB-13.9* HCT-42.5 MCV-88
MCH-28.7 MCHC-32.7 RDW-12.8

ECHO:
PRE-CPB:1. No spontaneous echo contrast is seen in the body of
the left atrium. No mass/thrombus is seen in the left atrium or
left atrial appendage. No thrombus is seen in the left atrial
appendage.
2. No atrial septal defect is seen by 2D or color Doppler.
3. Left ventricular wall thicknesses and cavity size are normal.
Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal.
4. Right ventricular chamber size and free wall motion are
normal.
5. The aortic root is mildly dilated at the sinus level. The
sinuses of Valsalva are dilated.
6. The ascending aorta is mildly dilated.
7. There are three aortic valve leaflets. There is no aortic
valve stenosis. Severe (4+) aortic regurgitation is seen. The
aortic regurgitation jet is eccentric, directed toward the
anterior mitral leaflet.
8. Mild (1+) mitral regurgitation is seen.
Dr. [**Last Name (STitle) **] was notified in person of the results.

POST-CPB:
1. Well seated Mechanical valve with washing jets visible, no
paravalvular leak.
2. Preserved LV systolic function.
3. No sign of aortic dissection.
4. Mitral regurgitation and tricuspid regurgitation remained
trace.
Dr. [**Last Name (STitle) **] was notified in person of the results.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2138-7-15**] 12:11


Brief Hospital Course:
The patient was admitted to the hospital and brought to the
operating room on [**2138-7-15**] where the patient underwent Aortic
valve replacement with a 25-mm St. [**Male First Name (un) 923**]
mechanical valve.  Reference #[**Serial Number 110221**].  Serial #[**Serial Number 110222**].
Coronary artery bypass grafting x2:  Left internal mammary
artery to left anterior descending artery, and reverse saphenous
vein graft to the posterior descending artery.

Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.   POD 1 found
the patient extubated, alert and oriented and breathing
comfortably.  The patient was neurologically intact and
hemodynamically stable. Low dose beta blocker was initiated and
unable to be increased due to bordeline low systolic blood
pressure. The patient was gently diuresed toward the
preoperative weight. Coumadin therapy with heparin bridge was
initiated due to the placement of his mechcanical AVR. The
patient was transferred to the telemetry floor for further
recovery.  Chest tubes and pacing wires were discontinued
without complication.  The patient was evaluated by the physical
therapy service for assistance with strength and mobility.  By
the time of discharge on POD #4 the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.  The patient was discharged to home in good
condition with appropriate follow up instructions.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. butalbital-acetaminophen-caff *NF* 50-325-40 mg Oral q4h prn
headache
2. modafinil *NF* 100 mg Oral [**Hospital1 **]
3. Metoprolol Tartrate 50 mg PO DAILY
4. Fluticasone Propionate NASAL 2 SPRY NU [**Hospital1 **]:PRN prn
5. Multivitamins 1 TAB PO DAILY
6. Ibuprofen 800 mg PO Q8H:PRN pain
7. Pantoprazole 40 mg PO Q24H
8. Cetirizine *NF* 10 mg Oral daily
9. Tamsulosin 0.4 mg PO HS
10. Fluoxetine 20 mg PO DAILY


Discharge Medications:
1. Fluoxetine 20 mg PO DAILY
2. Ibuprofen 800 mg PO Q8H:PRN pain
3. Metoprolol Tartrate 12.5 mg PO BID
Hold for HR < 55 or SBP < 90 and call medical provider.
[**Last Name (NamePattern4) 9641**] *metoprolol tartrate 25 mg [**1-8**] tablet(s) by mouth twice a day
Disp #*30 Tablet Refills:*1
4. modafinil *NF* 100 mg Oral [**Hospital1 **] Reason for Ordering: Wish to
maintain preadmission medication while hospitalized, as there is
no acceptable substitute drug product available on formulary.
hold tonights dose, thx
5. Multivitamins 1 TAB PO DAILY
6. Pantoprazole 40 mg PO Q24H
7. Tamsulosin 0.4 mg PO HS
8. Aspirin EC 81 mg PO DAILY
RX *Adult Low Dose Aspirin 81 mg 1 tablet(s) by mouth once a day
Disp #*30 Tablet Refills:*1
9. Atorvastatin 10 mg PO DAILY
RX *atorvastatin 10 mg 1 tablet(s) by mouth once a day Disp #*30
Tablet Refills:*1
10. HYDROmorphone (Dilaudid) 2-4 mg PO Q3H:PRN pain
RX *hydromorphone 2 mg [**1-6**] tablet(s) by mouth every four (4)
hours Disp #*65 Tablet Refills:*0
11. Warfarin 2.5 mg PO DAILY16
Dose will be based on INR and determined by Dr. [**Last Name (STitle) **]
RX *warfarin 2.5 mg 1 tablet(s) by mouth once a day Disp #*60
Tablet Refills:*1
12. butalbital-acetaminophen-caff *NF* 50 mg ORAL Q4H PRN
headache
13. Cetirizine *NF* 10 mg Oral daily
14. Fluticasone Propionate NASAL 2 SPRY NU [**Hospital1 **]:PRN prn
15. Furosemide 40 mg PO DAILY Duration: 5 Days
RX *furosemide 20 mg 2 tablet(s) by mouth once a day Disp #*10
Tablet Refills:*0
16. Potassium Chloride 20 mEq PO DAILY Duration: 5 Days
RX *Klor-Con M20 20 mEq 20 mEq by mouth once a day Disp #*5
Tablet Refills:*0


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
[**2138-7-15**] CABG X2(LIMA->mLAD,SVG->PDA)AVR(mechanical 25 mm)
Short term memory loss s/p MVA, Dilated Aortic Root with Aortic
Insufficiency, Hypertension, Dyslipidemia, Prostatism, PTSD with
Anxiety/Depression, Obesity, Sleep Apnea, wears CPAP, Chronic
Low Back Pain, History of MVA, History of renal stones, Ureter
surgery s/p renal stones


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right- healing well, no erythema or drainage.
Edema; trace lower extremity edema



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**]

**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:
The following appointments have been made for you:
Your surgeon: Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2138-8-21**] 1:00 in the [**Hospital **] medical office building,
[**Doctor First Name **], [**Hospital Unit Name **]
wound check [**2138-7-24**] at 10:45a in the [**Hospital **] medical office
building, [**Doctor First Name **], [**Hospital Unit Name **]
cardiologist: [**Doctor First Name 110223**] Butte [**2138-8-25**] at 4:00p

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 11992**] in [**4-10**] 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**

Labs: PT/INR for Coumadin ?????? indication mechcanical AVR
Goal INR 2.5-3.0
First draw [**2138-7-21**]
Results to Dr. [**Last Name (STitle) **] phone [**Telephone/Fax (1) 11992**] fax [**Telephone/Fax (1) 6808**]



Completed by:[**2138-7-19**]
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Posttraumatic stress disorder,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Obesity, unspecified,Obstructive sleep apnea (adult)(pediatric),Lumbago'}


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: fatigue

PRESENT ILLNESS: This is a 60yo male with history of
dilated aortic root and aortic insufficiency. Serial
echocardiograms have shown worsening aortic insufficiency and
increasing left ventricular dimensions. Based upon
echocardiogram
findings, he has been referred for cardiac surgical evaluation.
He presents to [**Hospital1 18**] today for cardiac cath preop Bentall on
[**2138-7-15**] with Dr.[**Last Name (STitle) **].

MEDICAL HISTORY: - Short term memory loss s/p MVA
- Dilated Aortic Root with Aortic Insufficiency
- Hypertension
- Dyslipidemia
- Prostatism
- PTSD with Anxiety/Depression
- Obesity
- Sleep Apnea, wears CPAP
- Chronic Low Back Pain
- History of MVA
- History of renal stones
Past Surgical History
- Ureter surgery s/p renal stones.

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. butalbital-acetaminophen-caff *NF* 50-325-40 mg Oral q4h prn
headache
2. modafinil *NF* 100 mg Oral [**Hospital1 **]
3. Metoprolol Tartrate 50 mg PO DAILY
4. Fluticasone Propionate NASAL 2 SPRY NU [**Hospital1 **]:PRN prn
5. Multivitamins 1 TAB PO DAILY
6. Ibuprofen 800 mg PO Q8H:PRN pain
7. Pantoprazole 40 mg PO Q24H
8. Cetirizine *NF* 10 mg Oral daily
9. Tamsulosin 0.4 mg PO HS
10. Fluoxetine 20 mg PO DAILY

ALLERGIES: Sulfa(Sulfonamide Antibiotics) / Wellbutrin

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Posttraumatic stress disorder,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Obesity, unspecified,Obstructive sleep apnea (adult)(pediatric),Lumbago'}
