CHIEF COMPLAINT: Shortness of breath, syncope

PRESENT ILLNESS: This is a 78 year old male with known aortic stenosis since
[**2173**]. He has been followed by serial echocardiograms and has
been asymptomatic until this past year when he began to
experience progressive fatigue, shortness of breath and dyspnea
on exertion. He also experienced a syncopal episode. Cardiac
catheterization in [**2184-2-17**] confirmed moderate to severe
aortic stenosis with a valve area of 0.9 cm2. Angiography showed
no significant coronary artery disease with only a 20% lesion in
the first diagonal artery. His most recent ECHO from [**2184-7-19**]
revealed an aortic valve area of 0.7cm2 with peak and mean
gradients of 91 and 48 mmHg. There was mild to moderte aortic
insufficiency and only trace mitral regurgitation.

MEDICAL HISTORY: Aortic Stenosis; Hypertension; Chronic Renal Insufficiency;
COPD; Anemia; GERD; BPH; Depression; Asthma; Diverticular
Disease; Hiatal Hernia; Hemorrhoids; Appendectomy; Bilateral
Cataract Surgery; Skin Cancer; s/p appendectomy

MEDICATION ON ADMISSION: 1. Depakote 500 [**Hospital1 **]
2. Zyprexa 7.5 qam
3. Aricept 10 qam
4. Remeron 45 qpm
5. Flomax 0.4 qd
6. Effexor 150 [**Hospital1 **]
7. Proscar 5 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: BP 120/70, HR 84
GENERAL: elderly male in no acute distress
HEENT: oropharynx benign
NECK: supple, no JVD
HEART: regular rate, normal s1s2, 2/6 systolic murmur
LUNGS: decreased right base o/w clear. delayed expiration, no
wheeze
ABDOMEN: soft, nontender, normoactive bowel sounds
EXT: warm, trace edema
PULSES: 2+ distally
NEURO: alert and oriented; normal gait but slow, upper extremity
tremors noted, no focal deficits noted

FAMILY HISTORY: No prematue coronary disease. Father died at age 39 of rheumatic
heart disease.

SOCIAL HISTORY: Married, retired, lives in [**Hospital1 1562**]. At least a 65 pack year
history of tobacco - quit 2 years ago.
Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic obstructive asthma, unspecified,Incomplete bladder emptying,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Anemia, unspecified,Unspecified essential hypertension,Abnormal involuntary movements,Esophageal reflux,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Cataract extraction status,Personal history of other malignant neoplasm of skin
Aortic valve disorder,Surg compl-heart,Atrial fibrillation,Chronic obst asthma NOS,Incmplet bldder emptying,Chronic kidney dis NOS,CHF NOS,Anemia NOS,Hypertension NOS,Abn involun movement NEC,Esophageal reflux,Abn react-artif implant,BPH w/o urinary obs/LUTS,History of tobacco use,Cataract extract status,Hx-skin malignancy NEC
Admission Date:  [**2184-10-12**]              Discharge Date:   [**2184-10-27**]

Date of Birth:  [**2106-6-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Shortness of breath, syncope

Major Surgical or Invasive Procedure:
[**2184-10-13**] Aortic valve replacement with 25 millimeter CE
Pericardial Tissue Valve


History of Present Illness:
This is a 78 year old male with known aortic stenosis since
[**2173**]. He has been followed by serial echocardiograms and has
been asymptomatic until this past year when he began to
experience progressive fatigue, shortness of breath and dyspnea
on exertion. He also experienced a syncopal episode. Cardiac
catheterization in [**2184-2-17**] confirmed moderate to severe
aortic stenosis with a valve area of 0.9 cm2. Angiography showed
no significant coronary artery disease with only a 20% lesion in
the first diagonal artery. His most recent ECHO from [**2184-7-19**]
revealed an aortic valve area of 0.7cm2 with peak and mean
gradients of 91 and 48 mmHg. There was mild to moderte aortic
insufficiency and only trace mitral regurgitation.

Past Medical History:
Aortic Stenosis; Hypertension; Chronic Renal Insufficiency;
COPD; Anemia; GERD; BPH; Depression; Asthma; Diverticular
Disease; Hiatal Hernia; Hemorrhoids; Appendectomy; Bilateral
Cataract Surgery; Skin Cancer; s/p appendectomy

Social History:
Married, retired, lives in [**Hospital1 1562**]. At least a 65 pack year
history of tobacco - quit 2 years ago.

Family History:
No prematue coronary disease. Father died at age 39 of rheumatic
heart disease.

Physical Exam:
VITALS: BP 120/70, HR 84
GENERAL: elderly male in no acute distress
HEENT: oropharynx benign
NECK: supple, no JVD
HEART: regular rate, normal s1s2, 2/6 systolic murmur
LUNGS: decreased right base o/w clear. delayed expiration, no
wheeze
ABDOMEN: soft, nontender, normoactive bowel sounds
EXT: warm, trace edema
PULSES: 2+ distally
NEURO: alert and oriented; normal gait but slow, upper extremity
tremors noted, no focal deficits noted

Pertinent Results:
[**2184-10-12**] 04:15PM BLOOD WBC-5.3 RBC-3.32* Hgb-11.3* Hct-32.5*
MCV-98 MCH-34.1* MCHC-34.9 RDW-13.5 Plt Ct-166
[**2184-10-17**] 04:37AM BLOOD WBC-8.2 RBC-2.69* Hgb-8.6* Hct-25.7*
MCV-96 MCH-32.1* MCHC-33.5 RDW-15.7* Plt Ct-63*
[**2184-10-24**] 06:00AM BLOOD WBC-10.9 RBC-3.44* Hgb-10.6* Hct-32.6*
MCV-95 MCH-30.8 MCHC-32.5 RDW-14.7 Plt Ct-174
[**2184-10-12**] 04:15PM BLOOD PT-12.5 PTT-24.3 INR(PT)-1.0
[**2184-10-25**] 06:10AM BLOOD PT-13.0 PTT-23.9 INR(PT)-1.1
[**2184-10-12**] 04:15PM BLOOD Glucose-101 UreaN-39* Creat-1.5* Na-141
K-4.6 Cl-105 HCO3-27 AnGap-14
[**2184-10-17**] 01:40PM BLOOD Glucose-93 UreaN-59* Creat-3.0* Na-137
K-5.2* Cl-102 HCO3-24 AnGap-16
[**2184-10-25**] 06:10AM BLOOD Glucose-98 UreaN-28* Creat-1.6* Na-143
K-4.4 Cl-103 HCO3-30 AnGap-14
[**2184-10-19**] 09:18PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.019
[**2184-10-19**] 09:18PM URINE Blood-LG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2184-10-27**] 07:40AM BLOOD WBC-11.9* RBC-2.90* Hgb-9.3* Hct-28.0*
MCV-96 MCH-32.1* MCHC-33.3 RDW-14.8 Plt Ct-215
[**2184-10-27**] 07:40AM BLOOD Plt Ct-215
[**2184-10-27**] 07:40AM BLOOD Glucose-93 UreaN-36* Creat-1.9* Na-144
K-4.7 Cl-105 HCO3-29 AnGap-15

[**2184-10-27**] CXR
Comparison made to prior study of [**2184-10-24**]. There are
small bilateral pleural effusions. The lungs are otherwise
clear. Mild cardiac enlargement is present and is unchanged from
the prior study.

[**2184-10-22**] MRI/MRA Head
Diffusion images demonstrate no evidence of acute infarct. There
is no evidence of midline shift, mass effect, or hydrocephalus
seen. Mild changes of small-vessel disease are noted in the
white matter. There is mild-to-moderate brain atrophy seen.
IMPRESSION: No evidence of acute infarct.
MRA OF THE HEAD: The head MRA is somewhat limited by motion. The
MRA demonstrates no evidence of vascular occlusion or high-grade
stenosis in the arteries of anterior or posterior circulation.
IMPRESSION: Slightly motion-limited normal MRA of the head.


Brief Hospital Course:
Mr. [**Known lastname 18134**] was admitted on [**2184-10-12**]. The following day, he
underwent an aortic valve replacement with a 25 millimeter
pericardial tissue valve. Surgery was uneventful and he
transferred to the CSRU for invasive monitoring. Within 24
hours, he was extubated and awoke neurologically intact. He was
successfully weaned from inotropic support and transferred to
the SDU on postoperative day one. He remained somewhat
hypotensive with a low hematocrit, dropping as low as 24%. He
was concomitantly noted to have an acute decline in renal
function with creatinine peaking to 3.0 on postoperative day
five. Over several days, he received several units of packed red
blood cells with an appropriate response in blood pressure and
hematocrit. His renal function slowly improved. Due to worsening
tremulousness of his upper extremities(which was noted preop),
along with gait disturbance and hallucinations, the neurology
service was consulted. A brain MRI/MRA was essentially normal. A
full work-up as an outpatient was recommended and follow-up
appointments were scheduled. He was also noted to have
thrombocytopenia. An HIT assay was checked which was negative.
By time of discharge, his platelet count had normalized. He also
continued to have bilateral expiratory wheezes post-operatively
and required nebulizer treatments. Mr. [**Known lastname 18134**] had a run of
Atrial fibrillation on POD #9 and Amiodarone and Lopressor were
started with conversion to normal sinus rhythm. Despite him
being rather stable, he was not able to achieve a level 5 status
at POD #12. On post-op Day # 13, his Foley was re-inserted for a
post-void residual of roughly 1 liter. Flomax and proscar were
started, and he should attempt another voiding trial at rehab.
Bactrim was started for prophylactic foley coverage and
follow-up should be made with a urologist if retention
continues. The occupational therapy and physical therapy service
worked with Mr. [**Known lastname 18134**] daily. He continued to make steady
progress and was discharged to [**Hospital3 **] on
postoperative day fourteen. He will follow-up with Dr. [**Last Name (Prefixes) **], his cardiologist, his primary care physician, [**Name10 (NameIs) **]
neurology service and the urology service as an outpatient.

Medications on Admission:
1. Depakote 500 [**Hospital1 **]
2. Zyprexa 7.5 qam
3. Aricept 10 qam
4. Remeron 45 qpm
5. Flomax 0.4 qd
6. Effexor 150 [**Hospital1 **]
7. Proscar 5 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. Divalproex Sodium 500 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO BID (2 times a day).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
4. Olanzapine 7.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
5. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO QAM (once a day
(in the morning)).
Disp:*30 Tablet(s)* Refills:*0*
6. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*1*
7. Mirtazapine 15 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
Disp:*90 Tablet(s)* Refills:*0*
8. Venlafaxine 37.5 mg Tablet Sig: Four (4) Tablet PO BID (2
times a day).
Disp:*240 Tablet(s)* Refills:*0*
9. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
10. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
11. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*1*
12. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
13. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Take 400mg 2x/day for until [**2184-10-28**]. Than 200mg 2x/day
for 1week. Than 200mg 1x/day thereafter.
Disp:*120 Tablet(s)* Refills:*1*
14. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
15. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO DAILY (Daily) for 7 days.
Disp:*14 Capsule, Sustained Release(s)* Refills:*0*
16. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
17. Albuterol 90 mcg/Actuation Aerosol Sig: One (1)  Inhalation
every four (4) hours as needed for shortness of breath or
wheezing.
18. Combivent 103-18 mcg/Actuation Aerosol Sig: Two (2)
Inhalation four times a day.
19. Sulfamethazine     Powder Sig: One (1) Tablet Miscell.
DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital of [**Location (un) **] & Islands - [**Location (un) 6251**]

Discharge Diagnosis:
Aortic Stenosis s/p Aortic Valve Replacement (tissue valve ) on
[**2184-10-13**]
Post-operative Atrial Fibrillation
Hypertension
Chronic Renal Insufficiency
Chronic Obstructive Pulmonary Disease
Anemia
Gastroesophageal Refulx Disease
Benign Prostatic Hypertophy
Depression
Asthma
Diverticular Disease
Tremor
Hiatal Hernia


Discharge Condition:
Good

Discharge Instructions:
1) Can take shower, wash incision with soap and water and gently
pat dry. Do not apply any lotions, creams, ointments or powders
until wound has healed.
2) Do not take baths or swim until wound has healed.
3) Call office if you notice any redness or drainage from
incision, fever>101, or weight gain more than 2 pounds in one
day or five in one week.
4) No lifting more then 10 pounds for 10 weeks or driving for 1
month.
5) Bactrim for foley coverage. Void trial at rehab. If fails
void trial, please schedule appointment with urologist.
Discontinue bactrim when foley out.
6) Amiodarone 400 [**Hospital1 **] until [**2184-10-28**], then 200mg twice daily for
1 week then 200mg once daily thereafter until seen by
cardiologist.
7) Lasix and potassium should be taken as directed for 1 week
then stopped unless otherwise directed by a physician. [**Name10 (NameIs) 357**]
monitor electrolytes while on lasix and replete as needed.
8) Call with any questions or concerns.

Followup Instructions:
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1290**] in 4 weeks
Dr. [**Last Name (STitle) **] or Dr. [**Last Name (STitle) **](cardiologist) in [**1-22**] weeks
Dr. [**Last Name (STitle) **](PCP) in [**12-21**] weeks
Please call providers for appointmnets.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 658**], M.D. Phone:[**Telephone/Fax (1) 1690**]
Date/Time:[**2184-11-19**] 1:00 [**Hospital Ward Name 860**] 253
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8384**], MD Phone:[**Telephone/Fax (1) 1690**]
Date/Time:[**2184-12-27**] 10:00



Completed by:[**2184-10-27**]
{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic obstructive asthma, unspecified,Incomplete bladder emptying,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Anemia, unspecified,Unspecified essential hypertension,Abnormal involuntary movements,Esophageal reflux,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Cataract extraction status,Personal history of other malignant neoplasm of skin'}


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, syncope

PRESENT ILLNESS: This is a 78 year old male with known aortic stenosis since
[**2173**]. He has been followed by serial echocardiograms and has
been asymptomatic until this past year when he began to
experience progressive fatigue, shortness of breath and dyspnea
on exertion. He also experienced a syncopal episode. Cardiac
catheterization in [**2184-2-17**] confirmed moderate to severe
aortic stenosis with a valve area of 0.9 cm2. Angiography showed
no significant coronary artery disease with only a 20% lesion in
the first diagonal artery. His most recent ECHO from [**2184-7-19**]
revealed an aortic valve area of 0.7cm2 with peak and mean
gradients of 91 and 48 mmHg. There was mild to moderte aortic
insufficiency and only trace mitral regurgitation.

MEDICAL HISTORY: Aortic Stenosis; Hypertension; Chronic Renal Insufficiency;
COPD; Anemia; GERD; BPH; Depression; Asthma; Diverticular
Disease; Hiatal Hernia; Hemorrhoids; Appendectomy; Bilateral
Cataract Surgery; Skin Cancer; s/p appendectomy

MEDICATION ON ADMISSION: 1. Depakote 500 [**Hospital1 **]
2. Zyprexa 7.5 qam
3. Aricept 10 qam
4. Remeron 45 qpm
5. Flomax 0.4 qd
6. Effexor 150 [**Hospital1 **]
7. Proscar 5 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: BP 120/70, HR 84
GENERAL: elderly male in no acute distress
HEENT: oropharynx benign
NECK: supple, no JVD
HEART: regular rate, normal s1s2, 2/6 systolic murmur
LUNGS: decreased right base o/w clear. delayed expiration, no
wheeze
ABDOMEN: soft, nontender, normoactive bowel sounds
EXT: warm, trace edema
PULSES: 2+ distally
NEURO: alert and oriented; normal gait but slow, upper extremity
tremors noted, no focal deficits noted

FAMILY HISTORY: No prematue coronary disease. Father died at age 39 of rheumatic
heart disease.

SOCIAL HISTORY: Married, retired, lives in [**Hospital1 1562**]. At least a 65 pack year
history of tobacco - quit 2 years ago. 

### Response:
{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Atrial fibrillation,Chronic obstructive asthma, unspecified,Incomplete bladder emptying,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Anemia, unspecified,Unspecified essential hypertension,Abnormal involuntary movements,Esophageal reflux,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Cataract extraction status,Personal history of other malignant neoplasm of skin'}
