CHIEF COMPLAINT: dypnea

PRESENT ILLNESS: This 72 year old  male had rheumatic fever at the age of 5 years
old. Has had a heart murmur since that time. Five years ago he
developed atrial fibrillation and was found to have moderate
aortic stenosis. Since that time he has been followed by serial
echocardiograms which have shown worsening of his aortic
stenosis with recent development of left ventricular hypertrophy
with diminished LV function.

MEDICAL HISTORY: chronic atrial fibrillation
aortic stenosis
mitral regurgitation
rheumatic fever at age 5
h/o  compression fracture of vertebrae x 2
Osteoporosis
s/p Left hernia repair

MEDICATION ON ADMISSION: Medications at home:
Coumadin 5 mg q night except 7.5 mg q Wed - last dose 11/26
Fosamax 70mg once a week
Lipitor 20mg daily
Candesartan 16mg daily
Flonase 50mcg daily
Lopressor 75mg twice daily
Temazepam 15mg prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: 48 y/o son with MI and stent
otherwisw noncontributory

SOCIAL HISTORY: Race:Caucasian
Last Dental Exam:every 6 months
Lives with:Lives with wife in [**Name (NI) 932**]
Occupation:Retired
Tobacco:Remote past use (quit 40 years ago)
ETOH:Quit 5 years ago due to palpitations with drinking
Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Osteoporosis, unspecified,Other iatrogenic hypotension,Oliguria and anuria,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of tobacco use,Family history of ischemic heart disease,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified
Mitral insuf/aort stenos,Rheumatic heart failure,Osteoporosis NOS,Iatrogenc hypotnsion NEC,Oliguria & anuria,Atrial fibrillation,Long-term use anticoagul,History of tobacco use,Fam hx-ischem heart dis,Abn react-anastom/graft,Anemia NOS
Admission Date:  [**2151-12-13**]              Discharge Date:   [**2151-12-18**]

Date of Birth:  [**2079-1-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
dypnea

Major Surgical or Invasive Procedure:
Aortic valve replacement (#25 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] Epic Supra Porcine)/
Mitral valve repair (#32 [**Company 1543**] CG Future ring)[**2151-12-14**]


History of Present Illness:
This 72 year old  male had rheumatic fever at the age of 5 years
old. Has had a heart murmur since that time. Five years ago he
developed atrial fibrillation and was found to have moderate
aortic stenosis. Since that time he has been followed by serial
echocardiograms which have shown worsening of his aortic
stenosis with recent development of left ventricular hypertrophy
with diminished LV function.


Past Medical History:
chronic atrial fibrillation
aortic stenosis
mitral regurgitation
rheumatic fever at age 5
h/o  compression fracture of vertebrae x 2
Osteoporosis
s/p Left hernia repair


Social History:
Race:Caucasian
Last Dental Exam:every 6 months
Lives with:Lives with wife in [**Name (NI) 932**]
Occupation:Retired
Tobacco:Remote past use (quit 40 years ago)
ETOH:Quit 5 years ago due to palpitations with drinking

Family History:
48 y/o son with MI and stent
otherwisw noncontributory

Physical Exam:
Admission:

Pulse:63  Resp:18  O2 sat:96% RA
B/P  Right:120/82    Left:
Height:72"     Weight:195#
General:AAOx3 in NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular [x]  Murmur IV/VII SEM
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [], well-perfused []  Edema Varicosities:
None[x]
Neuro: Grossly intact
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        Right:    Left: transmitted murmur vs bruit


Pertinent Results:
[**2151-12-16**] 06:20AM BLOOD WBC-12.3* RBC-3.33* Hgb-11.1* Hct-33.2*
MCV-100* MCH-33.4* MCHC-33.5 RDW-13.4 Plt Ct-92*
[**2151-12-15**] 02:46AM BLOOD WBC-10.2 RBC-3.30* Hgb-11.2* Hct-33.4*
MCV-102* MCH-34.1* MCHC-33.6 RDW-14.3 Plt Ct-115*
[**2151-12-17**] 07:30AM BLOOD PT-17.9* INR(PT)-1.6*
[**2151-12-16**] 11:30AM BLOOD PT-21.0* INR(PT)-1.9*
[**2151-12-15**] 02:46AM BLOOD PT-15.4* PTT-30.9 INR(PT)-1.3*
[**2151-12-14**] 01:23PM BLOOD PT-17.9* PTT-49.5* INR(PT)-1.6*
[**2151-12-14**] 12:00PM BLOOD PT-20.2* PTT-38.9* INR(PT)-1.9*
[**2151-12-16**] 06:20AM BLOOD Glucose-134* UreaN-18 Creat-0.9 Na-133
K-4.4 Cl-99 HCO3-28 AnGap-10
[**2151-12-15**] 02:46AM BLOOD Glucose-100 UreaN-13 Creat-0.7 Na-137
K-4.9 Cl-107 HCO3-25 AnGap-10

Brief Hospital Course:
[**Known lastname 63347**] was a same day admission to the Operating Room for
aortic valve replacement and mitral valve replacement on [**12-13**].
Please see the operative note for details, in summary he had and
aortic valve replacement with #25 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] Epic Supra porcine
valve and a Mitral valve repair with 32 [**Company 1543**] CG Future
annuloplasty ring. His bypass time was 107 minutes with a
crossclamp of 87 minutes. He tolerated the operation well and
was transferred to the cardiac surgery ICU in stable condition
on a Neosynephrine infusion for blood pressure support.

He remained stable in the immediate post-op period, his
anesthesia was reversed, he woke neurologically intact was
weaned from the ventilator and extubated. Following extubation
he was weaned from the Neosynephrine infusion. He remained
hemodynamically stable and on POD 1 was transferred from the ICU
to the stepdown floor for continued care and recovery.

All tubes, lines and drains were removed according to cardiac
surgery protocol. He was started on beta blockers and diuretics
and these were titrated to effect. Beacause of his atrial
fibrillation his Coumadin was resumed on POD 2.
He was seen by Physical Therapy and activity was advanced per
cardiac surgery protocol. The remainder of his hospital stay was
uneventful and on POD*** he was discharged home with visiting
nurses.

Arrangements were made for follow up.  His INR is to be checked
by the visiting nurses on [**12-20**] with results called to Dr
[**Last Name (STitle) 40075**](PCP)@ [**Telephone/Fax (1) 40076**].

Diuretics were continued for two weeks after discharge as he was
still fluid overloaded at the time of discharge, albeit
asymptomatic.

Stable for DC

Medications on Admission:
Medications at home:
Coumadin 5 mg q night except 7.5 mg q Wed - last dose 11/26
Fosamax 70mg once a week
Lipitor 20mg daily
Candesartan 16mg daily
Flonase 50mcg daily
Lopressor 75mg twice daily
Temazepam 15mg prn


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 4 weeks.
Disp:*56 Tablet(s)* Refills:*0*
3. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain for 4 weeks.
Disp:*50 Tablet(s)* Refills:*0*
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for 2
weeks.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
10. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QSUN (every
Sunday).
Disp:*20 Tablet(s)* Refills:*2*
11. Coumadin 5 mg Tablet Sig: as directed Tablet PO once a day:
5mg 12/5,6. INR drawn on [**12-20**] then dose as directed.
Disp:*100 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] Area VNA

Discharge Diagnosis:
s/p Aortic valve replacement (#25 [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] Epic Supra
Porcine)/Mitral valve repair (#32 [**Company 1543**] CG Future ring)
chronic atrial fibrillation
Aortic stenosis
Mitral regurgitation
h/o rheumatic fever
h/o compression fracture of vertebrae x 2
Osteoporosis
s/p Left hernia repair


Discharge Condition:
Mental Status: Clear and coherent
Activity Status: Ambulatory - Independent
Hemodynamically stable
Wounds healing well, no drainage or erythema




Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) in 4 weeks scheduled for [**2152-1-20**] @1PM
Dr. [**Last Name (STitle) 40075**](PCP) ([**Telephone/Fax (1) 40076**]) in [**1-15**] weeks call for appt
Dr [**First Name8 (NamePattern2) 518**] [**Last Name (NamePattern1) 8579**] or Dr [**Last Name (STitle) 40149**](cardiologist) in [**2-16**] weeks
[**Hospital Ward Name 121**] 6 wound clinic in 2 weeks. Your nurse [**First Name (Titles) **] [**Last Name (Titles) **] an
appointment.



Completed by:[**2151-12-18**]
{'Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Osteoporosis, unspecified,Other iatrogenic hypotension,Oliguria and anuria,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of tobacco use,Family history of ischemic heart disease,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified'}


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: dypnea

PRESENT ILLNESS: This 72 year old  male had rheumatic fever at the age of 5 years
old. Has had a heart murmur since that time. Five years ago he
developed atrial fibrillation and was found to have moderate
aortic stenosis. Since that time he has been followed by serial
echocardiograms which have shown worsening of his aortic
stenosis with recent development of left ventricular hypertrophy
with diminished LV function.

MEDICAL HISTORY: chronic atrial fibrillation
aortic stenosis
mitral regurgitation
rheumatic fever at age 5
h/o  compression fracture of vertebrae x 2
Osteoporosis
s/p Left hernia repair

MEDICATION ON ADMISSION: Medications at home:
Coumadin 5 mg q night except 7.5 mg q Wed - last dose 11/26
Fosamax 70mg once a week
Lipitor 20mg daily
Candesartan 16mg daily
Flonase 50mcg daily
Lopressor 75mg twice daily
Temazepam 15mg prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: 48 y/o son with MI and stent
otherwisw noncontributory

SOCIAL HISTORY: Race:Caucasian
Last Dental Exam:every 6 months
Lives with:Lives with wife in [**Name (NI) 932**]
Occupation:Retired
Tobacco:Remote past use (quit 40 years ago)
ETOH:Quit 5 years ago due to palpitations with drinking 

### Response:
{'Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Osteoporosis, unspecified,Other iatrogenic hypotension,Oliguria and anuria,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of tobacco use,Family history of ischemic heart disease,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified'}
