CHIEF COMPLAINT: Syncope

PRESENT ILLNESS: 84 year old female who was brought to the ED after syncope/fall,
and is admitted to medicine due to elevated troponin. At her
baseline, she feels well and is active, able to climb a few
flights of stairs without complaints. She was
brought to [**Hospital1 18**] Ed for further evaluation. During admission an
echocardiogram was done and she was found to have aortic
stenosis [**Location (un) 109**]=0.4 and is now being referred to cardiac surgery
for an aortic valve replacement.

MEDICAL HISTORY: -s/p fall a few years ago with small SAH
fall

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
VS - Temp 99.7 F, BP 113/64, HR 72, R 20, O2-sat 96% RA
GENERAL - well-appearing lady in NAD, comfortable, appropriate
HEENT - EOMI, MMM, OP clear
NECK - supple, no thyromegaly, no JVD
LUNGS - CTA bilaterally
HEART - PMI non-displaced, RRR, nl S1-S2 , grade 3 systolic
crescrndo-decrescendo murmur that radiates to carotids; no loss
of S2 and murmur is not late-peaking
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
--no pulsus parvus et tardus; left knee with 3cm area of
erythema at site of impact but knee has full ROM and is not very
tender
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**4-12**] throughout, sensation grossly intact throughout, DTRs 2+ and
symmetric, gait deferred

FAMILY HISTORY: No MI, stroke. Mother died of "lung problems," father died of
colon cancer.

SOCIAL HISTORY: -Home: Married, lives with husband. Three grown kids.
-Occupation: Retired dressmaker.
-Tobacco: None
-EtOH: None
-Illicits: None
Aortic valve disorders,Iatrogenic pneumothorax,Atrial fibrillation,Syncope and collapse,History of fall,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Aortic valve disorder,Iatrogenic pneumothorax,Atrial fibrillation,Syncope and collapse,Personal history of fall,Abn react-artif implant
Admission Date:  [**2114-10-17**]              Discharge Date:   [**2114-10-30**]

Date of Birth:  [**2030-3-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Syncope

Major Surgical or Invasive Procedure:
[**2114-10-23**]: Aortic valve replacement with a size 19-mm
[**Last Name (un) 3843**]-[**Doctor Last Name **] Magna tissue valve.


History of Present Illness:
84 year old female who was brought to the ED after syncope/fall,
and is admitted to medicine due to elevated troponin. At her
baseline, she feels well and is active, able to climb a few
flights of stairs without complaints. She was
brought to [**Hospital1 18**] Ed for further evaluation. During admission an
echocardiogram was done and she was found to have aortic
stenosis [**Location (un) 109**]=0.4 and is now being referred to cardiac surgery
for an aortic valve replacement.


Past Medical History:
-s/p fall a few years ago with small SAH
fall

Social History:
-Home: Married, lives with husband. Three grown kids.
-Occupation: Retired dressmaker.
-Tobacco: None
-EtOH: None
-Illicits: None

Family History:
No MI, stroke. Mother died of "lung problems," father died of
colon cancer.

Physical Exam:
Admission Exam:
VS - Temp 99.7 F, BP 113/64, HR 72, R 20, O2-sat 96% RA
GENERAL - well-appearing lady in NAD, comfortable, appropriate
HEENT - EOMI, MMM, OP clear
NECK - supple, no thyromegaly, no JVD
LUNGS - CTA bilaterally
HEART - PMI non-displaced, RRR, nl S1-S2 , grade 3 systolic
crescrndo-decrescendo murmur that radiates to carotids; no loss
of S2 and murmur is not late-peaking
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
--no pulsus parvus et tardus; left knee with 3cm area of
erythema at site of impact but knee has full ROM and is not very
tender
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**4-12**] throughout, sensation grossly intact throughout, DTRs 2+ and
symmetric, gait deferred


Pertinent Results:
[**2114-10-30**] CXR: In comparison with the study of [**10-29**], there is
little change in the appearance of the small-to-moderate apical
pneumothorax on the right. Bilateral pleural effusions are more
prominent on the left. Continued evidence of chronic pulmonary
disease without definite acute pneumonia.
.
[**2114-10-23**] Echo: PRE-CPB: Left ventricular wall thicknesses are
normal. The left ventricular cavity size is normal. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. There
are simple atheroma in the descending thoracic aorta. The aortic
valve leaflets are severely thickened/deformed. The aortic valve
is functionally bicuspid with apparent fusion of the right and
left coronary cusps. There is critical aortic valve stenosis
(valve area <0.8cm2). Mild (1+) aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen.
Post CPB: 1. Prserved [**Hospital1 **]-ventricular systolci function. 2.
Bioprosthetic valve visualized in aortic position.Well seated
and stable with good leaflet excursion. There was intially [**12-10**] +
perivalvular AI immediately after separation from CPB which
improved to 1+ AI after protamine administration. There are two
perivalvular jets (low velocity and trace) and located on the
right and left coronary cusps. Peak gradient across the valve -
14 mm Hg. 3. No other change in an y other valve structure and
function.
.
[**2114-10-22**] Carotid U/S: Mild heterogeneous plaque is seen
bilaterally at the carotid bulb and the proximal internal
carotid arteries. The peak systolic velocity and right internal
carotid artery ranges from 77 to 102 cm/sec and in the left
internal carotid artery from 72 to 96 cm/sec. The peak systolic
velocity in the right common carotid artery 71 cm/sec and in the
left common carotid artery is 80 cm/sec. Bilateral external
carotid arteries are patent. There is antegrade flow in the
bilateral vertebral arteries. The ICA to CCA ratio on the right
is 1.4 and on the left was 1.2.
.
[**2114-10-19**] Cath: 1. No angiographically-apparent coronary artery
disease. 2. Severe aortic stenosis. 3. No pulmonary arterial
hypertension. 4. Slightly depressed cardiac output.
.
[**2114-10-17**] Head CT: There is no evidence of hemorrhage, edema, mass
effect, or territorial infarction. The ventricles and sulci are
mildly prominent
consistent with atrophy. There is a small hypodensity in the
left basal
ganglia which could be an old lacunar infarct or Virchow-[**Doctor First Name **]
vascular space. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The osseous structures
are intact. There is no fracture.
.
[**2114-10-17**] 01:00PM BLOOD WBC-6.8 RBC-4.04* Hgb-12.5 Hct-37.2
MCV-92 MCH-30.9 MCHC-33.6 RDW-12.4 Plt Ct-250
[**2114-10-29**] 05:37AM BLOOD WBC-6.8 RBC-3.54* Hgb-10.9* Hct-32.5*
MCV-92 MCH-30.6 MCHC-33.4 RDW-13.0 Plt Ct-274#
[**2114-10-17**] 01:00PM BLOOD PT-12.3 PTT-27.8 INR(PT)-1.0
[**2114-10-23**] 06:44PM BLOOD PT-13.7* PTT-47.6* INR(PT)-1.2*
[**2114-10-17**] 01:00PM BLOOD Glucose-156* UreaN-15 Creat-0.8 Na-139
K-3.7 Cl-103 HCO3-27 AnGap-13
[**2114-10-27**] 04:40AM BLOOD Glucose-104* UreaN-16 Creat-0.8 Na-139
K-4.4 Cl-102 HCO3-31 AnGap-10
[**2114-10-29**] 05:37AM BLOOD UreaN-21* Creat-1.1 Na-138 K-4.4 Cl-99
[**2114-10-25**] 03:48AM BLOOD Calcium-8.1* Phos-3.1 Mg-2.0
[**2114-10-22**] 07:30AM BLOOD Triglyc-93 HDL-73 CHOL/HD-2.7 LDLcalc-108
[**2114-10-20**] 08:00AM BLOOD %HbA1c-5.5 eAG-111

Brief Hospital Course:
The patient was admitted to the hospital after syncope/fall, to
medicine service for elevated troponin. During admission she
underwent an echocardiogram and she was found to have aortic
stenosis with [**Location (un) 109**]=0.4cm2. In addition she underwent a cardiac
cath and complete surgical work-up. On [**10-23**] she was brought to
the operating room where the patient underwent Aortic valve
replacement with a size 19-mm [**Last Name (un) 3843**]-[**Doctor Last Name **] Magna tissue
valve. Please see operative note for surgical details. 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 on no inotropic
or vasopressor support. Beta blocker was initiated and the
patient was gently diuresed toward the preoperative weight. 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. On post-op
day 5 she had a brief burst of atrial fibrillation which was
treated with beta-blockers and Amiodarone. She converted to
sinus rhythm and remained in SR at discharge. By the time of
discharge on POD 7 the patient was ambulating with assistance,
the wound was healing and pain was controlled with oral
analgesics. The patient was discharged to [**Hospital 1036**] rehab in
good condition with appropriate follow up instructions.

Medications on Admission:
None

Discharge Medications:
1. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. 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*
4. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
5. metoprolol tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
6. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
7. potassium chloride 20 mEq Packet Sig: One (1) Packet PO once
a day for 7 days.
Disp:*7 Packet(s)* Refills:*0*
8. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Please take two 200mg tablets twice daily for 5 days.
Then one 200mg tablet twice daily for 7 days. Then one 200mg
table once daily until stopped by cardiologist.

Discharge Disposition:
Extended Care

Facility:
[**Location (un) 1036**] - [**Location (un) 620**]

Discharge Diagnosis:
Aortic Stenosis

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with assistance
Incisional pain managed with Percocet
Incisions:
Sternal - healing well, no erythema or drainage
Edema: Trace

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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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:
You are scheduled for the following appointments
Surgeon: Dr [**First Name (STitle) **] on [**11-27**] at 2:00pm
Cardiologist/PCP: [**Name10 (NameIs) **] [**Last Name (STitle) **] on [**11-14**] at 1:20pm

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2114-10-30**]
{'Aortic valve disorders,Iatrogenic pneumothorax,Atrial fibrillation,Syncope and collapse,History of fall,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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: Syncope

PRESENT ILLNESS: 84 year old female who was brought to the ED after syncope/fall,
and is admitted to medicine due to elevated troponin. At her
baseline, she feels well and is active, able to climb a few
flights of stairs without complaints. She was
brought to [**Hospital1 18**] Ed for further evaluation. During admission an
echocardiogram was done and she was found to have aortic
stenosis [**Location (un) 109**]=0.4 and is now being referred to cardiac surgery
for an aortic valve replacement.

MEDICAL HISTORY: -s/p fall a few years ago with small SAH
fall

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
VS - Temp 99.7 F, BP 113/64, HR 72, R 20, O2-sat 96% RA
GENERAL - well-appearing lady in NAD, comfortable, appropriate
HEENT - EOMI, MMM, OP clear
NECK - supple, no thyromegaly, no JVD
LUNGS - CTA bilaterally
HEART - PMI non-displaced, RRR, nl S1-S2 , grade 3 systolic
crescrndo-decrescendo murmur that radiates to carotids; no loss
of S2 and murmur is not late-peaking
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
--no pulsus parvus et tardus; left knee with 3cm area of
erythema at site of impact but knee has full ROM and is not very
tender
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**4-12**] throughout, sensation grossly intact throughout, DTRs 2+ and
symmetric, gait deferred

FAMILY HISTORY: No MI, stroke. Mother died of "lung problems," father died of
colon cancer.

SOCIAL HISTORY: -Home: Married, lives with husband. Three grown kids.
-Occupation: Retired dressmaker.
-Tobacco: None
-EtOH: None
-Illicits: None 

### Response:
{'Aortic valve disorders,Iatrogenic pneumothorax,Atrial fibrillation,Syncope and collapse,History of fall,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
