CHIEF COMPLAINT: Shortness of Breath

PRESENT ILLNESS: 76 y/o male with h/o CABG in [**2185**] and Aortic Stenosis c/o
increased shortness of breath along with fatigue and chest pain.
Most recent echo revealed severe aortic stenosis.

MEDICAL HISTORY: Aortic Stenosi, Coronary Artery Disease s/p Coronary Artery
Bypass Graft [**2185**], Hypertension, Hyperlipidemia, Depression s/p
ECT therapy, Benign Prostatic Hypertrophy, Sleep Apnea, Venous
Insuff. w/ superficial venous thrombosis, s/p Nasal polypectomy,
Chronic pleural effusion s/p VATS and pleurodesis

MEDICATION ON ADMISSION: Simvastatin 40mg [**Last Name (LF) **], [**First Name3 (LF) **] 60mg [**Hospital1 **], Digoxin 0.125mg qd, Folic
Acid 1mg qd, Lopressor 50mg [**Hospital1 **], Uroxatral 10mg qd, Detral LA
4mg qd, DDAVP 0.1mg qd, Miralax 17g qd, Aspirin 81mg qd, MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 76 12 128/80 5'[**94**]" 195#
Gen: WDWN in NAD
Skin: Warm, dry with well healed sternotomy, left radial and
right EVH incisions, multiple nevi and keratosis
HEENT: NC/AT, EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD
Chest: CTAB, diminished left base
Heart: RRR, 3/6 systolic murmur
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 1+ LLE edema, LLE grossly varicosed
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: non- smoker. no exposure
retired lawyer, lives w/ wife
Aortic valve disorders,Congestive heart failure, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status
Aortic valve disorder,CHF NOS,Hypertension NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass
Admission Date:  [**2191-4-7**]              Discharge Date:   [**2191-4-13**]

Date of Birth:  [**2114-7-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Shortness of Breath

Major Surgical or Invasive Procedure:
[**2191-4-7**] Redo-Sternotomy, Aortic Valve Replacement w/ 21mm CE
perimount pericardial tissue valve

History of Present Illness:
76 y/o male with h/o CABG in [**2185**] and Aortic Stenosis c/o
increased shortness of breath along with fatigue and chest pain.
Most recent echo revealed severe aortic stenosis.

Past Medical History:
Aortic Stenosi, Coronary Artery Disease s/p Coronary Artery
Bypass Graft [**2185**], Hypertension, Hyperlipidemia, Depression s/p
ECT therapy, Benign Prostatic Hypertrophy, Sleep Apnea, Venous
Insuff. w/ superficial venous thrombosis, s/p Nasal polypectomy,
Chronic pleural effusion s/p VATS and pleurodesis

Social History:
non- smoker. no exposure
retired lawyer, lives w/ wife

Family History:
Non-contributory

Physical Exam:
VS: 76 12 128/80 5'[**94**]" 195#
Gen: WDWN in NAD
Skin: Warm, dry with well healed sternotomy, left radial and
right EVH incisions, multiple nevi and keratosis
HEENT: NC/AT, EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD
Chest: CTAB, diminished left base
Heart: RRR, 3/6 systolic murmur
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 1+ LLE edema, LLE grossly varicosed
Neuro: A&O x 3, MAE, non-focal

Discharge
Vitals 99.2, 118/70 SR 80, 20 RR, RA sat 98% wt 101.8kg
Skin: Warm dry, rash on back red no draining improving
Chest CTA bilat
Card RRR no murmur/rub/gallop
Abd soft, NT, ND +BS + flatus BM [**4-11**]
Ext warm pulses palpable +1 edema LE
Neuro A/0 x3 nonfocal MAE
Sternal inc healing no drainage/erythema sternum stable


Pertinent Results:
[**2191-4-12**] 06:30AM BLOOD WBC-6.1 RBC-3.54* Hgb-11.0* Hct-32.8*
MCV-93 MCH-31.1 MCHC-33.6 RDW-14.8 Plt Ct-185
[**2191-4-7**] 01:21PM BLOOD WBC-15.3*# RBC-3.20*# Hgb-10.0*#
Hct-29.7*# MCV-93 MCH-31.2 MCHC-33.6 RDW-14.9 Plt Ct-89*#
[**2191-4-12**] 06:30AM BLOOD Plt Ct-185
[**2191-4-11**] 03:08AM BLOOD PT-13.4* PTT-28.2 INR(PT)-1.2*
[**2191-4-7**] 01:21PM BLOOD Plt Smr-LOW Plt Ct-89*#
[**2191-4-7**] 01:21PM BLOOD PT-16.6* PTT-56.8* INR(PT)-1.5*
[**2191-4-12**] 06:30AM BLOOD Glucose-126* UreaN-23* Creat-1.0 Na-142
K-4.1 Cl-104 HCO3-32 AnGap-10
[**2191-4-7**] 02:43PM BLOOD Glucose-200* UreaN-20 Creat-0.9 Na-142
K-3.6 Cl-112* HCO3-21* AnGap-13
[**2191-4-10**] 04:12AM BLOOD ALT-16 AST-58* LD(LDH)-518* AlkPhos-64
Amylase-41 TotBili-0.6
[**2191-4-10**] 04:12AM BLOOD Lipase-19
[**2191-4-11**] 03:08AM BLOOD Calcium-8.4 Phos-3.2 Mg-2.5

RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2191-4-12**] 8:38 AM

CHEST (PA & LAT)

Reason: evaluate effusion

[**Hospital 93**] MEDICAL CONDITION:
76 year old man s/p AVR
REASON FOR THIS EXAMINATION:
evaluate effusion
REASON FOR EXAMINATION: Follow up of patient after aortic valve
replacement.

Heart size is mildly enlarged but unchanged. Mediastinal
contours are unremarkable. No pneumothorax is identified. There
is no evidence of congestive heart failure.

There is unchanged loculated left pleural effusion, elevated
left hemidiaphragm and left lower lobe opacity which may
represent atelectasis.
The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Approved: TUE [**2191-4-12**] 10:57 PM

   RADIOLOGY  Final Report

PORTABLE ABDOMEN  [**2191-4-10**] 10:20 AM

PORTABLE ABDOMEN

Reason: eval obstruction

[**Hospital 93**] MEDICAL CONDITION:
76 year old man s/p redo sternotomy/ AVR with abd pain
REASON FOR THIS EXAMINATION:
eval obstruction
PORTABLE ABDOMEN SINGLE VIEW, [**2191-3-23**] AT 10:24 A.M.

HISTORY: Redo sternotomy and AVR, presenting with abdominal
pain.

COMPARISON: No prior radiographs.

FINDINGS: Single supine view demonstrates gas-filled loops of
nondilated small bowel throughout the abdomen. There is
scattered colonic air and stool as well. The rectum is not well
visualized on the submitted view. There is mild gaseous
distention of the stomach. There is suggestion of a left pleural
effusion. Preperitoneal fat stripes are not well defined and
there is mild central clumping of the bowel loops. These may be
seen in the setting of ascites.

IMPRESSION: Suggestion of possible ascites. No frankly dilated
loops of small bowel noted, although there is diffuse gaseous
distention. This may be seen in the setting of ileus. Continued
surveillance as indicated is recommended. No definitive
radiographic evidence of obstruction noted.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7411**]
Approved: SUN [**2191-4-10**] 1:13 PM

Pathology Examination

Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 102401**],[**Known firstname 412**]       [**2114-7-6**]    76 Male      [**-5/1971**] [**Numeric Identifier 102402**]
Report to:   DR. [**Last Name (STitle) **]. [**Doctor Last Name **]
Gross Description by:   DR. [**Last Name (STitle) **]. SAMEDI/mtd



SPECIMEN SUBMITTED: AORTIC VALVE TISSUE.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2191-4-7**] [**2191-4-7**] [**2191-4-12**] DR. [**Last Name (STitle) **]. [**Doctor Last Name 1431**]/mrr??????
Previous biopsies:    [**Numeric Identifier 102403**]  RT. NASAL MASS.
  [**-3/4603**]  LEFT PARIETAL PLEURAL BIOPSY, LEFT PARIETAL PLEURA
  [**Numeric Identifier 102404**]  SKIN RT UPPER ARM.
  [**-2/4340**]  R. ARM SKIN.
(and more)

DIAGNOSIS:

Aortic valve tissue:
Aortic valve with degenerative changes and calcification.
Clinical: Aortic valve stenosis, aortic valve replacement, redo
sternotomy.
Gross: The specimen is received fresh labeled with the patient's
name, "[**Known firstname **] [**Known lastname 1726**]", the medical record number and "aortic
valve tissue". It consists of a fragment of yellow-tan and
calcified tissue measuring 3.4 x 2.5 x 1.1 cm in aggregate. The
specimen is represented in cassette A, and also submitted for
decalcification.

Cardiology Report ECHO Study Date of [**2191-4-7**]



PATIENT/TEST INFORMATION:
Indication: Intraop redo sternotomy AVR.  Evaluate Aorta,
valves, Biventricular function
Height: (in) 71
Weight (lb): 195
BSA (m2): 2.09 m2
BP (mm Hg): 129/69
HR (bpm): 58
Status: Inpatient
Date/Time: [**2191-4-7**] at 09:29
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007AW1-:
Test Location: Anesthesia West OR cardiac
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name (STitle) **] R. [**Doctor Last Name **]

MEASUREMENTS:
Left Atrium - Long Axis Dimension: *5.6 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: *6.1 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: *6.0 cm (nl <= 5.0 cm)
Left Ventricle - Inferolateral Thickness: *1.8 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 3.4 cm (nl <= 5.6 cm)
Left Ventricle - Systolic Dimension: 1.8 cm
Left Ventricle - Fractional Shortening: 0.47 (nl >= 0.29)
Left Ventricle - Ejection Fraction: >= 45% (nl >=55%)
Aorta - Valve Level: 2.8 cm (nl <= 3.6 cm)
Aorta - Ascending: 2.4 cm (nl <= 3.4 cm)
Aorta - Arch: 2.1 cm (nl <= 3.0 cm)
Aortic Valve - Peak Velocity: *4.1 m/sec (nl <= 2.0 m/sec)
Aortic Valve - Peak Gradient: 67 mm Hg
Aortic Valve - Mean Gradient: 44 mm Hg
Aortic Valve - LVOT Peak Vel: 0.80 m/sec
Aortic Valve - LVOT VTI: 23
Aortic Valve - LVOT Diam: 2.0 cm
Aortic Valve - Valve Area: *0.6 cm2 (nl >= 3.0 cm2)
Mitral Valve - Peak Velocity: 1.2 m/sec
Mitral Valve - Mean Gradient: 2 mm Hg
Mitral Valve - Pressure Half Time: 90 ms
Mitral Valve - MVA (P [**11-23**] T): 2.4 cm2
Mitral Valve - E Wave: 1.2 m/sec

INTERPRETATION:

Findings:

LEFT ATRIUM: Moderate LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Moderately dilated RA.

LEFT VENTRICLE: Severe symmetric LVH. Mildly depressed LVEF.

LV WALL MOTION: Regional LV wall motion abnormalities include:
basal inferior
- hypo; mid inferior - hypo;

RIGHT VENTRICLE: Dilated RV cavity. Mild global RV free wall
hypokinesis.

AORTA: Complex (>4mm) atheroma in the aortic arch. Normal
descending aorta
diameter. Complex (>4mm) atheroma in the descending thoracic
aorta.

AORTIC VALVE: Three aortic valve leaflets. Severely
thickened/deformed aortic
valve leaflets. Severe AS (AoVA <0.8cm2). Trace AR. Eccentric AR
jet.

MITRAL VALVE: Moderately thickened mitral valve leaflets.
Moderate mitral
annular calcification. Minimally increased gradient consistent
with trivial
MS. Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
No PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify
I was present in compliance with HCFA regulations. No TEE
related
complications. See Conclusions for post-bypass data The
post-bypass study was
performed while the patient was receiving vasoactive infusions
(see
Conclusions for listing of medications).

Conclusions:
PRE-BYPASS: The left atrium is moderately dilated. The right
atrium is
moderately dilated. There is severe symmetric left ventricular
hypertrophy.
Overall left ventricular systolic function is mildly depressed.
The right
ventricular cavity is dilated. There is mild global right
ventricular free
wall hypokinesis. There are complex (>4mm) atheroma in the
aortic arch. There
are complex (>4mm) atheroma in the descending thoracic aorta.
There are three
aortic valve leaflets. The aortic valve leaflets are severely
thickened/deformed. There is severe aortic valve stenosis (area
<0.8cm2).
Trace aortic regurgitation is seen. The aortic regurgitation jet
is eccentric.
The mitral valve leaflets are moderately thickened. There is a
minimally
increased gradient consistent with trivial mitral stenosis. Mild
(1+) mitral
regurgitation is seen. There is no pericardial effusion.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive
infusions including Norepi, Epi, Vasopressin, Milrinone. The
patient was AV
paced . A well-seated bioprosthetic valve is seen in the aortic
position with
normal leaflet motion and gradients (mean gradient = 20 mmHg,
peak 22 mmHg).
No aortic regurgitation is seen. RV is now moderately
hypokinetic. LV function
is slightly improved on inontropes with unchanged wall motion.
Aortic contours
are intact. Remaining exam is unchanged. All findings discussed
with surgeons
at the time of the exam.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD on [**2191-4-12**] 18:51.
[**Location (un) **] PHYSICIAN:





Brief Hospital Course:
Mr. [**Known lastname 1726**] was a same day admit after undergoing all
pre-operative work-up as an outpatient. On day of admission he
was brought to the operating room where he underwent a
redo-sternotomy and aortic valve replacement. Please see
operative report for surgical details. Following surgery he was
transferred to the CSRU for invasive monitoring in stable
condition. Within 24 hours he was weaned from sedation, awoke
neurologically intact and extubated. Over the next couple of
days his Inotropes were weaned and he was started on beta
blockers and diuretics. He was gently diuresed towards he pre-op
weight. On post-op day two his chest tubes were removed. On
post-op day three he had some abd. pain but abd. x-ray was
negative for obstruction. On post-op day four he was transferred
to the telemetry floor and began working with physical therapy
for strength and mobility. He continued to make improvements
without complications and was discharged home with VNA services
and the appropriate follow-up appointments on post-op day five.

Medications on Admission:
Simvastatin 40mg [**Last Name (LF) **], [**First Name3 (LF) **] 60mg [**Hospital1 **], Digoxin 0.125mg qd, Folic
Acid 1mg qd, Lopressor 50mg [**Hospital1 **], Uroxatral 10mg qd, Detral LA
4mg qd, DDAVP 0.1mg qd, Miralax 17g qd, Aspirin 81mg qd, MVI

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
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:*40 Tablet(s)* Refills:*0*
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
6. UROXATRAL 10 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO daily ().
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*1*
7. Miralax 17 g (100%) Powder in Packet Sig: One (1)  PO twice a
day as needed for constipation.
Disp:*30 * Refills:*1*
8. Desmopressin 0.1 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
10. Tolterodine 4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*1*
11. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO Q12H (every
12 hours) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
12. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for
5 days.
Disp:*20 Capsule, Sustained Release(s)* Refills:*0*
13. [**Doctor First Name **] 60 mg Tablet Sig: One (1) Tablet PO twice a day.
14. Senna 187 mg Tablet Sig: One (1) Tablet PO at bedtime.
15. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): decrease to 400mg once a day [**4-15**] for 7 days then
decrease to 200mg daily .
16. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
TID (3 times a day).
17. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
TBA

Discharge Diagnosis:
Aortic Stenosis s/p Redo-Sternotomy, Aortic Valve Replacement
PMH: Coronary Artery Disease s/p Coronary Artery Bypass Graft
[**2185**], Hypertension, Hyperlipidemia, Depression s/p ECT therapy,
Benign Prostatic Hypertrophy, Sleep Apnea, Venous Insuff., s/p
Nasal polypectomy, Chronic pleural effusion s/p VATS and
pleurodesis

Discharge Condition:
Good

Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. Please shower and wash incisions daily. No bathing or
swimming for 1 month. Use sunscreen on incision if exposed to
sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7)  Call with any questions or concerns [**Telephone/Fax (1) 170**].

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) 2472**] after discharge from rehab [**Telephone/Fax (1) 133**]
Dr. [**First Name (STitle) **] in [**12-26**] weeks
please call to schedule all appointments



Completed by:[**2191-4-13**]
{'Aortic valve disorders,Congestive heart failure, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}


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

PRESENT ILLNESS: 76 y/o male with h/o CABG in [**2185**] and Aortic Stenosis c/o
increased shortness of breath along with fatigue and chest pain.
Most recent echo revealed severe aortic stenosis.

MEDICAL HISTORY: Aortic Stenosi, Coronary Artery Disease s/p Coronary Artery
Bypass Graft [**2185**], Hypertension, Hyperlipidemia, Depression s/p
ECT therapy, Benign Prostatic Hypertrophy, Sleep Apnea, Venous
Insuff. w/ superficial venous thrombosis, s/p Nasal polypectomy,
Chronic pleural effusion s/p VATS and pleurodesis

MEDICATION ON ADMISSION: Simvastatin 40mg [**Last Name (LF) **], [**First Name3 (LF) **] 60mg [**Hospital1 **], Digoxin 0.125mg qd, Folic
Acid 1mg qd, Lopressor 50mg [**Hospital1 **], Uroxatral 10mg qd, Detral LA
4mg qd, DDAVP 0.1mg qd, Miralax 17g qd, Aspirin 81mg qd, MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 76 12 128/80 5'[**94**]" 195#
Gen: WDWN in NAD
Skin: Warm, dry with well healed sternotomy, left radial and
right EVH incisions, multiple nevi and keratosis
HEENT: NC/AT, EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD
Chest: CTAB, diminished left base
Heart: RRR, 3/6 systolic murmur
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 1+ LLE edema, LLE grossly varicosed
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: non- smoker. no exposure
retired lawyer, lives w/ wife 

### Response:
{'Aortic valve disorders,Congestive heart failure, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}
