CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: Mr. [**Known lastname 1557**] is a very active 77 year old male with known aortic
stenosis who recently complained of increasing dyspnea on
exertion. There is no history of chest pain, syncope,
presyncope, orthopnea or PND. An excercise tolerance test in
[**2114-10-24**] revealed 2mm flat inferolateral ST depressions
which resolved with rest. He subsequently underwent cardiac
catheterization in [**2114-11-23**] which confirmed severe aortic
stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.6cm2, peak gradient of 65 mmHg and
mean of 62 mmHg. Coronary angiography showed a right dominant
system and no significant coronary artery disease. LV gram
showed LVEF of 58%. Based upon the above results, he was
referred for aortic valve replacment.

MEDICAL HISTORY: Aortic Stenosis, Cataracts, Glaucoma, Hard of hearing, Shoulder
Bursitis, s/p Skin Cancer removal

MEDICATION ON ADMISSION: Aspirin 81 qd, Multivitamin, Xalantan eye gtts, Cosopt eye gtts,
Amoxicillin prn dental procedures

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 134/74, HR 68, RR 14
General: well developed male in no acute distress, rubor face
HEENT: oropharynx benign, PERRL, sclera anicteric
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 4/6 systolic ejection murmur
Lungs: clear bilaterally
Abdomen: +ventral hernia, otherwise soft, nontender, normoactive
bowel sounds
Ext: warm, trace edema L>R, no varicosities
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Brother died of MI at age 42.

SOCIAL HISTORY: 20 pack year history of tobacco, quit 45 years ago. Admits to
occasional ETOH. Patient is married and retired from Fire
Department.
Aortic valve disorders,Unspecified cataract,Unspecified glaucoma
Aortic valve disorder,Cataract NOS,Glaucoma NOS
Admission Date:  [**2115-2-21**]              Discharge Date:   [**2115-2-26**]

Date of Birth:  [**2037-11-4**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 922**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2115-2-21**] Aortic Valve Replacement utilizing a 25mm [**Company 1543**]
Mosaic Porcine Heart Valve


History of Present Illness:
Mr. [**Known lastname 1557**] is a very active 77 year old male with known aortic
stenosis who recently complained of increasing dyspnea on
exertion. There is no history of chest pain, syncope,
presyncope, orthopnea or PND. An excercise tolerance test in
[**2114-10-24**] revealed 2mm flat inferolateral ST depressions
which resolved with rest. He subsequently underwent cardiac
catheterization in [**2114-11-23**] which confirmed severe aortic
stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.6cm2, peak gradient of 65 mmHg and
mean of 62 mmHg. Coronary angiography showed a right dominant
system and no significant coronary artery disease. LV gram
showed LVEF of 58%. Based upon the above results, he was
referred for aortic valve replacment.

Past Medical History:
Aortic Stenosis, Cataracts, Glaucoma, Hard of hearing, Shoulder
Bursitis, s/p Skin Cancer removal

Social History:
20 pack year history of tobacco, quit 45 years ago. Admits to
occasional ETOH. Patient is married and retired from Fire
Department.

Family History:
Brother died of MI at age 42.

Physical Exam:
Vitals: BP 134/74, HR 68, RR 14
General: well developed male in no acute distress, rubor face
HEENT: oropharynx benign, PERRL, sclera anicteric
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 4/6 systolic ejection murmur
Lungs: clear bilaterally
Abdomen: +ventral hernia, otherwise soft, nontender, normoactive
bowel sounds
Ext: warm, trace edema L>R, no varicosities
Pulses: 1+ distally
Neuro: nonfocal

Discharge
Vitals 98.0, 71 SR, 118/58, 18, RA sat 97% wt 88.1kg
General A/O x3 nonfocal
Cardiac RRR no M/R/G
Pulm CTA bilat
Abd Soft, NT, ND +BS
Ext warm +1 edema pulses palpable
Inc: Sternal healing no erythema/drainage sternum stable


Pertinent Results:
[**2115-2-25**] 06:35AM BLOOD WBC-6.5 RBC-2.70* Hgb-8.7* Hct-25.0*
MCV-93 MCH-32.2* MCHC-34.7 RDW-14.7 Plt Ct-162
[**2115-2-21**] 11:05AM BLOOD WBC-8.3# RBC-2.51*# Hgb-8.1*# Hct-23.8*#
MCV-95 MCH-32.1* MCHC-33.8 RDW-14.0 Plt Ct-93*
[**2115-2-25**] 06:35AM BLOOD Plt Ct-162
[**2115-2-21**] 12:49PM BLOOD PT-16.3* PTT-34.5 INR(PT)-1.5*
[**2115-2-21**] 11:05AM BLOOD Plt Smr-LOW Plt Ct-93*
[**2115-2-21**] 11:05AM BLOOD PT-14.8* PTT-25.2 INR(PT)-1.3*
[**2115-2-25**] 06:35AM BLOOD Glucose-101 UreaN-13 Creat-0.7 Na-138
K-3.9 Cl-102 HCO3-30 AnGap-10
[**2115-2-22**] 03:20AM BLOOD Glucose-107* UreaN-12 Creat-0.8 Na-141
K-4.4 Cl-111* HCO3-22 AnGap-12
[**2115-2-25**] 06:35AM BLOOD Calcium-7.6* Phos-2.2* Mg-2.3

CHEST (PA & LAT)  [**2115-2-25**] 11:07 AM

CHEST (PA & LAT)

Reason: evaluate for effusion

[**Hospital 93**] MEDICAL CONDITION:
77 year old man s/p AVR
REASON FOR THIS EXAMINATION:
evaluate for effusion
TWO VIEW CHEST OF [**2115-2-25**]

COMPARISON: [**2115-2-23**].

INDICATION: Status post aortic valvular replacement.

The patient is status post median sternotomy and aortic valvular
surgery. Cardiac and mediastinal contours are stable in the
postoperative period. Left basilar atelectasis has markedly
improved, but there has been no substantial change in partial
right lower lobe atelectasis. Small pleural effusions are again
demonstrated. There is no pneumothorax.

IMPRESSION: Improved left lower lobe atelectasis, but no change
in small effusions and right basilar atelectasis.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]
Approved: MON [**2115-2-25**] 11:51 AM

PATIENT/TEST INFORMATION:
Indication: Intraoperative for AVR
Status: Inpatient
Date/Time: [**2115-2-21**] at 09:46
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007AW-:01
Test Location: Anesthesia West OR cardiac
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**Known firstname 177**] [**Last Name (NamePattern1) **]

MEASUREMENTS:
Left Ventricle - Inferolateral Thickness: *1.4 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 4.8 cm (nl <= 5.6 cm)
Left Ventricle - Systolic Dimension: 3.9 cm
Left Ventricle - Fractional Shortening: *0.19 (nl >= 0.29)
Aorta - Valve Level: 3.1 cm (nl <= 3.6 cm)
Aorta - Ascending: 2.8 cm (nl <= 3.4 cm)
Aorta - Arch: 2.5 cm (nl <= 3.0 cm)
Aorta - Descending Thoracic: *2.6 cm (nl <= 2.5 cm)
Aortic Valve - Peak Velocity: *6.2 m/sec (nl <= 2.0 m/sec)
Aortic Valve - Peak Gradient: 153 mm Hg
Aortic Valve - Mean Gradient: 133 mm Hg
Aortic Valve - LVOT Peak Vel: 1.00 m/sec
Aortic Valve - LVOT Diam: 2.2 cm
Aortic Valve - Valve Area: *0.4 cm2 (nl >= 3.0 cm2)
Mitral Valve - Peak Velocity: 0.6 m/sec
Mitral Valve - E Wave: 0.6 m/sec
Mitral Valve - A Wave: 0.3 m/sec
Mitral Valve - E/A Ratio: 2.00
Mitral Valve - E Wave Deceleration Time: 253 msec

INTERPRETATION:

Findings:

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size.
Normal regional LV
systolic function. Overall normal LVEF (>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Simple atheroma in aortic arch. Simple atheroma in
descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Severely
thickened/deformed aortic
valve leaflets. Severe AS (AoVA <0.8cm2). Mild to moderate
([**12-25**]+) AR.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR. [**First Name (Titles) **] [**Last Name (Titles) **]S. Trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) 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. Results were personally reviewed with the MD
caring for the
patient.

Conclusions:
Pre Bypass: There is mild symmetric left ventricular
hypertrophy. The left
ventricular cavity size is normal. Regional left ventricular
wall motion 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. There are three
aortic valve
leaflets. The aortic valve leaflets are severely
thickened/deformed. There is
severe aortic valve stenosis (area <0.8cm2). Mild to moderate
([**12-25**]+) aortic
regurgitation is seen. The mitral valve appears structurally
normal with
trivial mitral regurgitation. Trivial mitral regurgitation is
seen. There is
no pericardial effusion.

Post bypass: Patient is AV paced, on phenylepherine gtt. Overall
preserved
biventrciular function LVEF 50-55%. Septum appears
dyssynchronous, consistent
with ventricular pacing. There is a bioprosthetic Aortic valve
insitu. There
is no aortic insufficiency. The valve is well seated without
perivalvular
leaks. Prominent support struts are visulalized. There is normal
leaflet
motion. Post bypass peak and mean gradients are 24 mm Hg and 11
mm Hg,
respectively. There are no new valvular or aortic abnormalities
visualized.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD on [**2115-2-25**] 14:00.

Aortic valve pathology - not finalized





Brief Hospital Course:
Mr. [**Known lastname 1557**] was admitted and underwent an aortic valve
replacement by Dr. [**Last Name (STitle) 914**]. For surgical details, please see
seperate dictated operative note. Following the operation, he
was brought to the CSRU for invasive monitoring. Within 24
hours, he awoke neurologically intact and was extubated without
incident. He weaned from intravenous therapy and transferred to
the SDU on postoperative day two. Low dose beta blockade was
initiated and advanced as tolerated. He remained in a normal
sinus rhythm. Physical followed patient during entire post-op
course for strength and mobility. He continued to make steady
process without any post-op complications and was discharged
home with VNA services on post-op day five.

Medications on Admission:
Aspirin 81 qd, Multivitamin, Xalantan eye gtts, Cosopt eye gtts,
Amoxicillin prn dental procedures

Discharge Medications:
1. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
2. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
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:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
7. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
8. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO BID (2 times a day) for 5
days.
Disp:*20 Capsule, Sustained Release(s)* Refills:*0*
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 5 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Aortic Stenosis - s/p AVR,
Cataracts,
Glaucoma,
Shoulder Bursitis,
Hard of Hearing


Discharge Condition:
Good


Discharge Instructions:
[**Month (only) 116**] shower, no baths or swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns


Followup Instructions:
Dr [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

Dr [**Last Name (STitle) 2539**] in 1 week ([**Telephone/Fax (1) 49151**]) please call for appointment
Dr [**Last Name (STitle) **] in [**1-26**] weeks - please call for appointment
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3633**])



Completed by:[**2115-2-26**]
{'Aortic valve disorders,Unspecified cataract,Unspecified glaucoma'}


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: Dyspnea on exertion

PRESENT ILLNESS: Mr. [**Known lastname 1557**] is a very active 77 year old male with known aortic
stenosis who recently complained of increasing dyspnea on
exertion. There is no history of chest pain, syncope,
presyncope, orthopnea or PND. An excercise tolerance test in
[**2114-10-24**] revealed 2mm flat inferolateral ST depressions
which resolved with rest. He subsequently underwent cardiac
catheterization in [**2114-11-23**] which confirmed severe aortic
stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.6cm2, peak gradient of 65 mmHg and
mean of 62 mmHg. Coronary angiography showed a right dominant
system and no significant coronary artery disease. LV gram
showed LVEF of 58%. Based upon the above results, he was
referred for aortic valve replacment.

MEDICAL HISTORY: Aortic Stenosis, Cataracts, Glaucoma, Hard of hearing, Shoulder
Bursitis, s/p Skin Cancer removal

MEDICATION ON ADMISSION: Aspirin 81 qd, Multivitamin, Xalantan eye gtts, Cosopt eye gtts,
Amoxicillin prn dental procedures

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 134/74, HR 68, RR 14
General: well developed male in no acute distress, rubor face
HEENT: oropharynx benign, PERRL, sclera anicteric
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 4/6 systolic ejection murmur
Lungs: clear bilaterally
Abdomen: +ventral hernia, otherwise soft, nontender, normoactive
bowel sounds
Ext: warm, trace edema L>R, no varicosities
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Brother died of MI at age 42.

SOCIAL HISTORY: 20 pack year history of tobacco, quit 45 years ago. Admits to
occasional ETOH. Patient is married and retired from Fire
Department. 

### Response:
{'Aortic valve disorders,Unspecified cataract,Unspecified glaucoma'}
