CHIEF COMPLAINT: Shortness of breath with activity

PRESENT ILLNESS: Ms. [**Known lastname **] is a 75-year-old
patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 11493**] who was referred to us with a
history of severe aortic stenosis.  She does not complain of
any chest pain, but does report progressive shortness of
breath with exertion that has been getting worse over the
past year.  She finds that she needs to stop and rest to
catch her breath while cleaning the house and becomes very
short of breath in doing things such as ascending a flight of
stairs.  Her last echocardiogram in [**2147-8-21**] demonstrated
a mean aortic valve gradient of 45 mmHg and a peak gradient
of 70 mmHg with an estimated valve area of 0.5 square cm.
She had a cardiac catheterization that demonstrated a 50%
lesion in the LAD and mid right coronary artery lesion.  At
time of catheterization, she had a mean gradient to 60 mmHg.

MEDICAL HISTORY: 1.  Aortic stenosis
2.  Hypertension
3.  Hypercholesterolemia

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is not allergic to any medicines.

PHYSICAL EXAM: VITAL SIGNS:  Her heart rate is 54.  Her blood pressure is
153/69.  Her preoperative weight is 46.8 kg.
GENERAL:  She is an older woman in no acute distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Her pupils are equally
round and reactive to light.  Neck is supple, good range of
motion, no tenderness or swelling.  There is no jugular
venous distention.
CHEST:  Distant breath sounds, but is otherwise clear to
auscultation.  She has a hard gumball size nodule in her
right breast.
HEART:  Normal S1 and S2 with a loud blowing systolic murmur
heard best at the left sternal border.
ABDOMEN:  Soft with no active bowel sounds.  No masses, no
aortic pulsations or abdominal bruits.
EXTREMITIES:  Warm with slightly cool toes.
NEUROLOGIC:  She is awake and oriented with equal strength
throughout.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Atrial fibrillation,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Aortic valve disorder,Atrial fibrillation,Pleural effusion NOS,Chr airway obstruct NEC,Pneumonia, organism NOS,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2148-4-23**]       Discharge Date:  [**2148-5-4**]

Date of Birth:   [**2072-3-30**]       Sex:  F

Service:  CARDIAC SURGERY

CHIEF COMPLAINT:  Shortness of breath with activity

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname **] is a 75-year-old
patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 11493**] who was referred to us with a
history of severe aortic stenosis.  She does not complain of
any chest pain, but does report progressive shortness of
breath with exertion that has been getting worse over the
past year.  She finds that she needs to stop and rest to
catch her breath while cleaning the house and becomes very
short of breath in doing things such as ascending a flight of
stairs.  Her last echocardiogram in [**2147-8-21**] demonstrated
a mean aortic valve gradient of 45 mmHg and a peak gradient
of 70 mmHg with an estimated valve area of 0.5 square cm.
She had a cardiac catheterization that demonstrated a 50%
lesion in the LAD and mid right coronary artery lesion.  At
time of catheterization, she had a mean gradient to 60 mmHg.

PAST MEDICAL HISTORY:
1.  Aortic stenosis
2.  Hypertension
3.  Hypercholesterolemia

MEDICATIONS:
1.  Aspirin 325 mg po q day
2.  Nifedipine 60 mg po bid
3.  Lopressor 50 mg po bid
4.  Vasotec 20 mg po bid
5.  Hydrochlorothiazide

ALLERGIES:  The patient is not allergic to any medicines.

PHYSICAL EXAM:
VITAL SIGNS:  Her heart rate is 54.  Her blood pressure is
153/69.  Her preoperative weight is 46.8 kg.
GENERAL:  She is an older woman in no acute distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Her pupils are equally
round and reactive to light.  Neck is supple, good range of
motion, no tenderness or swelling.  There is no jugular
venous distention.
CHEST:  Distant breath sounds, but is otherwise clear to
auscultation.  She has a hard gumball size nodule in her
right breast.
HEART:  Normal S1 and S2 with a loud blowing systolic murmur
heard best at the left sternal border.
ABDOMEN:  Soft with no active bowel sounds.  No masses, no
aortic pulsations or abdominal bruits.
EXTREMITIES:  Warm with slightly cool toes.
NEUROLOGIC:  She is awake and oriented with equal strength
throughout.

ADMISSION LABS:  Her white count is 6.9, hematocrit 36.8,
platelets 186.  BUN and creatinine are 19 and 1.2.  Her
potassium is 4.4.

HOSPITAL COURSE:  The patient was admitted through same day
admissions and on [**2148-4-23**], was taken to the Operating
Room where she had a two vessel coronary artery bypass graft
with a tissue aortic valve replacement.  Her grafts are left
internal mammary artery to LAD and saphenous vein graft to
distal right coronary artery.  In addition, she has a #19 RSR
pericardial valve.  Her procedure itself was unremarkable
postoperatively.  She was taken intubated on Levophed and
propofol drips to the Cardiac Surgery Intensive Care Unit.
That night she had what we considered to be an enormous
volume requirement and had to be transfused with 2 units of
packed red blood cells, 2 units of fresh frozen plasma and
another 3500 cc of crystalloid.  In addition, she required
milrinone in addition to her Levophed.  All of this for
cardiac index swan numbers that continued to diminish.  She
did have some atrial and ventricular ectopy and was started
on intravenous amiodarone.

By the first postoperative day, she remained intubated, but
later on that day was extubated.  She never had to be
reintubated, but she did require BIPAP on that evening for in
increase work up breathing.  By the second postoperative day,
she was maintaining her saturations on 100% nonrebreather and
over the next day was able to be weaned to a face tent and 4
liters of nasal cannula.  She spent several days in the
Intensive Care Unit because of her tenuous pulmonary status.
In addition, she had several bouts of atrial fibrillation
with rates anywhere from 80 to 130.  Each time these
corrected with a little bit of intravenous Lopressor or oral
Lopressor and intravenous amiodarone.  She continued to have
these paroxysmal episodes of atrial fibrillation for about
the first five postoperative days.  However, since that time,
no further episodes were seen and it was believed that she
had become therapeutic on her amiodarone.  For this reason,
she did not need to be anticoagulated.

The patient remained in the Intensive Care Unit for a total
of nine days during this time.  We used her intensive
monitoring setting to properly diurese her and observe her
for any further arrhythmia.  On the ninth postoperative day,
she was transferred to the floor without incident.  From
there she remained stable and discharge planning was
initiated.  This discharge summary was dictated on [**5-3**]
in the anticipation that the patient may go to rehabilitation
on the following day.

The patient was transferred to rehabilitation on the
following medications:
1.  Lopressor 25 mg po bid, hold for heart rate less than 55,
systolic blood pressure less than 100
2.  Colace 100 mg po bid
3.  Aspirin 325 mg po q day
4.  Amiodarone 400 mg po bid x7 days, then 400 mg po q day
5.  Protonix 40 mg po q day
6.  Heparin 5000 units subcutaneous [**Hospital1 **]
7.  Klonopin 0.25 mg po q hs prn
8.  Lasix 40 mg po bid x7 days
9.  Potassium chloride 20 milliequivalents po bid x7 days
10. Tylenol 650 mg po q 4 to 6 hours prn
11. Colace 100 mg po bid
12. Atrovent metered dose inhaler 2 puffs qid

After seven days, the patient's Lasix and potassium may or
may not need to continue.  Of note, she is not presently on
her Vasotec and hydrochlorothiazide that she took
preoperatively.  These may need to be restarted in the next
seven days.

The patient is instructed to follow up with her primary care
physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 27542**], in approximately two weeks.
In addition, she is to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] in
approximately four weeks.

DISCHARGE DIAGNOSES:
1.  Aortic stenosis
2.  Coronary artery disease, now status post coronary artery
bypass graft x2 with tissue aortic valve replacement
3.  Hypertension, controlled
4.  Hypercholesterolemia, controlled




                            [**First Name11 (Name Pattern1) 275**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 9638**]
MEDQUIST36

D:  [**2148-5-3**]  13:10
T:  [**2148-5-3**]  13:23
JOB#:  [**Job Number 4515**]


Admission Date:  [**2148-4-23**]       Discharge Date:  [**2148-5-7**]

Date of Birth:   [**2072-3-30**]       Sex:  F

Service:  Cardiac [**Doctor First Name **]

DISCHARGE SUMMARY ADDENDUM: On the day that we anticipated
the patient to be transferred to rehabilitation, she became
acutely more short of breath with an increased oxygen
requirement. In addition she had a new left lower lobe
infiltrate that was interpreted as a consolidation versus
atelectasis. In addition her white blood cell count surged
from 7,000 to 27,000. For this reason we believe she had
developed acute pneumonia. She was transferred back to the
Intensive Care Unit for aggressive pulmonary toilet and close
observation.

Over the course of the following two days her white count
improved. She remained afebrile and her pulmonary status
improved. Her diuretics were adjusted from 40 of Lasix [**Hospital1 **] to
20 of Lasix [**Hospital1 **] as around the time of this episode her
creatinine spiked from 1.4 to 1.9. This improved by the time
of her discharge back to a baseline creatinine of
approximately 1.5. While she was in the Intensive Care Unit
she had further episodes of paroxysmal atrial fibrillation.
For this reason the decision was made to finally
anticoagulate her. She was started on 2.5 mg of Coumadin po q
HS. This will need to be adjusted once she goes to
rehabilitation.

On [**2148-5-6**] the patient was transferred out of Intensive
Care and the following day was stable enough to be discharged
to rehabilitation. She was discharged to the [**Hospital3 38761**]at [**Location (un) **].

DISCHARGE MEDICATIONS:
1.  Lopressor 25 mg po bid.
2.  Aspirin 325 mg po q day.
3.  Amiodarone 200 mg po bid.
4.  Zantac 150 mg po bid.
5.  Heparin sub q 5,000 units [**Hospital1 **].
6.  Colace 100 mg po bid.
7.  Lasix 20 mg po bid.
8.  Potassium chloride 20 milliequivalents po bid.
9.  Atrovent metered dose inhaler two puffs q four hours prn.
10. Coumadin 2.5 mg po q HS.
11. Levaquin 250 mg po q day.

The rehabilitation staff was advised that in approximately
one week they will need to reevaluate her need for Lasix and
potassium in addition she may need to restart her Ace
inhibitors and hydrochlorothiazide. Finally her primary care
physician [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 30442**] was telephoned at
[**Telephone/Fax (1) 27541**]. He was told that the patient was being
discharged on Coumadin and he will be following up with the
rehabilitation center team to ensure that her outpatient
anticoagulation is correct.



                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 9638**]
MEDQUIST36

D:  [**2148-5-7**]  13:52
T:  [**2148-5-9**]  10:27
JOB#:  [**Job Number 38762**]
{'Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Atrial fibrillation,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Unspecified essential hypertension,Pure hypercholesterolemia'}


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 with activity

PRESENT ILLNESS: Ms. [**Known lastname **] is a 75-year-old
patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 11493**] who was referred to us with a
history of severe aortic stenosis.  She does not complain of
any chest pain, but does report progressive shortness of
breath with exertion that has been getting worse over the
past year.  She finds that she needs to stop and rest to
catch her breath while cleaning the house and becomes very
short of breath in doing things such as ascending a flight of
stairs.  Her last echocardiogram in [**2147-8-21**] demonstrated
a mean aortic valve gradient of 45 mmHg and a peak gradient
of 70 mmHg with an estimated valve area of 0.5 square cm.
She had a cardiac catheterization that demonstrated a 50%
lesion in the LAD and mid right coronary artery lesion.  At
time of catheterization, she had a mean gradient to 60 mmHg.

MEDICAL HISTORY: 1.  Aortic stenosis
2.  Hypertension
3.  Hypercholesterolemia

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is not allergic to any medicines.

PHYSICAL EXAM: VITAL SIGNS:  Her heart rate is 54.  Her blood pressure is
153/69.  Her preoperative weight is 46.8 kg.
GENERAL:  She is an older woman in no acute distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Her pupils are equally
round and reactive to light.  Neck is supple, good range of
motion, no tenderness or swelling.  There is no jugular
venous distention.
CHEST:  Distant breath sounds, but is otherwise clear to
auscultation.  She has a hard gumball size nodule in her
right breast.
HEART:  Normal S1 and S2 with a loud blowing systolic murmur
heard best at the left sternal border.
ABDOMEN:  Soft with no active bowel sounds.  No masses, no
aortic pulsations or abdominal bruits.
EXTREMITIES:  Warm with slightly cool toes.
NEUROLOGIC:  She is awake and oriented with equal strength
throughout.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Atrial fibrillation,Unspecified pleural effusion,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Unspecified essential hypertension,Pure hypercholesterolemia'}
