CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 79-year-old female
with a known history of aortic stenosis who presented to the
hospital on [**2135-9-11**] with increasing shortness of
breath.  The patient had aortic regurgitation recent hospital
admission in [**2135-6-24**] for syncope at which time she was
noted to have AV block leading to permanent pacemaker
placement.  The patient was also found to be anemic at that
time.  She was discharged from the hospital without sequelae
and was doing well at home until the day prior to admission
when she had mild epigastric discomfort, orthopnea and
shortness of breath with minimal exertion.  The patient came
to the Emergency Department where she was treated with
intravenous Lasix and started on intravenous nitroglycerin
and admitted to the coronary care unit.

MEDICAL HISTORY: 1.  Aortic stenosis.  The patient had an echocardiogram in
[**Month (only) **] of this year which revealed severe aortic stenosis with
aortic valve are of 0.8 and left ventricular ejection
fraction of 50%.  She also underwent a cardiac
catheterization on [**2135-7-7**] which revealed an LAD
lesion of 80%.
2.  Hypertension
3.  Permanent pacemaker, status post AV block
4.  Status post total abdominal hysterectomy/bilateral
salpingo-oophorectomy
5.  Gastroesophageal reflux disease
6.  Hypercholesterolemia
7.  Chronic anemia
8.  Atrial fibrillation/flutter on amiodarone and Coumadin
preoperatively

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Aortic valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux,Unspecified essential hypertension
Aortic valve disorder,CHF NOS,Atrial fibrillation,Pneumonia, organism NOS,Crnry athrscl natve vssl,Pure hypercholesterolem,Esophageal reflux,Hypertension NOS
Admission Date:  [**2135-9-11**]       Discharge Date:  [**2135-9-23**]


Service:  CARDIOTHORACIC SURGERY

HISTORY OF PRESENT ILLNESS:  This is a 79-year-old female
with a known history of aortic stenosis who presented to the
hospital on [**2135-9-11**] with increasing shortness of
breath.  The patient had aortic regurgitation recent hospital
admission in [**2135-6-24**] for syncope at which time she was
noted to have AV block leading to permanent pacemaker
placement.  The patient was also found to be anemic at that
time.  She was discharged from the hospital without sequelae
and was doing well at home until the day prior to admission
when she had mild epigastric discomfort, orthopnea and
shortness of breath with minimal exertion.  The patient came
to the Emergency Department where she was treated with
intravenous Lasix and started on intravenous nitroglycerin
and admitted to the coronary care unit.

PAST MEDICAL HISTORY:
1.  Aortic stenosis.  The patient had an echocardiogram in
[**Month (only) **] of this year which revealed severe aortic stenosis with
aortic valve are of 0.8 and left ventricular ejection
fraction of 50%.  She also underwent a cardiac
catheterization on [**2135-7-7**] which revealed an LAD
lesion of 80%.
2.  Hypertension
3.  Permanent pacemaker, status post AV block
4.  Status post total abdominal hysterectomy/bilateral
salpingo-oophorectomy
5.  Gastroesophageal reflux disease
6.  Hypercholesterolemia
7.  Chronic anemia
8.  Atrial fibrillation/flutter on amiodarone and Coumadin
preoperatively

ALLERGIES:  The patient states no known drug allergies.

ADMISSION MEDICATIONS:
1.  Hydrochlorothiazide 25 mg po qd
2.  Aspirin 325 mg po qd
3.  Verapamil 60 mg po qd
4.  Zyrtec 10 mg po qd
5.  Eyedrops for glaucoma
6.  Prilosec 20 mg po qd
7.  Multivitamins
8.  Iron
9.  Coumadin, varying doses, 2 mg alternating with 4 mg every
other day
10. Amiodarone
11. Lopressor 25 mg [**Hospital1 **]

PHYSICAL EXAMINATION ON ADMISSION:
GENERAL:  The patient is a pleasant female who is acutely
short of breath.
CORONARY:  Regular rate and rhythm with a grade 2/6 systolic
murmur.
PULMONARY:  She has bibasilar crackles with wheezes.
ABDOMEN:  Unremarkable.
EXTREMITIES:  Cool.  Pulses are palpable distally.
NEUROLOGIC:  Unremarkable, alert and oriented x3.

LABORATORY VALUE ON ADMISSION:  White blood cell count 8.9,
hematocrit 33.2, platelets 280,000.  Creatinine upon
admission is 1.6.  CPK total was 47 and troponin 0.3.
Blood gas upon admission was pH 7.26, PCO2 42, PO2 63 on 100%
nonrebreather mask.

HOSPITAL COURSE:  The patient was subsequently admitted to
the coronary care unit.  She was placed on intravenous
nitroglycerin and heparin and she was on BIPAP mask and was
pan cultured.  She was empirically placed on antibiotics for
presumed pneumonia.  A cardiology consultation was obtained
and it was the thought of the cardiology service to consider
aortic valve replacement at that time.  She was maintained on
the medicine service where she was being treated for presumed
pneumonia with levofloxacin.  She was being followed in the
Intensive Care Unit by cardiology service, as well as
medicine service.  She was being aggressively diuresed
throughout this course.

On[**Last Name (STitle) **]tal day #4, [**2135-9-14**], the patient was
transferred out of the coronary care unit to the telemetry
floor.  The patient was taken to the cardiac catheterization
lab on [**2135-9-15**] where she was found to have critical
aortic stenosis and markedly depressed cardiac output and one
vessel coronary artery disease.  An endocrine medicine
consult was obtained on [**2135-9-16**] due to elevate T4
and decreased TSH on amiodarone.  It was their feeling at
that time to not intervene or change anything in her care.
She was asymptomatic from these abnormal thyroid function
studies.  Cardiothoracic surgery consult was obtained on
[**2135-9-17**] by Dr. [**Last Name (Prefixes) **] who felt that she was an
appropriate candidate for aortic valve replacement which was
scheduled for [**2135-9-19**].  A dental consultation was
obtained also on [**9-17**] and it was a dental consultant's
feeling that there was no contraindication to the surgical
procedure.  The patient was taken to the Operating Room on
[**2135-9-19**] where she underwent an aortic valve
replacement with a #21 St. [**Male First Name (un) 923**] aortic valve.
Postoperatively, she was on dobutamine.  She was AV paced on
propofol drip.  She was transported from the Operating Room
to the cardiac surgery recovery in stable condition.

On postoperative day #1, the patient remained fully paced on
intravenous amiodarone, apparently to suppress her history of
atrial fibrillation which was her baseline rhythm as well.
Her Neo-Synephrine was placed on the night of surgery and
weaned off by the morning of postoperative day #1.  She was
weaned off all vasoactive drips.  She was weaned from
mechanical ventilator and extubated successfully and her
chest tubes were discontinued.  On postoperative day #1, also
[**2135-9-20**], her permanent pacemaker was interrogated
and found to be functioning appropriately.  On postoperative
day #2, the patient remained hemodynamically stable.  She was
continued on diuretics.  She was begun on Coumadin for
anticoagulation for her chronic atrial fibrillation, as well
as her mechanical aortic valve and she was transferred from
the Intensive Care Unit to the telemetry floor.  The patient
was evaluated on postoperative day #2 by physical therapy.
The patient was found to be significantly deconditioned,
requiring assistance with ambulation and mobility.

On postoperative day #3, [**2135-9-22**], the patient
remained 100% AV paced with a stable blood pressure.  On
postoperative day #4, [**2135-9-23**], the patient remains
hemodynamically stable and ready to be transferred to a
rehabilitation facility to increase with strength and
endurance on physical therapy.  The patient's condition today
is as follows:  Most recent laboratory values are from today
[**9-23**], which reveal a white blood cell count of
16.5000, hematocrit of 33.6, platelet count od 219,000.  Her
PT is 19.0 with an INR of 2.4 today which is up from 1.6
yesterday on [**9-22**].  Sodium 138, potassium 4.5,
chloride 103, CO2 20, BUN 43, creatinine 1.4, glucose 79.
Vital signs:  Temperature 98.3??????, pulse 70, respiratory rate
18, blood pressure 138/70.  Weight today is 54.8 kg which is
up somewhat from her preoperative weight of 47 kg.

PHYSICAL EXAMINATION TODAY:
NEUROLOGIC:  The patient is alert and oriented in no apparent
distress.
CARDIAC:  She has an audible S1, S2 with no murmurs, rubs or
gallops.
STERNUM:  Her sternum is stable.  Her incision is clean, dry
and intact with staples in place.
PULMONARY:  The patient does have bibasilar crackles, but is
otherwise clear to auscultation.
ABDOMEN:  Unremarkable.
EXTREMITIES:  Peripherally, the patient has minimal edema in
her feet bilaterally.  Her feet are warm and well perfused
with palpable pulses.

DISCHARGE MEDICATIONS:
1.  Lopressor 25 mg po bid
2.  Lasix 40 mg po bid x10 days
3.  Potassium chloride 20 milliequivalents po bid x10 day
4.  Colace 100 mg po bid
5.  Protonix 40 mg po qd
6.  Zyrtec 10 mg po qd
7.  Amiodarone 400 mg po qd
8.  Alphagan 1 drop to the left eye tid
9.  Timolol 0.5% 1 drop left eye tid
10. Trusopt eyedrops 1 drop to the left eye tid
11. Coumadin.  The patient has received 5 mg of Coumadin on
[**9-21**].  She also received 5 mg of Coumadin on [**9-22**].  She is scheduled to receive 2 mg of Coumadin today,
[**9-23**], as she is therapeutic with an INR today of 2.4.
Her goal INR is 2.5 to 3.

The patient had received some captopril postoperatively, but
there was a question of a possible history of renal artery
stenosis which is not possible to ascertain definitively at
this time.  It was felt best not to continue the captopril
since her blood pressure had been fairly well controlled on
the Lopressor.

DISCHARGE CONDITION:  Stable

DISCHARGE DIAGNOSES:
1.  Aortic stenosis, status post aortic valve replacement
2.  Hypertension
3.  Permanent pacemaker
4.  Gastroesophageal reflux disease
5.  Hypercholesterolemia

Th[**Last Name (STitle) 1050**] is being discharged today to rehabilitation
facility to increase her strength and mobility.  She is to
follow up with Dr. [**Last Name (Prefixes) **] in approximately one month for
postoperative evaluation.  She is also to follow up with
primary care physician, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], in three to four weeks
or upon discharge from rehabilitation facility.




                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 964**]
MEDQUIST36

D:  [**2135-9-23**]  10:09
T:  [**2135-9-23**]  10:28
JOB#:  [**Job Number 94779**]
{'Aortic valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux,Unspecified essential hypertension'}


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: 

PRESENT ILLNESS: This is a 79-year-old female
with a known history of aortic stenosis who presented to the
hospital on [**2135-9-11**] with increasing shortness of
breath.  The patient had aortic regurgitation recent hospital
admission in [**2135-6-24**] for syncope at which time she was
noted to have AV block leading to permanent pacemaker
placement.  The patient was also found to be anemic at that
time.  She was discharged from the hospital without sequelae
and was doing well at home until the day prior to admission
when she had mild epigastric discomfort, orthopnea and
shortness of breath with minimal exertion.  The patient came
to the Emergency Department where she was treated with
intravenous Lasix and started on intravenous nitroglycerin
and admitted to the coronary care unit.

MEDICAL HISTORY: 1.  Aortic stenosis.  The patient had an echocardiogram in
[**Month (only) **] of this year which revealed severe aortic stenosis with
aortic valve are of 0.8 and left ventricular ejection
fraction of 50%.  She also underwent a cardiac
catheterization on [**2135-7-7**] which revealed an LAD
lesion of 80%.
2.  Hypertension
3.  Permanent pacemaker, status post AV block
4.  Status post total abdominal hysterectomy/bilateral
salpingo-oophorectomy
5.  Gastroesophageal reflux disease
6.  Hypercholesterolemia
7.  Chronic anemia
8.  Atrial fibrillation/flutter on amiodarone and Coumadin
preoperatively

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Aortic valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux,Unspecified essential hypertension'}
