CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: This is a 67 year old female with known history of aortic
stenosis that is followed by serial echocardiograms. She
complains of progressively worsening dyspnea on exertion.
Cardiac cath revealed no coronary artery disease.
She is now scheduled for aortic valve replacement this month.
Overall she feels well and has no major change in symptoms from
[**2182-8-1**].

MEDICAL HISTORY: Past Medical History:
Aotic Stenosis
Hypercholesterolemia
Hypertension
Hyperthyroidism with thyroid nodule
Nonspecific Thrombocytopenia ( mild)
Obesity
Depression
Meralgia paresthetica
Asthma
GERD
Dysglycemia
Thoracic back pain/sciatica
SVT ( episode during stress test)
remote esopagitis
Past Surgical History:
s/p Tonsillectomy

MEDICATION ON ADMISSION: METHIMAZOLE - 15 mg once a day
METOPROLOL SUCCINATE -50 mg Extended Release once a day
ROSUVASTATIN 5 mg once a day
CALCIUM CARBONATE - 500 mg calcium (1,250 mg) - 1 Tablet once a
day
CHOLECALCIFEROL 1,000 unit once a day
LYSINE -500 mg once a day

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: VS:
B/P  Right: 118/66  Left: 116/60
Height: 5'7 [**12-2**]"  Weight: 190 lbs

FAMILY HISTORY: Family History: Denies premature coronary artery disease

SOCIAL HISTORY: Race:Caucasian
Dental: clearance letter obtained
Lives with: Daughter
Contact: [**Name (NI) **] [**Name (NI) 88836**], [**First Name3 (LF) **]      Phone #[**Telephone/Fax (1) 88837**]
[**Name2 (NI) 27057**]tion: Runs coat checking business (has summer off)
Cigarettes: Smoked no [] yes [X] last cigarette [**2147**] Hx: 1.5 ppd
Other Tobacco use: no
ETOH: < 1 drink/week []  [**1-7**] drinks/week [X] >8 drinks/week []
Illicit drug use: Denies
Aortic valve disorders,Unspecified pleural effusion,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Toxic uninodular goiter without mention of thyrotoxic crisis or storm,Other secondary thrombocytopenia,Antithyroid agents causing adverse effects in therapeutic use,Personal history of tobacco use,Anemia, unspecified,Esophageal reflux,Depressive disorder, not elsewhere classified,Obesity, unspecified,Asthma, unspecified type, unspecified,Other iatrogenic hypotension,Meralgia paresthetica,Sciatica
Aortic valve disorder,Pleural effusion NOS,Hyperlipidemia NEC/NOS,Hypertension NOS,Tox uninod goit no cris,Sec thrombocytpenia NEC,Adv eff antithyroid agnt,History of tobacco use,Anemia NOS,Esophageal reflux,Depressive disorder NEC,Obesity NOS,Asthma NOS,Iatrogenc hypotnsion NEC,Meralgia paresthetica,Sciatica
Admission Date:  [**2182-12-3**]              Discharge Date:   [**2182-12-8**]

Date of Birth:  [**2115-4-23**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Ace Inhibitors

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion


Major Surgical or Invasive Procedure:
[**2182-12-3**] Aortic Valve Replacement (21mm [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] tissue)


History of Present Illness:
This is a 67 year old female with known history of aortic
stenosis that is followed by serial echocardiograms. She
complains of progressively worsening dyspnea on exertion.
Cardiac cath revealed no coronary artery disease.
She is now scheduled for aortic valve replacement this month.
Overall she feels well and has no major change in symptoms from
[**2182-8-1**].


Past Medical History:
Past Medical History:
Aotic Stenosis
Hypercholesterolemia
Hypertension
Hyperthyroidism with thyroid nodule
Nonspecific Thrombocytopenia ( mild)
Obesity
Depression
Meralgia paresthetica
Asthma
GERD
Dysglycemia
Thoracic back pain/sciatica
SVT ( episode during stress test)
remote esopagitis
Past Surgical History:
s/p Tonsillectomy


Social History:
Race:Caucasian
Dental: clearance letter obtained
Lives with: Daughter
Contact: [**Name (NI) **] [**Name (NI) 88836**], [**First Name3 (LF) **]      Phone #[**Telephone/Fax (1) 88837**]
[**Name2 (NI) 27057**]tion: Runs coat checking business (has summer off)
Cigarettes: Smoked no [] yes [X] last cigarette [**2147**] Hx: 1.5 ppd
Other Tobacco use: no
ETOH: < 1 drink/week []  [**1-7**] drinks/week [X] >8 drinks/week []
Illicit drug use: Denies


Family History:
Family History: Denies premature coronary artery disease


Physical Exam:
VS:
B/P  Right: 118/66  Left: 116/60
Height: 5'7 [**12-2**]"  Weight: 190 lbs

General: WDWN female in NAD
Skin: Dry []x intact [x]
HEENT: PERRLA [x] EOMI [x]anicteric sclera;OP unremarkable
Neck: Supple [x] Full ROM []no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR [x] Irregular [] Murmur [x] grade ___3/6 systolic
radiates throughout chest to carotids___
Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x] no
HSM
Extremities: Warm [x], well-perfused [x] Edema  none
Varicosities: R lat thigh
Neuro: Grossly intact [x];nonfocal exam;MAE [**4-5**] strengths
Pulses:
Femoral      Right: 2+  Left:2+
DP           Right: 1+  Left:1+
PT           [**Name (NI) 167**]:NP   Left:NP
Radial       Right:2+   Left:2+

Carotid Bruit    -murmur radiates to carotids


Pertinent Results:
Admission labs:
[**2182-12-3**] 10:31AM   WBC-8.5# RBC-2.67*# HGB-7.8*# HCT-23.7*#
MCV-89 MCH-29.0 MCHC-32.7 RDW-13.7
[**2182-12-3**] 12:15PM   PT-11.6 PTT-30.5 INR(PT)-1.1
[**2182-12-3**] 12:15PM   WBC-7.0 RBC-3.02* HGB-9.0* HCT-27.0* MCV-90
MCH-29.9 MCHC-33.3 RDW-13.8
[**2182-12-3**] 12:15PM   UREA N-12 CREAT-0.6 SODIUM-143 POTASSIUM-4.0
CHLORIDE-114* TOTAL CO2-24 ANION GAP-9
Discharge labs:

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  60% to 65%  >= 55%
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  *4.2 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *81 mm Hg  < 20 mm Hg
Aortic Valve - LVOT diam:  2.0 cm
Aortic Valve - Valve Area:  *0.9 cm2  >= 3.0 cm2
Findings
LEFT ATRIUM: Mild LA enlargement. No spontaneous echo contrast
or thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. No mass/thrombus in
the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good (>20 cm/s) LAA ejection velocity. No
thrombus in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or
color Doppler.
LEFT VENTRICLE: Severe symmetric LVH. Normal LV cavity size.
Overall normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV free wall thickness. Normal RV
chamber size. Normal RV systolic function.
AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Normal
descending aorta diameter. Simple atheroma in descending aorta.
AORTIC VALVE: Three aortic valve leaflets. Severely
thickened/deformed aortic valve leaflets. No masses or
vegetations on aortic valve. Severe AS (area 0.8-1.0cm2).
Moderate (2+) AR.
MITRAL VALVE: Moderate mitral annular calcification. No MS.
Moderate (2+) MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.
PERICARDIUM: Trivial/physiologic pericardial effusion.
GENERAL COMMENTS: The patient was under general anesthesia
throughout the procedure. The patient received antibiotic
prophylaxis. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications. Results were personally reviewed with the MD
caring for the patient.
REGIONAL LEFT VENTRICULAR WALL MOTION:
     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
Pre-CPB: 1.The left atrium is mildly dilated. No spontaneous
echo contrast or thrombus is seen in the body of the left atrium
or left atrial appendage. No mass/thrombus is seen in the left
atrium or left atrial appendage. No thrombus is seen in the left
atrial appendage.
2. No atrial septal defect is seen by 2D or color Doppler.
3. There is severe symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
4. The right ventricular free wall thickness is normal. Right
ventricular chamber size is normal. with normal free wall
contractility.
5. There are simple atheroma in the descending thoracic aorta.
6. There are three aortic valve leaflets. There was minimal
movement of the NCC and RCC. The aortic valve leaflets are
severely thickened/deformed. No masses or vegetations are seen
on the aortic valve. There is severe aortic valve stenosis
(valve area 0.8-1.0cm2). Moderate (2+) aortic regurgitation is
seen.
7. Moderate (2+) mitral regurgitation is seen.
8. There is a trivial/physiologic pericardial effusion.
Dr. [**Last Name (STitle) **] was notified in person of the results.
Post-CPB: On infusion of phenylephrine, AV-pacing for slow CHB
(initially). Well-seated bioprosthetic valve in aortic position
with trivial valvular AI, transvalvular gradient measured at
15mmHg. Preserved biventricular systolic function, 1+ MR, aortic
contour normal post-decannulation.


Brief Hospital Course:
Ms [**Known lastname 88836**] was a same day admission to the operating room for a
scheduled aortic valve replacement. Please see the operative
report for details,in summary she had:
Aortic valve replacement with a 21mm [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**] tissue valve. Her
cardiopulmonary bypass time was 57 minutes with a crossclamp
time of 42 minutes.
She tolerated the operation well and was transferred from the
operating room to the cardiac surgery ICU in stable condition
with minimal vasopressor support.
She remained hemodynamically stable in the immediate post-op
period, her anesthesia was reversed, she woke neurologically
intact and was extubated.
On POD1 she was transferred from the cardiac surgery ICU too the
stepdown floor for continued post-op care. All tubes lines and
drains were removed per cardiac surgery protocol. She was
transfused one unit PRBC for post-op anemia. She reports
postoperative intermittent visual changes, lasting only seconds.
No focal defecit appreciated. As discussed with Dr.[**Last Name (STitle) **],
Ms.[**Known lastname 88836**] will alert the cardiac surgery service if these
symptoms persist. Dr[**Last Name (STitle) **] office will also follow up in 1
week after discharge to ascertain whether Ms.[**Known lastname 88836**] will require
an outpatient eval by Neuro and/or Opthamologist.
The remainder of her hospital course was uneventful. She worked
with nursing and physical therapy to increase her strength and
endurance. By POD# 5 she was ready for discharge home with
visiting nurses. She is to follow up with Dr [**Last Name (STitle) **] in 1week at
wound clinic and at 1 month in cardiac surgery clinic.

Medications on Admission:
METHIMAZOLE - 15 mg once a day
METOPROLOL SUCCINATE -50 mg Extended Release once a day
ROSUVASTATIN 5 mg once a day
CALCIUM CARBONATE - 500 mg calcium (1,250 mg) - 1 Tablet once a
day
CHOLECALCIFEROL 1,000 unit once a day
LYSINE -500 mg once a day


Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO Q12H (every 12 hours) for 5 days.
Disp:*20 Tablet Extended Release(s)* Refills:*0*
3. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
8. methimazole 10 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Aortic Stenosis s/p AVR
PMH:
Hypercholesterolemia
Hypertension
Hyperthyroidism with thyroid nodule
Nonspecific Thrombocytopenia ( mild)
Obesity
Depression
Meralgia paresthetica
Asthma
GERD
Dysglycemia
Thoracic back pain/sciatica
SVT ( episode during stress test)
remote esopagitis
PSH:
Tonsillectomy


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesia
Incisions: Sternal - healing well, no erythema or drainage
Leg Edema:


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:
Wound Check on [**12-12**] at 11:00am [**Hospital **] Medical Office Building
[**Hospital Unit Name **] [**Telephone/Fax (1) 1504**]
Surgeon: Dr [**First Name (STitle) **] [**Name (STitle) **] on [**1-8**] at 1:15pm [**Hospital **] Medical Office
Building [**Hospital Unit Name **] [**Telephone/Fax (1) 1504**]
Cardiologist:Dr [**First Name8 (NamePattern2) 88838**] [**Last Name (NamePattern1) 1923**] on [**12-31**] at 2:30pm

Please call to schedule appointment with:
Primary Care: Dr [**Last Name (STitle) **],[**First Name3 (LF) **] L. [**Telephone/Fax (1) 88839**] in [**3-6**] weeks

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




Completed by:[**2182-12-8**]
{'Aortic valve disorders,Unspecified pleural effusion,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Toxic uninodular goiter without mention of thyrotoxic crisis or storm,Other secondary thrombocytopenia,Antithyroid agents causing adverse effects in therapeutic use,Personal history of tobacco use,Anemia, unspecified,Esophageal reflux,Depressive disorder, not elsewhere classified,Obesity, unspecified,Asthma, unspecified type, unspecified,Other iatrogenic hypotension,Meralgia paresthetica,Sciatica'}


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: This is a 67 year old female with known history of aortic
stenosis that is followed by serial echocardiograms. She
complains of progressively worsening dyspnea on exertion.
Cardiac cath revealed no coronary artery disease.
She is now scheduled for aortic valve replacement this month.
Overall she feels well and has no major change in symptoms from
[**2182-8-1**].

MEDICAL HISTORY: Past Medical History:
Aotic Stenosis
Hypercholesterolemia
Hypertension
Hyperthyroidism with thyroid nodule
Nonspecific Thrombocytopenia ( mild)
Obesity
Depression
Meralgia paresthetica
Asthma
GERD
Dysglycemia
Thoracic back pain/sciatica
SVT ( episode during stress test)
remote esopagitis
Past Surgical History:
s/p Tonsillectomy

MEDICATION ON ADMISSION: METHIMAZOLE - 15 mg once a day
METOPROLOL SUCCINATE -50 mg Extended Release once a day
ROSUVASTATIN 5 mg once a day
CALCIUM CARBONATE - 500 mg calcium (1,250 mg) - 1 Tablet once a
day
CHOLECALCIFEROL 1,000 unit once a day
LYSINE -500 mg once a day

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: VS:
B/P  Right: 118/66  Left: 116/60
Height: 5'7 [**12-2**]"  Weight: 190 lbs

FAMILY HISTORY: Family History: Denies premature coronary artery disease

SOCIAL HISTORY: Race:Caucasian
Dental: clearance letter obtained
Lives with: Daughter
Contact: [**Name (NI) **] [**Name (NI) 88836**], [**First Name3 (LF) **]      Phone #[**Telephone/Fax (1) 88837**]
[**Name2 (NI) 27057**]tion: Runs coat checking business (has summer off)
Cigarettes: Smoked no [] yes [X] last cigarette [**2147**] Hx: 1.5 ppd
Other Tobacco use: no
ETOH: < 1 drink/week []  [**1-7**] drinks/week [X] >8 drinks/week []
Illicit drug use: Denies 

### Response:
{'Aortic valve disorders,Unspecified pleural effusion,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Toxic uninodular goiter without mention of thyrotoxic crisis or storm,Other secondary thrombocytopenia,Antithyroid agents causing adverse effects in therapeutic use,Personal history of tobacco use,Anemia, unspecified,Esophageal reflux,Depressive disorder, not elsewhere classified,Obesity, unspecified,Asthma, unspecified type, unspecified,Other iatrogenic hypotension,Meralgia paresthetica,Sciatica'}
