CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Mrs. [**Known lastname 77670**] is an 83 year old female with known aortic
stenosis and new onset atrial fibrillation. In preperation for
aortic valve replacement she underwent cardiac catheterization
which revealed only a 70% lesion in the first diagonal artery.
Her coronaries were otherwise normal. Her LVEF was estimated at
60% and there was mild mitral regurgitation.  On echocardiogram,
she had severe aortic stenosis with a mean gradient of 68mmHg.
There was moderate mitral regurgitation. Prior to surgery, her
major complaints were dyspnea on exertion, worsening fatigue and
lower extremity edema. She had no history of syncope.

MEDICAL HISTORY: Aortic Stenosis
Atrial Fibrillation
Chronic Diastolic Congestive Heart Failure
Hypertension
Dyslipidemia
Anemia
History of Kidney Stones
Appendectomy
Resection of Benign Breast Tumor
Ceserean Section

MEDICATION ON ADMISSION: Metoprolol 200 qd, Lipitor 10 qd, Lisinopril 20 qd, Warfarin,
Imodium prn, HCTZ 25 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 150/80, 87, 14
General: Elderly female in no acute distress
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, 4/6 systolic ejection murmur >
carotids
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, 1+ edema bilaterally
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Denies premature coronary disease.

SOCIAL HISTORY: Denies tobacco and ETOH. Widowed, lives alone.
Atrial fibrillation,Acute on chronic diastolic heart failure,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified
Atrial fibrillation,Ac on chr diast hrt fail,Aortic valve disorder,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Anemia NOS
Admission Date:  [**2120-4-25**]              Discharge Date:   [**2120-4-30**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2120-4-25**] Aortic Valve Replacement(19mm St. [**Male First Name (un) 923**] Epic Suprannular
Tissue Valve) and Maze Procedure


History of Present Illness:
Mrs. [**Known lastname 77670**] is an 83 year old female with known aortic
stenosis and new onset atrial fibrillation. In preperation for
aortic valve replacement she underwent cardiac catheterization
which revealed only a 70% lesion in the first diagonal artery.
Her coronaries were otherwise normal. Her LVEF was estimated at
60% and there was mild mitral regurgitation.  On echocardiogram,
she had severe aortic stenosis with a mean gradient of 68mmHg.
There was moderate mitral regurgitation. Prior to surgery, her
major complaints were dyspnea on exertion, worsening fatigue and
lower extremity edema. She had no history of syncope.

Past Medical History:
Aortic Stenosis
Atrial Fibrillation
Chronic Diastolic Congestive Heart Failure
Hypertension
Dyslipidemia
Anemia
History of Kidney Stones
Appendectomy
Resection of Benign Breast Tumor
Ceserean Section


Social History:
Denies tobacco and ETOH. Widowed, lives alone.

Family History:
Denies premature coronary disease.

Physical Exam:
Vitals: 150/80, 87, 14
General: Elderly female in no acute distress
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, 4/6 systolic ejection murmur >
carotids
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, 1+ edema bilaterally
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

Discharge
Neuro Alert and oriented x3 nonfocal
Pulm CTA but decreased bilat bases, strong non productive cough
Cardiac Irregular (afib) no murmur/rub/gallop
Sternal incision healing, no erythema/drainage, staples intact -
plan to remove [**5-9**] at rehab
Abd soft, NT ND + BS, last BM [**4-29**]
Ext warm, +2 edema, rt UE with phlebitis - warm packs TID,
elevate and keflex x 7 days


Pertinent Results:
[**2120-4-25**] Intraop TEE:
PRE-BYPASS: The left atrium is dilated. Mild spontaneous echo
contrast is present in the left atrial appendage. Right
ventricular chamber size and free wall motion are normal. There
are focal calcifications in the aortic arch. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets are moderately thickened. There is severe aortic valve
stenosis (area <0.8cm2). Mild (1+) aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen.

POST-BYPASS: Thoracic aortic contour is intact. Normal RV
systolic function. Mild MR, Mild TR. There is a bioprosthesis in
the native aortic position, stable and functioning well. OVERALL
LVEF 50%.
[**2120-4-30**] 05:20AM BLOOD WBC-14.8* RBC-3.15* Hgb-8.2* Hct-26.5*
MCV-84 MCH-26.1* MCHC-31.0 RDW-17.7* Plt Ct-231
[**2120-4-29**] 05:40AM BLOOD WBC-16.3* RBC-3.08* Hgb-8.1* Hct-25.5*
MCV-83 MCH-26.4* MCHC-31.8 RDW-18.3* Plt Ct-182
[**2120-4-25**] 11:29AM BLOOD WBC-27.0*# RBC-3.96* Hgb-10.3* Hct-32.1*
MCV-81* MCH-26.1* MCHC-32.2 RDW-16.1* Plt Ct-187
[**2120-4-26**] 02:43AM BLOOD Neuts-89.4* Bands-0 Lymphs-5.2* Monos-5.1
Eos-0 Baso-0.3
[**2120-4-30**] 05:20AM BLOOD Plt Ct-231
[**2120-4-30**] 05:20AM BLOOD Plt Ct-231
[**2120-4-25**] 11:41AM BLOOD PT-17.3* PTT-56.5* INR(PT)-1.6*
[**2120-4-25**] 11:29AM BLOOD Plt Ct-187
[**2120-4-30**] 05:20AM BLOOD Glucose-134* UreaN-23* Creat-0.7 Na-142
K-3.5 Cl-106 HCO3-28 AnGap-12
[**2120-4-25**] 11:41AM BLOOD UreaN-25* Creat-0.6 Cl-117* HCO3-23
[**2120-4-30**] 05:20AM BLOOD Calcium-8.0* Phos-2.1* Mg-1.7

CHEST (PA & LAT)

Reason: r/o inf, eff

[**Hospital 93**] MEDICAL CONDITION:
83 year old woman with
REASON FOR THIS EXAMINATION:
r/o inf, eff
INDICATION: Evaluate for infection or effusion.

COMPARISON: [**2120-4-27**], [**2120-4-25**].

FRONTAL AND LATERAL CHEST RADIOGRAPHS: Median sternotomy wires
and surgical staples overlying the chest are unchanged in
position. Cardiac and mediastinal contours appear unchanged.
Moderate bilateral pleural effusions with retrocardiac opacity
are again seen. There is likely a subpulmonic component to the
left-sided pleural effusion. Improving left upper lobe
atelectasis is seen. Increasing right basilar atelectasis is
present.

IMPRESSION: Persistent moderate bilateral pleural effusions,
with likely subpulmonic component to the left effusion.
Persistent retrocardiac opacity and increasing right basilar
subsegmental atelectasis.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]
Approved: MON [**2120-4-29**] 4:28 PM


Brief Hospital Course:
Mrs. [**Known lastname 77670**] was admitted and underwent aortic valve
replacement and Maze procedure by Dr. [**Last Name (STitle) **]. For surgical
details, please see seperate dictated operative note. Following
the operation, she was brought to the CVICU for invasive
monitoring. Within 24 hours, she awoke neurologically intact and
was extubated without incident. She maintained stable
hemodynamics and transferred to the SDU on postoperative day
two. Warfarin was resumed and Amiodarone was started for atrial
fibrillation. Beta blockade was slowly advanced for rate
control. Over several days, she continued to make clinical
improvements with diuresis. Medical therapy was optimized and
she was medically cleared for discharge to rehab on
postoperative day 5.  With plans for continued diuresis and
coumadin for atrial fibrillation goal INR 2.0-2.5 at rehab.

Medications on Admission:
Metoprolol 200 qd, Lipitor 10 qd, Lisinopril 20 qd, Warfarin,
Imodium prn, HCTZ 25 qd

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
5. Metoprolol Tartrate 100 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
6. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO BID (2 times a day):
please continue while on lasix .
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): please continue and monitor weights
please check biweekly bun, cr, K while on lasix and potassium.
8. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
9. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
please give 400mg daily for 7 days then decrease to 200mg daily
and follow up with cardiologist .
11. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 7 days: for rt arm phlebitis .


Discharge Disposition:
Extended Care

Facility:
Life Care Center - [**Location (un) 3320**]

Discharge Diagnosis:
Aortic Stenosis, Atrial Fibrillation - s/p AVR/Maze Procedure
Acute on Chronic Diastolic Congestive Heart Failure
Hypertension
Dyslipidemia
Anemia


Discharge Condition:
Good


Discharge Instructions:
1)Please shower daily. No baths. Pat dry incisions, do not rub.
2)No creams, ointments, or lotions to surgical incisions.
3)Call cardiac surgeon if there is concern for wound infection
[**Telephone/Fax (1) 170**].
4)No lifting more than 10 lbs for at least 10 weeks from
surgical date.
5)No driving for at least one month.
6)Adjust Warfarin for goal INR between 2.0 - 2.5.
7) PLEASE WEIGH DAILY AND MONITOR CLOSELY FOR DIURESIS. PLEASE
CALL IF QUESTIONS OR CONCERNS.
8) Sternal wound with staples - please remove [**2120-5-9**] call if
questions [**Telephone/Fax (1) 170**]
9) warm packs TID to rt arm phlebitis
10) Labs - please check biweekly Potassium, BUN, CR while on
lasix

Followup Instructions:
Dr. [**Last Name (STitle) **] in [**3-23**] weeks, call for appt
Dr. [**Last Name (STitle) 1270**] after discharge from rehab, call for appt
Dr. [**Last Name (STitle) 656**] after discharge from rehab, call for appt



Completed by:[**2120-4-30**]

Name:  [**Known lastname 12543**],[**Known firstname **]                  Unit No:   [**Numeric Identifier 12544**]

Admission Date:  [**2120-4-25**]              Discharge Date:   [**2120-4-30**]

Date of Birth:  [**2036-6-18**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4551**]
Addendum:
medication correction

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
5. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO BID (2 times a day):
please continue while on lasix .
6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): please continue and monitor weights
please check biweekly bun, cr, K while on lasix and potassium.
7. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
8. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
please give 400mg daily for 7 days then decrease to 200mg daily
and follow up with cardiologist .
10. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 7 days: for rt arm phlebitis .
11. warfarin
coumadin daily for atrial fibrillation goal INR 2.0-2.5
Has received 2mg [**4-29**] and [**4-30**] with INR 1.1
12. Toprol XL 200 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.


Discharge Disposition:
Extended Care

Facility:
Life Care Center - [**Location (un) 1541**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 358**] MD [**MD Number(1) 359**]

Completed by:[**2120-4-30**]

Name:  [**Known lastname 12543**],[**Known firstname **]                  Unit No:   [**Numeric Identifier 12544**]

Admission Date:  [**2120-4-25**]              Discharge Date:   [**2120-4-30**]

Date of Birth:  [**2036-6-18**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4551**]
Addendum:
medication updated

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
5. Metoprolol Tartrate 100 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
6. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO BID (2 times a day):
please continue while on lasix .
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): please continue and monitor weights
please check biweekly bun, cr, K while on lasix and potassium.
8. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
9. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
please give 400mg daily for 7 days then decrease to 200mg daily
and follow up with cardiologist .
11. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 7 days: for rt arm phlebitis .
12. warfarin
coumadin daily for atrial fibrillation goal INR 2.0-2.5
Has received 2mg [**4-29**] and [**4-30**] with INR 1.1


Discharge Disposition:
Extended Care

Facility:
Life Care Center - [**Location (un) 1541**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 358**] MD [**MD Number(1) 359**]

Completed by:[**2120-4-30**]
{'Atrial fibrillation,Acute on chronic diastolic heart failure,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified'}


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: Mrs. [**Known lastname 77670**] is an 83 year old female with known aortic
stenosis and new onset atrial fibrillation. In preperation for
aortic valve replacement she underwent cardiac catheterization
which revealed only a 70% lesion in the first diagonal artery.
Her coronaries were otherwise normal. Her LVEF was estimated at
60% and there was mild mitral regurgitation.  On echocardiogram,
she had severe aortic stenosis with a mean gradient of 68mmHg.
There was moderate mitral regurgitation. Prior to surgery, her
major complaints were dyspnea on exertion, worsening fatigue and
lower extremity edema. She had no history of syncope.

MEDICAL HISTORY: Aortic Stenosis
Atrial Fibrillation
Chronic Diastolic Congestive Heart Failure
Hypertension
Dyslipidemia
Anemia
History of Kidney Stones
Appendectomy
Resection of Benign Breast Tumor
Ceserean Section

MEDICATION ON ADMISSION: Metoprolol 200 qd, Lipitor 10 qd, Lisinopril 20 qd, Warfarin,
Imodium prn, HCTZ 25 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 150/80, 87, 14
General: Elderly female in no acute distress
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, 4/6 systolic ejection murmur >
carotids
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, 1+ edema bilaterally
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Denies premature coronary disease.

SOCIAL HISTORY: Denies tobacco and ETOH. Widowed, lives alone. 

### Response:
{'Atrial fibrillation,Acute on chronic diastolic heart failure,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified'}
