CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 74 year-old
woman who has a history of a murmur, hypertension and aortic
stenosis who was undergoing a preoperative work up for a left
knee replacement and cardiac evaluation demonstrated
worsening of her aortic stenosis. She underwent cardiac
catheterization which confirmed an aortic valve area of 0.5
and two vessel coronary artery disease. She was evaluated by
the cardiac surgery team and she presents for elective aortic
valve replacement and coronary artery bypass graft.

MEDICAL HISTORY: Significant for hypertension,
degenerative joint disease of the left knee, hypothyroidism
and aortic stenosis.

MEDICATION ON ADMISSION: Included atenolol 75 mg p.o. daily
and Synthroid 0.25 mg daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Is noncontributory.

SOCIAL HISTORY: She lives [**Location 6409**] with her husband. She
is retired. Denies tobacco or ETOH use.
Aortic valve disorders,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other specified disorders of peritoneum,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Unspecified acquired hypothyroidism,Esophageal reflux,Hip joint replacement
Aortic valve disorder,CHF NOS,Crnry athrscl natve vssl,Peritoneal disorder NEC,Hypertension NOS,Osteoarthros NOS-l/leg,Hypothyroidism NOS,Esophageal reflux,Joint replaced hip
Admission Date: [**2129-2-21**]        Discharge Date: [**2129-3-2**]

Date of Birth:  [**2054-8-24**]        Sex:  F

Service:  CSU


HISTORY OF PRESENT ILLNESS:  The patient is a 74 year-old
woman who has a history of a murmur, hypertension and aortic
stenosis who was undergoing a preoperative work up for a left
knee replacement and cardiac evaluation demonstrated
worsening of her aortic stenosis. She underwent cardiac
catheterization which confirmed an aortic valve area of 0.5
and two vessel coronary artery disease. She was evaluated by
the cardiac surgery team and she presents for elective aortic
valve replacement and coronary artery bypass graft.

REVIEW OF SYSTEMS:  She denies angina, shortness of breath,
dyspnea on exertion, palpitations, syncope or edema.

PAST MEDICAL HISTORY:  Significant for hypertension,
degenerative joint disease of the left knee, hypothyroidism
and aortic stenosis.

PAST SURGICAL HISTORY:  Significant for bilateral cataract
removal.

MEDICATIONS ON ADMISSION:  Included atenolol 75 mg p.o. daily
and Synthroid 0.25 mg daily.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  She lives [**Location 6409**] with her husband. She
is retired. Denies tobacco or ETOH use.

FAMILY HISTORY:  Is noncontributory.

REVIEW OF SYSTEMS:  Overall is in good health. Denies any
respiratory, cardiovascular, gastrointestinal, neurologic or
hematologic symptoms.

PHYSICAL EXAMINATION:  Patient is 4 foot 11 inches, 136
pounds, temperature is 97.7, heart rate is 68 and regular,
blood pressure 148/70, breathing 15, 98 percent on room air.
She is in no acute distress. Her neck has no carotid bruits,
no jugular venous distension. Heart is regular rate and
rhythm with a holosystolic ejection murmur with radiation to
the carotids. Lungs are clear to auscultation bilaterally.
Abdomen is soft and nontender. She has palpable distal
pulses.

LABORATORY DATA:  On admission included white count of 7.4,
hematocrit of 35, platelets of 305. BUN of 13, creatinine
0.6. The remainder of her laboratories are remarkable for an
AST of 46, ALT of 12, alkaline phosphatase of 90, total
bilirubin of 0.5, amylase of 108 and albumin of 3.9.
Preoperative chest x-ray demonstrated no congestion, no
infiltrate. A preoperative carotid series demonstrated a left
sided 60 to 69 percent carotid stenosis and a right sided 40
percent carotid stenosis. Cardiac catheterization done
[**2128-12-30**] demonstrated an aortic valve area of 0.5 cm sq, a
proximal right coronary artery that was diffusely diseased, a
mid right coronary artery that was diffusely diseased and a
distal right coronary artery that was diffusely diseased. The
proximal left anterior descending coronary artery and a 30
percent lesion, the mid left anterior descending coronary
artery an 80 percent lesion and diagonal 1 with 60 percent
lesion.

HOSPITAL COURSE:  The patient on the day of admission was
taken to the operating room where she underwent an aortic
valve replacement with a 19 mm paracardial Magna CE valve,
coronary artery bypass graft times on with left internal
mammary artery to the left anterior descending coronary
artery. She tolerated the procedure well, postoperatively was
transferred to the cardiac surgery Intensive Care Unit. She
was extubated, weaned off the drips and transferred to the
floor on postoperative day #1. Postoperative #2 she remained
hemodynamically normal, afebrile, with benign examination and
her chest tubes were removed. On a follow up chest x-ray
there was evidence of free intraperitoneal air with no
pneumothorax. General surgery was consulted due to worry of
hollow viscous injury or diaphragmatic injury. Abdominal CT
scan was obtained with Gastrografin area and this
demonstrated extensive pneumoperitoneum but no evidence of
bowel perforation. A small left pneumothorax and
cholelithiasis with focal gallbladder wall calcifications and
stool throughout the colon. She was observed with serial
examinations, intravenous fluids and nothing by mouth. Her
examination remained benign and after 24 hours remaining
stable. Her diet was advanced which was tolerated and her
examination unchanged. She also continued to receive physical
therapy and at this point she is cleared to level 5
evaluation. Her white count has been monitored and is
currently 8.4. She has remained hemodynamically normal and
now is ready for discharge to home.

DISCHARGE DIAGNOSES:
1. Aortic stenosis.
2. Coronary artery disease.
3. Postoperative pneumoperitoneum without evidence of hollow
   viscous injury.
4. Congestive heart failure.
5. Gastroesophageal reflux disease.
6. Hypertension.


MAJOR SURGICAL INTERVENTIONS:  Aortic valve placement with a
19 mm pericardial CE Magna and coronary artery bypass graft
times one.

MEDICATIONS ON DISCHARGE:  Lasix 20 mg p.o. b.i.d. times 7
days.
Potassium 20 mEq p.o. daily times 7 days.
Atenolol 100 mg p.o. daily.
Synthroid 25 mcg daily.
Lipitor 10 mg daily.
Percocet 5/325 1 to 2 p.o. q 4 hours p.r.n.
Aspirin 81 mg daily.
Colace 100 mg p.o. b.i.d.

[**Last Name (STitle) 59187**] follow up with Dr. [**Last Name (Prefixes) **] in four weeks.
Call [**Telephone/Fax (1) 59188**]. Patient will follow up with Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]
[**Last Name (NamePattern4) **] in two weeks, call [**Telephone/Fax (1) **]-9204. Patient will
follow up with primary care physician in two weeks. She
should call for an appointment.


DISCHARGE CONDITION:  Good.



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern1) 8958**]
MEDQUIST36
D:  [**2129-3-1**] 16:42:32
T:  [**2129-3-1**] 18:35:21
Job#:  [**Job Number 59189**]
{'Aortic valve disorders,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other specified disorders of peritoneum,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Unspecified acquired hypothyroidism,Esophageal reflux,Hip joint replacement'}


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: The patient is a 74 year-old
woman who has a history of a murmur, hypertension and aortic
stenosis who was undergoing a preoperative work up for a left
knee replacement and cardiac evaluation demonstrated
worsening of her aortic stenosis. She underwent cardiac
catheterization which confirmed an aortic valve area of 0.5
and two vessel coronary artery disease. She was evaluated by
the cardiac surgery team and she presents for elective aortic
valve replacement and coronary artery bypass graft.

MEDICAL HISTORY: Significant for hypertension,
degenerative joint disease of the left knee, hypothyroidism
and aortic stenosis.

MEDICATION ON ADMISSION: Included atenolol 75 mg p.o. daily
and Synthroid 0.25 mg daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Is noncontributory.

SOCIAL HISTORY: She lives [**Location 6409**] with her husband. She
is retired. Denies tobacco or ETOH use. 

### Response:
{'Aortic valve disorders,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other specified disorders of peritoneum,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Unspecified acquired hypothyroidism,Esophageal reflux,Hip joint replacement'}
