CHIEF COMPLAINT: 83F with ^SOB

PRESENT ILLNESS: This 83WF has a h/o rheumatic fever and had been followed for
aortic stenosis and mitral regurgitation for several years.  She
has had increasing fatigue over the past several months and an
echo in [**3-26**] revealed: severe AS, moderate MS, severe MAC, LAE,
dil. RA, tr. AI, 3+TR, an AV peak gradient of 123mmHg, severe
pulm HTN and and LVEF of 60%.  Cardiac cath in [**5-26**] confirmed
these findings and showed clean coronaries.  She is now admitted
for elective AVR/MVR.

MEDICAL HISTORY: Hypercholesterolemia
Rheumatic heart disease x 45+ years
Mitral and aortic stenosis
s/p mitral valvuloplasty in '[**68**]
h/o atrial fib x 30 years on coumadin
cardiac cath x 2 in [**2120**]
Left parotid gland tumor s/p excision many years ago

MEDICATION ON ADMISSION: Digoxin 0.125 mg PO daily
Fosamax 70 mg PO q week
Coumadin 2 mg PO daily
Cardizem CD 120 mg PO daily
Lipitor 10 mg PO daily
Lasix 40 mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Elderly WF in NAD
HR: 60 BP: 128/68 Ht.: 60"  Wt. 105 lbs.
HEENT:  NC/AT, PERLA, EOMI, anicteric schlera, oropharynx benign
with good dentition.
Neck:  supple, FROM< no lymphadenopathy or thyromegaly, carotids
2+=bilat. w/ transmitted murmurs.
Lungs: Clear to A+P
CV: IRRR w/ IV/VI harsh SEM w/ diastolic rumble.
Abd.: +BS, soft, nontender without masses, +hepatomegaly
Ext: tr. bilat. pedal edema, pulses 2+=bilat. throughout.
Neuro: non-focal.

FAMILY HISTORY: paternal CAD s/p 4 vessel CABG

SOCIAL HISTORY: No ETOH, No tob, no drugs
Emigrated from Sicily at age 14, lives alone
Multiple involvement of mitral and aortic valves,Atrial fibrillation,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia
Mitr/aortic mult involv,Atrial fibrillation,CHF NOS,Thrombocytopenia NOS,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2176-8-5**]              Discharge Date:   [**2176-8-14**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
83F with ^SOB

Major Surgical or Invasive Procedure:
AVR(19mm CE)/MVR(25mm Mosaic) [**2176-8-6**]


History of Present Illness:
This 83WF has a h/o rheumatic fever and had been followed for
aortic stenosis and mitral regurgitation for several years.  She
has had increasing fatigue over the past several months and an
echo in [**3-26**] revealed: severe AS, moderate MS, severe MAC, LAE,
dil. RA, tr. AI, 3+TR, an AV peak gradient of 123mmHg, severe
pulm HTN and and LVEF of 60%.  Cardiac cath in [**5-26**] confirmed
these findings and showed clean coronaries.  She is now admitted
for elective AVR/MVR.

Past Medical History:
Hypercholesterolemia
Rheumatic heart disease x 45+ years
Mitral and aortic stenosis
s/p mitral valvuloplasty in '[**68**]
h/o atrial fib x 30 years on coumadin
cardiac cath x 2 in [**2120**]
Left parotid gland tumor s/p excision many years ago

Social History:
No ETOH, No tob, no drugs
Emigrated from Sicily at age 14, lives alone


Family History:
paternal CAD s/p 4 vessel CABG

Physical Exam:
Elderly WF in NAD
HR: 60 BP: 128/68 Ht.: 60"  Wt. 105 lbs.
HEENT:  NC/AT, PERLA, EOMI, anicteric schlera, oropharynx benign
with good dentition.
Neck:  supple, FROM< no lymphadenopathy or thyromegaly, carotids
2+=bilat. w/ transmitted murmurs.
Lungs: Clear to A+P
CV: IRRR w/ IV/VI harsh SEM w/ diastolic rumble.
Abd.: +BS, soft, nontender without masses, +hepatomegaly
Ext: tr. bilat. pedal edema, pulses 2+=bilat. throughout.
Neuro: non-focal.

Pertinent Results:
[**2176-8-13**] 05:38AM BLOOD WBC-11.1* RBC-3.10* Hgb-9.4* Hct-27.9*
MCV-90 MCH-30.3 MCHC-33.8 RDW-14.7 Plt Ct-195
[**2176-8-13**] 05:38AM BLOOD PT-20.7* PTT-44.4* INR(PT)-2.8
[**2176-8-13**] 05:38AM BLOOD Glucose-91 UreaN-48* Creat-1.8* Na-138
K-4.1 Cl-102 HCO3-25 AnGap-15

Brief Hospital Course:
She was admitted on [**8-5**] and was started on heparin.  On [**8-6**]
she underwent AVR(19mm CE Magna Pericardial)/MVR(25mm Mosaic).
Cross clamp time was 79 min. and total bypass time was 124 min.
She tolerated the procedure well and was transferred to the CSRU
on Epi and Propofol in stable condition.  She was immediately
weaned off Epi and was extubated on POD#1.  She was on Nipride,
but this was weaned as well.  POD#2 she had her chest tubes and
epicardial pacing wires d/c'd and she was started on heparin and
coumadin.  She was transferred to the floor on POD#3 and
continued to progress slowly.  She was discharged to rehab in
stable condition on POD#7.

Medications on Admission:
Digoxin 0.125 mg PO daily
Fosamax 70 mg PO q week
Coumadin 2 mg PO daily
Cardizem CD 120 mg PO daily
Lipitor 10 mg PO daily
Lasix 40 mg PO daily

Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
5. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day.
7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
8. Coumadin 1 mg Tablet as directed for INR goal 2-2.5. 0mg on
[**8-14**]
9. FOSAMAX 70 mg Tablet Sig: One (1) Tablet PO once a week.


Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 57850**] Healthcare Center - [**Location (un) **]

Discharge Diagnosis:
Aortic stenosis s/p AVR
Mitral regurgitation s/p MVR
^chol.
Atrial Fibrillation
CHF
OA
HTN
CRI


Discharge Condition:
Good.


Discharge Instructions:
Follow medications on discharge instructions.
You may not drive for 4 weeks.
You may not lift more than 10 lbs.
You should shower, let water flow over wounds, pat dry with a
towel.
Do not use lotions, creams, or powders on wounds.
Cal our office for sternal drainage, temp > 101.5

Followup Instructions:
Make an appointment with Dr. [**First Name (STitle) **] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) 1290**] for 4 weeks.



Completed by:[**2176-8-14**]
{'Multiple involvement of mitral and aortic valves,Atrial fibrillation,Congestive heart failure, unspecified,Thrombocytopenia, 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: 83F with ^SOB

PRESENT ILLNESS: This 83WF has a h/o rheumatic fever and had been followed for
aortic stenosis and mitral regurgitation for several years.  She
has had increasing fatigue over the past several months and an
echo in [**3-26**] revealed: severe AS, moderate MS, severe MAC, LAE,
dil. RA, tr. AI, 3+TR, an AV peak gradient of 123mmHg, severe
pulm HTN and and LVEF of 60%.  Cardiac cath in [**5-26**] confirmed
these findings and showed clean coronaries.  She is now admitted
for elective AVR/MVR.

MEDICAL HISTORY: Hypercholesterolemia
Rheumatic heart disease x 45+ years
Mitral and aortic stenosis
s/p mitral valvuloplasty in '[**68**]
h/o atrial fib x 30 years on coumadin
cardiac cath x 2 in [**2120**]
Left parotid gland tumor s/p excision many years ago

MEDICATION ON ADMISSION: Digoxin 0.125 mg PO daily
Fosamax 70 mg PO q week
Coumadin 2 mg PO daily
Cardizem CD 120 mg PO daily
Lipitor 10 mg PO daily
Lasix 40 mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Elderly WF in NAD
HR: 60 BP: 128/68 Ht.: 60"  Wt. 105 lbs.
HEENT:  NC/AT, PERLA, EOMI, anicteric schlera, oropharynx benign
with good dentition.
Neck:  supple, FROM< no lymphadenopathy or thyromegaly, carotids
2+=bilat. w/ transmitted murmurs.
Lungs: Clear to A+P
CV: IRRR w/ IV/VI harsh SEM w/ diastolic rumble.
Abd.: +BS, soft, nontender without masses, +hepatomegaly
Ext: tr. bilat. pedal edema, pulses 2+=bilat. throughout.
Neuro: non-focal.

FAMILY HISTORY: paternal CAD s/p 4 vessel CABG

SOCIAL HISTORY: No ETOH, No tob, no drugs
Emigrated from Sicily at age 14, lives alone 

### Response:
{'Multiple involvement of mitral and aortic valves,Atrial fibrillation,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia'}
