CHIEF COMPLAINT: CP/DOE

PRESENT ILLNESS: This is a 76 y/o male pt who initially presented to our service
in [**10-12**], at which time he was anemic w/ Hct 20.8 & UGIB. He was
known to have AS w/ [**Location (un) 109**] of 0.7 and CSURG was consulted for AVR.
It was recommended that he have resolution of UGIB with recovery
of Hct prior to surgery. Admitted today with plans for IV
heparin (now off coumadin) prior to cath tomorrow and planned
AVR. He also admits to intermmittent CP, DOE, edema, and
palpitations.

MEDICAL HISTORY: AS
CAD s/p LCx stent
HTN
^Chol
PVD
L. Knee OA
Anemia
AFib
UGIB
?DM2
s/p R. CEA '[**27**]
s/p R fem-[**Doctor Last Name **] '[**27**]
s/p L fem-popo
s/p L TKR

MEDICATION ON ADMISSION: 1. Oscal 500 [**Hospital1 **]
2. Lipitor 80 qd
3. Zetia 10 qd
4. Potassium 20 qd
5. Fosamax qweekly
6. Feosol [**Hospital1 **]
7. Protonix [**Hospital1 **]
8. Plavix 75 qd
9. Coumadin 1 qd
10. ASA 81 qd
11. Coreg 12.5 [**Hospital1 **]
12. Lasix 20 qd

ALLERGIES: Penicillins / Sulfonamides

PHYSICAL EXAM: VS: T 97.7 BP 149/67 HR 61 RR 20 Wt: 5'7" Ht: 200lbs
Gen: Walked into room in NAD
Neuro: A&O x 3, appropriate
Resp: CTAB
CV: Irreg, +S1/S2 +#/^ SEM with radiation to both carotids
GI: soft, round NT/ND +BS
Ext: warm, dry, +varicosities, r>l, -edema, well-healed old
fem-[**Doctor Last Name **] incisions
Pulses: radial 2+ bilat., DP & PT 1+ bilat.

FAMILY HISTORY: CAD, Father died of MI at 59. Sister died of MI at 61.

SOCIAL HISTORY: Lives with wife. Retired from telephone company. Quit smoking 32
yrs ago. 30 pack/yr hx. Denies ETOH.
Aortic valve disorders,Atrial fibrillation,Other complications due to other cardiac device, implant, and graft,Diastolic heart failure, unspecified,Cellulitis and abscess of leg, except foot,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Abnormal coagulation profile,Knee joint replacement
Aortic valve disorder,Atrial fibrillation,Comp-oth cardiac device,Diastolc hrt failure NOS,Cellulitis of leg,Crnry athrscl natve vssl,Chr pulmon heart dis NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Abnrml coagultion prfile,Joint replaced knee
Admission Date:  [**2134-2-1**]              Discharge Date:   [**2134-2-16**]

Date of Birth:  [**2057-6-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Sulfonamides

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
CP/DOE

Major Surgical or Invasive Procedure:
AVR (19mm Regent/mechanical) & CABG x 1 (SVG to OM) [**2134-2-5**]


History of Present Illness:
This is a 76 y/o male pt who initially presented to our service
in [**10-12**], at which time he was anemic w/ Hct 20.8 & UGIB. He was
known to have AS w/ [**Location (un) 109**] of 0.7 and CSURG was consulted for AVR.
It was recommended that he have resolution of UGIB with recovery
of Hct prior to surgery. Admitted today with plans for IV
heparin (now off coumadin) prior to cath tomorrow and planned
AVR. He also admits to intermmittent CP, DOE, edema, and
palpitations.

Past Medical History:
AS
CAD s/p LCx stent
HTN
^Chol
PVD
L. Knee OA
Anemia
AFib
UGIB
?DM2
s/p R. CEA '[**27**]
s/p R fem-[**Doctor Last Name **] '[**27**]
s/p L fem-popo
s/p L TKR

Social History:
Lives with wife. Retired from telephone company. Quit smoking 32
yrs ago. 30 pack/yr hx. Denies ETOH.

Family History:
CAD, Father died of MI at 59. Sister died of MI at 61.

Physical Exam:
VS: T 97.7 BP 149/67 HR 61 RR 20 Wt: 5'7" Ht: 200lbs
Gen: Walked into room in NAD
Neuro: A&O x 3, appropriate
Resp: CTAB
CV: Irreg, +S1/S2 +#/^ SEM with radiation to both carotids
GI: soft, round NT/ND +BS
Ext: warm, dry, +varicosities, r>l, -edema, well-healed old
fem-[**Doctor Last Name **] incisions
Pulses: radial 2+ bilat., DP & PT 1+ bilat.

Pertinent Results:
Cardiac Cath: The peak to peak gradient across the aortic valve
was 60 mmHg. The mean gradient was 52 mmHg. The calculated
aortic valve area was 0.9 mmHg. Selective coronary arteriography
of this right-dominant system
revealed single vessel disease. The LMCA and the LAD were free
of flow-limiting stenoses. The previously placed stent in the
LCX had a proximal 90% instent restenotic lesion. The RCA had an
80% lesion in the major acute marginal branch.
Pre-op CXR: No acute pulmonary process.

[**2134-2-1**] 09:34PM BLOOD WBC-4.8 RBC-3.35* Hgb-9.8* Hct-29.6*
MCV-89 MCH-29.2 MCHC-33.0 RDW-17.0* Plt Ct-140*
[**2134-2-15**] 11:38AM BLOOD WBC-7.3 RBC-3.11* Hgb-8.9* Hct-27.4*
MCV-88 MCH-28.7 MCHC-32.5 RDW-15.6* Plt Ct-357
[**2134-2-1**] 09:34PM BLOOD PT-16.2* PTT-27.4 INR(PT)-1.7
[**2134-2-1**] 09:34PM BLOOD Plt Ct-140*
[**2134-2-15**] 11:38AM BLOOD PT-18.9* INR(PT)-2.2
[**2134-2-15**] 11:38AM BLOOD Plt Ct-357
[**2134-2-1**] 09:34PM BLOOD Glucose-162* UreaN-21* Creat-1.4* Na-143
K-3.7 Cl-104 HCO3-31* AnGap-12
[**2134-2-15**] 11:38AM BLOOD Glucose-130* UreaN-19 Creat-1.3* Na-139
K-4.9 Cl-105 HCO3-27 AnGap-12
[**2134-2-1**] 09:34PM BLOOD ALT-33 AST-33 LD(LDH)-235 AlkPhos-94
Amylase-134* TotBili-1.0
[**2134-2-8**] 03:11AM BLOOD Calcium-8.2* Phos-4.9* Mg-1.9
[**2134-2-1**] 08:31PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.013
[**2134-2-11**] 01:25AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.010
[**2134-2-1**] 08:31PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG

Brief Hospital Course:
As mentioned in the HPI, pt admitted prior to cath & surgery for
d/c of coumadin and to start heparin. HD #2 pt underwent cardiac
cath which revealed severe AS and LCX 90% in stent restenosis.
Plan was then for AVR & CABG x 1 when INR decreased to ar least
1.3 HD #3 pt rec.'d Vit. k. Repeat INR was 1.5. HD #5, pt.'s INR
was 1.4 and it was felt that this was low enough for surgery. On
[**2134-2-5**], pt was brought to the OR and after general anesthesia
pt underwent an AVR and CABG x 1. Please refer to OP note
summary for full surgical details. Pt tolerated the procedure
well and was transferred to CSRU in stable condition with a MAP
of 67, CVP 16, PAD 24, [**Doctor First Name 1052**] 30, HR 86 v-paced and being titrated
on Neo. Later on op day pt was weaned from propofol and
extubated. He was neurologically intact, MAE to command and
hemodynam. stable (HR was AF, h/o AF)
POD #1 - Lasix and Lopressor were started per protocol.
POD #3 - Chest tubes, pacing wires, foley removed per protocol.
Pt was OOB and ambulated in [**Doctor Last Name **]. Transferred to telemetry
floor.
POD #4 - Pt already receiving coumadin. Heparin was started
today. INR was 1.3. Encouraged pt to ambulate & po intake.
POD #5 - Awaiting increase in INR. Coumadin & heparin increased.
Some L. leg cellulitis (abx started), few bibasal rales,
erythema at tiny area at superior aspect of sternal incision.
POD #6 - Pt. cont. to be in A. Fib. Increased temp 102.3
Erythema at Left leg incision, mild increased warmth. Ancef
continued. UA neg. Bloodd cultures negative. Pt. denies
diarrhea. f/u CXR.
POD #7 - Kefzol D/C'd for cellulitic l. leg and levofloxacin
started. temp decreased to 100.
POD #8 - repeat CXR showed decreased l. pleural effusion. temp
decreased to 99.7. Some erythema cont. on l. leg. heparin d/c'd.
coumadin at 1mg. wbc 6,700.
POD #9 - pt. had run of RAF in130s. Lopressir increased. small
amount of aerosang. drainage at upper pole of sternal incision.
POD #10 - Pt. stable, ambulating well. Cont. to be in A. Fib.
INR at therapeutic level. afebrile and will be d/c'd hometoday
with vna services.
D/C PE:
T 99.2 P 120 BP 120/60 RR 20
Neuro: alert, oriented, non-focal
Pulm: CTAB
Cardiac: irreg
Chest: warm, trace edema
Ext: leg inc. c/d

Medications on Admission:
1. Oscal 500 [**Hospital1 **]
2. Lipitor 80 qd
3. Zetia 10 qd
4. Potassium 20 qd
5. Fosamax qweekly
6. Feosol [**Hospital1 **]
7. Protonix [**Hospital1 **]
8. Plavix 75 qd
9. Coumadin 1 qd
10. ASA 81 qd
11. Coreg 12.5 [**Hospital1 **]
12. Lasix 20 qd

Discharge Medications:
1. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7
days.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
9. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Lopressor 50 mg Tablet Sig: 1.5 Tablets PO twice a day.
Disp:*90 Tablet(s)* Refills:*2*
11. Warfarin Sodium 2 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
AS s/p AVR w/ [**Street Address(2) 17167**]. [**Male First Name (un) 923**] Regent Valve (mechanical)
CAD s/p CABG x 1 (SVG to OM)
s/p LCx stent
HTN
^Chol
PVD
L. Knee OA
Anemia
AFib
UGIB
?DM2
s/p R. CEA '[**27**]
s/p R fem-[**Doctor Last Name **] '[**27**]
s/p L fem-popo
s/p L TKR

Discharge Condition:
good

Discharge Instructions:
no lifting > 10# or driving for 1 month
no creams or lotions to incisions
may shower, no bathing for 1 month

Followup Instructions:
with Dr. [**Last Name (STitle) **] in 1 weeks
with Dr. [**Last Name (STitle) **] in 4 weeks



Completed by:[**2134-3-4**]
{'Aortic valve disorders,Atrial fibrillation,Other complications due to other cardiac device, implant, and graft,Diastolic heart failure, unspecified,Cellulitis and abscess of leg, except foot,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Abnormal coagulation profile,Knee 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: CP/DOE

PRESENT ILLNESS: This is a 76 y/o male pt who initially presented to our service
in [**10-12**], at which time he was anemic w/ Hct 20.8 & UGIB. He was
known to have AS w/ [**Location (un) 109**] of 0.7 and CSURG was consulted for AVR.
It was recommended that he have resolution of UGIB with recovery
of Hct prior to surgery. Admitted today with plans for IV
heparin (now off coumadin) prior to cath tomorrow and planned
AVR. He also admits to intermmittent CP, DOE, edema, and
palpitations.

MEDICAL HISTORY: AS
CAD s/p LCx stent
HTN
^Chol
PVD
L. Knee OA
Anemia
AFib
UGIB
?DM2
s/p R. CEA '[**27**]
s/p R fem-[**Doctor Last Name **] '[**27**]
s/p L fem-popo
s/p L TKR

MEDICATION ON ADMISSION: 1. Oscal 500 [**Hospital1 **]
2. Lipitor 80 qd
3. Zetia 10 qd
4. Potassium 20 qd
5. Fosamax qweekly
6. Feosol [**Hospital1 **]
7. Protonix [**Hospital1 **]
8. Plavix 75 qd
9. Coumadin 1 qd
10. ASA 81 qd
11. Coreg 12.5 [**Hospital1 **]
12. Lasix 20 qd

ALLERGIES: Penicillins / Sulfonamides

PHYSICAL EXAM: VS: T 97.7 BP 149/67 HR 61 RR 20 Wt: 5'7" Ht: 200lbs
Gen: Walked into room in NAD
Neuro: A&O x 3, appropriate
Resp: CTAB
CV: Irreg, +S1/S2 +#/^ SEM with radiation to both carotids
GI: soft, round NT/ND +BS
Ext: warm, dry, +varicosities, r>l, -edema, well-healed old
fem-[**Doctor Last Name **] incisions
Pulses: radial 2+ bilat., DP & PT 1+ bilat.

FAMILY HISTORY: CAD, Father died of MI at 59. Sister died of MI at 61.

SOCIAL HISTORY: Lives with wife. Retired from telephone company. Quit smoking 32
yrs ago. 30 pack/yr hx. Denies ETOH. 

### Response:
{'Aortic valve disorders,Atrial fibrillation,Other complications due to other cardiac device, implant, and graft,Diastolic heart failure, unspecified,Cellulitis and abscess of leg, except foot,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Abnormal coagulation profile,Knee joint replacement'}
