CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 73 year old male with history of aortic stenosis, most recent
echo showed [**Location (un) 109**] of 0.7cm2.  He had been experiencing worsening
shortness of breath and dyspnea on exertion over the past 6
months.

MEDICAL HISTORY: Aortic Stenosis, Hypercholesterolemia, Diverticulosis, Benign
Prostatic Hypertrophy, Erectile Dysfunction, Idiopathic
Thrombocytopenia, s/p Appendectomy

MEDICATION ON ADMISSION: Flomax 0.4mg qd, Lipitor 20mg qd, Cialis prn, Androgel qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 16 140/88 5'8" 162#
Gen: NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 4/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused -edema
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: No premature CAD

SOCIAL HISTORY: Denies tobacco use. Occ. ETOH use. Insurance broker
Aortic valve disorders,Atrial flutter,Immune thrombocytopenic purpura,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Aortic valve disorder,Atrial flutter,Immune thrombocyt purpra,Hypertension NOS,Pure hypercholesterolem,BPH w/o urinary obs/LUTS
Admission Date:  [**2108-10-30**]              Discharge Date:   [**2108-11-5**]

Date of Birth:  [**2035-1-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

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

Major Surgical or Invasive Procedure:
[**2108-10-31**] Aortic Valve Replacement (23mm CE Magna Tissue)

History of Present Illness:
73 year old male with history of aortic stenosis, most recent
echo showed [**Location (un) 109**] of 0.7cm2.  He had been experiencing worsening
shortness of breath and dyspnea on exertion over the past 6
months.

Past Medical History:
Aortic Stenosis, Hypercholesterolemia, Diverticulosis, Benign
Prostatic Hypertrophy, Erectile Dysfunction, Idiopathic
Thrombocytopenia, s/p Appendectomy


Social History:
Denies tobacco use. Occ. ETOH use. Insurance broker

Family History:
No premature CAD

Physical Exam:
VS: 16 140/88 5'8" 162#
Gen: NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 4/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused -edema
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2108-10-30**] Cardiac Cath: 1. Selective coronary angiography of this
right dominant system demonstrated no angiographically evident
coronary artery disease. The LMCA, LAD, LCx and RCA showed no
CAD. 2. Limited resting hemodynamic measurements showed mildly
elevated right sided filling pressure (RA mean 8mmHg, RVEDP
11mmHg).  The left sided filling pressure was mildly elevated as
well with PCWP mean of 13 mmHg. The pulmonary artery pressure
was at the upper end of normal at 30/14mmHg.  There was moderate
systemic arterial hypertension of 155/88mmHg.  Cardiac index,
calculated using an assumed oxygen consumption, was preserved at
2.6 l/min/m2.
[**2108-10-31**] Echo: PRE CPB 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 atrial septal defect is
seen by 2D or color Doppler. There is moderate symmetric left
ventricular hypertrophy. The left ventricular cavity is
unusually small. Regional left ventricular wall motion is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. There are simple atheroma in the descending thoracic
aorta. There are three aortic valve leaflets. The aortic valve
leaflets are severely thickened/deformed. There is severe aortic
valve stenosis (area < 1.0 cm2). Mild (1+) aortic regurgitation
is seen. The severity of aortic regurgitation may be
underestimated. The aortic regurgitation jet is eccentric,
directed toward the anterior mitral leaflet. The mitral valve
appears structurally normal with trivial mitral regurgitation.
Tricuspid regurgitation is present but cannot be quantified.
There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in
person of the results in the operating room at the time of the
study. POST CPB There is normal biventricular systolic function.
There is a bioprosthesis in the aortic position. It is well
seated and displays normal leaflet function. There is trace
valvular aortic regurgitation in the center of the valve. There
may be a trace paravalvular jet near the native right coronary
cusp area but it is only very poorly seen. With a cardiac output
of about 4.5 liters/minute, the mean gradient across the valve
is 7 mm Hg with a maximum gradient of 11 mm Hg. No other changes
from the pre bypass study.

 Surgeon:  [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 6477**]

PREOPERATIVE DIAGNOSIS:  Critical symptomatic aortic
stenosis.

POSTOPERATIVE DIAGNOSIS:  Critical symptomatic aortic
stenosis.

OPERATION PERFORMED:  Aortic valve replacement with a 23-
millimeter [**Last Name (un) 3843**]-[**Doctor Last Name **] Magna tissue valve.

ASSISTANT:  [**Name6 (MD) 6478**] [**Name8 (MD) 6479**], MD.

ANESTHESIA:  General endotracheal.

CLINICAL NOTE:  Mr. [**Known lastname 1728**] is a 73-year-old male with
worsening symptoms related to critical symptomatic aortic
stenosis confirmed by echocardiography and cardiac
catheterization.  He has normal coronary artery disease
presenting for revascularization.

DESCRIPTION OF PROCEDURE:  After adequate anesthesia was
achieved and with the patient supine, he was prepped and
draped in the usual sterile manner. Mediastinotomy was
performed through which the pericardium was exposed left.
Heparinized and cannulated ascending aortic Soft-Flow
cannula, two-stage venous cannula was placed through the
right atrial appendage. A TEE confirmed the presence of a
very calcified stenotic aortic valve.  He was placed on
bypass and retrograde coronary sinus cannula was placed
through the right atrial wall. A vent was placed in the left
ventricle through the superior pulmonary vein. The aorta was
crossclamped.  Heart was arrested with cold antegrade blood
cardioplegia followed by multiple retrograde doses. The aorta
was opened in a transverse hockey-stick fashion exposing a
very calcified stenotic aortic valve that was excised. The
annulus was debrided.  The root was irrigated and sized to 23-
mm Magna valve.  Interrupted mattress sutures were placed
through the annulus and then through the sewing ring of 23-mm
Magna aortic pericardial tissue valve that was seated and
secured in place. The aorta was closed in two layers of
running 4-0 Prolene sutures. Warm cardioplegia was given
retrograde. The crossclamp was released with the patient's
head down while de-airing the root. The root was maintained
on low vent suction. CO2 insufflation was used throughout the
case.  Epicardial pacing wires were placed. He was weaned off
bypass successfully with TE guidance showing minimal air
entrapment and the left heart was vented through the root
came off bypass nicely. Protamine was given. He was
decannulated and once the field was dry, two mediastinal
tubes were left in place. The sternotomy was closed with
heavy steel wires.  Presternal layers were closed with Vicryl
suture. The skin was closed with subcuticular closure. Dry
dressing was applied.  He tolerated the procedure well and
left the OR in stable condition.

                        [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 5897**]


Brief Hospital Course:
Mr. [**Known lastname 1728**] was admitted following his cardiac cath on [**10-30**]. Cath
revealed no coronary disease and he was worked-up in the usual
manner for surgery the following day. On [**10-31**] he was brought to
the operating room where he underwent an Aortic Valve
Replacement. Please see operative report for surgical details.
Following surgery he was transferred to the CVICU in stable
condition for invasive monitoring.
He was extubated on POD 1 and meds were advanced.
Patient was noted to be in atrial fibrillation on [**2108-11-1**] at
19:12.  Given IV magnesium, lopressor, and ultimately required
amiodarone IV to control his AFIB.  He was started on coumadin
and maintained on PO Amiodarone.
He was transferred to the floor on POD 3. He remained
hemodynamically stable and in rate controlled AFIB.  Coumadin
was continued with a therapeutic goal of [**3-3**].5.  On POD 5 he was
cleared by Physical Therapy to be discharged home.

Medications on Admission:
Flomax 0.4mg qd, Lipitor 20mg qd, Cialis prn, Androgel qd

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*0*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
3. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO once
a day for 5 days.
Disp:*5 Packet(s)* Refills:*0*
4. Pantoprazole 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:*0*
5. 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:*0*
6. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO QOD ().
Disp:*15 Tablet(s)* Refills:*0*
7. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0*
8. Warfarin 1 mg Tablet Sig: Five (5) Tablet PO DAILY (Daily):
[**First Name8 (NamePattern2) 6480**] [**Last Name (NamePattern1) 2716**] will call you with what dose to take.
Disp:*60 Tablet(s)* Refills:*0*
9. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*0*
10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Take 2 pills twice daily for five days, then 2 pills
once daily for seven days, then 1 pill once daily for seven
days.
Disp:*45 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Hospice and VNA

Discharge Diagnosis:
Aortic Stenosis s/p Aortic Valve Replacement
PMH: Hypercholesterolemia, Diverticulosis, Benign Prostatic
Hypertrophy, Erectile Dysfunction, Idiopathic Thrombocytopenia,
s/p Appendectomy

Discharge Condition:
Good

Discharge Instructions:
shower daily , no baths or swimming
no lotion, creams, or powders on any incision
no driving for one month and until off all narcotics
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 100.5, redness, or drainage of
incisions
take all medications as directed

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) **] in [**3-4**] weeks
Dr. [**Last Name (STitle) 6481**] in [**2-1**] weeks
You will follow up with [**First Name8 (NamePattern2) 6480**] [**Last Name (NamePattern1) 2716**] at Dr [**Last Name (STitle) **] office
for your INR. ([**Telephone/Fax (1) 2037**]



Completed by:[**2108-11-5**]
{'Aortic valve disorders,Atrial flutter,Immune thrombocytopenic purpura,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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: 73 year old male with history of aortic stenosis, most recent
echo showed [**Location (un) 109**] of 0.7cm2.  He had been experiencing worsening
shortness of breath and dyspnea on exertion over the past 6
months.

MEDICAL HISTORY: Aortic Stenosis, Hypercholesterolemia, Diverticulosis, Benign
Prostatic Hypertrophy, Erectile Dysfunction, Idiopathic
Thrombocytopenia, s/p Appendectomy

MEDICATION ON ADMISSION: Flomax 0.4mg qd, Lipitor 20mg qd, Cialis prn, Androgel qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 16 140/88 5'8" 162#
Gen: NAD
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD
Chest: CTAB -w/r/r
Heart: RRR 4/6 SEM
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused -edema
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: No premature CAD

SOCIAL HISTORY: Denies tobacco use. Occ. ETOH use. Insurance broker 

### Response:
{'Aortic valve disorders,Atrial flutter,Immune thrombocytopenic purpura,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
