CHIEF COMPLAINT: echocardiogram showed [**Location (un) 109**]=0.6

PRESENT ILLNESS: 66yo male s/p CABG in [**2137-9-15**]. He
had known aortic stenosis at time of surgical revascularization
but it was not significant enough to require
aortic valve replacement. However since that time,  serial
echocardiograms have confirmed progression of aortic valve
stenosis. Currently he denies chest pain, dyspnea, syncope,
presyncope, palpitations, orthopnea, PND and pedal edema. He has
been referred for surgical evaluation.

MEDICAL HISTORY: - Aortic Stenosis
- Myocardial infarction
- Coronary Disease
- Dyslipidemia
- Hypertension
- History of postop PAF
- Hypothyroid related to amiodarone
Past Surgical History
- Emergent coronary bypass grafting x5, on intra-aortic balloon
pump with endoscopic left greater saphenous vein harvesting and
endoscopic right greater saphenous vein harvesting on [**2137-9-19**]
- Re-Exploration for bleeding following CABG

MEDICATION ON ADMISSION: AMIODARONE -  (Prescribed by Other Provider) - 200 mg Tablet - 1
Tablet(s) by mouth daily
CITALOPRAM [CELEXA] -  (Prescribed by Other Provider) - 20 mg
Tablet - 1 Tablet(s) by mouth once a day
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth daily
LEVOTHYROXINE -  (Prescribed by Other Provider) - 50 mcg Tablet
-
1 Tablet(s) by mouth daily
LORAZEPAM -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth twice a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 50 mg
Tablet - 1 Tablet(s) by mouth twice a day
SIMVASTATIN [ZOCOR] -  (Prescribed by Other Provider) - 40 mg
Tablet - 1 Tablet(s) by mouth once a day

ALLERGIES: Penicillins

PHYSICAL EXAM: Pulse:59 Resp:16  O2 sat: 98/RA
B/P  Right:137/82    Left: 157/79
Height:5'9"     Weight:200 lbs

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives with: Wife in [**Name2 (NI) **]
Occupation: Lithographer for [**Location (un) 86**] Globe
Tobacco: Smoked infrequently between ages 16-21.
ETOH:1 beer and 1 whiskey nip/day
Aortic valve disorders,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Other iatrogenic hypothyroidism,Cardiac rhythm regulators causing adverse effects in therapeutic use,Personal history of tobacco use,Aortocoronary bypass status
Aortic valve disorder,Retention urine NOS,Crnry athrscl natve vssl,Old myocardial infarct,Hyperlipidemia NEC/NOS,Hypertension NOS,Iatrogen hypothyroid NEC,Adv eff card rhyth regul,History of tobacco use,Aortocoronary bypass
Admission Date:  [**2142-5-2**]              Discharge Date:   [**2142-5-6**]

Date of Birth:  [**2075-12-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
echocardiogram showed [**Location (un) 109**]=0.6


Major Surgical or Invasive Procedure:
[**2142-5-2**]
1. Redo sternotomy.
2. Redo coronary artery bypass grafting x1 with a reverse
    saphenous vein graft from the aorta to the previously
    placed double sequential vein graft to the posterior
descending coronary artery and second obtuse marginal coronary
artery
3. Aortic valve replacement with a 25-mm [**Doctor Last Name **] Magna Ease
    aortic valve bioprosthesis model number 3300TFX, serial
    number [**Serial Number 69062**].
4. Endoscopic vein harvesting.


History of Present Illness:
66yo male s/p CABG in [**2137-9-15**]. He
had known aortic stenosis at time of surgical revascularization
but it was not significant enough to require
aortic valve replacement. However since that time,  serial
echocardiograms have confirmed progression of aortic valve
stenosis. Currently he denies chest pain, dyspnea, syncope,
presyncope, palpitations, orthopnea, PND and pedal edema. He has
been referred for surgical evaluation.


Past Medical History:
- Aortic Stenosis
- Myocardial infarction
- Coronary Disease
- Dyslipidemia
- Hypertension
- History of postop PAF
- Hypothyroid related to amiodarone
Past Surgical History
- Emergent coronary bypass grafting x5, on intra-aortic balloon
pump with endoscopic left greater saphenous vein harvesting and
endoscopic right greater saphenous vein harvesting on [**2137-9-19**]
- Re-Exploration for bleeding following CABG


Social History:
Lives with: Wife in [**Name2 (NI) **]
Occupation: Lithographer for [**Location (un) 86**] Globe
Tobacco: Smoked infrequently between ages 16-21.
ETOH:1 beer and 1 whiskey nip/day


Family History:
Non contributory

Physical Exam:
Pulse:59 Resp:16  O2 sat: 98/RA
B/P  Right:137/82    Left: 157/79
Height:5'9"     Weight:200 lbs

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x] Sternotomy incision, sternum
stable
Heart: RRR [x]  Irregular []  Murmur III/VI SEM
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x] Bilateral vein harvest sites
Neuro: Grossly intact
Pulses:
Femoral      Right: cath site   Left: +2
DP           Right:+2   Left:+2
PT           [**Name (NI) 167**]:+2   Left:+2
Radial       Right: +2  Left:+2

Carotid Bruit        Right/Left:transmitted murmur

Discharge Exam
VS:T: 98.6  HR: 93 SR BP: 124/70 RR 18 Sats: 95% RA WT: 97 kg
General: 66 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR
Resp: bibasilar crackles otherwise clear
GI: benign
Extr: warm tr edema bilateral
Incision: sternal clean dry intact no erythema.
Neuro: awake, alert oriented


Pertinent Results:
[**2142-5-2**], Intraop TEE
Conclusions
Pre CPB (before first bypass run):
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.
Overall left ventricular systolic function is low normal (LVEF
50-55%). Doppler parameters are indeterminate for left
ventricular diastolic function.
Right ventricular chamber size and free wall motion are normal.
The ascending aorta is mildly dilated. The aortic arch is mildly
dilated. There are simple atheroma in the descending thoracic
aorta.
The aortic valve leaflets are severely thickened/deformed. There
is severe aortic valve stenosis (valve area 0.8-1.0cm2). Mild to
moderate ([**12-17**]+) aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen.
Wire was seen in descending aorta during femoral artery
cannulation.
Femoral venous cannula seen entering SVC during placement by
surgeon.

Post CPB:
The patient is being A-paced on phenylephrine and epinephrine
infusions.
The is a well seated bioprosthetic valve in the aortic position
which has mean/peak gradients of 7/16mmHg with a cardiac output
of 6/1L/minute.
There is trivial mitral regurgitation.
The visible contours of the thoracic aorta are intact.

[**2142-5-6**] WBC-10.9 RBC-2.81* Hgb-9.3* Hct-27.1* MCV-96 MCH-33.3*
MCHC-34.5 RDW-12.6 Plt Ct-179
[**2142-5-2**] WBC-20.5*# RBC-3.08* Hgb-10.2* Hct-29.4* MCV-96
MCH-33.1* MCHC-34.7 RDW-12.6 Plt Ct-132*
[**2142-5-6**] Glucose-109* UreaN-17 Creat-0.9 Na-137 K-4.2 Cl-98
HCO3-29
[**2142-5-2**] UreaN-17 Creat-0.7 Na-139 K-3.9 Cl-112* HCO3-21*
AnGap-10
[**2142-5-6**] Mg-2.3

Brief Hospital Course:
The patient was brought to the operating room on [**2142-5-2**] where
the patient underwent redo, AVR (tissue), revision of PDA/OM
graft .   Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.  The patient
was transferred to the telemetry floor for further recovery.  He
developed urinary retention.  Foley was re-inserted and Flomax
started, he voided following 2nd foley removal.  Chest tubes and
pacing wires were discontinued without complication.

The patient was evaluated by the physical therapy service for
assistance with strength and mobility.  By the time of discharge
on POD4 the patient was ambulating freely, the wound was healing
and pain was controlled with oral analgesics.  The patient was
discharged to home with Partners [**Name (NI) 269**] in good condition with
appropriate follow up instructions.

Medications on Admission:
AMIODARONE -  (Prescribed by Other Provider) - 200 mg Tablet - 1
Tablet(s) by mouth daily
CITALOPRAM [CELEXA] -  (Prescribed by Other Provider) - 20 mg
Tablet - 1 Tablet(s) by mouth once a day
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth daily
LEVOTHYROXINE -  (Prescribed by Other Provider) - 50 mcg Tablet
-
1 Tablet(s) by mouth daily
LORAZEPAM -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth twice a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 50 mg
Tablet - 1 Tablet(s) by mouth twice a day
SIMVASTATIN [ZOCOR] -  (Prescribed by Other Provider) - 40 mg
Tablet - 1 Tablet(s) by mouth once a day

Medications - OTC
ASPIRIN [ENTERIC COATED ASPIRIN] -  (Prescribed by Other
Provider) - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s)
by
mouth once a day
CHLORHEXIDINE GLUCONATE - 4 % Liquid - apply topically daily
Shower daily using chlorhexidine for 5 days prior to surgery and
the day of surgery
MULTIVITAMIN-MINERALS-LUTEIN [CENTRUM SILVER] -  (Prescribed by
Other Provider) -   Tablet - Tablet(s) by mouth daily
THIAMINE HCL -  (Prescribed by Other Provider) - 100 mg Tablet -
1 Tablet(s) by mouth once a day
--------------- --------------- --------------- ---------------


Discharge Medications:
1. lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
10. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
11. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Ext Release 24 hr(s)* Refills:*2*
12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
13. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
14. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
15. potassium chloride 10 mEq Capsule, Extended Release Sig: One
(1) Capsule, Extended Release PO once a day: take with
furosemide.
Disp:*5 Capsule, Extended Release(s)* Refills:*0*
16. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
- Aortic Stenosis
- Myocardial infarction
- Coronary Disease
- Dyslipidemia
- Hypertension
- History of postop PAF
- Hypothyroid related to amiodarone
Past Surgical History
- Emergent coronary bypass grafting x5, on intra-aortic balloon
pump with endoscopic left greater saphenous vein harvesting and
endoscopic right greater saphenous vein harvesting on [**2137-9-19**]
- Re-Exploration for bleeding following CABG


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments:
Wound Check at Cardiac Surgery Office [**Telephone/Fax (1) 170**] WOUND CARE
NURSE Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2142-5-15**] 10:15 [**Last Name (un) 2577**]
Building [**Last Name (NamePattern1) **] [**Location (un) 551**] [**Hospital Unit Name **]

Surgeon Dr. [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2142-5-29**] 1:00 [**Last Name (un) 2577**] Building [**Last Name (NamePattern1) **] [**Location (un) 551**]
[**Hospital Unit Name **]

Cardiologist Dr. [**Last Name (STitle) 4469**] [**5-30**] at 1:45pm

Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] J. [**Telephone/Fax (1) 14328**] in [**3-20**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2142-5-8**]
{'Aortic valve disorders,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Other iatrogenic hypothyroidism,Cardiac rhythm regulators causing adverse effects in therapeutic use,Personal history of tobacco use,Aortocoronary bypass status'}


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: echocardiogram showed [**Location (un) 109**]=0.6

PRESENT ILLNESS: 66yo male s/p CABG in [**2137-9-15**]. He
had known aortic stenosis at time of surgical revascularization
but it was not significant enough to require
aortic valve replacement. However since that time,  serial
echocardiograms have confirmed progression of aortic valve
stenosis. Currently he denies chest pain, dyspnea, syncope,
presyncope, palpitations, orthopnea, PND and pedal edema. He has
been referred for surgical evaluation.

MEDICAL HISTORY: - Aortic Stenosis
- Myocardial infarction
- Coronary Disease
- Dyslipidemia
- Hypertension
- History of postop PAF
- Hypothyroid related to amiodarone
Past Surgical History
- Emergent coronary bypass grafting x5, on intra-aortic balloon
pump with endoscopic left greater saphenous vein harvesting and
endoscopic right greater saphenous vein harvesting on [**2137-9-19**]
- Re-Exploration for bleeding following CABG

MEDICATION ON ADMISSION: AMIODARONE -  (Prescribed by Other Provider) - 200 mg Tablet - 1
Tablet(s) by mouth daily
CITALOPRAM [CELEXA] -  (Prescribed by Other Provider) - 20 mg
Tablet - 1 Tablet(s) by mouth once a day
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth daily
LEVOTHYROXINE -  (Prescribed by Other Provider) - 50 mcg Tablet
-
1 Tablet(s) by mouth daily
LORAZEPAM -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth twice a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 50 mg
Tablet - 1 Tablet(s) by mouth twice a day
SIMVASTATIN [ZOCOR] -  (Prescribed by Other Provider) - 40 mg
Tablet - 1 Tablet(s) by mouth once a day

ALLERGIES: Penicillins

PHYSICAL EXAM: Pulse:59 Resp:16  O2 sat: 98/RA
B/P  Right:137/82    Left: 157/79
Height:5'9"     Weight:200 lbs

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives with: Wife in [**Name2 (NI) **]
Occupation: Lithographer for [**Location (un) 86**] Globe
Tobacco: Smoked infrequently between ages 16-21.
ETOH:1 beer and 1 whiskey nip/day 

### Response:
{'Aortic valve disorders,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Other iatrogenic hypothyroidism,Cardiac rhythm regulators causing adverse effects in therapeutic use,Personal history of tobacco use,Aortocoronary bypass status'}
