CHIEF COMPLAINT: Dyspnea on exertion, exertional chest pain, and decreased
exercise tolerance.

PRESENT ILLNESS: 85 yo male with DOE, exertional CP, and decreased exercise
tolerance, work up revealed AS and single vessel CAD.

MEDICAL HISTORY: AS/CAD
COPD/asthma
Anal fissure with stricture
Prostate ca./BPH
chronic constipation
s/p melenoma removal [**12-13**]
s/p rectal fissure repair
s/p Appy. s/p T&A
s/p TURP '[**86**]

MEDICATION ON ADMISSION: Altace 5(1)
Pulmicort 2 puffs(2)
Xopenex (2)
Colace 100(2)
Pepcid 20 qhs
Ativan 0.5 prn

ALLERGIES: Erythromycin / Aspirin

PHYSICAL EXAM: On admission
vs:afebrile, p:115, 110/60
general; A & Ox 3, NAD
HEENT: unremarkable
CVS:RRR, murmur noted
Lungs:CTA
ABD: benign
EXT: no C/C/E

FAMILY HISTORY: nc

SOCIAL HISTORY: retired MD
40 PY hx. quit "several years ago"
Aortic valve disorders,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic obstructive asthma, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Aortic valve disorder,Surg compl-heart,Crnry athrscl natve vssl,Atrial fibrillation,Chronic obst asthma NOS,Abn react-artif implant
Admission Date:  [**2192-4-20**]              Discharge Date:   [**2192-4-24**]


Service: CARDIOTHORACIC

Allergies:
Erythromycin / Aspirin

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Dyspnea on exertion, exertional chest pain, and decreased
exercise tolerance.

Major Surgical or Invasive Procedure:
status post CABG x1/ AVR (#23 CE Magna) [**2192-4-20**]

History of Present Illness:
85 yo male with DOE, exertional CP, and decreased exercise
tolerance, work up revealed AS and single vessel CAD.

Past Medical History:
AS/CAD
COPD/asthma
Anal fissure with stricture
Prostate ca./BPH
chronic constipation
s/p melenoma removal [**12-13**]
s/p rectal fissure repair
s/p Appy. s/p T&A
s/p TURP '[**86**]

Social History:
retired MD
40 PY hx. quit "several years ago"

Family History:
nc

Physical Exam:
On admission
vs:afebrile, p:115, 110/60
general; A & Ox 3, NAD
HEENT: unremarkable
CVS:RRR, murmur noted
Lungs:CTA
ABD: benign
EXT: no C/C/E


Pertinent Results:
[**2192-4-22**] 05:27AM BLOOD WBC-10.5 RBC-3.68* Hgb-9.7* Hct-30.5*
MCV-83 MCH-26.4* MCHC-31.9 RDW-13.3 Plt Ct-179
[**2192-4-22**] 05:27AM BLOOD Glucose-110* UreaN-26* Creat-1.4* Na-135
K-4.7 Cl-99 HCO3-29 AnGap-12
RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2192-4-22**] 12:52 PM

CHEST (PA & LAT)

Reason: assess for pnuemo

[**Hospital 93**] MEDICAL CONDITION:
85 year old man with post CT removal post cabg
REASON FOR THIS EXAMINATION:
assess for pnuemo
PA AND LATERAL CHEST, [**4-22**]

HISTORY: Chest tube removed after CABG.

IMPRESSION: AP chest compared to [**4-20**]:

Patient has been extubated. Small bilateral pleural effusions
are unchanged and there is no pneumothorax. Bilateral lower lobe
collapse is unchanged. Postoperative cardiomediastinal
silhouette is normal and unchanged.

DR. [**Known firstname **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 77682**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 77683**] (Complete)
Done [**2192-4-20**] at 1:35:15 PM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**]
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2107-2-8**]
Age (years): 85 M  Hgt (in): 72
BP (mm Hg): 142/90  Wgt (lb): 185
HR (bpm): 74  BSA (m2): 2.06 m2
Indication: Intraop CABG, AVR, evaluate vales, aortic contours,
ventricular function
ICD-9 Codes: 440.0, 424.1, 424.0
Test Information
Date/Time: [**2192-4-20**] at 13:35    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW4-: Machine: 4
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *6.0 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.0 cm  <= 5.2 cm
Left Atrium - Peak Pulm Vein S:  0.4 m/s
Left Atrium - Peak Pulm Vein D:  0.4 m/s
Left Atrium - Peak Pulm Vein A:  0.2 m/s  < 0.4 m/s
Left Ventricle - Inferolateral Thickness:  *1.6 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  2.9 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  1.8 cm
Left Ventricle - Fractional Shortening:  0.38  >= 0.29
Left Ventricle - Ejection Fraction:  55% to 65%  >= 55%
Left Ventricle - Peak Resting LVOT gradient:  3 mm Hg  <= 10 mm
Hg
Aorta - Annulus:  2.3 cm  <= 3.0 cm
Aorta - Sinus Level:  3.3 cm  <= 3.6 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aorta - Arch:  2.3 cm  <= 3.0 cm
Aorta - Descending Thoracic:  *3.1 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *2.5 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *25 mm Hg  < 20 mm Hg
Aortic Valve - LVOT pk vel:  0.[**Age over 90 **] m/sec
Aortic Valve - LVOT diam:  2.1 cm
Aortic Valve - Valve Area:  *1.2 cm2  >= 3.0 cm2
Mitral Valve - Mean Gradient:  5 mm Hg
Mitral Valve - Pressure Half Time:  77 ms
Mitral Valve - MVA (P [**12-7**] T):  1.8 cm2

Findings
LEFT ATRIUM: Marked LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Lipomatous hypertrophy of the
interatrial septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Moderate symmetric LVH. Normal LV cavity size.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Complex (>4mm) atheroma in the
ascending aorta. Normal aortic arch diameter. Complex (>4mm)
atheroma in the aortic arch. Mildly dilated descending aorta.
Complex (>4mm) atheroma in the descending thoracic aorta.

AORTIC VALVE: Moderate AS (AoVA 1.0-1.2cm2) No AR.

MITRAL VALVE: Moderately thickened mitral valve leaflets. Severe
mitral annular calcification. Moderate thickening of mitral
valve chordae. Torn mitral chordae. Mild valvular MS (MVA
1.5-2.0cm2). Mild to moderate ([**12-7**]+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. No TEE related complications. The patient appears
to be in sinus rhythm.
Conclusions
Pre bypass: The left atrium is markedly dilated. No atrial
septal defect is seen by 2D or color Doppler. There is moderate
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Right ventricular chamber size and free
wall motion are normal. The descending thoracic aorta is mildly
dilated. There is complex atheroma of the ascending, arch and
descending thoracic aorta. An epiaortic scan was conducted to
deliniate areas of least plaque/calcifcation for aortic cross
clamp and cannula prior to bypass. There is moderate aortic
valve stenosis (area 1.0-1.2cm2). No aortic regurgitation is
seen. The mitral valve leaflets are moderately thickened. There
is severe mitral annular calcification. There is calcium
extending onto a significant portion of the posterior mitral
leaflet. There is moderate thickening of the mitral valve
chordae. A torn mitral chord is present, originating from the
posteromedial papillary muscle. There is borderline mild
valvular mitral stenosis (area 1.8 cm2, 3.2 on recheck at higher
blood pressure). Mild to moderate ([**12-7**]+) mitral regurgitation is
seen, most prominent when blood pressure is in 170's systolic.
Vena contracta <.5 cm consistently.

Post byass: Preserved biventricular funciton. LVEF >55%. An
aortic valve bioprosthesis is seen (#23 magna per surgeons).
Peak gradient 12 mm Hg, Mean gradient 6 mm Hg post bypass. No
AI, no perivalvular leaks on aortic valve. Peak MR remains [**12-7**]+.
Aortic contours intact. Remaining exam is unchanged.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting ph


Brief Hospital Course:
[**2192-4-20**] Mr [**Known lastname **] was taken to the OR where he underwent
CABG x1 (SVG->PLB) and AVR (#23mm CE Magna pericardial) with Dr
[**Last Name (STitle) 914**]. Cross clamp time=104 minutes, CPB time=130 minutes.
Please refer to Dr.[**Name (NI) 9379**] operative report for further
details.Mr [**Known lastname **] was transferred to the CVICU in stable
condition, requiring Neo and Propofol to optimize blood pressure
while sedated.All drips were weaned in a timely fashion and the
patient was extubated postop night. He was transferred to the
SDU floor on POD#1.All lines and tubes were discontinued in a
timely fashion. On POD#2 Mr[**Known lastname **]'s rhythm went into a rapid
atrial fibrillation. He was beta blockaded and started on
Amiodarone po dosing.Anticoagulation was initiated with
Coumadin. Day #3 his rhythm converted to NSR in the 80s.On POD
#4 Mr [**Known lastname **] was doing well and it was felt that he was ready
for discharge to rehab for further strength and exercise
tolerance.

Medications on Admission:
Altace 5(1)
Pulmicort 2 puffs(2)
Xopenex (2)
Colace 100(2)
Pepcid 20 qhs
Ativan 0.5 prn

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
4. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
8. Famotidine 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Levalbuterol HCl 0.63 mg/3 mL Solution for Nebulization Sig:
One (1) ML Inhalation 1 neb [**Hospital1 **] prn () as needed for dyspnea.
10. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day.

11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
12. Warfarin 3 mg Tablet Sig: INR 2-2.5 Tablets PO once a day:
Dose based on INR goal 2-2.5, please check INR Mon/Wed/Fri.
13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
14. Mucinex 600 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO twice a day for 5 days.
15. Combivent 18-103 mcg/Actuation Aerosol Sig: Two (2)
Inhalation every six (6) hours.


Discharge Disposition:
Extended Care

Facility:
[**Location **], at [**Location (un) **]

Discharge Diagnosis:
CAD/AS s/p CABG x1/AVR (#23mm CE Magna)
COPD, asthma, anal fissure, prostate ca./BPH, melanoma
removal1/08, s/pT7A, s/p appy, s/p TURP'[**86**]

Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr [**Last Name (STitle) 914**] after discharge from rehab ([**Telephone/Fax (1) 170**]) please call
for appointment
Dr [**First Name (STitle) **] in 6weeks following discharge from rehab
([**Telephone/Fax (1) 77684**])
Dr [**Last Name (STitle) 55499**] in 4 weeks following discharge from rehab



Completed by:[**2192-4-24**]
{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic obstructive asthma, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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, exertional chest pain, and decreased
exercise tolerance.

PRESENT ILLNESS: 85 yo male with DOE, exertional CP, and decreased exercise
tolerance, work up revealed AS and single vessel CAD.

MEDICAL HISTORY: AS/CAD
COPD/asthma
Anal fissure with stricture
Prostate ca./BPH
chronic constipation
s/p melenoma removal [**12-13**]
s/p rectal fissure repair
s/p Appy. s/p T&A
s/p TURP '[**86**]

MEDICATION ON ADMISSION: Altace 5(1)
Pulmicort 2 puffs(2)
Xopenex (2)
Colace 100(2)
Pepcid 20 qhs
Ativan 0.5 prn

ALLERGIES: Erythromycin / Aspirin

PHYSICAL EXAM: On admission
vs:afebrile, p:115, 110/60
general; A & Ox 3, NAD
HEENT: unremarkable
CVS:RRR, murmur noted
Lungs:CTA
ABD: benign
EXT: no C/C/E

FAMILY HISTORY: nc

SOCIAL HISTORY: retired MD
40 PY hx. quit "several years ago" 

### Response:
{'Aortic valve disorders,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Chronic obstructive asthma, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
