CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 86 yo F with critical AS. PMH sig for CABG [**04**] years ago, PPM
placement, and NSTEMI in [**9-3**] with LM DES and aortic
valvuloplasty x 2. Readmitted at OSH for ?ileus/CHF and
transferred to [**Hospital1 **] for surgical eval.

MEDICAL HISTORY: Aortic Stenosis
Congestive Heart Failure
Coronary Artery Disease - s/p CABG, s/p Left Main Drug Eluding
Stent, History of NSTEMI
Peripheral Vascular Disease
Cerebrovascular Disease - history of TIA
Bilateral Carotid Disease
Hypertension
Pacemaker in Situ
GERD
History of Lyme Disease
Bilateral Cataract Surgery

MEDICATION ON ADMISSION: ECASA 325, plavix 75, atenolol 50", altace 5, Vytorin [**9-16**],
zantac 300", protonix 40", MVI, lasix 20', Famotidine 20

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:
General: WDWN
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Son deceased at age 42 of myocardial infarction

SOCIAL HISTORY: Retired - worked in resturant. Lives in apartment next to
daughter. [**Name (NI) 1139**] quit > 20 years ago, smoked [**11-28**] cigarettes/
day for 40 years. Denies ETOH.
Aortic valve disorders,Chronic systolic heart failure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Anemia, unspecified,Peripheral vascular disease, unspecified,Aortocoronary bypass status,Cardiac pacemaker in situ,Old myocardial infarction
Aortic valve disorder,Chr systolic hrt failure,Surg compl-heart,Atrial fibrillation,Hypertension NOS,Anemia NOS,Periph vascular dis NOS,Aortocoronary bypass,Status cardiac pacemaker,Old myocardial infarct
Admission Date:  [**2192-12-17**]              Discharge Date:   [**2192-12-26**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
[**2192-12-18**] Apico-Aortic Conduit(utilizing a 19mm [**Company 1543**]
Freestyle Aortic Root Heart Valve) via Left Thoractomy


History of Present Illness:
86 yo F with critical AS. PMH sig for CABG [**04**] years ago, PPM
placement, and NSTEMI in [**9-3**] with LM DES and aortic
valvuloplasty x 2. Readmitted at OSH for ?ileus/CHF and
transferred to [**Hospital1 **] for surgical eval.

Past Medical History:
Aortic Stenosis
Congestive Heart Failure
Coronary Artery Disease - s/p CABG, s/p Left Main Drug Eluding
Stent, History of NSTEMI
Peripheral Vascular Disease
Cerebrovascular Disease - history of TIA
Bilateral Carotid Disease
Hypertension
Pacemaker in Situ
GERD
History of Lyme Disease
Bilateral Cataract Surgery

Social History:
Retired - worked in resturant. Lives in apartment next to
daughter. [**Name (NI) 1139**] quit > 20 years ago, smoked [**11-28**] cigarettes/
day for 40 years. Denies ETOH.


Family History:
Son deceased at age 42 of myocardial infarction

Physical Exam:
Vitals:
General: WDWN
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

Pertinent Results:
[**2192-12-25**] 04:40AM BLOOD WBC-11.4* RBC-4.10* Hgb-11.8* Hct-34.9*
MCV-85 MCH-28.7 MCHC-33.7 RDW-15.4 Plt Ct-137*
[**2192-12-25**] 04:40AM BLOOD Plt Ct-137*
[**2192-12-23**] 02:09AM BLOOD PT-13.8* PTT-27.7 INR(PT)-1.2*
[**2192-12-26**] 04:50AM BLOOD Glucose-92 UreaN-41* Creat-1.1 Na-138
K-3.4 Cl-102 HCO3-27 AnGap-12

CHEST (PORTABLE AP)  [**2192-12-25**] 9:22 AM

CHEST (PORTABLE AP)

Reason: eval ptx with chest tubes clamped

[**Hospital 93**] MEDICAL CONDITION:
86 year old woman s/p apicoaortic conduit
REASON FOR THIS EXAMINATION:
eval ptx with chest tubes clamped
INDICATIONS: 86-year-old woman status post apical aortic conduit
placement. Please evaluate for pneumothorax with chest tubes
clamped.

CHEST, PORTABLE AP: Comparison is made to the prior day. The
configuration of two left-sided chest tubes, a right internal
jugular central venous catheter, and a dual-lead pacemaker/ICD
device is unchanged. There is no evidence for pneumothorax or
effusion. Mild prominence of central pulmonary vessels is
unchanged. Left basilar atelectasis appears improved.

IMPRESSION: No evidence of pneumothorax.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 75681**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 75683**] (Complete)
Done [**2192-12-18**] at 11:59:16 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Last Name (Prefixes) 413**], [**First Name3 (LF) 412**]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2105-12-29**]
Age (years): 86 F  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Redo AVR
ICD-9 Codes: 402.90, 786.05, 786.51, 799.02, 440.0, V43.3,
424.1, 424.0
Test Information
Date/Time: [**2192-12-18**] at 11:59    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW1-: Machine: [**Pager number **]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  *1.8 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.2 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  30% to 35%  >= 55%
Aorta - Ascending:  *3.7 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.2 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *5.1 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *103 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  58 mm Hg
Aortic Valve - LVOT pk vel:  0.[**Age over 90 **] m/sec
Aortic Valve - LVOT diam:  1.8 cm
Aortic Valve - Valve Area:  *0.5 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

LEFT VENTRICLE: Severe symmetric LVH. Moderately depressed LVEF.


RIGHT VENTRICLE: Moderate global RV free wall hypokinesis.

AORTA: Mildly dilated ascending aorta. Simple atheroma in
ascending aorta. Normal descending aorta diameter. Complex
(>4mm) atheroma in the descending thoracic aorta.

AORTIC VALVE: Severe AS (AoVA <0.8cm2).

MITRAL VALVE: Moderately thickened mitral valve leaflets. Mild
(1+) MR.

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: 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. The patient was under general anesthesia throughout
the procedure. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
Pred-CPB: No spontaneous echo contrast is seen in the left
atrial appendage. There is severe symmetric left ventricular
hypertrophy. Overall left ventricular systolic function is
moderately depressed (LVEF= 30 - 35 %). with moderate global
free wall hypokinesis. The ascending aorta is mildly dilated.
There are simple atheroma in the ascending aorta. There are
complex (>4mm) atheroma in the descending thoracic aorta. There
is severe aortic valve stenosis (area <0.8cm2). The mitral valve
leaflets are moderately thickened. Mild (1+) mitral
regurgitation is seen. There is no pericardial effusion.

Post-CPB: The patient received a valved conduit from the LV apex
to the descending aorta, on bypass, with continuous VFib. Meds
are Amiodarone infusion and low dose Phenylephrine. A-Paced.
LV fxn is still moderately depressed with EF 30%. There is a
conduit from the LV apex to the descending aorta, with flow
noted. There is considerable reduction in the flow thru the
LVOT. Aorta is intact otherwise. RV systolic fxn mildly to
moderately reduced.


Brief Hospital Course:
She was admitted preoperatively. On [**12-18**] she underwent an
apico-aortic conduit with 19 mm tissue valve. She was
transferred to the ICU in stable condition. She was extubated on
POD #1. She was started on amio and must remain on it for life.
She remained in the ICU for pulmonary toilet. Creatinine bumped
but peaked at 1.9, and has returned to [**Location 213**]. She was
transferred to the floor on POD #6. She had an air leak and her
chest tubes were placed to water seal and then clamped with no
pneumothorax prior to being discontinued. She was ready for
discharge to rehab on POD #8.

Medications on Admission:
ECASA 325, plavix 75, atenolol 50", altace 5, Vytorin [**9-16**],
zantac 300", protonix 40", MVI, lasix 20', Famotidine 20

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for LM stent.
5. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. Citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
8. Albuterol Sulfate 2.5 mg/3 mL Solution for Nebulization Sig:
One (1)  Inhalation Q6H (every 6 hours) as needed.
9. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q4H
(every 4 hours) as needed.
10. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.
11. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
200 mg daily x 1 week, then 200 mg daily ongoing for life.
12. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for shortness of breath or
wheezing.
13. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
14. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

15. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
16. Lasix 20 mg Tablet Sig: Two (2) Tablet PO twice a day for 7
days: 40 [**Hospital1 **] x 7 days then 20 daily as prior to surgery.
17. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 7
days.


Discharge Disposition:
Extended Care

Facility:
Friendly [**Name2 (NI) **] INC

Discharge Diagnosis:
Aortic Stenosis - s/p Apico-Aortic Conduit
Postoperative Anemia
Coronary Artery Disease - prior CABG
Congestive Heart Failure(Systolic)
Pacemaker in Situ
Hypertension
Peripheral Vascular Disease
Bilateral Carotid Disease
History of TIA


Discharge Condition:
Stable


Discharge Instructions:
1)Please shower daily. No baths. Pat dry incisions, do not rub.
2)Avoid creams and lotions to surgical incisions.
3)Call cardiac surgeon if there is concern for wound infection.
4)No lifting more than 10 lbs for at least 10 weeks from
surgical date.
5)No driving for at least one month.

Followup Instructions:
Dr. [**Last Name (STitle) 1290**] in [**3-2**] weeks, call for appt
Dr. [**Last Name (STitle) 64868**] in [**12-30**] weeks, call for appt
Dr. [**Name (NI) 71003**] in [**12-30**] weeks, call for appt



Completed by:[**2192-12-26**]
{'Aortic valve disorders,Chronic systolic heart failure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Anemia, unspecified,Peripheral vascular disease, unspecified,Aortocoronary bypass status,Cardiac pacemaker in situ,Old myocardial infarction'}


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: SOB

PRESENT ILLNESS: 86 yo F with critical AS. PMH sig for CABG [**04**] years ago, PPM
placement, and NSTEMI in [**9-3**] with LM DES and aortic
valvuloplasty x 2. Readmitted at OSH for ?ileus/CHF and
transferred to [**Hospital1 **] for surgical eval.

MEDICAL HISTORY: Aortic Stenosis
Congestive Heart Failure
Coronary Artery Disease - s/p CABG, s/p Left Main Drug Eluding
Stent, History of NSTEMI
Peripheral Vascular Disease
Cerebrovascular Disease - history of TIA
Bilateral Carotid Disease
Hypertension
Pacemaker in Situ
GERD
History of Lyme Disease
Bilateral Cataract Surgery

MEDICATION ON ADMISSION: ECASA 325, plavix 75, atenolol 50", altace 5, Vytorin [**9-16**],
zantac 300", protonix 40", MVI, lasix 20', Famotidine 20

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:
General: WDWN
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Son deceased at age 42 of myocardial infarction

SOCIAL HISTORY: Retired - worked in resturant. Lives in apartment next to
daughter. [**Name (NI) 1139**] quit > 20 years ago, smoked [**11-28**] cigarettes/
day for 40 years. Denies ETOH. 

### Response:
{'Aortic valve disorders,Chronic systolic heart failure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Anemia, unspecified,Peripheral vascular disease, unspecified,Aortocoronary bypass status,Cardiac pacemaker in situ,Old myocardial infarction'}
