CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 86 year old male with history of atrial fibrillation and aortic
stenosis ([**Location (un) 109**] 1 on Cardiac catheterization). Over the past 24
hours he presented to outside
hospital with complaint of chest pain, fatique, weakness and
mild upper back pain. EKG with chronic ST segment
changes,inferior infarct, anterior ST changes, troponin 0.4.
His hematocrit was found to be 17 and he was transfused with 2
units PRBC. Additionally INR was elevated 5.7 related to
coumadin for atrial fibrillation and was treated 2 units FFP and
Vitamin K 10mg po. Due to recurrent chest pain he was
transferred for further evaluation due to known coronary artery
disease and aortic stenosis.  He was seen by cardiac surgery in
[**Month (only) **] in evaluation for cardiac surgery however declined
surgery.

MEDICAL HISTORY: Hard of hearing
Atrial fibrillation- on Coumadin
Aortic valve disorder ([**Location (un) 109**] 1)
Arthritis
Anemia recieves IV Iron
Gastroesophageal reflux disease
Colon cancer s/p colon resection
Prostate cancer s/p radioactive seed implant

MEDICATION ON ADMISSION: Doxazosin 8 mg daily
Lasix 80 mg daily
Hydroxyurea 1000 mg wednesday and saturday
Prilosec 20 mg daily
Coumadin 5 mg mon-wed-fri-sun, 2.5 mg tues-thrus-sat - last dose

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:80's irreg, Resp: 14 O2 sat: 2l 98%
B/P  Right: 108/52   Left: 109/54
Height: 5'[**52**]"    Weight: 80.4kg

FAMILY HISTORY: None

SOCIAL HISTORY: Last Dental Exam: edentulous
Lives with: widowed, lives with [**First Name9 (NamePattern2) 89616**] [**Doctor First Name 5627**]
Occupation:Retired
Tobacco: none quit [**2113**]
ETOH: [**2-10**]+ beers/day
Hemorrhage of gastrointestinal tract, unspecified,Abnormal coagulation profile,Atrial fibrillation,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Internal hemorrhoids without mention of complication,Iron deficiency anemia, unspecified,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diverticulosis of colon (without mention of hemorrhage),Personal history of malignant neoplasm of large intestine,Personal history of malignant neoplasm of prostate,Examination of participant in clinical trial
Gastrointest hemorr NOS,Abnrml coagultion prfile,Atrial fibrillation,Aortic valve disorder,Crnry athrscl natve vssl,Esophageal reflux,Int hemorrhoid w/o compl,Iron defic anemia NOS,Angio stm/dudn w/o hmrhg,Dvrtclo colon w/o hmrhg,Hx of colonic malignancy,Hx-prostatic malignancy,Exam-clincal trial
Admission Date:  [**2154-6-11**]              Discharge Date:   [**2154-6-18**]


Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2154-6-13**] - Colonoscopy
[**2154-6-13**] - Esophagogastroduodonoscopy
[**2154-6-14**] - Capsule Study


History of Present Illness:
86 year old male with history of atrial fibrillation and aortic
stenosis ([**Location (un) 109**] 1 on Cardiac catheterization). Over the past 24
hours he presented to outside
hospital with complaint of chest pain, fatique, weakness and
mild upper back pain. EKG with chronic ST segment
changes,inferior infarct, anterior ST changes, troponin 0.4.
His hematocrit was found to be 17 and he was transfused with 2
units PRBC. Additionally INR was elevated 5.7 related to
coumadin for atrial fibrillation and was treated 2 units FFP and
Vitamin K 10mg po. Due to recurrent chest pain he was
transferred for further evaluation due to known coronary artery
disease and aortic stenosis.  He was seen by cardiac surgery in
[**Month (only) **] in evaluation for cardiac surgery however declined
surgery.

Past Medical History:
Hard of hearing
Atrial fibrillation- on Coumadin
Aortic valve disorder ([**Location (un) 109**] 1)
Arthritis
Anemia recieves IV Iron
Gastroesophageal reflux disease
Colon cancer s/p colon resection
Prostate cancer s/p radioactive seed implant

Social History:
Last Dental Exam: edentulous
Lives with: widowed, lives with [**First Name9 (NamePattern2) 89616**] [**Doctor First Name 5627**]
Occupation:Retired
Tobacco: none quit [**2113**]
ETOH: [**2-10**]+ beers/day


Family History:
None

Physical Exam:
Pulse:80's irreg, Resp: 14 O2 sat: 2l 98%
B/P  Right: 108/52   Left: 109/54
Height: 5'[**52**]"    Weight: 80.4kg

General: Hard of hearing, sitting up in chair no acute distress
denies any pain
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular [x]  Murmur [**2-10**] syst.
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] well healed mid-line scar s/p partial colectomy
Extremities: Warm [x], well-perfused [x]
Edema- none
Varicosities- minimal
Neuro: alert and oriented x3 nonfocal
Pulses:
Femoral      Right: 2+  Left:2+
DP           Right: 1+  Left:1+
PT           [**Name (NI) 167**]: Doppler  Left:doppler
Radial       Right: 2+  Left:2+

Carotid Bruit        Right: None   Left:None


Pertinent Results:
ECHO [**2154-6-13**]
The left atrium is dilated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is moderate global left ventricular hypokinesis
(LVEF = 35 %). Tissue Doppler imaging suggests an increased left
ventricular filling pressure (PCWP>18mmHg). The right
ventricular free wall thickness is normal. Right ventricular
chamber size is normal. with borderline normal free wall
function. The ascending aorta is mildly dilated. There are focal
calcifications in the aortic arch. The aortic valve leaflets are
severely thickened/deformed. There is severe aortic valve
stenosis (valve area 0.9 cm2). Mild (1+) aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. There is
no mitral valve prolapse. Moderate (2+) mitral regurgitation is
seen. [Due to acoustic shadowing, the severity of mitral
regurgitation may be significantly UNDERestimated.] The
tricuspid valve leaflets are mildly thickened. Moderate [2+]
tricuspid regurgitation is seen. There is moderate pulmonary
artery systolic hypertension. There is no pericardial effusion.


Colonoscopy [**2154-6-13**]
Normal terminal ileum
Grade 1 internal hemorrhoids
Diverticulosis of the sigmoid colon
No avms seen
Otherwise normal colonoscopy to cecum and ileum

EGD [**2154-6-13**]
Angioectasia in the second part of the duodenum
Otherwise normal EGD to second part of the duodenum

Capsule study [**2154-6-14**]
Nonbleeding angioectasia

CT scan [**2154-6-17**]
1. Multifocal patchy ground-glass opacities predominantly in the
upper lobes, but also involve the RLL, concerning for multifocal
PNA. DDx also includes NSIP.
2. Moderate bilateral pleural effusions, without evidence of
loculation.
3. Sub-5mm solid nodules in the RML and RLL. Punctate calcified
granuloma in the right base. Calcified perihepatic nodule.
4. Significant 3-vessel coronary artery disease.
5. Small amount of scattered calcified atherosclerotic plaques
in the
ascending aorta, with a 2.8-cm relatively calcification-free
segment starting approximately 1.2 cm superior to the origin of
the right coronary artery.

Carotid ultrasound [**2154-6-18**]
Results pending


Brief Hospital Course:
Mr. [**Known lastname 5239**] was admitted to the [**Hospital1 18**] on [**2154-6-11**] for further
management of his cardiac disease and gastrointestinal bleed. He
was placed in the intensive care unit and a gastroenterology
consult was obtained. Anticoagulation was held and he was
transfused to maintain a hematocrit of 30. A proton pump
inhibitor was started. A cardiology consult was obtained who
recommended a low dose beta blocker and a high dose statin given
his presentation of demand ischemia in the setting of anemia.
His troponin peaked at 1.39. An EGD was performed which showed
angioectasia that were not bleeding in the duodenum with an
otherwise normal study. A colonoscopy was also performed which
showed diverticulum and internal hemorrhoid but was otherwise
normal. He was transferred to the step down unit on [**2154-6-14**] for
further management and surgical planning. As there was no
further evidence of GI bleeding, aspirin was restarted. A
capsule study/virtual colonoscopy was started on [**2154-6-14**] which
showed non bleeding angioectasia. He remained in rate controlled
atrial fibrillation. Coumadin remained on hold and will be
addressed after he has had his surgery. Surgery was scheduled
for [**2154-7-1**]. As he remained stable, he was discharged home on
[**2154-6-18**]. He will have biweekly hematocrits sent to both our
office and Dr.[**Name (NI) 5318**] office drawn by the visiting
nurse.. Surgical consent was obtained with the understanding
that there was a higher risk of further gastrointestinal
bleeding with heparinization with his surgery.

Medications on Admission:
Doxazosin 8 mg daily
Lasix 80 mg daily
Hydroxyurea 1000 mg wednesday and saturday
Prilosec 20 mg daily
Coumadin 5 mg mon-wed-fri-sun, 2.5 mg tues-thrus-sat - last dose

Vitamin C 500mg daily
Leutin 1 tab in am and 1 tab in PM
Tylenol 650 mg twice a day
Ascorbic acid
Aspirin 81 mg daily
Ferrous sulfate 325 mg TID
Multivitamin


Discharge Medications:
1. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.
Disp:*30 Tablet, Sublingual(s)* Refills:*0*
2. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. ferrous sulfate 300  mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. ascorbic acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
7. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day.
Disp:*30 Tablet, ER Particles/Crystals(s)* Refills:*0*
8. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. PreserVision 226-200-5 mg-unit-mg Capsule Sig: One (1)
Capsule PO BID (2 times a day).
Disp:*60 Capsule(s)* Refills:*0*
10. hydroxyurea 500 mg Capsule Sig: Two (2) Capsule PO 2X/WEEK
(WE,SA).
Disp:*20 Capsule(s)* Refills:*0*
11. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*0*
12. multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Gastrointestinal bleed - source unidentified in setting of
supratherapeutic INR.
Hard of hearing
Atrial fibrillation - Coumadin currently on hold
Aortic valve stenosis
Coronary artery disease
Arthritis
Anemia recieves IV Iron
Gastroesophageal reflux disease
Colon cancer s/p colon resection
Prostate cancer s/p radioactive seed implant


Discharge Condition:
Alert and oriented x3 nonfocal


Discharge Instructions:
1) You will need twice weekly hematocrit blood draws drawn by
visiting nurse.
2) Surgery scheduled for [**2154-7-1**]. You will be contact[**Name (NI) **] by our
office with a surgical time so you know when to arrive at the
hospital on [**2154-7-1**].
3) Visiting nurse to monitor you for signs of heart failure.
4) Call with any blood in stools, dark/tarry stools or abdominal
pain.
5) Call with any questions or concerns.

Followup Instructions:
You are scheduled for surgery on Monday [**2154-7-1**]. You will
be called with the timing by our office prior to your surgery.
Surgeon: Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 1504**]
Cardiologist: Dr. [**Last Name (STitle) 5310**] ([**Telephone/Fax (1) 5319**]
Primary care physician: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 18998**] ([**Telephone/Fax (1) 18999**]

**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:[**2154-6-18**]
{'Hemorrhage of gastrointestinal tract, unspecified,Abnormal coagulation profile,Atrial fibrillation,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Internal hemorrhoids without mention of complication,Iron deficiency anemia, unspecified,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diverticulosis of colon (without mention of hemorrhage),Personal history of malignant neoplasm of large intestine,Personal history of malignant neoplasm of prostate,Examination of participant in clinical trial'}


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: 86 year old male with history of atrial fibrillation and aortic
stenosis ([**Location (un) 109**] 1 on Cardiac catheterization). Over the past 24
hours he presented to outside
hospital with complaint of chest pain, fatique, weakness and
mild upper back pain. EKG with chronic ST segment
changes,inferior infarct, anterior ST changes, troponin 0.4.
His hematocrit was found to be 17 and he was transfused with 2
units PRBC. Additionally INR was elevated 5.7 related to
coumadin for atrial fibrillation and was treated 2 units FFP and
Vitamin K 10mg po. Due to recurrent chest pain he was
transferred for further evaluation due to known coronary artery
disease and aortic stenosis.  He was seen by cardiac surgery in
[**Month (only) **] in evaluation for cardiac surgery however declined
surgery.

MEDICAL HISTORY: Hard of hearing
Atrial fibrillation- on Coumadin
Aortic valve disorder ([**Location (un) 109**] 1)
Arthritis
Anemia recieves IV Iron
Gastroesophageal reflux disease
Colon cancer s/p colon resection
Prostate cancer s/p radioactive seed implant

MEDICATION ON ADMISSION: Doxazosin 8 mg daily
Lasix 80 mg daily
Hydroxyurea 1000 mg wednesday and saturday
Prilosec 20 mg daily
Coumadin 5 mg mon-wed-fri-sun, 2.5 mg tues-thrus-sat - last dose

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:80's irreg, Resp: 14 O2 sat: 2l 98%
B/P  Right: 108/52   Left: 109/54
Height: 5'[**52**]"    Weight: 80.4kg

FAMILY HISTORY: None

SOCIAL HISTORY: Last Dental Exam: edentulous
Lives with: widowed, lives with [**First Name9 (NamePattern2) 89616**] [**Doctor First Name 5627**]
Occupation:Retired
Tobacco: none quit [**2113**]
ETOH: [**2-10**]+ beers/day 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Abnormal coagulation profile,Atrial fibrillation,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Internal hemorrhoids without mention of complication,Iron deficiency anemia, unspecified,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diverticulosis of colon (without mention of hemorrhage),Personal history of malignant neoplasm of large intestine,Personal history of malignant neoplasm of prostate,Examination of participant in clinical trial'}
