CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: Mr. [**Known lastname **] is an 84 year old gentleman with a history of
multiple admissions for congestive heart failure exascerbations.
 On his most recent admission for this complaint, he underwent a
cardiac catheterization which revealed 70% stenosis of the left
anterior descending artery.  He was transferred to [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 1675**]
[**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for evaluation for cardiac surgery

MEDICAL HISTORY: severe aortic stenosis
mitral stenosis
coronary artery disease
chronic atrial fibrillation
ascending aortic aneurysm
chronic diastolic congestive heart failure
carotid artery disease
hyperlipidemia
eczema
peripheral vascular disease
duodenal ulcer 30 yrs ago
s/p TURP

MEDICATION ON ADMISSION: diltiazem 480mg, lasix 80mg in am and 40mg in pm, aspirin 325mg,
antivert 25mg, digoxin 0.25 every other day, celebrex 200mg,
betamethasone topically as needed for eczema, lipitor 20mg,
serax 15mg, potassium chloride 40meq

ALLERGIES: Penicillins / Lopressor / Indocin

PHYSICAL EXAM: On admission Mr. [**Known lastname **] was found to be well nourished.
Multiple bruises were noted on his arms, as was eczema.  His
neck was supple with a full range of motion.  His lungs were
clear to auscultation bilaterally.  A IV/VI holosystolic cardiac
murmur was ausculated. His abdomen was soft, non-tender,
non-distended.  1+ edema was noted and his extremities were
noted to be warm.  No varicosities were noted, however there
were bilateral venous stasis ulcers.  He was awake, alert, and
oriented times three.

FAMILY HISTORY: His cardiac family health history is unremarkable.

SOCIAL HISTORY: Mr. [**Known lastname **] lives alone and is retired.
Mitral valve stenosis and aortic valve stenosis,Acute kidney failure with lesion of tubular necrosis,Rheumatic heart failure (congestive),Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other and unspecified hyperlipidemia,Contact dermatitis and other eczema, unspecified cause,Other specified cardiac dysrhythmias,Tricuspid valve disorders, specified as nonrheumatic,Benign neoplasm of skin of other and unspecified parts of face,Peripheral vascular disease, unspecified,Long-term (current) use of aspirin
Mitral/aortic stenosis,Ac kidny fail, tubr necr,Rheumatic heart failure,Crnry athrscl natve vssl,Thoracic aortic aneurysm,Ocl crtd art wo infrct,Hyperlipidemia NEC/NOS,Dermatitis NOS,Cardiac dysrhythmias NEC,Nonrheum tricusp val dis,Benign neo skin face NEC,Periph vascular dis NOS,Long-term use of aspirin
Admission Date:  [**2160-1-30**]              Discharge Date:   [**2160-2-14**]


Service: CARDIOTHORACIC

Allergies:
Penicillins / Lopressor / Indocin

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
Aortic valve replacement(25mm [**Company 1543**] Mosaic Ultra), Tricuspid
repair, Coronary artery bypass graft times one (LIMA to LAD),
Left atrial ligation [**2160-2-6**]


History of Present Illness:
Mr. [**Known lastname **] is an 84 year old gentleman with a history of
multiple admissions for congestive heart failure exascerbations.
 On his most recent admission for this complaint, he underwent a
cardiac catheterization which revealed 70% stenosis of the left
anterior descending artery.  He was transferred to [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 1675**]
[**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for evaluation for cardiac surgery

Past Medical History:
severe aortic stenosis
mitral stenosis
coronary artery disease
chronic atrial fibrillation
ascending aortic aneurysm
chronic diastolic congestive heart failure
carotid artery disease
hyperlipidemia
eczema
peripheral vascular disease
duodenal ulcer 30 yrs ago
s/p TURP


Social History:
Mr. [**Known lastname **] lives alone and is retired.

Family History:
His cardiac family health history is unremarkable.

Physical Exam:
On admission Mr. [**Known lastname **] was found to be well nourished.
Multiple bruises were noted on his arms, as was eczema.  His
neck was supple with a full range of motion.  His lungs were
clear to auscultation bilaterally.  A IV/VI holosystolic cardiac
murmur was ausculated. His abdomen was soft, non-tender,
non-distended.  1+ edema was noted and his extremities were
noted to be warm.  No varicosities were noted, however there
were bilateral venous stasis ulcers.  He was awake, alert, and
oriented times three.

Pertinent Results:
[**2160-2-6**] ECHO
Prebypass

1. The left atrial appendage emptying velocity is depressed
(<0.2m/s). A definite thrombus is seen in the left atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler.
2. There is mild regional left ventricular systolic dysfunction
with hypokinesia of the apex, apical and mid portions of the
inferior and inferoseptal walls.. Overall left ventricular
systolic function is mildly depressed (LVEF= 45 %).
3.Right ventricular chamber size and free wall motion are
normal.
4.The ascending aorta is moderately dilated.
5. There are simple atheroma in the descending thoracic aorta.
6.The aortic valve leaflets are severely thickened/deformed.
There is moderate to severe aortic valve stenosis (area
0.8-1.0cm2). Trace aortic regurgitation is seen.
7. The mitral valve leaflets are moderately thickened. There is
mild valvular mitral stenosis (area 1.5-2.0cm2). Moderate (2+)
mitral regurgitation is seen.
8. The tricuspid valve leaflets are mildly thickened. Severe
[4+] tricuspid regurgitation is seen. Dr. [**Last Name (STitle) 914**] was notified
in person of the results on [**2160-2-6**] at 1030am..

POST-BYPASS: The patient is AV paced and on infusions of
phenylephrine, milrinone and epinephrine.

1. Biventricular function is unchanged.
2. The aorta is intact post decannulation.
3. The aortic valve has been replaced with a tissue valve. The
valve appears well seated and the leaflets move well. There is
no AR. The peak gradient is approximately 20mmHg at a CO of 5
L/m.
4. The opening of the mitral valve leaflets has slightly
improved. The MR is now mild.
5. An annuloplasty ring has been placed around the tricuspid
valve. There is trivial regurgitation.
6. The left atrial appendage has been resected.
The remainder of the examination is unchanged.



Brief Hospital Course:
Upon admission, Mr. [**Known lastname **] was was seen by podiatry for his
extensive bilateral caluses, which they debrided.  The dental
service saw him and cleared him for surgery.  Carotid ultrasound
was performed and revealed an occluded left internal carotid and
60-69% stenosis of the right internal carotid.  Vascular surgery
was consulted given his risk of stroke during bypass with his
carotid disease.  The suggested that no carotid endartarectomy
is indicated currently, but they recommended coumadin after
surgery.  Vein mapping was performed.  A chest radiograph
demonstrated multiple asbestos plaques, so it was followed by a
chest CT.  This second study showed stable fusiform ascending
aorta dilation and mediastinal lymphadenopathy from a study on
[**9-28**].  Thoracic surgery recommended continued follow-up as an
outpatient with the patient's pulmonologist.  Endocrinology was
consulted for an elevated TSH, which discourage adding synthroid
at this point.  Dermatology was consulted for his extensive
eczema and a steroid cream was recommended.  He was also seen by
psychiatry for suicidality, and they felt he was not depressed
or suicidal and continued to follow Mr. [**Known lastname **] throughout his
hospitalization.

Incidentally, pt seen by dermatology for chronic eczemtous
dermatitis. Also had biopsy of forhead lesion which tuned out to
be atypical spindle cell neoplasm which warrents further follow
up.

On [**2160-2-6**] he was taken to the operating room and underwent an
aortic valve replacement(25mm [**Company 1543**] Mosaic Ultra), tricuspid
repair, coronary artery bypass graft times one (LIMA to LAD),
left atrial ligation.  This procedure was performed by Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 914**].  He tolerated the procedure well and was
transferred intubated in critical but stable condition to the
surgical intensive care unit on Milrinone, amiodarone,
epinephrine, levophed, insulin, propofol.
POD#1 extubated and weaned from pressors and inotropes.
POD# 2 amiodarone stopped due to bradycardia. Electrophysiology
consulted for possible pacer placement. Permanent pacer was
placed on [**2-11**] for ongoing bradycardia -idioventricular rhythm
20-30's off amiodarone.
Decision made by Dr. [**Last Name (STitle) 914**] not to anticoagulate Mr. [**Known lastname **]
due to fakk risk benefit profile.
Chest tubes and pacing wires removed on [**2159-2-11**] after permanent
pacer placed.
Post operatively Mr. [**Known lastname **] [**Last Name (Titles) **] rose to 2.5 from
baseline of 1.2. Nephrology was consulted. Causation thought to
be ATN from hypoprofusion/hypotension.  Nephrotoxins were
eliminated and over time creat imporved - presently 1.4-1.6.
Diuresis was resumed after [**Last Name (Titles) **] recovered.
Mr. [**Known lastname **] transferred from the ICU on POD#6 and continued to
make slow and study progress. He was evaluated by Physical
therapy and rehab was recommended.


Medications on Admission:
diltiazem 480mg, lasix 80mg in am and 40mg in pm, aspirin 325mg,
antivert 25mg, digoxin 0.25 every other day, celebrex 200mg,
betamethasone topically as needed for eczema, lipitor 20mg,
serax 15mg, potassium chloride 40meq

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
7. Atorvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Fluocinolone 0.01 % Solution Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
9. Ammonium Lactate 12 % Liquid Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
10. Mupirocin Calcium 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
11. Urea 20 % Cream Sig: One (1)  Topical [**Hospital1 **] (2 times a day).
12. Triamcinolone Acetonide 0.1 % Cream Sig: One (1) Appl
Topical [**Hospital1 **] (2 times a day) for 7 days.
13. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
14. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
15. Beclomethasone Dipropionate 80 mcg/Actuation Aerosol Sig:
One (1)  Inhalation [**Hospital1 **] (2 times a day).
16. Furosemide 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily): home med regimen 80mg qam/40mg qpm- totrate accordingly
based on edma and renal function.
17. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily) for 7 days: the decrease to 200mg daily .
18. humalog insulin
per sliding scale fingersticks


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location 15289**]

Discharge Diagnosis:
severe aortic stenosis
mitral stenosis
coronary artery disease
chronic atrial fibrillation
ascending aortic aneurysm
chronic diastolic congestive heart failure
carotid artery disease
hyperlipidemia
eczema
peripheral vascular disease
duodenal ulcer 30 yrs ago
s/p TURP


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 [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 914**] in 4 weeks ([**Telephone/Fax (1) 11763**] please call for
appointment
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34547**] in 1 week (cardiologist) please call for
appointment
Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 6160**] in [**12-25**] weeks ([**Telephone/Fax (1) 81092**] please call for
appointment
Dr. [**Last Name (STitle) **] (podiatry @ [**Hospital1 18**])
Repeat TFTs in 2 months with follow-up by primary care provider.

Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2160-2-14**]
{'Mitral valve stenosis and aortic valve stenosis,Acute kidney failure with lesion of tubular necrosis,Rheumatic heart failure (congestive),Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other and unspecified hyperlipidemia,Contact dermatitis and other eczema, unspecified cause,Other specified cardiac dysrhythmias,Tricuspid valve disorders, specified as nonrheumatic,Benign neoplasm of skin of other and unspecified parts of face,Peripheral vascular disease, unspecified,Long-term (current) use of aspirin'}


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

PRESENT ILLNESS: Mr. [**Known lastname **] is an 84 year old gentleman with a history of
multiple admissions for congestive heart failure exascerbations.
 On his most recent admission for this complaint, he underwent a
cardiac catheterization which revealed 70% stenosis of the left
anterior descending artery.  He was transferred to [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 1675**]
[**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for evaluation for cardiac surgery

MEDICAL HISTORY: severe aortic stenosis
mitral stenosis
coronary artery disease
chronic atrial fibrillation
ascending aortic aneurysm
chronic diastolic congestive heart failure
carotid artery disease
hyperlipidemia
eczema
peripheral vascular disease
duodenal ulcer 30 yrs ago
s/p TURP

MEDICATION ON ADMISSION: diltiazem 480mg, lasix 80mg in am and 40mg in pm, aspirin 325mg,
antivert 25mg, digoxin 0.25 every other day, celebrex 200mg,
betamethasone topically as needed for eczema, lipitor 20mg,
serax 15mg, potassium chloride 40meq

ALLERGIES: Penicillins / Lopressor / Indocin

PHYSICAL EXAM: On admission Mr. [**Known lastname **] was found to be well nourished.
Multiple bruises were noted on his arms, as was eczema.  His
neck was supple with a full range of motion.  His lungs were
clear to auscultation bilaterally.  A IV/VI holosystolic cardiac
murmur was ausculated. His abdomen was soft, non-tender,
non-distended.  1+ edema was noted and his extremities were
noted to be warm.  No varicosities were noted, however there
were bilateral venous stasis ulcers.  He was awake, alert, and
oriented times three.

FAMILY HISTORY: His cardiac family health history is unremarkable.

SOCIAL HISTORY: Mr. [**Known lastname **] lives alone and is retired. 

### Response:
{'Mitral valve stenosis and aortic valve stenosis,Acute kidney failure with lesion of tubular necrosis,Rheumatic heart failure (congestive),Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other and unspecified hyperlipidemia,Contact dermatitis and other eczema, unspecified cause,Other specified cardiac dysrhythmias,Tricuspid valve disorders, specified as nonrheumatic,Benign neoplasm of skin of other and unspecified parts of face,Peripheral vascular disease, unspecified,Long-term (current) use of aspirin'}
