CHIEF COMPLAINT: aortic stenosis

PRESENT ILLNESS: This 74 year old female with known aortic stenosis overthe last
several months has noted increased shortness of breath with
activity and occcasional
palpitations. She denies any chest pain, syncope, orthopnea, but
does admit to occasional PND. Previously catheterization has
revealed no coronary disease
and severe aortic stenosis.  She was admitted now for surgery.

MEDICAL HISTORY: Hypertension
noninsulin dependent diabetes mellitus
Dyslipidemia
anxiety disorder
osteoporosis
osteoarthritis
aortic stenosis

MEDICATION ON ADMISSION: Ocuvite [**Hospital1 **]
ferrous sulfate 325 mg daily
KCL 20meq qMWF
Metformin 1000 mg [**Hospital1 **]
Famotidine 40mg [**Hospital1 **]
Simvastatin 80 mg qd
Citalopram 40 mg qd
Lasix 40mg alternating with 60 mg daily
Glipizide 5 mg qd
Diovan 160 mg qd
Alendronate 70 mg qweek
colace 100 mg daily

ALLERGIES: Aspirin / Lisinopril / Avelox

PHYSICAL EXAM: admission:
Pulse:91  Resp:16   O2 sat: 97% RA
B/P Right: 112/60 Left:  124/71
Height: 60 inches Weight: 180
General: NAD
Skin: Dry [x] intact [x]; very slight area of pale erythema left
anterior LE ( pt states it has been like this for a while)
HEENT: PERRLA [x] EOMI [x]  anicteric sclera;OP unremarkable
Neck: Supple [x] Full ROM []  no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR [x] Irregular [] Murmur- harsh 4/6 SEM radiates
throughout precordium to carotids
Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds
+[x]
no HSM/CVA tenderness; obese
Extremities: Warm [x], well-perfused [x] Edema- trace bilat.
 Varicosities: significant bilat.
Neuro: Grossly intact ;nonfocal exam; MAE [**3-19**] strengths
Pulses:
Femoral Right: 1+     Left: 2+
DP      Right:  NP   Left:  NP
PT      [**Name (NI) 167**]:  1+    Left: 1+
Radial  Right:  2+    Left:  2+
Carotid Bruit:  murmur radiates to bil. carotids

FAMILY HISTORY: No premature coronary disease

SOCIAL HISTORY: Lives with:  husband
Occupation: retired shipping clerk
Tobacco: Denies
ETOH: Denies
Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Varicose veins of lower extremities with inflammation,Unspecified essential hypertension,Obesity, unspecified,Dizziness and giddiness,Knee joint replacement,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Anxiety state, unspecified
Aortic valve disorder,DMII wo cmp nt st uncntr,Leg varicosity w inflam,Hypertension NOS,Obesity NOS,Dizziness and giddiness,Joint replaced knee,Osteoporosis NOS,Hyperlipidemia NEC/NOS,Anxiety state NOS
Admission Date:  [**2200-3-31**]              Discharge Date:   [**2200-4-5**]

Date of Birth:  [**2125-4-6**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Aspirin / Lisinopril / Avelox

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
aortic stenosis

Major Surgical or Invasive Procedure:
[**2200-3-31**] AVR ( [**Street Address(2) 17167**]. [**Male First Name (un) 923**] porcine)


History of Present Illness:
This 74 year old female with known aortic stenosis overthe last
several months has noted increased shortness of breath with
activity and occcasional
palpitations. She denies any chest pain, syncope, orthopnea, but
does admit to occasional PND. Previously catheterization has
revealed no coronary disease
and severe aortic stenosis.  She was admitted now for surgery.

Past Medical History:
Hypertension
noninsulin dependent diabetes mellitus
Dyslipidemia
anxiety disorder
osteoporosis
osteoarthritis
aortic stenosis


Social History:
Lives with:  husband
Occupation: retired shipping clerk
Tobacco: Denies
ETOH: Denies


Family History:
No premature coronary disease


Physical Exam:
admission:
Pulse:91  Resp:16   O2 sat: 97% RA
B/P Right: 112/60 Left:  124/71
Height: 60 inches Weight: 180
General: NAD
Skin: Dry [x] intact [x]; very slight area of pale erythema left
anterior LE ( pt states it has been like this for a while)
HEENT: PERRLA [x] EOMI [x]  anicteric sclera;OP unremarkable
Neck: Supple [x] Full ROM []  no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR [x] Irregular [] Murmur- harsh 4/6 SEM radiates
throughout precordium to carotids
Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds
+[x]
no HSM/CVA tenderness; obese
Extremities: Warm [x], well-perfused [x] Edema- trace bilat.
 Varicosities: significant bilat.
Neuro: Grossly intact ;nonfocal exam; MAE [**3-19**] strengths
Pulses:
Femoral Right: 1+     Left: 2+
DP      Right:  NP   Left:  NP
PT      [**Name (NI) 167**]:  1+    Left: 1+
Radial  Right:  2+    Left:  2+
Carotid Bruit:  murmur radiates to bil. carotids


Pertinent Results:
Conclusions
PRE BYPASS The left atrium is moderately dilated. The left
atrium is elongated. No spontaneous echo contrast is seen in the
body of the left atrium. A patent foramen ovale is present. A
left-to-right shunt across the interatrial septum is seen at
rest. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Regional left ventricular
wall motion is normal. Overall left ventricular systolic
function is normal (LVEF>55%). No masses or thrombi are seen in
the left ventricle. Right ventricular chamber size and free wall
motion are normal. There are simple atheroma in the ascending
aorta. There are simple atheroma in the descending thoracic
aorta. There are three aortic valve leaflets. The aortic valve
leaflets are severely thickened/deformed. There is critical
aortic valve stenosis (valve area <0.8cm2). No aortic
regurgitation is seen. The mitral valve leaflets are moderately
thickened. Mild to moderate ([**11-16**]+) mitral regurgitation is seen.
Dr. [**Last Name (STitle) **] was notified in person of the results in the
operating room at the time of the study.

POST BYPASS There is normal biventricular systolic function.
There is a bioprosthesis in the aortic position. It appears well
seated. The leaflets can not be seen. No aortic regurgitation is
appreciated. The maximum pressure gradient across the aortic
valve is 31 mmHg with a mean pressure of 16 mmHg at a cardiac
output of around 4 liters/minute. The effective orifice area of
the valve is about 1.4 cm2. The mitral regurgitation is still
mild to moderate. The thoracic aorta appears intact. No other
changes from pre-bypass findings.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD, Interpreting physician
[**Last Name (NamePattern4) **] [**2200-3-31**] 13:55


[**2200-4-3**] 05:15AM BLOOD WBC-7.6 RBC-3.16* Hgb-9.4* Hct-27.4*
MCV-87 MCH-29.8 MCHC-34.4 RDW-14.1 Plt Ct-127*
[**2200-3-31**] 10:23AM BLOOD WBC-8.3 RBC-3.03*# Hgb-8.8*# Hct-26.0*#
MCV-86 MCH-28.9 MCHC-33.7 RDW-13.4 Plt Ct-136*
[**2200-4-2**] 03:28AM BLOOD PT-12.1 PTT-25.4 INR(PT)-1.0
[**2200-3-31**] 10:23AM BLOOD PT-14.2* PTT-31.4 INR(PT)-1.2*
[**2200-4-3**] 05:15AM BLOOD Glucose-149* UreaN-16 Creat-0.8 Na-138
K-4.4 Cl-102 HCO3-27 AnGap-13
[**2200-4-1**] 02:27AM BLOOD Glucose-100 UreaN-17 Creat-0.8 Na-139
K-4.5 Cl-108 HCO3-25 AnGap-11

Brief Hospital Course:
[**3-31**]  Mrs.[**Known lastname 45957**] was taken to the operating room and underwent
aortic valve replacement. Please refer to Dr[**Last Name (STitle) **] operative
note for further surgical details. She tolerated the procedure
well and was transferred to the CVICU for further invasive
monitoring. She awoke neurologically intact and was extubated
postoperatively without difficulty. All lines and drains were
discontinued in a timely fashion without complications. Beta
blockers/Statin/ASA and diuresis were initiated. She continued
to progress and on POD# 2 she transferred to the floor for
further monitoring. Physical Therapy was consulted for
evaluation of strength and mobility. On POD#5 she was cleared by
Dr.[**Last Name (STitle) **] for discharge to home with VNA. All follow up
appointments were advised.


Medications on Admission:
Ocuvite [**Hospital1 **]
ferrous sulfate 325 mg daily
KCL 20meq qMWF
Metformin 1000 mg [**Hospital1 **]
Famotidine 40mg [**Hospital1 **]
Simvastatin 80 mg qd
Citalopram 40 mg qd
Lasix 40mg alternating with 60 mg daily
Glipizide 5 mg qd
Diovan 160 mg qd
Alendronate 70 mg qweek
colace 100 mg daily


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO at bedtime.
3. Famotidine 40 mg Tablet Sig: One (1) Tablet PO twice a day.
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
5. Citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain/fever.
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*55 Tablet(s)* Refills:*0*
9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
10. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
11. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
TID (3 times a day) as needed for itching.
12. Glipizide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Famotidine 20 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
14. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day): previous home dose 40 mg alternating with 60mg.
Disp:*60 Tablet(s)* Refills:*2*
15. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours).
Disp:*60 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*
16. Alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week.



Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
aortic stenosis
s/p aortic valve replacement
noninsulin dependent diabetes
dyslipidemia
hypertension
degenerative joint disease
s/p bilateral total knee replacements
anxiety disorder
s/p tonsillectomy
osteoporosis


Discharge Condition:
Alert and oriented x3,nonfocal
Ambulating independently steady gait

Incisional pain managed with oral analgesics
Incisions:

Sternal - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage

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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge



**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:
Surgeon: Dr. [**Last Name (STitle) **] on Thursday,[**5-8**] @ 1:00 pm ([**Telephone/Fax (1) 170**])

Please call to schedule appointments with:
Primary Care: Dr.[**First Name4 (NamePattern1) 3613**] [**Last Name (un) **] ([**Telephone/Fax (1) 6699**]in [**11-16**] weeks
Cardiologist: Dr. [**Last Name (STitle) **] in [**11-16**] 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:[**2200-4-5**]
{'Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Varicose veins of lower extremities with inflammation,Unspecified essential hypertension,Obesity, unspecified,Dizziness and giddiness,Knee joint replacement,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Anxiety state, unspecified'}


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: aortic stenosis

PRESENT ILLNESS: This 74 year old female with known aortic stenosis overthe last
several months has noted increased shortness of breath with
activity and occcasional
palpitations. She denies any chest pain, syncope, orthopnea, but
does admit to occasional PND. Previously catheterization has
revealed no coronary disease
and severe aortic stenosis.  She was admitted now for surgery.

MEDICAL HISTORY: Hypertension
noninsulin dependent diabetes mellitus
Dyslipidemia
anxiety disorder
osteoporosis
osteoarthritis
aortic stenosis

MEDICATION ON ADMISSION: Ocuvite [**Hospital1 **]
ferrous sulfate 325 mg daily
KCL 20meq qMWF
Metformin 1000 mg [**Hospital1 **]
Famotidine 40mg [**Hospital1 **]
Simvastatin 80 mg qd
Citalopram 40 mg qd
Lasix 40mg alternating with 60 mg daily
Glipizide 5 mg qd
Diovan 160 mg qd
Alendronate 70 mg qweek
colace 100 mg daily

ALLERGIES: Aspirin / Lisinopril / Avelox

PHYSICAL EXAM: admission:
Pulse:91  Resp:16   O2 sat: 97% RA
B/P Right: 112/60 Left:  124/71
Height: 60 inches Weight: 180
General: NAD
Skin: Dry [x] intact [x]; very slight area of pale erythema left
anterior LE ( pt states it has been like this for a while)
HEENT: PERRLA [x] EOMI [x]  anicteric sclera;OP unremarkable
Neck: Supple [x] Full ROM []  no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR [x] Irregular [] Murmur- harsh 4/6 SEM radiates
throughout precordium to carotids
Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds
+[x]
no HSM/CVA tenderness; obese
Extremities: Warm [x], well-perfused [x] Edema- trace bilat.
 Varicosities: significant bilat.
Neuro: Grossly intact ;nonfocal exam; MAE [**3-19**] strengths
Pulses:
Femoral Right: 1+     Left: 2+
DP      Right:  NP   Left:  NP
PT      [**Name (NI) 167**]:  1+    Left: 1+
Radial  Right:  2+    Left:  2+
Carotid Bruit:  murmur radiates to bil. carotids

FAMILY HISTORY: No premature coronary disease

SOCIAL HISTORY: Lives with:  husband
Occupation: retired shipping clerk
Tobacco: Denies
ETOH: Denies 

### Response:
{'Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Varicose veins of lower extremities with inflammation,Unspecified essential hypertension,Obesity, unspecified,Dizziness and giddiness,Knee joint replacement,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Anxiety state, unspecified'}
