CHIEF COMPLAINT: Fatigue/Angina

PRESENT ILLNESS: Mr. [**Known lastname 32458**] is a 73 year old male who has know murmur his entire
life. Has been undergoing serial echocardiograms with slowly
worsening symptoms of fatigue over last year. More recently
complaining of exertional angina. Most recent echo shows
moderate to severe aortic stenosis. In addition, echocardiogram
in past revealed dilated ascending aorta, measuring 4.8cm.
Presents today for surgical evaluation.

MEDICAL HISTORY: Aortic Stenosis
Hypercholesterolemia
Benign prostatic hypertrophy
Vertebral fracture [**2120**]'s
Osteoarthritis

MEDICATION ON ADMISSION: 1. Simvastatin 40 mg PO DAILY
2. Aspirin 81 mg PO DAILY
3. Multivitamins 1 TAB PO DAILY

ALLERGIES: ceftriaxone / chlorhexidine

PHYSICAL EXAM: Physical Exam:
Pulse: 47  Resp: 16  O2 sat: 99%
B/P  Right: 132/71   Left: 2
[**3-/2137**]
Height: 71"    Weight: 188lbs

FAMILY HISTORY: Family History: No premature coronary artery disease
Father died from MI at 68. Brother with same AV issue.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 3 months ago
Lives with: Wife
Occupation: [**Name2 (NI) 46841**]
Cigarettes: Smoked no [] yes [X] last cigarette [**2120**]'s Hx:
smoked for 4 yrs
Other Tobacco use: Denies
ETOH: [X] glass wine/night
Illicit drug use: Denies
Aortic valve disorders,Thoracic aneurysm without mention of rupture,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Osteoarthrosis, unspecified whether generalized or localized, site unspecified
Aortic valve disorder,Thoracic aortic aneurysm,Pure hypercholesterolem,BPH w/o urinary obs/LUTS,Osteoarthros NOS-unspec
Admission Date:  [**2172-6-29**]              Discharge Date:   [**2172-7-4**]

Date of Birth:  [**2098-8-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
ceftriaxone / chlorhexidine

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Fatigue/Angina


Major Surgical or Invasive Procedure:
[**2172-6-30**] AVR (25 tissue)Asc Aorta replacement(25 gelweave)


History of Present Illness:
Mr. [**Known lastname 32458**] is a 73 year old male who has know murmur his entire
life. Has been undergoing serial echocardiograms with slowly
worsening symptoms of fatigue over last year. More recently
complaining of exertional angina. Most recent echo shows
moderate to severe aortic stenosis. In addition, echocardiogram
in past revealed dilated ascending aorta, measuring 4.8cm.
Presents today for surgical evaluation.


Past Medical History:
Aortic Stenosis
Hypercholesterolemia
Benign prostatic hypertrophy
Vertebral fracture [**2120**]'s
Osteoarthritis


Social History:
Race: Caucasian
Last Dental Exam: 3 months ago
Lives with: Wife
Occupation: [**Name2 (NI) 46841**]
Cigarettes: Smoked no [] yes [X] last cigarette [**2120**]'s Hx:
smoked for 4 yrs
Other Tobacco use: Denies
ETOH: [X] glass wine/night
Illicit drug use: Denies


Family History:
Family History: No premature coronary artery disease
Father died from MI at 68. Brother with same AV issue.


Physical Exam:
Physical Exam:
Pulse: 47  Resp: 16  O2 sat: 99%
B/P  Right: 132/71   Left: 2
[**3-/2137**]
Height: 71"    Weight: 188lbs

General: Well-developed male in no acute distress
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X]
Neck: Supple [X] Full ROM []
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] Irregular [] Murmur [X] grade ______
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X] Edema/Varicosities:
None
[X]
Neuro: Grossly intact [X]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit     Right: -    Left: -

Discharge Exam:
VS: T:98.5  HR: 68-80's SR  BP: 109-127/60-70  Sats: 95% RA  Wt:
88.1
FSBS 138/127/121
General: 73 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes
Card: RRR normal S1,S2
Resp: decreased breath sounds at bases otherwise clear
GI: benign
Extr: warm no edema
Incision: sternal clean dry intact, no erythema, no click
Neuro: awake, alert oriented

Pertinent Results:
[**2172-6-27**]: Echocardiogram
Left Atrium - Long Axis Dimension:  *4.7 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  4.3 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  *1.3 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.3 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.6 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  2.2 cm
Left Ventricle - Fractional Shortening:  0.52  >= 0.29
Left Ventricle - Ejection Fraction:  65% to 75%  >= 55%
Aorta - Annulus:  2.8 cm  <= 3.0 cm
Aorta - Sinus Level:  *3.9 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  *3.3 cm  <= 3.0 cm
Aorta - Ascending:  *4.7 cm  <= 3.4 cm
Aorta - Descending Thoracic:  *2.9 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *5.5 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *120 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  76 mm Hg
Aortic Valve - LVOT diam:  2.9 cm
Findings
LEFT ATRIUM: Mild LA enlargement. No thrombus in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. No ASD by 2D or color
Doppler.
LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size.
Overall normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Moderately dilated ascending aorta Mildly dilated
descending aorta. Simple atheroma in descending aorta.
AORTIC VALVE: ?# aortic valve leaflets. Severely
thickened/deformed aortic valve leaflets. Severe AS (area
0.8-1.0cm2). Mild (1+) AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.
TRICUSPID VALVE: Physiologic TR.
PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
No PR.
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. Results were personally reviewed with the MD
caring for the patient.
Conclusions
PRE-CPB: The left atrium is mildly dilated. No thrombus is seen
in the left atrial appendage. No atrial septal defect is seen by
2D or color Doppler.
There is mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%). Right ventricular
chamber size and free wall motion are normal.
The ascending aorta is moderately dilated. The descending
thoracic aorta is mildly dilated. There are simple atheroma in
the descending thoracic aorta. The aortic valve appears to be
bileaflet on 2D echo; however, on color Doppler, there is flow
between the left and right coronary cusps, suggesting a
trileaflet valve with partial fusion of the left and right
coronary cusps. The aortic valve leaflets are severely
thickened/deformed. There is severe aortic valve stenosis (valve
area 0.8-1.0cm2). Mild (1+) eccentric aortic regurgitation is
seen.
The mitral valve leaflets are mildly thickened. There is
systolic doming of the anterior mitral leaflet. Mild (1+) mitral
regurgitation is seen.
The tricuspid leaflets appear mildly redundant with mild
prolapse.

POST-CPB:
A bioprosthetic valve is seen in the aortic position. The valve
is well seated with normally mobile leaflets. The peak gradient
across the aortic valve is 28mmHg, the mean gradient is 13mmHg
with CO of 4.8L/min. There are no paravalvular leaks seen. There
is no AI.
Brightly echogenic material is seen in the ascending aorta,
consistent with ascending aorta repair.
The left ventricular function remains normal, estimated EF>65%.
The right ventricular function remains normal.
The MR remains mild. Other valvular function remain unchanged.
There is no evidence of aortic dissection.

CXR: [**2172-7-4**]: small bilateral pleural effusion

[**2172-7-3**] WBC-11.3* RBC-3.35* Hgb-10.5* Hct-29.9* MCV-89 MCH-31.2
MCHC-35.0 RDW-13.3 Plt Ct-94*
[**2172-6-29**] WBC-5.7 RBC-4.70 Hgb-14.8 Hct-41.6 MCV-88 MCH-31.5
MCHC-35.7* RDW-13.0 Plt Ct-146*
[**2172-7-4**] Na-137 K-3.7 Cl-100
[**2172-7-3**] Glucose-109* UreaN-16 Creat-0.9 Na-138 K-3.5 Cl-102
HCO3-29
[**2172-6-29**] Glucose-125* UreaN-16 Creat-0.9 Na-137 K-3.7 Cl-105
HCO3-24
[**2172-6-30**] ALT-10 AST-23 AlkPhos-28* Amylase-32 TotBili-1.0
[**2172-7-3**] Mg-2.1

[**2172-6-30**] 1:53 MRSA SCREEN (Final [**2172-7-2**]):    No MRSA isolated.



Brief Hospital Course:
The patient was brought to the operating room on [**2172-6-30**] where
he underwent an AVR (25 tissue)Asc Aorta replacement(25
gelweave).  Please see the operative note for details. Overall
the patient tolerated the procedure well and post-operatively
was transferred to the CVICU in stable condition for recovery
and invasive monitoring.   Post-operative day one found the
patient extubated, alert and oriented and breathing comfortably.
 The patient was neurologically intact and hemodynamically
stable, weaned from inotropic and vasopressor support.  Beta
blocker was initiated and the patient was gently diuresed toward
the preoperative weight.  The patient was transferred to the
telemetry floor for further recovery.  Chest tubes and pacing
wires were discontinued without complication.  The patient was
evaluated by the physical therapy service for assistance with
strength and mobility.  He complained of sleepiness with
narcotics and was therefore switched to ultram.  By the time of
discharge on post-operative day four the patient was ambulating
freely, the [**Date Range **] was healing and pain was controlled with oral
analgesics.  The patient was discharged to home with VNA in good
condition with appropriate follow up instructions.

Medications on Admission:
1. Simvastatin 40 mg PO DAILY
2. Aspirin 81 mg PO DAILY
3. Multivitamins 1 TAB PO DAILY


Discharge Medications:
1. Aspirin EC 81 mg PO DAILY
2. Simvastatin 40 mg PO DAILY
3. Acetaminophen 650 mg PO Q4H:PRN pain, fever
4. Docusate Sodium 100 mg PO BID
5. Furosemide 20 mg PO DAILY
RX *furosemide 20 mg 1 Tablet(s) by mouth once a day Disp #*4
Tablet Refills:*0
6. Multivitamins W/minerals 1 TAB PO DAILY
7. TraMADOL (Ultram) 50 mg PO Q4H:PRN pain
RX *tramadol 50 mg 1 Tablet(s) by mouth every six (6) hours Disp
#*40 Tablet Refills:*0
8. Metoprolol Succinate XL 25 mg PO DAILY
RX *metoprolol succinate 25 mg 1 Tablet(s) by mouth once a day
Disp #*30 Tablet Refills:*5
9. Potassium Chloride 10 mEq PO DAILY Duration: 24 Hours
Hold for K >
RX *Klor-Con 10 10 mEq 1 10 mEq by mouth once a day Disp #*4
Tablet Refills:*0


Discharge Disposition:
Home With Service

Facility:
[**Doctor Last Name 46842**] [**Location 269**] & Hospice

Discharge Diagnosis:
Aortic Stenosis
Hypercholesterolemia
Benign prostatic hypertrophy
Vertebral fracture [**2120**]'s
Osteoarthritis

PSH: s/p Tonsillectomy


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 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**


Followup Instructions:
You are scheduled for the following appointments:
Provider: [**Name10 (NameIs) **] CARE NURSE Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2172-7-9**]
10:30
in the [**Hospital **] Medical Building [**Last Name (NamePattern1) **] [**Hospital Unit Name **]
Provider: [**Name10 (NameIs) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2172-8-5**] 1:45 [**Hospital **] Medical Building [**Last Name (NamePattern1) **]
[**Hospital Unit Name **]
Cardiologist Dr. [**First Name8 (NamePattern2) 5987**] [**Last Name (NamePattern1) 13114**] [**2172-7-20**] at 10:30a

Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) 11586**] in [**4-16**] weeks [**Telephone/Fax (1) 46843**]

**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:[**2172-7-4**]
{'Aortic valve disorders,Thoracic aneurysm without mention of rupture,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Osteoarthrosis, unspecified whether generalized or localized, site 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: Fatigue/Angina

PRESENT ILLNESS: Mr. [**Known lastname 32458**] is a 73 year old male who has know murmur his entire
life. Has been undergoing serial echocardiograms with slowly
worsening symptoms of fatigue over last year. More recently
complaining of exertional angina. Most recent echo shows
moderate to severe aortic stenosis. In addition, echocardiogram
in past revealed dilated ascending aorta, measuring 4.8cm.
Presents today for surgical evaluation.

MEDICAL HISTORY: Aortic Stenosis
Hypercholesterolemia
Benign prostatic hypertrophy
Vertebral fracture [**2120**]'s
Osteoarthritis

MEDICATION ON ADMISSION: 1. Simvastatin 40 mg PO DAILY
2. Aspirin 81 mg PO DAILY
3. Multivitamins 1 TAB PO DAILY

ALLERGIES: ceftriaxone / chlorhexidine

PHYSICAL EXAM: Physical Exam:
Pulse: 47  Resp: 16  O2 sat: 99%
B/P  Right: 132/71   Left: 2
[**3-/2137**]
Height: 71"    Weight: 188lbs

FAMILY HISTORY: Family History: No premature coronary artery disease
Father died from MI at 68. Brother with same AV issue.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 3 months ago
Lives with: Wife
Occupation: [**Name2 (NI) 46841**]
Cigarettes: Smoked no [] yes [X] last cigarette [**2120**]'s Hx:
smoked for 4 yrs
Other Tobacco use: Denies
ETOH: [X] glass wine/night
Illicit drug use: Denies 

### Response:
{'Aortic valve disorders,Thoracic aneurysm without mention of rupture,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}
