CHIEF COMPLAINT: Dizziness

PRESENT ILLNESS: Ms.[**Name14 (STitle) 89346**] is a 61 year old female with known aortic stenosis
followed by serial echos was doing fairly well but reports
episodes of transient dizziness since [**Holiday **] to her
cardiologist at her follow up echo.  She denies chest pain or
shortness of breath. Cath reveals no significant coronary artery
stenosis. Aortic valve area =0.7cm'2. She is transferred to
[**Hospital1 18**] for surgical correction/AVR.

MEDICAL HISTORY: Past Medical History:
Aortic stenosis
hyperlipidemia
hypertension
Diabetes mellitus
fibromyalgia
Past Surgical History:
right knee menicus repair
right carpal tunnel repair
T&A as child

MEDICATION ON ADMISSION: Cartia Xt 240 mg daily
Lisinopril 40mg daily
Hydrochlorothiazide 12.5 mg daily
Metformin 500mg twice daily
Simvastatin 80 mg daily
Cymbalta 30 mg daily
Zetia 10 mg daily
Trazadone 25 mg HS
Etodolac 400-800 prn [**Hospital1 **]
Albuterol prn

ALLERGIES: Codeine / IV Dye, Iodine Containing Contrast Media

PHYSICAL EXAM: Pulse: 78  Resp: 18  O2 sat: 96 RA
B/P  113/66

FAMILY HISTORY: grandfather deceased MI at 60

SOCIAL HISTORY: Last Dental Exam: > 6months
Lives with: significant other
Occupation: program counselor - community action
Tobacco: 30 pack year history
ETOH:1-2 drinks a month
Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Myalgia and myositis, unspecified,Personal history of tobacco use
Aortic valve disorder,DMII wo cmp nt st uncntr,Anemia NOS,Hyperlipidemia NEC/NOS,Obstructive sleep apnea,Hypertension NOS,Myalgia and myositis NOS,History of tobacco use
Admission Date:  [**2191-3-2**]              Discharge Date:   [**2191-3-10**]

Date of Birth:  [**2130-11-17**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / IV Dye, Iodine Containing Contrast Media

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

Major Surgical or Invasive Procedure:
[**2191-3-4**]  AVR ( 21 mm mechanical St. Jude valve)


History of Present Illness:
Ms.[**Name14 (STitle) 89346**] is a 61 year old female with known aortic stenosis
followed by serial echos was doing fairly well but reports
episodes of transient dizziness since [**Holiday **] to her
cardiologist at her follow up echo.  She denies chest pain or
shortness of breath. Cath reveals no significant coronary artery
stenosis. Aortic valve area =0.7cm'2. She is transferred to
[**Hospital1 18**] for surgical correction/AVR.


Past Medical History:
Past Medical History:
Aortic stenosis
hyperlipidemia
hypertension
Diabetes mellitus
fibromyalgia
Past Surgical History:
right knee menicus repair
right carpal tunnel repair
T&A as child


Social History:
Last Dental Exam: > 6months
Lives with: significant other
Occupation: program counselor - community action
Tobacco: 30 pack year history
ETOH:1-2 drinks a month


Family History:
grandfather deceased MI at 60


Physical Exam:
Pulse: 78  Resp: 18  O2 sat: 96 RA
B/P  113/66

General: No acute distress
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [**1-23**] holosytolic
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] no palpable mass
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: +1   Left: +1
DP           Right: +1   Left: +1
PT           [**Name (NI) 167**]: +1   Left: +1
Radial       Right: +1   Left: +1

Carotid Bruit        Right: murmur   Left: murmur


Pertinent Results:
[**2191-3-3**] Carotid Ultrasound
Impression: Right ICA near 40% stenosis. Left ICA with no
stenosis.

[**2191-3-4**] Echocardiogram
PRE-BYPASS:
The left atrium is dilated. No spontaneous echo contrast or
thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage.
No atrial septal defect is seen by 2D or color Doppler.
There is mild symmetric left ventricular hypertrophy with normal
cavity size and regional/global systolic function (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the aortic arch. There are complex
(>4mm) atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. The aortic valve leaflets
are moderately thickened. There is severe aortic valve stenosis
(valve area 0.8-1.0cm2).
The mitral valve leaflets are mildly thickened. Mild to moderate
([**11-21**]+) mitral regurgitation is seen. There is no pericardial
effusion. There is posterior mitral annulus calcification.
Dr.[**Last Name (STitle) **] was notified in person of the results before surgical
incision.

Post Bypass: Preserved biventricular function. There is a
mechanical valve in the aortic position. No AI, no perivalvular
leaks. Mean gradient 8-9 mm hg, peak gradient 20 mm hg. Aortic
contours intact . Remaining exam is unchanged. All findings
discussed with surgeons at the time of the exam.

Brief Hospital Course:
Ms. [**Known lastname 89347**] was admitted to the [**Hospital1 18**] on [**2191-3-2**] via transfer
from an outside hospital for surgical management of her aortic
valve stenosis. She was worked-up in the usual preoperative
manner including a carotid duplex ultrasound which revealed no
significant carotid artery disease. A dental consult was
obtained for oral clearance for surgery. After obtaining a
panorex, no oral contraindication to valve surgery was noted. On
[**2191-3-4**], she was taken to the operating room where she underwent
an aortic valve replacement. Please see the operative note for
details.  She tolerated the procedure well and was transferred
in critical but stable condition to the surgical intensive care
unit.  She extubated without incident.  Her chest tubes and
epicardial wires were removed and she was started on coumadin
for her mechanical aortic valve.  She was transferred to the
step down floor.  By post-operative day six her INR was
therapeutic and she was ready for discharge to home with
coumadin follow-up and an INR check on [**2191-3-11**].  All follow-up
appoinments were advised.

Medications on Admission:
Cartia Xt 240 mg daily
Lisinopril 40mg daily
Hydrochlorothiazide 12.5 mg daily
Metformin 500mg twice daily
Simvastatin 80 mg daily
Cymbalta 30 mg daily
Zetia 10 mg daily
Trazadone 25 mg HS
Etodolac 400-800 prn [**Hospital1 **]
Albuterol prn


Discharge Medications:
1. CPAP
Autoset CPAP at 5 - 15 cm H20
fit for mask
2. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
7. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
Disp:*45 Tablet(s)* Refills:*2*
8. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 10 days.
Disp:*10 Tablet(s)* Refills:*2*
9. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO DAILY (Daily) for 10 days.
Disp:*20 Tablet Extended Release(s)* Refills:*2*
10. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
11. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day:
coumadin for mechanical AVR, goal [**12-23**].  First INR check on [**3-11**]
with results for Dr. [**Last Name (STitle) 35852**] fax ([**Telephone/Fax (1) 89348**].
Disp:*30 Tablet(s)* Refills:*2*
12. Outpatient Lab Work
First INR check on [**3-11**] with results for Dr. [**Last Name (STitle) 35852**] fax
([**Telephone/Fax (1) 89348**].  Coumadin for mechanical AVR, goal [**12-23**].


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Aortic stenosis s/p AVR
hyperlipidemia
hypertension
Diabetes mellitus
fibromyalgia
sleep apnea ( CPAP recommended)


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Edema 1+ LE


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 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 with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge

****Please use CPAP machine as directed- will be delivered to
your home
**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:
Wound check Cardiac surgery office [**Hospital Ward Name **] 2A [**3-22**] at 10:45 AM
Surgeon: Dr. [**Last Name (STitle) **] on Thursday [**3-31**] at 1:00 PM [**Hospital Ward Name **] 2A
Cardiologist:Dr. [**Last Name (STitle) 4922**] on [**4-15**] at 1:45 PM

Please call to schedule appointments with your
Primary Care Dr.[**Last Name (STitle) 35852**] in [**2-22**] weeks [**Telephone/Fax (1) 34088**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication is mechanical AVR
Goal INR 2.0-3.0
First draw day after discharge, [**3-11**]
Results to Dr. [**Last Name (STitle) 35852**] phone [**Telephone/Fax (1) 34088**]  fax [**Telephone/Fax (1) 89349**]



Completed by:[**2191-3-10**]
{'Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Myalgia and myositis, unspecified,Personal history of tobacco use'}


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: Dizziness

PRESENT ILLNESS: Ms.[**Name14 (STitle) 89346**] is a 61 year old female with known aortic stenosis
followed by serial echos was doing fairly well but reports
episodes of transient dizziness since [**Holiday **] to her
cardiologist at her follow up echo.  She denies chest pain or
shortness of breath. Cath reveals no significant coronary artery
stenosis. Aortic valve area =0.7cm'2. She is transferred to
[**Hospital1 18**] for surgical correction/AVR.

MEDICAL HISTORY: Past Medical History:
Aortic stenosis
hyperlipidemia
hypertension
Diabetes mellitus
fibromyalgia
Past Surgical History:
right knee menicus repair
right carpal tunnel repair
T&A as child

MEDICATION ON ADMISSION: Cartia Xt 240 mg daily
Lisinopril 40mg daily
Hydrochlorothiazide 12.5 mg daily
Metformin 500mg twice daily
Simvastatin 80 mg daily
Cymbalta 30 mg daily
Zetia 10 mg daily
Trazadone 25 mg HS
Etodolac 400-800 prn [**Hospital1 **]
Albuterol prn

ALLERGIES: Codeine / IV Dye, Iodine Containing Contrast Media

PHYSICAL EXAM: Pulse: 78  Resp: 18  O2 sat: 96 RA
B/P  113/66

FAMILY HISTORY: grandfather deceased MI at 60

SOCIAL HISTORY: Last Dental Exam: > 6months
Lives with: significant other
Occupation: program counselor - community action
Tobacco: 30 pack year history
ETOH:1-2 drinks a month 

### Response:
{'Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Myalgia and myositis, unspecified,Personal history of tobacco use'}
