CHIEF COMPLAINT: fatigue, dyspnea

PRESENT ILLNESS: This 87 year old gentleman has a history significant for aortic
stenosis, tachy-brady syndrome s/p pacemaker and paroxysmal
atrial fibrillation. Recently, he has been experiencing
shortness
of breath with minimal exertion and also reports intermittent
chest pressure that occurs unrelated to activity. He had a fall
in his basement last week. He denies having syncope and states
he
tripped. He denies LOC. He denies any dizziness or
lightheadedness at all. He has chronic right foot edema after
knee replacement surgery. He denies any PND or orthopnea
andstates he sleeps very well. He sleeps in a recliner due
tochronic back pain.  He denies any claudication symptoms.
Hereports frequent skin tears and currently has one on his right
lower leg and left forearm.

MEDICAL HISTORY: Prostate cancer diagnosed 7 months ago, treated conservatively
TURP 21 years ago for BPH
Aortic stenosis
Atrial fibrillation
Pacemaker [**2162-4-29**]
Chronic back pain s/p remote spinal fusion surgery [**2118**]
Breast tumor removed at age 15
Bilateral hernia repairs
Rectal surgery x 4 for fissures and hemorrhoids
Total knee replacement- right
Appendectomy age 13
Elbow surgery
s/p cardiac catheterization  approx 13 years ago with clean
coronaries
essential tremor of unknown origin
hypothyroid

MEDICATION ON ADMISSION: Slow K 600mg 1 capsule [**Hospital1 **]
Warfarin 5mg/7.5mg MWF,  last dose Monday
Amiodarone 200mg daily
Amlodipine 5mg daily
Primidone 50mg daily
Lasix 20mg, 3 tablets daily
Docusate sodium 100mg [**Hospital1 **]
Erythromycin Ophthalmic ointment daily for dry eye
Synthroid 0.125mg daily
konsyl OTC for fiber 6 grams daily with juice
aspirin 81mg daily

ALLERGIES: Procainamide / Flomax / Uroxatral

PHYSICAL EXAM: VS -  T 96.6 HR 60s BPs 130s-160s/40s-60s RR18 O2sat 98RA
Gen: WDWN elderly male in NAD.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink. MMM
Neck: Supple with no JVD.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. [**2-4**] soft systolic murmur at RUSB radiating to
carotids No thrills, lifts. No S3 or S4.
Chest: CTAB, no crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Groin site without
hematoma, dressing c/d/i. No bruit.
Ext: Edema to ankles bilaterally R>L. Neg homans signs
Skin: stasis dermatitis bilaterally, no ulcers.

FAMILY HISTORY: both parents died at age 76-mother died from a
stroke, father died following a stroke from complications from
carotid artery surgery. Father had an MI at age 60. Brother died
from suicide. Another brother died from pancreatic cancer.

SOCIAL HISTORY: Social history is significant for the 3ppd X 20yrs quit 47 years
ago.  There is no history of alcohol abuse. Married, patient??????s
wife and daughter will accompany pt to procedure and then return
home. They would like to be called post procedure and can be
reached at [**Telephone/Fax (1) 81183**] or cell # [**Telephone/Fax (1) 81184**] [**Doctor First Name 717**].
Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Aortic valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Essential and other specified forms of tremor,Pure hypercholesterolemia,Other chronic pain,Other iatrogenic hypotension,Dermatophytosis of nail,Knee joint replacement,Long-term (current) use of anticoagulants,Arthrodesis status,Cardiac pacemaker in situ,Other acquired absence of organ,Personal history of malignant neoplasm of prostate,History of fall
Crnry athrscl natve vssl,Acute kidney failure NOS,Aortic valve disorder,CHF NOS,Atrial fibrillation,Hypothyroidism NOS,Tremor NEC,Pure hypercholesterolem,Chronic pain NEC,Iatrogenc hypotnsion NEC,Dermatophytosis of nail,Joint replaced knee,Long-term use anticoagul,Arthrodesis status,Status cardiac pacemaker,Acq absence of organ NEC,Hx-prostatic malignancy,Personal history of fall
Name:  [**Known lastname 13010**],[**Known firstname 33**] T                Unit No:   [**Numeric Identifier 13011**]

Admission Date:  [**2163-3-11**]              Discharge Date:   [**2163-3-21**]

Date of Birth:  [**2075-6-2**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Procainamide / Flomax / Uroxatral

Attending:[**First Name3 (LF) 265**]
Addendum:
Clarification on medication
Lasix to be 40 mg twice a day oral - spoke with rehab [**3-21**] at
1535

Discharge Disposition:
Extended Care

Facility:
[**Location (un) 1353**]

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 266**]

Completed by:[**2163-3-21**]

Admission Date:  [**2163-3-11**]              Discharge Date:   [**2163-3-21**]


Service: CARDIOTHORACIC

Allergies:
Procainamide / Flomax / Uroxatral

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
fatigue, dyspnea

Major Surgical or Invasive Procedure:
Cardiac Catheterization
Coronary artery bypass graft times two and aortic valve
replacement with a 27mm [**Company 1543**] Mosaic Porcine valve [**2163-3-16**]


History of Present Illness:
This 87 year old gentleman has a history significant for aortic
stenosis, tachy-brady syndrome s/p pacemaker and paroxysmal
atrial fibrillation. Recently, he has been experiencing
shortness
of breath with minimal exertion and also reports intermittent
chest pressure that occurs unrelated to activity. He had a fall
in his basement last week. He denies having syncope and states
he
tripped. He denies LOC. He denies any dizziness or
lightheadedness at all. He has chronic right foot edema after
knee replacement surgery. He denies any PND or orthopnea
andstates he sleeps very well. He sleeps in a recliner due
tochronic back pain.  He denies any claudication symptoms.
Hereports frequent skin tears and currently has one on his right
lower leg and left forearm.

Due to concern about these symptoms, the patient was seen by his
PCP and an echo was done on [**2163-3-8**]. This report is not
presently
available, however it reportedly revealed worsening aortic
stenosis. The patient was referred for catheterization to
further evaluate need for AVR and possbly CABG.

 On [**2163-3-11**] patient [**Date Range 1834**] cardiac cath which revealed a
tight stenosis in LCx and RCA. It was therefore decided that he
would undergo both CABG for his CAD as well as AVR for his
severe AS complicated by CHF.


Past Medical History:
Prostate cancer diagnosed 7 months ago, treated conservatively
TURP 21 years ago for BPH
Aortic stenosis
Atrial fibrillation
Pacemaker [**2162-4-29**]
Chronic back pain s/p remote spinal fusion surgery [**2118**]
Breast tumor removed at age 15
Bilateral hernia repairs
Rectal surgery x 4 for fissures and hemorrhoids
Total knee replacement- right
Appendectomy age 13
Elbow surgery
s/p cardiac catheterization  approx 13 years ago with clean
coronaries
essential tremor of unknown origin
hypothyroid

Cardiac Risk Factors: Diabetes(-), Dyslipidemia(+),
Hypertension(+)

Pacemaker/ICD for AF/tachy-brady syndrome


Social History:
Social history is significant for the 3ppd X 20yrs quit 47 years
ago.  There is no history of alcohol abuse. Married, patient??????s
wife and daughter will accompany pt to procedure and then return
home. They would like to be called post procedure and can be
reached at [**Telephone/Fax (1) 81183**] or cell # [**Telephone/Fax (1) 81184**] [**Doctor First Name 717**].

Family History:
both parents died at age 76-mother died from a
stroke, father died following a stroke from complications from
carotid artery surgery. Father had an MI at age 60. Brother died
from suicide. Another brother died from pancreatic cancer.


Physical Exam:
VS -  T 96.6 HR 60s BPs 130s-160s/40s-60s RR18 O2sat 98RA
Gen: WDWN elderly male in NAD.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink. MMM
Neck: Supple with no JVD.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. [**2-4**] soft systolic murmur at RUSB radiating to
carotids No thrills, lifts. No S3 or S4.
Chest: CTAB, no crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Groin site without
hematoma, dressing c/d/i. No bruit.
Ext: Edema to ankles bilaterally R>L. Neg homans signs
Skin: stasis dermatitis bilaterally, no ulcers.

Pulses:
Right: Femoral 2+  DP 2+ PT 2+
Left: DP 2+ PT 2+



Pertinent Results:
[**2163-3-11**] 09:15AM   GLUCOSE-150* UREA N-27* CREAT-1.4* SODIUM-137
POTASSIUM-3.5 CHLORIDE-100 TOTAL CO2-28 ANION GAP-13
[**2163-3-11**] 09:15AM   ALT(SGPT)-10 AST(SGOT)-16 ALK PHOS-119*
AMYLASE-54 TOT BILI-0.5 DIR BILI-0.1 INDIR BIL-0.4
[**2163-3-11**] 09:15AM   ALBUMIN-3.8
[**2163-3-11**] 09:15AM   %HbA1c-5.4
[**2163-3-11**] 09:15AM   WBC-5.1 RBC-3.07* HGB-9.8* HCT-29.0* MCV-94
MCH-31.9 MCHC-33.8 RDW-14.6
[**2163-3-11**] 09:15AM   NEUTS-78.5* LYMPHS-14.1* MONOS-4.4 EOS-2.7
BASOS-0.2
[**2163-3-11**] 09:15AM   PLT COUNT-144*
[**2163-3-11**] 08:56AM   TYPE-ART PO2-114* PCO2-44 PH-7.44 TOTAL
CO2-31* BASE XS-5 INTUBATED-NOT INTUBA
[**2163-3-11**] 08:56AM   HGB-12.2* calcHCT-37 O2 SAT-98
[**2163-3-11**] 08:00AM   INR(PT)-0.9
[**2163-3-20**] 05:16AM BLOOD WBC-8.8 RBC-3.07* Hgb-9.8* Hct-27.8*
MCV-91 MCH-32.0 MCHC-35.4* RDW-16.6* Plt Ct-91*
[**2163-3-20**] 05:16AM BLOOD PT-15.5* INR(PT)-1.4*
[**2163-3-20**] 05:16AM BLOOD Glucose-106* UreaN-26* Creat-1.0 Na-139
K-3.3 Cl-104 HCO3-28 AnGap-10

Brief Hospital Course:
A cardiac catheterization was performed on [**2163-3-11**] which
demonstrated two vessel coronary artery disease. On [**2163-3-11**]
carotids were performed and revealed less than 40% stenosis on
the right and 70-79% on the left.  Dental clearance was
obtained.  He was seen by podiatry for right 2nd digit pain and
an abscess was drained at bedside.  He was seen by speech and
swallow and found to have mild dysphagia.  He was seen by wound
care for a right lower leg ulcer which has been healing poorly.
Adaptic was recommended to be placed on the wound.  He was
placed on Kefzol for thrombophlebitis on his right upper
extremity. On [**2163-3-16**] Mr. [**Known lastname 43400**] [**Last Name (Titles) 1834**] a coronary artery
bypass grafting times two and an aortic valve replacement with a
27mm [**Company 1543**] Mosaic Porcine valve.  He tolerated the procedure
well and was transferred in critical but stable condition to the
surgical intensive care unit.
Mr. [**Known lastname 43400**] was weaned from the ventilator and extubated without
difficulty. His pacing wires were removed on POD#2 since he has
his own internal pacer.
He was transferred from the ICU to the floor on POD#2. He was
started on coumadin  for baseline atrial fibrillation which he
was in prior to surgery and betablocker and diuretics.  His
platelet count was noted to be steadily declining. His
medications were reviewed and zantac d/c'd. A HIT panel was
negative. His chest tubes were removed on POD#3. Hematocrit and
platelets are recovering.  Mr. [**Known lastname 43400**] was evaluated by physical
therapy and rehab was recomended.  The patient was found stable
for discharge to rehab on POD 5.


Medications on Admission:
Slow K 600mg 1 capsule [**Hospital1 **]
Warfarin 5mg/7.5mg MWF,  last dose Monday
Amiodarone 200mg daily
Amlodipine 5mg daily
Primidone 50mg daily
Lasix 20mg, 3 tablets daily
Docusate sodium 100mg [**Hospital1 **]
Erythromycin Ophthalmic ointment daily for dry eye
Synthroid 0.125mg daily
konsyl OTC for fiber 6 grams daily with juice
aspirin 81mg daily

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily). Tablet, Delayed
Release (E.C.)(s)
2. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Erythromycin 5 mg/g Ointment Sig: One (1)  Ophthalmic DAILY
(Daily).
4. Docusate Sodium 50 mg/5 mL Liquid Sig: Two (2)  PO BID (2
times a day).
5. Primidone 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
8. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
10. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
11. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
12. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: dose
will change daily for goal INR [**2-1**], Dx: A-fib.
13. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
14. Potassium & Sodium Phosphates 280-160-250 mg Powder in
Packet Sig: One (1) Powder in Packet PO TID (3 times a day) for
2 days: through [**2163-3-22**].
15. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
16. Furosemide 40 mg IV Q12H
17. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours).


Discharge Disposition:
Extended Care

Facility:
TBA

Discharge Diagnosis:
two vessel coronary artery disease
severe aortic stenosis
hypertension
hypercholesterolemia
prostate cancer
tachy-brady syndrome
atrial fibrillation
chronic back pain
essential tremor of unknown origin
hypothyroidism
s/p fall last week (no syncope)
s/p rectal surgery for fissures
s/p appendectomy
s/p permanent pacemaker
s/p right total knee replacement
s/p transurethral resection of prostate
s/p bilateral elbow surgery
s/p spinal fusion in [**2118**]
s/p breast tumor removed age 15
s/p hernia repairs
s/p bilateral cataract surgery


Discharge Condition:
good


Discharge Instructions:
You were admitted to the hospital with fatigue and an abnormal
valve in your heart. You had a catheterization to evaluate the
valve and this showed some coronary artery disease as well.

You were having trouble swallowing. You had some tests that show
that the muscles that help you swallow are very tight which is
causing your trouble swallowing. You were given instructions for
how to swallow and should follow them at home. You should crush
your medications to take them. You may at some point want to
have surgery for this and your primary care doctor can help you
arrange this.
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 [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for
appointment
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 1 week ([**Telephone/Fax (1) 81185**] please call for
appointment
Dr [**First Name8 (NamePattern2) 518**] [**Last Name (NamePattern1) 8579**] in [**2-1**] weeks  ([**Telephone/Fax (1) 81186**] please call for
appointment
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3071**])


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2163-3-21**]
{'Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Aortic valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Essential and other specified forms of tremor,Pure hypercholesterolemia,Other chronic pain,Other iatrogenic hypotension,Dermatophytosis of nail,Knee joint replacement,Long-term (current) use of anticoagulants,Arthrodesis status,Cardiac pacemaker in situ,Other acquired absence of organ,Personal history of malignant neoplasm of prostate,History of fall'}


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, dyspnea

PRESENT ILLNESS: This 87 year old gentleman has a history significant for aortic
stenosis, tachy-brady syndrome s/p pacemaker and paroxysmal
atrial fibrillation. Recently, he has been experiencing
shortness
of breath with minimal exertion and also reports intermittent
chest pressure that occurs unrelated to activity. He had a fall
in his basement last week. He denies having syncope and states
he
tripped. He denies LOC. He denies any dizziness or
lightheadedness at all. He has chronic right foot edema after
knee replacement surgery. He denies any PND or orthopnea
andstates he sleeps very well. He sleeps in a recliner due
tochronic back pain.  He denies any claudication symptoms.
Hereports frequent skin tears and currently has one on his right
lower leg and left forearm.

MEDICAL HISTORY: Prostate cancer diagnosed 7 months ago, treated conservatively
TURP 21 years ago for BPH
Aortic stenosis
Atrial fibrillation
Pacemaker [**2162-4-29**]
Chronic back pain s/p remote spinal fusion surgery [**2118**]
Breast tumor removed at age 15
Bilateral hernia repairs
Rectal surgery x 4 for fissures and hemorrhoids
Total knee replacement- right
Appendectomy age 13
Elbow surgery
s/p cardiac catheterization  approx 13 years ago with clean
coronaries
essential tremor of unknown origin
hypothyroid

MEDICATION ON ADMISSION: Slow K 600mg 1 capsule [**Hospital1 **]
Warfarin 5mg/7.5mg MWF,  last dose Monday
Amiodarone 200mg daily
Amlodipine 5mg daily
Primidone 50mg daily
Lasix 20mg, 3 tablets daily
Docusate sodium 100mg [**Hospital1 **]
Erythromycin Ophthalmic ointment daily for dry eye
Synthroid 0.125mg daily
konsyl OTC for fiber 6 grams daily with juice
aspirin 81mg daily

ALLERGIES: Procainamide / Flomax / Uroxatral

PHYSICAL EXAM: VS -  T 96.6 HR 60s BPs 130s-160s/40s-60s RR18 O2sat 98RA
Gen: WDWN elderly male in NAD.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink. MMM
Neck: Supple with no JVD.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. [**2-4**] soft systolic murmur at RUSB radiating to
carotids No thrills, lifts. No S3 or S4.
Chest: CTAB, no crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Groin site without
hematoma, dressing c/d/i. No bruit.
Ext: Edema to ankles bilaterally R>L. Neg homans signs
Skin: stasis dermatitis bilaterally, no ulcers.

FAMILY HISTORY: both parents died at age 76-mother died from a
stroke, father died following a stroke from complications from
carotid artery surgery. Father had an MI at age 60. Brother died
from suicide. Another brother died from pancreatic cancer.

SOCIAL HISTORY: Social history is significant for the 3ppd X 20yrs quit 47 years
ago.  There is no history of alcohol abuse. Married, patient??????s
wife and daughter will accompany pt to procedure and then return
home. They would like to be called post procedure and can be
reached at [**Telephone/Fax (1) 81183**] or cell # [**Telephone/Fax (1) 81184**] [**Doctor First Name 717**]. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Aortic valve disorders,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Essential and other specified forms of tremor,Pure hypercholesterolemia,Other chronic pain,Other iatrogenic hypotension,Dermatophytosis of nail,Knee joint replacement,Long-term (current) use of anticoagulants,Arthrodesis status,Cardiac pacemaker in situ,Other acquired absence of organ,Personal history of malignant neoplasm of prostate,History of fall'}
