CHIEF COMPLAINT: Increasing fatigue and pre-syncope

PRESENT ILLNESS: This is an 84 year old year old female with known aortic
stenosis and coronary artery disease since [**2133**], who recently
complained of worsening presyncopal episodes and progressive
dyspnea on exertion and fatigue. Her most recent echocardiogram
showed an aortic valve area of 0.76cm2 with a peak of 64 and
mean of 38mmHg. There was no aortic insufficiency, mild mitral
regurgitation and an LVEF of 65%. Cardiac catheterization in
[**2141-1-9**] confirmed severe aortic stenosis and three vessel
disease. Based on the above, she was referred for cardiac
surgical intervention.

MEDICAL HISTORY: Aortic Valve Stenosis, Coronary Artery Disease, Mild COPD,
Hypertension, Insulin Dependent Diabetes Mellitus, Dyslipidemia,
Mild Chronic Renal Insufficiency, Esophagitis, Recurrent UTI,
Osteoporosis, Obesity, s/p Nephrectomy, Colon Cancer - s/p
Colectomy, s/p Total Hip Replacments, s/p Chole, s/p
Appendectomy, s/p Vein Stripping, s/p Cataract Surgery

MEDICATION ON ADMISSION: Atenolol 50 qd, Avapro 150 qd, Diltiazem XT 120 qd, Evista 60
qd, Lasix 20 qd, Metformin 750 [**Hospital1 **], Zocor 20 qd, Aspirin 81 qd,
Nitrofurantoin 100 qd, Lantus, Humalog SS, MV

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Vitals: T 97.3, BP 160/66, HR 66, RR 20, SAT  97 on room air
General: Elderly female in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 4/6 systolic ejection murmur
throughout precordium, radiating to carotids
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, 1+ edema,
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Brother died of MI at age 50. Father died of MI at age 62.

SOCIAL HISTORY: Remote history of tobacco. Admits to only rare ETOH. She lives
alone.
Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of large intestine
Aortic valve disorder,Chr airway obstruct NEC,Chronic kidney dis NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hy kid NOS w cr kid I-IV,Hx of colonic malignancy
Admission Date:  [**2141-3-14**]              Discharge Date:   [**2141-3-21**]


Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Increasing fatigue and pre-syncope

Major Surgical or Invasive Procedure:
[**2141-3-15**] Aortic Valve Replacement(21mm Pericardial valve) and Two
Vessel Coronary Artery Bypass Grafting(left internal mammary to
left anterior descending and vein graft to obtuse marginal).


History of Present Illness:
This is an 84 year old year old female with known aortic
stenosis and coronary artery disease since [**2133**], who recently
complained of worsening presyncopal episodes and progressive
dyspnea on exertion and fatigue. Her most recent echocardiogram
showed an aortic valve area of 0.76cm2 with a peak of 64 and
mean of 38mmHg. There was no aortic insufficiency, mild mitral
regurgitation and an LVEF of 65%. Cardiac catheterization in
[**2141-1-9**] confirmed severe aortic stenosis and three vessel
disease. Based on the above, she was referred for cardiac
surgical intervention.

Past Medical History:
Aortic Valve Stenosis, Coronary Artery Disease, Mild COPD,
Hypertension, Insulin Dependent Diabetes Mellitus, Dyslipidemia,
Mild Chronic Renal Insufficiency, Esophagitis, Recurrent UTI,
Osteoporosis, Obesity, s/p Nephrectomy, Colon Cancer - s/p
Colectomy, s/p Total Hip Replacments, s/p Chole, s/p
Appendectomy, s/p Vein Stripping, s/p Cataract Surgery

Social History:
Remote history of tobacco. Admits to only rare ETOH. She lives
alone.

Family History:
Brother died of MI at age 50. Father died of MI at age 62.

Physical Exam:
Vitals: T 97.3, BP 160/66, HR 66, RR 20, SAT  97 on room air
General: Elderly female in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 4/6 systolic ejection murmur
throughout precordium, radiating to carotids
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, 1+ edema,
Pulses: 1+ distally
Neuro: nonfocal


Pertinent Results:
[**2141-3-21**] 07:10AM BLOOD Hct-31.5*
[**2141-3-20**] 05:46AM BLOOD WBC-7.5 RBC-3.28* Hgb-10.0* Hct-29.7*
MCV-91 MCH-30.6 MCHC-33.7 RDW-15.5 Plt Ct-130*
[**2141-3-20**] 05:46AM BLOOD Plt Ct-130*
[**2141-3-18**] 05:07AM BLOOD PT-11.8 PTT-27.8 INR(PT)-1.0
[**2141-3-20**] 05:46AM BLOOD Glucose-78 UreaN-18 Creat-1.0 Na-136
K-5.0 Cl-105 HCO3-25 AnGap-11
[**2141-3-21**] 07:10AM BLOOD UreaN-19 Creat-1.1 K-5.5*

Brief Hospital Course:
Mrs. [**Known lastname 20585**] was admitted on [**3-14**]. Due to operative
emergencies, surgery was postponed to the following day. On
[**3-15**], Dr. [**Last Name (STitle) 1290**] performed an aortic valve replacement
and coronary artery bypass grafting surgery. For surgical
details, please see seperate dictated operative note. Following
the operation, she was brought to the CSRU for invasive
monitoring. Within 24 hours, she awoke neurologically intact and
was extubated without incident. She weaned from inotropic
support without difficulty. She maintained stable hemodynamics
as beta blockade was resumed. Her CSRU course was otherwise
uneventful and she transferred to the SDU on postoperative day
three. She remained in a normal sinus rhythm. Beta blockade was
slowly advanced as tolerated. She remained fluid overloaded and
continue to require diuresis. Over several days, she continued
to make clinical improvements and was eventually cleared for
discharge on postoperative day 7.

Medications on Admission:
Atenolol 50 qd, Avapro 150 qd, Diltiazem XT 120 qd, Evista 60
qd, Lasix 20 qd, Metformin 750 [**Hospital1 **], Zocor 20 qd, Aspirin 81 qd,
Nitrofurantoin 100 qd, Lantus, Humalog SS, MV

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
2. 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:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
5. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Raloxifene 60 mg Tablet Sig: One (1) Tablet PO daily ().
7. Metformin 500 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day).
8. Lantus 100 unit/mL Solution Sig: Eight (8) units Subcutaneous
once a day.
9. Metoprolol Tartrate 25 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*0*
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
Aortic Valve Stenosis and Coronary Artery Disease - s/p AVR and
CABG, COPD, Hypertension, Insulin Dependent Diabetes Mellitus,
Dyslipidemia, Mild Chronic Renal Insufficiency, Esophagitis,
Recurrent UTI, Osteoporosis, Obesity


Discharge Condition:
Good


Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for at least one month. No lifting more
than 10 lbs for at least 10 weeks from the date of surgery.
Monitor wounds for signs of infection. Please call with any
concerns or questions.


Followup Instructions:
Cardiac surgeon, Dr. [**Last Name (STitle) 1290**] in [**4-13**] weeks.
Local PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 20458**] in [**2-11**] weeks.
Local cardiologist, Dr. [**Last Name (STitle) **] in [**2-11**] weeks.



Completed by:[**2141-3-27**]
{'Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of large intestine'}


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: Increasing fatigue and pre-syncope

PRESENT ILLNESS: This is an 84 year old year old female with known aortic
stenosis and coronary artery disease since [**2133**], who recently
complained of worsening presyncopal episodes and progressive
dyspnea on exertion and fatigue. Her most recent echocardiogram
showed an aortic valve area of 0.76cm2 with a peak of 64 and
mean of 38mmHg. There was no aortic insufficiency, mild mitral
regurgitation and an LVEF of 65%. Cardiac catheterization in
[**2141-1-9**] confirmed severe aortic stenosis and three vessel
disease. Based on the above, she was referred for cardiac
surgical intervention.

MEDICAL HISTORY: Aortic Valve Stenosis, Coronary Artery Disease, Mild COPD,
Hypertension, Insulin Dependent Diabetes Mellitus, Dyslipidemia,
Mild Chronic Renal Insufficiency, Esophagitis, Recurrent UTI,
Osteoporosis, Obesity, s/p Nephrectomy, Colon Cancer - s/p
Colectomy, s/p Total Hip Replacments, s/p Chole, s/p
Appendectomy, s/p Vein Stripping, s/p Cataract Surgery

MEDICATION ON ADMISSION: Atenolol 50 qd, Avapro 150 qd, Diltiazem XT 120 qd, Evista 60
qd, Lasix 20 qd, Metformin 750 [**Hospital1 **], Zocor 20 qd, Aspirin 81 qd,
Nitrofurantoin 100 qd, Lantus, Humalog SS, MV

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Vitals: T 97.3, BP 160/66, HR 66, RR 20, SAT  97 on room air
General: Elderly female in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, 4/6 systolic ejection murmur
throughout precordium, radiating to carotids
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, 1+ edema,
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Brother died of MI at age 50. Father died of MI at age 62.

SOCIAL HISTORY: Remote history of tobacco. Admits to only rare ETOH. She lives
alone. 

### Response:
{'Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of large intestine'}
