CHIEF COMPLAINT: DOE/fatigue

PRESENT ILLNESS: 49 yo F with a history of a bicsupid aortic valve followed by
serial echocardiograms. Recent echo revealed RV dysfunction with
increased MR, Ai and AS. She was referred for surgery.

MEDICAL HISTORY: PMH:
- Crohn's disease since age 19, no surgeries, treated with
prednisone off and on
- prednisone induced hyperglycemia
- COPD - PFTs in [**6-20**] showed FEV1/FEV 87% predicted
- Aortic Stenosis (moderate,per echo [**1-20**])
- hypertension
- high cholesterol
- gastritis/GERD, h/o GI bleed
- one seizures in the setting of emesis in [**12-20**], no AEDs
- skin cancer on nose
- inflammatory [**Last Name **] problem periodically
- pyoderma gangrenosum-on L calf and R ankle, tx with Prednisone
- osteopenia
- all teeth extracted secondary to prednisone
- right arm arterial bypass when she presented with right arm
pain and pulselessness

MEDICATION ON ADMISSION: Prednisone 10', Albuterol, Lipitor 20', Budesonide 6', Pletal
100", Duloxetine 30", Chantix, Lasix 40", Folate 1', Boniva
150'Qmo,
Lisinopril 20', Ativan 0.5", Methadone 5 Q6/prn, Percocet
5/325-prn, Donnatal 16.2'/prn, Lyrica 150", Protonix 40",
Carafate 1", Sulfasalazine 1000", Spiriva 18', Trazadone 300/hs,
ASA 81', Calcium 500", Vit B12 100', MVI

ALLERGIES: Penicillins / Darvocet-N 100 / Aspirin / Amitriptyline /
Wellbutrin

PHYSICAL EXAM: Admission:
HR 80 NSR RR 20 BP 140/80
NAD
Lungs Mild Rhonchi
Heart RRR 3/6 SEM
Abdomen obese, benign
Extrem warm, 1+ edema
No Varicosities

FAMILY HISTORY: mother deceased age 62 of stroke, HTN, high chol, father
deceased age 56 of MI and also had low back pain, sisters x 4
one with diabetes and neuropathy, one brother deceased (in
army), and another alive with HTN, high chol, and prostate
cancer, one son healthy.

SOCIAL HISTORY: completed 12th grade, currently on disability but formerly
worked in an airplane factory, divorced, lives with son, active
[**Name2 (NI) 1818**] - 1-1.5 ppd x 32 years. No drinking or drug use (IVDA).
Mitral valve insufficiency and aortic valve stenosis,Acute combined systolic and diastolic heart failure,Congenital insufficiency of aortic valve,Precipitous drop in hematocrit,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,Other chronic pulmonary heart diseases,Esophageal reflux,Depressive disorder, not elsewhere classified,Disorder of bone and cartilage, unspecified,Personal history of other malignant neoplasm of skin,Peripheral vascular disease, unspecified
Mitral insuf/aort stenos,Ac syst/diastol hrt fail,Cong aorta valv insuffic,Drop, hematocrit, precip,Chr airway obstruct NEC,Hypertension NOS,Pure hypercholesterolem,Chr pulmon heart dis NEC,Esophageal reflux,Depressive disorder NEC,Bone & cartilage dis NOS,Hx-skin malignancy NEC,Periph vascular dis NOS
Admission Date:  [**2149-4-1**]              Discharge Date:   [**2149-4-8**]

Date of Birth:  [**2100-1-23**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Darvocet-N 100 / Aspirin / Amitriptyline /
Wellbutrin

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
DOE/fatigue

Major Surgical or Invasive Procedure:
AVR(#21 [**Company 1543**] Mosaic)[**4-1**]


History of Present Illness:
49 yo F with a history of a bicsupid aortic valve followed by
serial echocardiograms. Recent echo revealed RV dysfunction with
increased MR, Ai and AS. She was referred for surgery.

Past Medical History:
PMH:
- Crohn's disease since age 19, no surgeries, treated with
prednisone off and on
- prednisone induced hyperglycemia
- COPD - PFTs in [**6-20**] showed FEV1/FEV 87% predicted
- Aortic Stenosis (moderate,per echo [**1-20**])
- hypertension
- high cholesterol
- gastritis/GERD, h/o GI bleed
- one seizures in the setting of emesis in [**12-20**], no AEDs
- skin cancer on nose
- inflammatory [**Last Name **] problem periodically
- pyoderma gangrenosum-on L calf and R ankle, tx with Prednisone
- osteopenia
- all teeth extracted secondary to prednisone
- right arm arterial bypass when she presented with right arm
pain and pulselessness

Social History:
completed 12th grade, currently on disability but formerly
worked in an airplane factory, divorced, lives with son, active
[**Name2 (NI) 1818**] - 1-1.5 ppd x 32 years. No drinking or drug use (IVDA).


Family History:
mother deceased age 62 of stroke, HTN, high chol, father
deceased age 56 of MI and also had low back pain, sisters x 4
one with diabetes and neuropathy, one brother deceased (in
army), and another alive with HTN, high chol, and prostate
cancer, one son healthy.

Physical Exam:
Admission:
HR 80 NSR RR 20 BP 140/80
NAD
Lungs Mild Rhonchi
Heart RRR 3/6 SEM
Abdomen obese, benign
Extrem warm, 1+ edema
No Varicosities

Discharge:
VS T 97  BP 105/56  HR 65 SR  RR 18  O2sat 94%/3LNP
Gen NAD
Neuro Alert, non focal exam
Pulm CTA bilat
CV RRR, no murmur. Sternum stable, incision CDI
Abdm Soft, NT/+BS
Ext warm, [**1-15**]+edema bilat


Pertinent Results:
[**2149-4-1**] 12:23PM   GLUCOSE-127* NA+-136 K+-3.0*
[**2149-4-1**] 12:12PM   UREA N-9 CREAT-0.7 CHLORIDE-114* TOTAL CO2-24
[**2149-4-1**] 12:12PM   WBC-18.4* RBC-3.49*# HGB-9.7*# HCT-29.2*#
MCV-84 MCH-27.8 MCHC-33.1 RDW-15.1
[**2149-4-1**] 12:12PM   PLT COUNT-187
[**2149-4-1**] 12:12PM   PT-13.8* PTT-38.8* INR(PT)-1.2*
[**2149-4-8**] 05:20AM BLOOD WBC-9.6 RBC-3.33* Hgb-9.4* Hct-28.8*
MCV-87 MCH-28.3 MCHC-32.7 RDW-15.4 Plt Ct-233
[**2149-4-8**] 05:20AM BLOOD Plt Ct-233
[**2149-4-8**] 05:20AM BLOOD PT-11.8 PTT-20.9* INR(PT)-1.0
[**2149-4-7**] 06:20AM BLOOD Glucose-76 UreaN-11 Creat-1.0 Na-141
K-3.7 Cl-99 HCO3-40* AnGap-6*

RADIOLOGY  Final Report
CHEST (PA & LAT)  [**2149-4-6**] 10:47 AM
CHEST (PA & LAT)
Reason: pna /plueral [**Hospital 18440**]
[**Hospital 93**] MEDICAL CONDITION:
49 year old woman with cosistanlt requiring O2, low BP post cabg

REASON FOR THIS EXAMINATION:
pna /plueral effussion
CHEST RADIOGRAPH
INDICATION: Oxygen requirement, rule out of pneumonia and
pleural effusion.
COMPARISON: [**2149-4-4**]. As compared to the previous
radiograph, the lung volumes have increased. Due to the
increased lung volumes, band-like opacities in both lung bases
are better seen than on the previous radiograph. These opacities
could correspond to plate-like atelectasis, old post- infectious
scars or cryptogenic organizing pneumonia. The remaining
differential diagnosis could be further worked up by CT. There
is unchanged subtle blunting of the right costophrenic angle,
suggestive of either a small pleural scar or a small pleural
effusion. No newly occurred opacities. No evidence of
hyperhydration or cardiac failure. The size of the cardiac
silhouette is slightly above the normal range.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname 18441**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 18442**]
(Complete) Done [**2149-4-1**] at 8:34:23 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 1112**] W.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2100-1-23**]
Age (years): 49 F  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Aortic valve disease. Left ventricular function.
Preoperative assessment.
ICD-9 Codes: 440.0, 424.1
Test Information
Date/Time: [**2149-4-1**] at 08:34    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 168**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW4-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.3 cm  0.6 - 1.1 cm
Left Ventricle - Ejection Fraction:  >= 55%  >= 55%
Aorta - Annulus:  2.1 cm  <= 3.0 cm
Aorta - Sinus Level:  3.1 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.4 cm  <= 3.0 cm
Aorta - Ascending:  *3.5 cm  <= 3.4 cm
Aortic Valve - Peak Gradient:  *40 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  16 mm Hg
Aortic Valve - LVOT diam:  2.1 cm
Aortic Valve - Valve Area:  *1.0 cm2  >= 3.0 cm2
Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.
LEFT VENTRICLE: Mild symmetric LVH. Overall normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Complex (>4mm) atheroma in the descending thoracic aorta.

AORTIC VALVE: Bicuspid aortic valve. Moderately thickened aortic
valve leaflets. Systolic doming of aortic valve leaflets.
Moderate AS (AoVA 1.0-1.2cm2) Mild (1+) AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) 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. No TEE related complications.
REGIONAL LEFT VENTRICULAR WALL MOTION:
     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PREBYPASS
No atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
aortic valve is bicuspid. The aortic valve leaflets are
moderately thickened. There is systolic doming of the aortic
valve leaflets. There is moderate aortic valve stenosis (area
1.0-1.2cm2). Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen.
POSTBYPASS
Biventricular systolic function is preserved. There is a well
seated, well functioning bioprosthesis in the aortic position.
There is trace perivalvular AI. MR remains mild. The study is
otherwise unchanged from prebypass.
I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2149-4-1**] 15:54


Brief Hospital Course:
She was a direct admission to the operating room on [**2149-4-1**]
where she underwent an AVR, please see OR report for details. In
summary she had AVR with 21mm [**Company 1543**] Mosaic valve, her bypass
time was 102 min with cross clamp of 75 minutes. She tolerated
the operation well and was transferred to the ICU in critical
but stable condition. She was extubated on the morning of POD #1
and later in the day was transferred to the floor. Once on the
floors she had an uneventful post-operative course. Her chest
tubes were removed late on POD1 and epicardial wires were
removed on POD3. Her activity was advanced by nursing and PT. On
POD4 she was transfused with PRBC's for a HCT of 22. her HCT
stayed stable over the next 2 days and on POD6 she was
transferred to rehabilitation at Lifecare of [**Location (un) 5165**].

Medications on Admission:
Prednisone 10', Albuterol, Lipitor 20', Budesonide 6', Pletal
100", Duloxetine 30", Chantix, Lasix 40", Folate 1', Boniva
150'Qmo,
Lisinopril 20', Ativan 0.5", Methadone 5 Q6/prn, Percocet
5/325-prn, Donnatal 16.2'/prn, Lyrica 150", Protonix 40",
Carafate 1", Sulfasalazine 1000", Spiriva 18', Trazadone 300/hs,
ASA 81', Calcium 500", Vit B12 100', MVI


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Prednisone 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Methadone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
6. Duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
7. Pregabalin 75 mg Capsule Sig: Two (2) Capsule PO bid ().
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
9. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO BID (2 times
a day).
10. Trazodone 100 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. Sulfasalazine 500 mg Tablet Sig: 1-2 Tablets PO TID (3 times
a day).
13. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
14. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
15. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
16. Albuterol 90 mcg/Actuation Aerosol Sig: 2-4 Puffs Inhalation
Q4H (every 4 hours) as needed.
17. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed.
18. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
19. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
20. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily): 14mg/day x 1 week then 7mg/day patch.

21. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
22. Hydromorphone 2 mg Tablet Sig: 1-3 Tablets PO Q4H (every 4
hours) as needed for pain.
23. Boniva 150 mg Tablet Sig: One (1) Tablet PO once a month.
24. Donnatal 16.2 mg Tablet Sig: One (1) Tablet PO once a day as
needed for diarrhea.


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location (un) 5165**]

Discharge Diagnosis:
AS/AI now s/p AVR
PMH: HTN,^chol,COPD,PHTN,PVD,Crohn's, s/p GIB,Gastritis,GERD,
Depression,CHF,Skin CA s/p excision(nose),L ear
chrondrodermatitis,osteopenia,restless leg,C-sectionx2,R arm
bypass/embolectomy,L caf debridement


Discharge Condition:
Good.


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.
No lifting more than 10 pounds for 10 weeks.
No driving until follow up with surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) **] 4 weeks
Already scheduled appointments:
Provider: [**Name10 (NameIs) **] [**First Name8 (NamePattern2) 18443**] [**Name12 (NameIs) 815**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2149-4-14**] 1:30
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2149-4-14**]
3:20
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2149-6-30**]
10:20



Completed by:[**2149-4-8**]
{'Mitral valve insufficiency and aortic valve stenosis,Acute combined systolic and diastolic heart failure,Congenital insufficiency of aortic valve,Precipitous drop in hematocrit,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,Other chronic pulmonary heart diseases,Esophageal reflux,Depressive disorder, not elsewhere classified,Disorder of bone and cartilage, unspecified,Personal history of other malignant neoplasm of skin,Peripheral vascular disease, 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: DOE/fatigue

PRESENT ILLNESS: 49 yo F with a history of a bicsupid aortic valve followed by
serial echocardiograms. Recent echo revealed RV dysfunction with
increased MR, Ai and AS. She was referred for surgery.

MEDICAL HISTORY: PMH:
- Crohn's disease since age 19, no surgeries, treated with
prednisone off and on
- prednisone induced hyperglycemia
- COPD - PFTs in [**6-20**] showed FEV1/FEV 87% predicted
- Aortic Stenosis (moderate,per echo [**1-20**])
- hypertension
- high cholesterol
- gastritis/GERD, h/o GI bleed
- one seizures in the setting of emesis in [**12-20**], no AEDs
- skin cancer on nose
- inflammatory [**Last Name **] problem periodically
- pyoderma gangrenosum-on L calf and R ankle, tx with Prednisone
- osteopenia
- all teeth extracted secondary to prednisone
- right arm arterial bypass when she presented with right arm
pain and pulselessness

MEDICATION ON ADMISSION: Prednisone 10', Albuterol, Lipitor 20', Budesonide 6', Pletal
100", Duloxetine 30", Chantix, Lasix 40", Folate 1', Boniva
150'Qmo,
Lisinopril 20', Ativan 0.5", Methadone 5 Q6/prn, Percocet
5/325-prn, Donnatal 16.2'/prn, Lyrica 150", Protonix 40",
Carafate 1", Sulfasalazine 1000", Spiriva 18', Trazadone 300/hs,
ASA 81', Calcium 500", Vit B12 100', MVI

ALLERGIES: Penicillins / Darvocet-N 100 / Aspirin / Amitriptyline /
Wellbutrin

PHYSICAL EXAM: Admission:
HR 80 NSR RR 20 BP 140/80
NAD
Lungs Mild Rhonchi
Heart RRR 3/6 SEM
Abdomen obese, benign
Extrem warm, 1+ edema
No Varicosities

FAMILY HISTORY: mother deceased age 62 of stroke, HTN, high chol, father
deceased age 56 of MI and also had low back pain, sisters x 4
one with diabetes and neuropathy, one brother deceased (in
army), and another alive with HTN, high chol, and prostate
cancer, one son healthy.

SOCIAL HISTORY: completed 12th grade, currently on disability but formerly
worked in an airplane factory, divorced, lives with son, active
[**Name2 (NI) 1818**] - 1-1.5 ppd x 32 years. No drinking or drug use (IVDA). 

### Response:
{'Mitral valve insufficiency and aortic valve stenosis,Acute combined systolic and diastolic heart failure,Congenital insufficiency of aortic valve,Precipitous drop in hematocrit,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,Other chronic pulmonary heart diseases,Esophageal reflux,Depressive disorder, not elsewhere classified,Disorder of bone and cartilage, unspecified,Personal history of other malignant neoplasm of skin,Peripheral vascular disease, unspecified'}
