CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: Ms. [**Known lastname 26213**] is a 71 yo F who has had previous bypass grafts x3
and also a
mitral valve repair in [**2142**], presented with increasing symptoms
of dyspnea on exertion and fatigue. On further investigation
with echocardiogram and coronary angiogram it was discovered
that she had patent coronary grafts with no significant disease,
but she did have severe aortic stenosis with a valve area of
4.8. Intraoperative transesophageal echocardiography also
demonstrated severe mitral stenosis. The mitral valve repair
previously has been with an annuloplasty band. Left ventricular
ejection fraction was about 50% and she was electively admitted
for redo aortic as well as mitral valve replacement.

MEDICAL HISTORY: Mitral stenosis
Aortic stenosis
CAD, s/p CABG and MV repair in [**2142**]
HTN
DMII
Hypercholesterolemia
b/l carotid stenosis
rectal ca, s/p resection and chemo/XRT
s/p TAH in [**2134**]
s/p cavernous malformation in the R. parietal region
pulmonary HTN

MEDICATION ON ADMISSION: Enalapril 20", Lasix 80', Klor-Con 10meq', Metoprolol 50",
Metalozone 2.5 QOD, Actos 30', Lipitor 80', Protonix 40', Diovan
160", FA 1', ASA 81'

ALLERGIES: Penicillins / Heparin Agents

PHYSICAL EXAM: Vitals: BP 135/50, HR 72, RR 20
General: elderly female in no acute distress
HEENT: oropharynx benign, PERRL
Neck: supple, no JVD,  bilateral carotid bruits noted
Heart: regular rate, normal s1s2, 4/6 SEM
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds, well healed
scar
Ext: warm, 1+ edema,
Pulses: 2+ distally
Neuro: alert and oriented, CN 2-12 intact, nonfocal

FAMILY HISTORY: No history of premature CAD

SOCIAL HISTORY: Patient is widowed. Her daughter lives in an apartment above her
home. She has four adult children and a daughter in law who is a
nurse.
Mitral valve stenosis and aortic valve stenosis,Cardiac complications, not elsewhere classified,Atrial fibrillation,Atrioventricular block, complete,Congestive heart failure, unspecified,Anticoagulants causing adverse effects in therapeutic use,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of malignant neoplasm of large intestine
Mitral/aortic stenosis,Surg compl-heart,Atrial fibrillation,Atriovent block complete,CHF NOS,Adv eff anticoagulants,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hx of colonic malignancy
Admission Date:  [**2149-6-17**]              Discharge Date:   [**2149-7-2**]

Date of Birth:  [**2077-10-10**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Heparin Agents

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2149-6-17**] Redo Sternotomy, Aortic valve replacement(21mm
Pericardial), Mitral valve replacement(27mm Porcine), and Aortic
Endarterectomy.
[**2149-6-27**] Implantation of Permanent Pacemaker([**Company 1543**])


History of Present Illness:
Ms. [**Known lastname 26213**] is a 71 yo F who has had previous bypass grafts x3
and also a
mitral valve repair in [**2142**], presented with increasing symptoms
of dyspnea on exertion and fatigue. On further investigation
with echocardiogram and coronary angiogram it was discovered
that she had patent coronary grafts with no significant disease,
but she did have severe aortic stenosis with a valve area of
4.8. Intraoperative transesophageal echocardiography also
demonstrated severe mitral stenosis. The mitral valve repair
previously has been with an annuloplasty band. Left ventricular
ejection fraction was about 50% and she was electively admitted
for redo aortic as well as mitral valve replacement.

Past Medical History:
Mitral stenosis
Aortic stenosis
CAD, s/p CABG and MV repair in [**2142**]
HTN
DMII
Hypercholesterolemia
b/l carotid stenosis
rectal ca, s/p resection and chemo/XRT
s/p TAH in [**2134**]
s/p cavernous malformation in the R. parietal region
pulmonary HTN

Social History:
Patient is widowed. Her daughter lives in an apartment above her
home. She has four adult children and a daughter in law who is a
nurse.

Family History:
No history of premature CAD

Physical Exam:
Vitals: BP 135/50, HR 72, RR 20
General: elderly female in no acute distress
HEENT: oropharynx benign, PERRL
Neck: supple, no JVD,  bilateral carotid bruits noted
Heart: regular rate, normal s1s2, 4/6 SEM
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds, well healed
scar
Ext: warm, 1+ edema,
Pulses: 2+ distally
Neuro: alert and oriented, CN 2-12 intact, nonfocal


Pertinent Results:
[**2149-7-1**] 07:10AM BLOOD Hct-30.1* Plt Ct-264#
[**2149-7-2**] 06:30AM BLOOD PT-28.8* INR(PT)-3.0*
[**2149-7-1**] 04:10PM BLOOD PT-31.2* PTT-37.8* INR(PT)-3.3*
[**2149-7-2**] 06:30AM BLOOD Creat-1.4*
[**2149-7-2**] 06:30AM BLOOD Creat-1.4*
[**2149-7-1**] 04:10PM BLOOD Creat-1.5*
[**2149-7-1**] 07:10AM BLOOD Glucose-105 UreaN-27* Creat-1.5* Na-136
K-4.1 Cl-92* HCO3-32 AnGap-16
[**2149-6-29**] 04:57AM BLOOD K-4.8
[**2149-6-28**] 04:40AM BLOOD Glucose-74 UreaN-26* Creat-1.3* Na-140
K-3.6 Cl-96 HCO3-31 AnGap-17

[**Last Name (NamePattern4) 4125**]ospital Course:
On [**2149-6-17**], Ms. [**Known lastname 26213**] was admitted to the cardiac surgery
service under the care of Dr. [**Last Name (Prefixes) **]. That same day, she
underwent a redo-sternotomy, mitral and aortic valve
replacements, with an aortic endarterectomy. For details of the
procedure please see Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] operative report.
Following the operation, she was brought to the CSRU for
invasive monitoring. Within 24 hours, she awoke neurologically
intact and was extubated. She maintained stable hemodynamics and
weaned from pressor support without difficulty. On postoperative
day two, she transferred to the SDU. On postoperative day three,
she converted to a rate controlled atrial fibrillation which was
initially treated with Amiodarone. She went on to develop
bradycardia/complete heart block with junctional escape rhythm
which required ventricular pacing. All nodal agents were
discontinued and the EP service was consulted for pacemaker
evaluation. After several days of observation, it was decided to
proceed with permanent pacemaker due to persistent complete
heart block/atrial fibrillation with junctional escape and the
need for beta blockade. On [**2149-6-27**], the EP service successfully
implanted a dual chamber [**Company 1543**] pacemaker with settings
DDD/AAI 60-120. Mrs. [**Known lastname 26213**] tolerated the procedure well and
there were no complications. Her hospital course was also
notable for the diagnosis of HIT which was confirmed by Heparin
PF4 antibody by [**Doctor First Name **] . Her platelet count dropped as low as
110K. She was temporarily treated with intravenous Argatroban
and slowly transitioned to Coumadin. Coumadin was dosed daily
for a goal INR between [**12-27**]. Once her pacemaker was implanted,
beta blockade was slowly advanced as tolerated. She otherwise
continued to make clinical improvements with medical therapy and
steady progress with physical therapy.

Medications on Admission:
Enalapril 20", Lasix 80', Klor-Con 10meq', Metoprolol 50",
Metalozone 2.5 QOD, Actos 30', Lipitor 80', Protonix 40', Diovan
160", FA 1', ASA 81'

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. 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:*2*
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 6-8 hours as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. Pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
Disp:*60 Tablet(s)* Refills:*0*
9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours).
Disp:*120 Capsule, Sustained Release(s)* Refills:*0*
10. Coumadin 1 mg Tablet Sig: Three (3) Tablet PO at bedtime: 3
mg x 2 days, check INR [**7-4**] with results to Dr. [**Last Name (STitle) 4783**] .
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
Severe aortic stenosis and prostheric mitral stenosis - s/p AVR,
MVR, Postoperative Complete Heart Block, Postop Atrial
Fibrillation, Heparin Induced Thrombocytopenia, Congestive Heart
Failure, Coronary Artery Disease - prior CABG, Hypertension,
Diabetes Mellitus, Hypercholesterolemia, Carotid Disease,
History of Colon Cancer - s/p colectomy, Hyperhomocystenemia


Discharge Condition:
Good


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

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks - call for appt [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) 5017**] in 2 weeks - call for appt [**Telephone/Fax (1) 5424**] and for
coumadin follow up
Device clinic early next week [**Telephone/Fax (1) 59**]



Completed by:[**2149-7-2**]
{'Mitral valve stenosis and aortic valve stenosis,Cardiac complications, not elsewhere classified,Atrial fibrillation,Atrioventricular block, complete,Congestive heart failure, unspecified,Anticoagulants causing adverse effects in therapeutic use,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,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: Dyspnea on exertion

PRESENT ILLNESS: Ms. [**Known lastname 26213**] is a 71 yo F who has had previous bypass grafts x3
and also a
mitral valve repair in [**2142**], presented with increasing symptoms
of dyspnea on exertion and fatigue. On further investigation
with echocardiogram and coronary angiogram it was discovered
that she had patent coronary grafts with no significant disease,
but she did have severe aortic stenosis with a valve area of
4.8. Intraoperative transesophageal echocardiography also
demonstrated severe mitral stenosis. The mitral valve repair
previously has been with an annuloplasty band. Left ventricular
ejection fraction was about 50% and she was electively admitted
for redo aortic as well as mitral valve replacement.

MEDICAL HISTORY: Mitral stenosis
Aortic stenosis
CAD, s/p CABG and MV repair in [**2142**]
HTN
DMII
Hypercholesterolemia
b/l carotid stenosis
rectal ca, s/p resection and chemo/XRT
s/p TAH in [**2134**]
s/p cavernous malformation in the R. parietal region
pulmonary HTN

MEDICATION ON ADMISSION: Enalapril 20", Lasix 80', Klor-Con 10meq', Metoprolol 50",
Metalozone 2.5 QOD, Actos 30', Lipitor 80', Protonix 40', Diovan
160", FA 1', ASA 81'

ALLERGIES: Penicillins / Heparin Agents

PHYSICAL EXAM: Vitals: BP 135/50, HR 72, RR 20
General: elderly female in no acute distress
HEENT: oropharynx benign, PERRL
Neck: supple, no JVD,  bilateral carotid bruits noted
Heart: regular rate, normal s1s2, 4/6 SEM
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds, well healed
scar
Ext: warm, 1+ edema,
Pulses: 2+ distally
Neuro: alert and oriented, CN 2-12 intact, nonfocal

FAMILY HISTORY: No history of premature CAD

SOCIAL HISTORY: Patient is widowed. Her daughter lives in an apartment above her
home. She has four adult children and a daughter in law who is a
nurse. 

### Response:
{'Mitral valve stenosis and aortic valve stenosis,Cardiac complications, not elsewhere classified,Atrial fibrillation,Atrioventricular block, complete,Congestive heart failure, unspecified,Anticoagulants causing adverse effects in therapeutic use,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of malignant neoplasm of large intestine'}
