CHIEF COMPLAINT: Aortic Stenosis/Mitral Valve Regurgitation

PRESENT ILLNESS: This 84 year-old man with a known history of valvular heart
disease was recently investigated and was found to have a
critical aortic stenosis and severe mitral regurgitation. His
coronary angiogram showed significant disease in the left
anterior descending artery and the circumflex artery and a
nondominant right coronary artery. His ejection fraction was
45%. He is currently asymptomatic and is electively admitted for
surgical management.

MEDICAL HISTORY: CAD
AF
HTN
Pacemaker insitu
AS/MR
Degenerative joint disease
Asbestosis
Pneumonia in past
Bilateral total hip replacements

MEDICATION ON ADMISSION: Plavix 75mg QD
Aspirin 81mg QD
Amiodarone 200mg QD
Lasix 40mg [**Hospital1 **]
Zocor 80mg QD
Zetia 10mg QD
Flonase
Fosamax

ALLERGIES: Penicillins / Bactrim

PHYSICAL EXAM: GEN: WDWN in NAD
NEURO: A+Ox3
HEENT: Perrl, EOMI, OP benign.
NECK: supple, No JVD
LUNGS: Clear
HEART: RRR, normal S1-S2 with systolic murmur
ABDOMEN: Soft, NT/ND,NABS
EXT: 2+ LE edema, 1+ pulses.

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking or alcohol use.
Mitral valve insufficiency and aortic valve stenosis,Atrial fibrillation,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery
Mitral insuf/aort stenos,Atrial fibrillation,Retention urine NOS,Crnry athrscl natve vssl
Name:  [**Known lastname 16154**],[**Known firstname 394**]                  Unit No:   [**Numeric Identifier 16155**]

Admission Date:  [**2128-9-12**]              Discharge Date:   [**2128-9-29**]

Date of Birth:  [**2044-7-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Bactrim

Attending:[**First Name3 (LF) 674**]
Addendum:
Mr. [**Known lastname **] had decreased urine output and urinary retention. A
foley was reinserted and flomax was started. He will undergo a
voiding trial at rehab. Levofloxacin was started for
prophylactic coverage.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 49**] - [**Location (un) 50**]

                             [**Doctor Last Name **] [**Last Name (Prefixes) **] MD [**MD Number(1) 681**]

Completed by:[**2128-9-29**]

Admission Date:  [**2128-9-12**]              Discharge Date:   [**2128-9-29**]


Service: CARDIOTHORACIC

Allergies:
Penicillins / Bactrim

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Aortic Stenosis/Mitral Valve Regurgitation

Major Surgical or Invasive Procedure:
[**2128-9-13**] - AVR(27mm CE magna pericardial), MVR(31mm CE
Pericardial) and CABGx2 (internal mammary to the left anterior
descending artery, Veiin graft to obtuse marginal artery).


History of Present Illness:
This 84 year-old man with a known history of valvular heart
disease was recently investigated and was found to have a
critical aortic stenosis and severe mitral regurgitation. His
coronary angiogram showed significant disease in the left
anterior descending artery and the circumflex artery and a
nondominant right coronary artery. His ejection fraction was
45%. He is currently asymptomatic and is electively admitted for
surgical management.

Past Medical History:
CAD
AF
HTN
Pacemaker insitu
AS/MR
Degenerative joint disease
Asbestosis
Pneumonia in past
Bilateral total hip replacements

Social History:
No smoking or alcohol use.

Physical Exam:
GEN: WDWN in NAD
NEURO: A+Ox3
HEENT: Perrl, EOMI, OP benign.
NECK: supple, No JVD
LUNGS: Clear
HEART: RRR, normal S1-S2 with systolic murmur
ABDOMEN: Soft, NT/ND,NABS
EXT: 2+ LE edema, 1+ pulses.

Pertinent Results:
[**2128-9-12**] 03:57PM   PT-13.6* INR(PT)-1.2
[**2128-9-12**] 03:57PM   PLT COUNT-150
[**2128-9-12**] 03:57PM   WBC-7.0 RBC-4.08* HGB-12.4* HCT-38.6* MCV-95
MCH-30.3 MCHC-32.0 RDW-13.9
[**2128-9-12**] 03:57PM   ALT(SGPT)-11 AST(SGOT)-16 LD(LDH)-195 ALK
PHOS-72 TOT BILI-0.7
[**2128-9-12**] 03:57PM   GLUCOSE-85 UREA N-41* CREAT-1.5* SODIUM-143
POTASSIUM-4.8 CHLORIDE-107 TOTAL CO2-27 ANION GAP-14
[**2128-9-12**] 06:28PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2128-9-12**] 06:28PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.024
[**2128-9-29**] 04:53AM BLOOD Hct-36.0*
[**2128-9-29**] 04:53AM BLOOD PT-18.3* INR(PT)-2.3
[**2128-9-29**] 04:53AM BLOOD UreaN-46* Creat-1.3* K-4.2

[**2128-9-24**] EKG
Dual chamber pacemaker rhythm with atrial sensed and ventricular
paced rhythm. First degree A-V block. Compared to the previous
tracing of [**2128-9-3**] there is one hundred percent atrial sensed
and ventricular paced rhythm.

[**2128-9-29**] CXR
Report Pending
[**2128-9-24**] CXR
Moderate-sized bilateral pleural effusion has increased with
worsening atelectasis in the left lower lobe. There may be
minimal interstitial edema. Large cardiac silhouette has grown.
Transvenous right atrial and right ventricular pacer leads are
in standard placements. There is no pneumothorax.


[**Last Name (NamePattern4) 4125**]ospital Course:
Mr. [**Known lastname 100479**] was admitted to the [**Hospital1 18**] on [**2128-9-12**] for elective
surgical management of his heart disease. He was worked-up in
the usual preoperative manner and found to be suitable for
surgery. On [**2128-9-13**], Mr. [**Known lastname 100479**] was taken to the operating room
where he underwent coronary artery bypass grafting to two
[**Last Name (LF) 56207**], [**First Name3 (LF) **] aortic valve replacement (27mm CE magna pericardial)
and a mitral valve replacement (31mm CE pericardial).
Postoperatively he was taken to the cardiac surgical intensive
care unit for monitoring. The electrophysiology service
interrogated his pacemaker postoperatively and lowered his rate
interval. They found his atrial lead to be poorly sensing with a
suboptimal sensing V lead however both were adequate at this
time. Dr. [**Last Name (STitle) 7047**], his EP/Cardiologist was notified of these
findings and the possibility of future lead changes. On
postoperative day one, Mr. [**Known lastname 100479**] [**Last Name (Titles) 5058**] neurologically intact
and was extubated. Amiodarone was resumed for atrial
fibrillation. Thyroid and cortisol studies were obtained which
revealed a normal thyroid and a mildly elevated cortisol of
23.9.  Mr. [**Known lastname 100479**] was slow to wean from pressors and thus stayed
in the intensive care unit for several days. Given his atrial
fibrillation, coumadin was started for anticoagulation. Natrecor
was started with good effect for volume overload. On
postoperative day thirteen, Mr. [**Known lastname 100479**] was transferred to the
cardiac surgical step down unit for further recovery.  The
physical therapy service was consulted to assist with his
postoperative strength and mobility. He was gently diuresed
towards his preoperative weight. An ace inhibitor was started
however his blood pressure would not tolerate it at this time.
An ace inhibitor should be started as an outpatient when his
blood pressure can tolerate. Mr. [**Known lastname 100479**] continued to make slow
but steady progress and was discharged to rehab on postoperative
day sixteen. He will follow-up with Dr. [**Last Name (Prefixes) **] and his
PCP/cardiologist Dr. [**Last Name (STitle) 7047**] as an outpatient. Dr. [**Last Name (STitle) 7047**] will
follow his coumadin dosing for atrial fibrillation upon
discharge from rehab. His target INR is 2.0-2.5.

Medications on Admission:
Plavix 75mg QD
Aspirin 81mg QD
Amiodarone 200mg QD
Lasix 40mg [**Hospital1 **]
Zocor 80mg QD
Zetia 10mg QD
Flonase
Fosamax

Discharge Medications:
1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 7
days: Take with lasix and stop when lasix stopped. Do not take
longer then 7 days unless instructed by physician.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg [**Hospital1 8426**], Delayed Release (E.C.) Sig: One (1)
[**Hospital1 8426**], Delayed Release (E.C.) PO DAILY (Daily).
4. Warfarin 1 mg [**Hospital1 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] DAILY (Daily):
Adjust for goal INR of 2.0-2.5 for AF. Likely dose is 2mg daily.

5. Hydromorphone 2 mg [**Last Name (Titles) 8426**] Sig: 1-2 Tablets PO Q3-4H (Every 3
to 4 Hours) as needed.
6. Levofloxacin 250 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO Q24H (every
24 hours).
7. Albuterol Sulfate 0.083 % Solution Sig: One (1) Neb
Inhalation Q6H (every 6 hours) as needed.
8. Pantoprazole 40 mg [**Last Name (Titles) 8426**], Delayed Release (E.C.) Sig: One
(1) [**Last Name (Titles) 8426**], Delayed Release (E.C.) PO Q24H (every 24 hours) for
1 months: Take for 1 month.
9. Amiodarone 200 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO DAILY
(Daily).
10. Zocor 80 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO at bedtime.
11. Ezetimibe 10 mg [**Last Name (Titles) 8426**] Sig: One (1) [**Last Name (Titles) 8426**] PO DAILY (Daily).

12. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
13. Lasix 40 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO twice a day for 7
days: Take until reach preop weight of 63.5 KG or not longer the
1 week unless instructed by physician.
14. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
15. Acetaminophen 325 mg [**Hospital1 8426**] Sig: Two (2) [**Hospital1 8426**] PO Q4H
(every 4 hours) as needed.
16. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Pacemaker insitu
AF
Hyperlipidemia
HTN
Failure to void


Discharge Condition:
Good


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
2) Report any fever greater then 100.5 or any weight gain
greater then 2 pounds in 24 hours.
3) Take coumadin daily as instructed. Monitor INR daily at rehab
and adjust coumadin dose for an INR between 2.0-2.5 for atrial
fibrillation. Dr. [**Last Name (STitle) 7047**] will follow your coumadin dosing after
discharge from rehab. Your daily dose will likely be 2mg for
atrial fibrillation with a goal INR of 2.0-2.5. Please note that
your dose may change based on your blood results and thus only
take your coumadin as directed by a physician. [**Name10 (NameIs) 357**] schedule
appointment for PT/INR blood draw with Dr. [**Last Name (STitle) 7047**] upon
discharge from rehab. ([**Telephone/Fax (1) 16005**].
4) Foley catheter in place for failure to void. Please attempt
voiding trial at rehab [**2128-10-1**]. Flomax started [**2128-9-29**].
Levofloxacin 250mg QD for prophylactic coverage.
5) Take lasix 40mg twice daily and potassium 20mEq twice daily
until reach preop weight of 63.5 KG or not longer then 1 week
unless instructed by a physician. [**Name10 (NameIs) **] electrolytes and
replete as needed while on lasix.
6) Monitor vital signs and oxygen saturations.
7) No lotions, creams or powders to wound until it has healed.
8) Patient may resume properative medications of flonase and
fosamax.
9) Please call with any questions or concerns.

[**Last Name (NamePattern4) 2138**]p Instructions:
Follow-up with Dr. [**Last Name (Prefixes) **]. ([**Telephone/Fax (1) 1504**]
Follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7047**] for coumadin dosing and in 2
weeks for routine postoperative follow-up. ([**Telephone/Fax (1) 16005**]
Follow-up with electrophysiologist in 2 weeks or per Dr.
[**Last Name (STitle) 7047**].
Please call all providers for appointments.



Completed by:[**2128-9-29**]
{'Mitral valve insufficiency and aortic valve stenosis,Atrial fibrillation,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery'}


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: Aortic Stenosis/Mitral Valve Regurgitation

PRESENT ILLNESS: This 84 year-old man with a known history of valvular heart
disease was recently investigated and was found to have a
critical aortic stenosis and severe mitral regurgitation. His
coronary angiogram showed significant disease in the left
anterior descending artery and the circumflex artery and a
nondominant right coronary artery. His ejection fraction was
45%. He is currently asymptomatic and is electively admitted for
surgical management.

MEDICAL HISTORY: CAD
AF
HTN
Pacemaker insitu
AS/MR
Degenerative joint disease
Asbestosis
Pneumonia in past
Bilateral total hip replacements

MEDICATION ON ADMISSION: Plavix 75mg QD
Aspirin 81mg QD
Amiodarone 200mg QD
Lasix 40mg [**Hospital1 **]
Zocor 80mg QD
Zetia 10mg QD
Flonase
Fosamax

ALLERGIES: Penicillins / Bactrim

PHYSICAL EXAM: GEN: WDWN in NAD
NEURO: A+Ox3
HEENT: Perrl, EOMI, OP benign.
NECK: supple, No JVD
LUNGS: Clear
HEART: RRR, normal S1-S2 with systolic murmur
ABDOMEN: Soft, NT/ND,NABS
EXT: 2+ LE edema, 1+ pulses.

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking or alcohol use. 

### Response:
{'Mitral valve insufficiency and aortic valve stenosis,Atrial fibrillation,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery'}
