CHIEF COMPLAINT: worsening shortness of breath

PRESENT ILLNESS: Patient is an 83yo caucasian male with known AS, CAD - s/p
CABGx4([**2084**]), PVD, and significant pulmonary disease
(restrictive
and obstructive, asbestosis) on home oxygen. He presents with
c/o
worsening shortness of breath. He reports prior activity of
walking to the senior center twice a week, now is visibly pale
and unsteady after observed walking 50 feet. Admits to
lightheadedness, denies chest pain. He was evaluated at [**Hospital1 2025**] and
was deemed to be prohibitively high risk for surgical AVR, and
not a candidate for TAVI there due to significant peripheral
vascular disease. He is referred here for evaluation for
treatment options for his symptomatic severe AS.

MEDICAL HISTORY: Aortic Stenosis
s/p CoreValve Aortic Valve Replacement
PMH:
CABG x 4 ([**Hospital3 **] - early [**2081**]'s)
Severe aortic stenosis
Pulmonary hypertension
Restrictive and Obstructive Lung disease (home O2)
Pulmonary asbestosis
Extensive pleural plaques
right cerebellar infarct
peripheral vascular disease
hypertension
dyslipidemia
left nephrectomy secondary to renal carcinoma
gastritis
herpes zoster
depression
right carotid endartectomy ([**2091**])
cholecystectomy ([**2090**])

MEDICATION ON ADMISSION: Atenolol 50mcg daily
Aspirin 81mg daily
Aggrenox 200/25 mg daily
Imdur 30mg dialy
Lasix 40mg daily
Zocor 40mg daily
Advair 250/25mg one puff twice daily
Celexa 20mg daily
Flonase 50mctg to each nostril daily
Prilosec 20mg daily
Trazodone 50mg before bedtime
Vitamin B12 1000mcg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 57
B/P: 118/57
Resp:20
O2 Sat: 93 (O2 - 2L nc)
Temp: 98.3
Height:  Weight:
General: Alert pleasant elderly male with oxygen in use
Skin: color pale, skin warm and dry
HEENT: normocephalic, anicteric, EOMI's. Oropharynx moist. Nasal
prongs in place, no decubiti.
Neck: Supple, trachea midline, bilateral bruits vs. murmer,
carotid upstroke.
Chest: Well healed sternal incision, mild kyphosis
Heart: murmer throughout
Abdomen: soft, nontender, nondistended, (+) BS
Extremities: 2+ lower extremity edema.
Neuro: Alert and oriented. Gross FROM. Unsteady gait.
Pulses: palpable peripheral pulses

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Usually stays with his girlfriend. [**Name (NI) **] has three
children (daughter, 2 sons). [**Name2 (NI) **] is a retired shoe repairman
where
he worked in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 20181**] environment with glues and solvents. He
also
had some asbestos exposure when working in a shipyard for a
year.
He never smoked. He rarely drinks alcohol.
Aortic valve disorders,Acidosis,Unspecified transient mental disorder in conditions classified elsewhere,Primary pulmonary hypertension,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Peripheral vascular disease, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of kidney,Asbestosis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other dependence on machines, supplemental oxygen
Aortic valve disorder,Acidosis,Transient mental dis NOS,Prim pulm hypertension,Chr airway obstruct NEC,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Periph vascular dis NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx of kidney malignancy,Asbestosis,Hx TIA/stroke w/o resid,Depend-supplement oxygen
Admission Date:  [**2103-9-24**]              Discharge Date:   [**2103-10-4**]

Date of Birth:  [**2019-8-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
worsening shortness of breath


Major Surgical or Invasive Procedure:
[**2103-9-25**]
1. Right mini thoracotomy.
2. Transaortic placement of a 29-mm core valve aortic valve
    bioprosthesis.  The valve data is the following:  Model
    number MCS-P3-943, serial number [**Serial Number 90597**].
3. Thoracic aortography.
4. Balloon aortic valvuloplasty.
5. Right and left heart catheterization.


History of Present Illness:
Patient is an 83yo caucasian male with known AS, CAD - s/p
CABGx4([**2084**]), PVD, and significant pulmonary disease
(restrictive
and obstructive, asbestosis) on home oxygen. He presents with
c/o
worsening shortness of breath. He reports prior activity of
walking to the senior center twice a week, now is visibly pale
and unsteady after observed walking 50 feet. Admits to
lightheadedness, denies chest pain. He was evaluated at [**Hospital1 2025**] and
was deemed to be prohibitively high risk for surgical AVR, and
not a candidate for TAVI there due to significant peripheral
vascular disease. He is referred here for evaluation for
treatment options for his symptomatic severe AS.

NYHA Class: III/IV


Past Medical History:
Aortic Stenosis
s/p CoreValve Aortic Valve Replacement
PMH:
CABG x 4 ([**Hospital3 **] - early [**2081**]'s)
Severe aortic stenosis
Pulmonary hypertension
Restrictive and Obstructive Lung disease (home O2)
Pulmonary asbestosis
Extensive pleural plaques
right cerebellar infarct
peripheral vascular disease
hypertension
dyslipidemia
left nephrectomy secondary to renal carcinoma
gastritis
herpes zoster
depression
right carotid endartectomy ([**2091**])
cholecystectomy ([**2090**])


Social History:
Usually stays with his girlfriend. [**Name (NI) **] has three
children (daughter, 2 sons). [**Name2 (NI) **] is a retired shoe repairman
where
he worked in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 20181**] environment with glues and solvents. He
also
had some asbestos exposure when working in a shipyard for a
year.
He never smoked. He rarely drinks alcohol.

Average Daily Living:
Live independently            Yes [x]   No [ ]
Bathing                [x] Independent  [ ] Dependent
Dressing               [x] Independent  [ ] Dependent
Toileting              [x] Independent  [ ] Dependent
Transferring           [x] Independent  [ ] Dependent
Continence             [x] Independent  [ ] Dependent
Feeding                [x] Independent  [ ] Dependent


Family History:
non-contributory

Physical Exam:
Pulse: 57
B/P: 118/57
Resp:20
O2 Sat: 93 (O2 - 2L nc)
Temp: 98.3
Height:  Weight:
General: Alert pleasant elderly male with oxygen in use
Skin: color pale, skin warm and dry
HEENT: normocephalic, anicteric, EOMI's. Oropharynx moist. Nasal
prongs in place, no decubiti.
Neck: Supple, trachea midline, bilateral bruits vs. murmer,
carotid upstroke.
Chest: Well healed sternal incision, mild kyphosis
Heart: murmer throughout
Abdomen: soft, nontender, nondistended, (+) BS
Extremities: 2+ lower extremity edema.
Neuro: Alert and oriented. Gross FROM. Unsteady gait.
Pulses: palpable peripheral pulses


Pertinent Results:
[**2103-10-4**] 08:40AM BLOOD WBC-10.6 RBC-4.40* Hgb-13.5* Hct-41.2
MCV-94 MCH-30.7 MCHC-32.7 RDW-14.0 Plt Ct-313
[**2103-10-3**] 03:32AM BLOOD WBC-9.1 RBC-3.87* Hgb-12.1* Hct-36.3*
MCV-94 MCH-31.2 MCHC-33.4 RDW-14.1 Plt Ct-252
[**2103-10-1**] 01:39AM BLOOD PT-12.7 PTT-25.0 INR(PT)-1.1
[**2103-10-4**] 08:40AM BLOOD UreaN-32* Creat-1.5* Na-138 K-4.3 Cl-98
[**2103-10-3**] 03:32AM BLOOD Glucose-102* UreaN-29* Creat-1.4* Na-138
K-4.1 Cl-98 HCO3-31 AnGap-13
[**2103-10-2**] 05:25AM BLOOD UreaN-24* Creat-1.2 Na-137 K-4.0 Cl-98
HCO3-33* AnGap-10

[**2103-10-2**], Intra-op Echo
Conclusions
The left atrium is markedly dilated. There is mild symmetric
left ventricular hypertrophy. The left ventricular cavity size
is normal. Due to suboptimal technical quality, a focal wall
motion abnormality cannot be fully excluded. Overall left
ventricular systolic function is normal (LVEF>55%). Tissue
Doppler imaging suggests an increased left ventricular filling
pressure (PCWP>18mmHg). Right ventricular chamber size and free
wall motion are normal. An aortic CoreValve prosthesis is
present. The transaortic gradient is normal for this prosthesis.
Trace/mild paravalvular aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. [Due to acoustic shadowing, the severity
of mitral regurgitation may be significantly UNDERestimated.]
The tricuspid valve leaflets are mildly thickened. There is
moderate pulmonary artery systolic hypertension. There is no
pericardial effusion.

Compared with the prior study (images reviewed) of [**2103-9-27**],
trace/mild paravalvular aortic regurgitation is now visualized
but prior study is suboptimal for comparison.


Brief Hospital Course:
The patient was brought to the Operating Room on [**2103-9-25**] where
the patient underwent Transcatheter Aortic Valve Implantation
with Dr. [**Last Name (STitle) 914**] in conjunction with cardiology.  Overall the
patient tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring.  He developed acidosis with rising lactate
immediately post-operatively.  He was given fluid boluses and
hemodynamics remained stable on low dose phenylephrine.  He was
chemically paralyzed and ventilation improved.  Echo showed good
LV function with no pericardial effusion and no evidence of
aortic valve malfunction.  Transplant surgery was consulted for
rising lactate.  Suspicion was low for mesenteric ischemia and
labs were followed.  KUB did not reveal any free air.  Lactate
trended down.  Vasopressor support was weaned.  The patient was
weaned from the ventilator and extubated on POD 4.  He did
exhibit some post-op delerium.  Geriatrics was consulted and
recommended improved sleep/wake cycles.  Mental status returned
to baseline and the patient as oriented and appropriate prior to
discharge.  Beta blocker was initiated and the patient was
gently diuresed toward the preoperative weight.  The patient was
transferred to the telemetry floor for further recovery.  Chest
tubes and pacing wires were discontinued without complication.
The patient was evaluated by the physical therapy service for
assistance with strength and mobility.

By the time of discharge on POD# 9 the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.  The patient was discharged to [**Hospital 4470**] Health Care
Center Rehab in good condition with appropriate follow up
instructions.

Medications on Admission:
Atenolol 50mcg daily
Aspirin 81mg daily
Aggrenox 200/25 mg daily
Imdur 30mg dialy
Lasix 40mg daily
Zocor 40mg daily
Advair 250/25mg one puff twice daily
Celexa 20mg daily
Flonase 50mctg to each nostril daily
Prilosec 20mg daily
Trazodone 50mg before bedtime
Vitamin B12 1000mcg daily

Discharge Medications:
1. metoprolol tartrate 50 mg Tablet [**Hospital **]: One (1) Tablet PO TID
(3 times a day).
2. citalopram 20 mg Tablet [**Hospital **]: One (1) Tablet PO DAILY (Daily).

3. trazodone 75 mg Tablet [**Hospital **]: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
4. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital **]: One (1)  Inhalation Q6H (every 6 hours).
5. ipratropium bromide 0.02 % Solution [**Hospital **]: One (1)  Inhalation
Q6H (every 6 hours).
6. clopidogrel 75 mg Tablet [**Hospital **]: One (1) Tablet PO DAILY
(Daily).
7. heparin (porcine) 5,000 unit/mL Solution [**Hospital **]: One (1)
Injection TID (3 times a day).
8. simvastatin 40 mg Tablet [**Hospital **]: One (1) Tablet PO DAILY
(Daily).
9. cyanocobalamin (vitamin B-12) 100 mcg Tablet [**Hospital **]: One (1)
Tablet PO DAILY (Daily).
10. fluticasone 110 mcg/Actuation Aerosol [**Hospital **]: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
11. aspirin 81 mg Tablet, Delayed Release (E.C.) [**Hospital1 **]: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
12. magnesium hydroxide 400 mg/5 mL Suspension [**Hospital1 **]: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
13. docusate sodium 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID
(2 times a day).
14. acetaminophen 325 mg Tablet [**Hospital1 **]: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain.
15. bisacodyl 10 mg Suppository [**Hospital1 **]: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
16. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
17. lisinopril 5 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO DAILY (Daily).

18. hydralazine 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q6H (every 6
hours).
19. furosemide 80 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times
a day) for 1 weeks: please re-evaluate need for ongoing diuresis
following 1 week course.
20. potassium chloride 10 mEq Tablet Extended Release [**Last Name (STitle) **]: Two
(2) Tablet Extended Release PO Q12H (every 12 hours) for 1
weeks.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 4470**] HealthCare Center at [**Location (un) 38**]

Discharge Diagnosis:
Aortic Stenosis
s/p CoreValve Aortic Valve Replacement
PMH:
CABG x 4 ([**Hospital3 **] - early [**2081**]'s)
Severe aortic stenosis
Pulmonary hypertension
Restrictive and Obstructive Lung disease (home O2)
Pulmonary asbestosis
Extensive pleural plaques
right cerebellar infarct
peripheral vascular disease
hypertension
dyslipidemia
left nephrectomy secondary to renal carcinoma
gastritis
herpes zoster
depression
right carotid endartectomy ([**2091**])
cholecystectomy ([**2090**])

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, deconditioned
Sternal pain managed with oral analgesics
Thoracotomy Incision - healing well, no erythema or drainage
Edema: 1+


Discharge Instructions:
**See attached TAVI discharge instructions**

Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 2 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2103-11-5**] 1:00
Provider: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2103-11-16**] 9:20
Provider: [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2103-10-29**]
9:00

Please schedule follow-up with your primary care physician [**Last Name (NamePattern4) **]
[**3-6**] weeks:
[**Last Name (LF) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 17503**]



Completed by:[**2103-10-4**]
{'Aortic valve disorders,Acidosis,Unspecified transient mental disorder in conditions classified elsewhere,Primary pulmonary hypertension,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Peripheral vascular disease, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of kidney,Asbestosis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other dependence on machines, supplemental oxygen'}


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: worsening shortness of breath

PRESENT ILLNESS: Patient is an 83yo caucasian male with known AS, CAD - s/p
CABGx4([**2084**]), PVD, and significant pulmonary disease
(restrictive
and obstructive, asbestosis) on home oxygen. He presents with
c/o
worsening shortness of breath. He reports prior activity of
walking to the senior center twice a week, now is visibly pale
and unsteady after observed walking 50 feet. Admits to
lightheadedness, denies chest pain. He was evaluated at [**Hospital1 2025**] and
was deemed to be prohibitively high risk for surgical AVR, and
not a candidate for TAVI there due to significant peripheral
vascular disease. He is referred here for evaluation for
treatment options for his symptomatic severe AS.

MEDICAL HISTORY: Aortic Stenosis
s/p CoreValve Aortic Valve Replacement
PMH:
CABG x 4 ([**Hospital3 **] - early [**2081**]'s)
Severe aortic stenosis
Pulmonary hypertension
Restrictive and Obstructive Lung disease (home O2)
Pulmonary asbestosis
Extensive pleural plaques
right cerebellar infarct
peripheral vascular disease
hypertension
dyslipidemia
left nephrectomy secondary to renal carcinoma
gastritis
herpes zoster
depression
right carotid endartectomy ([**2091**])
cholecystectomy ([**2090**])

MEDICATION ON ADMISSION: Atenolol 50mcg daily
Aspirin 81mg daily
Aggrenox 200/25 mg daily
Imdur 30mg dialy
Lasix 40mg daily
Zocor 40mg daily
Advair 250/25mg one puff twice daily
Celexa 20mg daily
Flonase 50mctg to each nostril daily
Prilosec 20mg daily
Trazodone 50mg before bedtime
Vitamin B12 1000mcg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 57
B/P: 118/57
Resp:20
O2 Sat: 93 (O2 - 2L nc)
Temp: 98.3
Height:  Weight:
General: Alert pleasant elderly male with oxygen in use
Skin: color pale, skin warm and dry
HEENT: normocephalic, anicteric, EOMI's. Oropharynx moist. Nasal
prongs in place, no decubiti.
Neck: Supple, trachea midline, bilateral bruits vs. murmer,
carotid upstroke.
Chest: Well healed sternal incision, mild kyphosis
Heart: murmer throughout
Abdomen: soft, nontender, nondistended, (+) BS
Extremities: 2+ lower extremity edema.
Neuro: Alert and oriented. Gross FROM. Unsteady gait.
Pulses: palpable peripheral pulses

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Usually stays with his girlfriend. [**Name (NI) **] has three
children (daughter, 2 sons). [**Name2 (NI) **] is a retired shoe repairman
where
he worked in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 20181**] environment with glues and solvents. He
also
had some asbestos exposure when working in a shipyard for a
year.
He never smoked. He rarely drinks alcohol. 

### Response:
{'Aortic valve disorders,Acidosis,Unspecified transient mental disorder in conditions classified elsewhere,Primary pulmonary hypertension,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Peripheral vascular disease, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of kidney,Asbestosis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other dependence on machines, supplemental oxygen'}
