CHIEF COMPLAINT: mild DOE/occasional palpitations

PRESENT ILLNESS: 68 yo M with hepatocellular ca diagnosed 6 months ago. Echo for
transplant workup showed AS, referred for AVR.

MEDICAL HISTORY: hepatitis C
hepatocellular cancer
severe aortic stenosis
celiac disease
prostate cancer
-treated with hormone therapy and radiation
R leg skin lesion
-biopsied at [**Hospital1 2177**] last week, results unknown

MEDICATION ON ADMISSION: Clotimazole 10''''', Trazodone 50'

ALLERGIES: Gluten

PHYSICAL EXAM: HR 76 BP 132/64
Anxious, NAD
Several echymotic areas on arms
Lungs CTAB
4/6 SEM t/o precordium radiating to carotids
Abdomen benign
Extrem warm, no edema

FAMILY HISTORY: nc

SOCIAL HISTORY: Lives alone, h/o tobacco (quit) and alcohol use (last alcohol 7
months ago), h/o drug use (quit)
Aortic valve disorders,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Malignant neoplasm of liver, primary,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol
Aortic valve disorder,Hemorrhage complic proc,Ac posthemorrhag anemia,Mal neo liver, primary,Chrnc hpt C wo hpat coma,Cirrhosis of liver NOS
Admission Date:  [**2149-6-12**]              Discharge Date:   [**2149-6-16**]

Date of Birth:  [**2080-5-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Gluten

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
mild DOE/occasional palpitations

Major Surgical or Invasive Procedure:
AVR (Magna pericardial tissue) [**6-12**]


History of Present Illness:
68 yo M with hepatocellular ca diagnosed 6 months ago. Echo for
transplant workup showed AS, referred for AVR.

Past Medical History:
hepatitis C
hepatocellular cancer
severe aortic stenosis
celiac disease
prostate cancer
-treated with hormone therapy and radiation
R leg skin lesion
-biopsied at [**Hospital1 2177**] last week, results unknown

Social History:
Lives alone, h/o tobacco (quit) and alcohol use (last alcohol 7
months ago), h/o drug use (quit)


Family History:
nc

Physical Exam:
HR 76 BP 132/64
Anxious, NAD
Several echymotic areas on arms
Lungs CTAB
4/6 SEM t/o precordium radiating to carotids
Abdomen benign
Extrem warm, no edema


Pertinent Results:
[**2149-6-15**] 04:20AM BLOOD WBC-7.0 RBC-2.59* Hgb-8.4* Hct-24.4*
MCV-94 MCH-32.5* MCHC-34.5 RDW-16.6* Plt Ct-123*
[**2149-6-14**] 04:00AM BLOOD WBC-9.2# RBC-2.80* Hgb-9.2* Hct-25.7*
MCV-92 MCH-32.8* MCHC-35.7* RDW-16.3* Plt Ct-106*
[**2149-6-13**] 04:56PM BLOOD Hct-27.9*
[**2149-6-14**] 04:00AM BLOOD PT-17.3* PTT-39.4* INR(PT)-1.6*
[**2149-6-13**] 03:23AM BLOOD PT-14.8* PTT-32.9 INR(PT)-1.3*
[**2149-6-16**] 04:24AM BLOOD Glucose-103 UreaN-17 Creat-0.6 Na-135
K-3.8 Cl-100 HCO3-30 AnGap-9

Radiology Report CHEST PORT. LINE PLACEMENT Study Date of
[**2149-6-14**] 7:11 AM


[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] CSRU [**2149-6-14**] SCHED
CHEST PORT. LINE PLACEMENT   Clip # [**Clip Number (Radiology) 33193**]
Reason: ? tlc placement change over wire, CT removal ? ptx



[**Hospital 93**] MEDICAL CONDITION:
   69 year old man with s/p avr
REASON FOR THIS EXAMINATION:
   ? tlc placement change over wire, CT removal ? ptx



Final Report
CHEST RADIOGRAPH

INDICATION: Followup.

COMPARISON: [**2149-6-12**].

FINDINGS: The right central venous access line has been
exchanged. The new
line
projects with its tip over the right atrium and could be
retracted by 2 to 3
cm. The nasogastric tube and the endotracheal tube have been
removed. There
is a decrease in lung volumes, with newly appeared bilateral
small pleural
effusions and moderate retrocardiac atelectasis seen together
with slightly
enlarged cardiac silhouette. Additional perihilar haziness
suggests moderate
overhydration. There are no focal parenchymal opacity suggestive
of
pneumonia.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 33194**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 33195**] (Complete)
Done [**2149-6-12**] at 10:02:32 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2080-5-6**]
Age (years): 69 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Aortic valve disease. Chest pain. Shortness of
breath.
ICD-9 Codes: 402.90, 786.05, 786.51, 440.0, 424.1
Test Information
Date/Time: [**2149-6-12**] at 10:02    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5209**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW3-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.3 cm  0.6 - 1.1 cm
Left Ventricle - Ejection Fraction:  50% to 60%  >= 55%
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  *5.0 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *94 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  58 mm Hg
Aortic Valve - Valve Area:  *1.1 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Mild LA enlargement. No thrombus in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA and extending into the RV. No ASD
by 2D or color Doppler.

LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size.
Overall normal LVEF (>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Simple
atheroma in aortic root. Mildly dilated ascending aorta. Simple
atheroma in ascending aorta. Normal aortic arch diameter. Simple
atheroma in aortic arch. Normal descending aorta diameter.
Simple atheroma in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Severely
thickened/deformed aortic valve leaflets. Moderate-severe AS
(area 0.8-1.0cm2). Mild to moderate ([**12-11**]+) AR. [Due to acoustic
shadowing, AR may be significantly UNDERestimated.]

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 leaflet.
No PS. Physiologic 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. The patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.
patient.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-CPB:1. The left atrium is mildly dilated. No thrombus is
seen in the left atrial appendage. No atrial septal defect is
seen by 2D or color Doppler.
2. There is mild symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
3. Right ventricular chamber size and free wall motion are
normal.
4. There are simple atheroma in the aortic root. The ascending
aorta is mildly dilated. There are simple atheroma in the
ascending aorta. There are simple atheroma in the aortic arch.
There are simple atheroma in the descending thoracic aorta.
5. There are three aortic valve leaflets. The aortic valve
leaflets are severely thickened/deformed. There is moderate to
severe aortic valve stenosis (area 0.8-1.0cm2). Mild to moderate
([**12-11**]+) aortic regurgitation is seen. [Due to acoustic shadowing,
the severity of aortic regurgitation may be significantly
UNDERestimated.]
6. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen.
Dr. [**Last Name (STitle) 33196**] was notified in person of the results.

POST-CPB: On infusion of phenylephrine. Well-seated
bioprosthetic valve in the aortic position. No paravulvular leak
seen. Initial [**Male First Name (un) **] improved with neo, esmolol and iv fluid
administration. Preserved biventricular function. Aortic contour
intact post decannulation


Brief Hospital Course:
He was taken to the operating room on [**2149-6-12**] where he
underwent an AVR. He was transferred to the ICU in stable
condition. He had significant bleeding post op and required
multiple blood products. He was extubated on POD #1. He was
transferred to the floor on POD #2. He did well postoperatively
and was ready for discharge to rehab on POD #4.


Medications on Admission:
Clotimazole 10''''', Trazodone 50'

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
6. Clotrimazole 10 mg Troche Sig: One (1) Troche Mucous membrane
QID (4 times a day).
7. Trazodone 50 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 10 days: then reassess need for diuresis.
9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours):
with lasix
.
10. Lactulose 10 gram/15 mL Solution Sig: Thirty (30) ML PO Q8H
(every 8 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] - [**Location (un) **]

Discharge Diagnosis:
AS s/p AVR
acute post op blood loss anemia
PMH: Hepatitis C cirrhosis, HCC, hx IV drugs, Basal cell Ca,
celiac disease, prostate Ca s/p seed implant, portan HTN, R knee
arthroscopy


Discharge Condition:
Stable.


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 incision.
No lifting more than 10 pounds for 10 weeks.
No driving until follow up with surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) **], [**First Name3 (LF) **] G. [**Telephone/Fax (1) 6951**]
Dr. [**Last Name (STitle) 914**] 4 weeks
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2149-7-16**]
2:20
Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2149-8-15**] 11:00
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2149-8-22**]
9:30



Completed by:[**2149-6-16**]
{'Aortic valve disorders,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Malignant neoplasm of liver, primary,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol'}


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: mild DOE/occasional palpitations

PRESENT ILLNESS: 68 yo M with hepatocellular ca diagnosed 6 months ago. Echo for
transplant workup showed AS, referred for AVR.

MEDICAL HISTORY: hepatitis C
hepatocellular cancer
severe aortic stenosis
celiac disease
prostate cancer
-treated with hormone therapy and radiation
R leg skin lesion
-biopsied at [**Hospital1 2177**] last week, results unknown

MEDICATION ON ADMISSION: Clotimazole 10''''', Trazodone 50'

ALLERGIES: Gluten

PHYSICAL EXAM: HR 76 BP 132/64
Anxious, NAD
Several echymotic areas on arms
Lungs CTAB
4/6 SEM t/o precordium radiating to carotids
Abdomen benign
Extrem warm, no edema

FAMILY HISTORY: nc

SOCIAL HISTORY: Lives alone, h/o tobacco (quit) and alcohol use (last alcohol 7
months ago), h/o drug use (quit) 

### Response:
{'Aortic valve disorders,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Malignant neoplasm of liver, primary,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol'}
