CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 56 year old
female with a history of rheumatic heart disease and severe
mitral stenosis, who had been developing gradual increase in
congestive heart failure and was thus scheduled for a mitral
valve repair.  The patient had had chronic dyspnea on
exertion which had been progressively increasing; no lower
extremity edema.

MEDICAL HISTORY: 1.  Rheumatic heart disease with severe mitral stenosis and
mild aortic insufficiency.
2.  Cerebrovascular accident approximately one year ago with
expressive aphasia and right hand weakness after stopping
Coumadin.
3.  Increasing cholesterol.
4.  Asthma.
5.  Status post cesarean section times two.
6.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Mitral valve stenosis and aortic valve insufficiency,Rheumatic heart failure (congestive),Atrial fibrillation,Late effects of cerebrovascular disease, aphasia,Pure hypercholesterolemia,Asthma, unspecified type, unspecified,Unspecified essential hypertension
Mitral stenos/aort insuf,Rheumatic heart failure,Atrial fibrillation,Late eff CV dis-aphasia,Pure hypercholesterolem,Asthma NOS,Hypertension NOS
Admission Date:  [**2143-10-9**]       Discharge Date:  [**2143-10-27**]

Date of Birth:   [**2087-7-12**]       Sex:  F

Service:  CT [**Doctor First Name 147**]

HISTORY OF PRESENT ILLNESS:   The patient is a 56 year old
female with a history of rheumatic heart disease and severe
mitral stenosis, who had been developing gradual increase in
congestive heart failure and was thus scheduled for a mitral
valve repair.  The patient had had chronic dyspnea on
exertion which had been progressively increasing; no lower
extremity edema.

No fever, chills, chest pain, shortness of breath or
abdominal pain.  She had stable two pillow orthopnea.  No
rashes or urinary symptoms.

PAST MEDICAL HISTORY:
1.  Rheumatic heart disease with severe mitral stenosis and
mild aortic insufficiency.
2.  Cerebrovascular accident approximately one year ago with
expressive aphasia and right hand weakness after stopping
Coumadin.
3.  Increasing cholesterol.
4.  Asthma.
5.  Status post cesarean section times two.
6.  Hypertension.

MEDICATIONS:
1.  Coumadin 7 mg p.o. q. day.
2.  Penicillin VK 125 mg p.o. twice a day.
3.  Lipitor 10 mg tablet p.o. q. day.
4.  Folate 1 mg p.o. q. day.
5.  Calcium multivitamin one per day.
6.  Albuterol p.r.n.
7.  Cozaar 22.5, one tablet p.o. q. day.

PHYSICAL EXAMINATION:   On physical examination, she is in no
acute distress.  Temperature maximum 98.5 F.; 64; 109/73; 16;
99% on room air.  HEENT:  Pupils were equal, round and
reactive to light.  Extraocular movements intact.  Oropharynx
clear.  Pulmonary:  Lungs are clear to auscultation
bilaterally.  Cardiac showed a regular rate and rhythm, II/VI
holosystolic systolic murmur; II/VI diastolic murmur at the
apex positive left.  Abdomen soft, nontender, nondistended,
bowel sounds.  Extremities with no edema.  Two plus dorsalis
pedis pulses and five out of five strength bilaterally.

LABORATORY:  On admission showed a white count of 6,
hematocrit of 39.4, platelets 241.  Chem-7 142, 4.6, 102, 29,
18, 0.8 and 90.  Her INR was 3.3 and PTT of 38.7.

HOSPITAL COURSE:   The patient was admitted to the hospital
on [**2143-10-9**], for management of her anti-coagulation prior
to surgery as well as for an elective colonoscopy.  She was
on the Cardiology Service until the date of her surgery,
[**2143-10-16**].  On [**2143-10-16**], the patient underwent a mitral
valve repair with a 29 millimeter [**First Name8 (NamePattern2) 1495**] [**Male First Name (un) 923**] Mechanical
Valve.  After surgery, the patient was transferred to the
CSRU and was extubated on the evening of postoperative day
number zero.

On postoperative day number two, the patient was started on
anti-coagulation.  She was kept on a heparin drip and her
goal INR was 3.0 to 3.5.  The patient was diuresed with
Lasix.  The patient continued to work with Physical Therapy
throughout her postoperative course and was doing well with
them.  The Physical Therapist felt that a rehabilitation stay
would benefit the patient and the plan was made for her to go
the Life Care Center in Attenborough.

On postoperative day number nine, [**2143-10-25**], the patient's
INR was 2.4.  Plans were made for her discharge to
rehabilitation on [**2143-10-27**] when Life Care in Attenborough
had a bed.

CONDITION ON DISCHARGE:   Stable.

DISCHARGE STATUS:   To Rehabilitation.

DISCHARGE DIAGNOSES:
1.  Status post mitral valve replacement with a 29 millimeter
[**First Name8 (NamePattern2) 1495**] [**Male First Name (un) 923**] valve.

DISCHARGE MEDICATIONS:
1.  Lopressor 100 mg p.o. twice a day. Hold for systolic
blood pressure of less than 100, heart rate less than 55.
2.  Vicodin one to two tablets p.o. q. four to six hours
p.r.n.
3.  Lasix 20 mg p.o. twice a day.
4.  Lipitor 10 mg p.o. q. day.
5.  Colace 100 mg p.o. twice a day.
6.  Tylenol 650 mg p.o. q. four to six hours p.r.n.
7.  Milk of Magnesia 30 cc. p.o. q. h.s. p.r.n.
8.  Dulcolax 10 mg p.o. or p.r. p.r.n.
9.  Pantoprazole 40 mg p.o. q. day.
10. Coumadin with a goal INR of 3.0 to 3.5.

DISCHARGE INSTRUCTIONS:
1.  The patient was sent home on a cardiac heart healthy
diet.
2.  She was to follow-up with Dr. [**Last Name (STitle) **] in four weeks.


                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 6067**]
MEDQUIST36

D:  [**2143-10-25**]  16:24
T:  [**2143-10-25**]  16:41
JOB#:  [**Job Number 99513**]
{'Mitral valve stenosis and aortic valve insufficiency,Rheumatic heart failure (congestive),Atrial fibrillation,Late effects of cerebrovascular disease, aphasia,Pure hypercholesterolemia,Asthma, unspecified type, unspecified,Unspecified essential hypertension'}


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: 

PRESENT ILLNESS: The patient is a 56 year old
female with a history of rheumatic heart disease and severe
mitral stenosis, who had been developing gradual increase in
congestive heart failure and was thus scheduled for a mitral
valve repair.  The patient had had chronic dyspnea on
exertion which had been progressively increasing; no lower
extremity edema.

MEDICAL HISTORY: 1.  Rheumatic heart disease with severe mitral stenosis and
mild aortic insufficiency.
2.  Cerebrovascular accident approximately one year ago with
expressive aphasia and right hand weakness after stopping
Coumadin.
3.  Increasing cholesterol.
4.  Asthma.
5.  Status post cesarean section times two.
6.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Mitral valve stenosis and aortic valve insufficiency,Rheumatic heart failure (congestive),Atrial fibrillation,Late effects of cerebrovascular disease, aphasia,Pure hypercholesterolemia,Asthma, unspecified type, unspecified,Unspecified essential hypertension'}
