CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 59-year-old man,
who was recently treated for endocarditis by Dr. [**First Name (STitle) 24344**].  He
was referred to [**Hospital1 69**] for an
outpatient cardiac catheterization prior to have mitral valve
surgery.  He was in his usual state of health until [**Month (only) 359**]
of last year, when he was running and noticed chest
tightness.  He went to bed that night and had nightsweats
throughout the night.  He lost over 20 pounds over the next
two months and he diagnosed with hypothyroidism and anemia at
[**Hospital3 4527**] Hospital.  He was diagnosed with
endocarditis and an echocardiogram on [**2176-2-2**]
showed moderate-to-severe mitral valve prolapse, partial
mitral leaflet failure and severe mitral regurgitation, and a
small pericardial effusion.  He was discharged in early
[**Month (only) 404**] and had one month of IV Ceftriaxone at home.  Since
then he has been feeling better.  He denied any chest pain,
shortness of breath, lightheadedness, and his lower extremity
edema have all resolved.  He denied claudication and edema,
however, he had two plus pillow orthopnea.  Risk factors for
coronary artery disease included hypertension and heavy
cigarette history.

MEDICAL HISTORY: 1.  Rheumatic fever.
2.  Renal calculus.

MEDICATION ON ADMISSION: 

ALLERGIES: He had allergies to Ceftriaxone, which resulted
in extreme rash and no shellfish or dye allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Rheumatic mitral insufficiency,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Unspecified osteomyelitis, other specified sites,Hematoma complicating a procedure,Unspecified acquired hypothyroidism,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified disc disorder, lumbar region
Rheumatic mitral insuff,Crnry athrscl natve vssl,Secundum atrial sept def,Osteomyelit NOS-oth site,Hematoma complic proc,Hypothyroidism NOS,Anemia NOS,Hypertension NOS,Disc dis NEC/NOS-lumbar
Admission Date:  [**2176-3-13**]       Discharge Date:

Date of Birth:   [**2117-2-17**]       Sex:  M

Service:

HISTORY OF THE PRESENT ILLNESS:  This is a 59-year-old man,
who was recently treated for endocarditis by Dr. [**First Name (STitle) 24344**].  He
was referred to [**Hospital1 69**] for an
outpatient cardiac catheterization prior to have mitral valve
surgery.  He was in his usual state of health until [**Month (only) 359**]
of last year, when he was running and noticed chest
tightness.  He went to bed that night and had nightsweats
throughout the night.  He lost over 20 pounds over the next
two months and he diagnosed with hypothyroidism and anemia at
[**Hospital3 4527**] Hospital.  He was diagnosed with
endocarditis and an echocardiogram on [**2176-2-2**]
showed moderate-to-severe mitral valve prolapse, partial
mitral leaflet failure and severe mitral regurgitation, and a
small pericardial effusion.  He was discharged in early
[**Month (only) 404**] and had one month of IV Ceftriaxone at home.  Since
then he has been feeling better.  He denied any chest pain,
shortness of breath, lightheadedness, and his lower extremity
edema have all resolved.  He denied claudication and edema,
however, he had two plus pillow orthopnea.  Risk factors for
coronary artery disease included hypertension and heavy
cigarette history.

PAST MEDICAL HISTORY:
1.  Rheumatic fever.
2.  Renal calculus.

PAST SURGICAL HISTORY:  The patient has a past surgical
history for tonsillectomy and adenoidectomy.  He denied any
blood in his stools, black stool, stroke, TIA, cancer.

ALLERGIES:  He had allergies to Ceftriaxone, which resulted
in extreme rash and no shellfish or dye allergies.

MEDICATIONS AT HOME:
1.  Synthroid 50 mg a day.
2.  Ferrous sulfate 325 mg three times a day.

LABORATORY DATA:  Laboratory data on [**2176-3-9**] revealed CBC of
7.5, 29.9, 202, chemistry of 139, 4.4, 102, 29, 19 and 1.4.
The INR is 1.  He is divorced.  He denied any alcohol abuse.

Cardiac catheterization done on [**2176-3-13**] showed three-vessel
coronary artery disease with severe stenosis in the RCA, LAD,
and the OM.  He had 4+ MR.

The patient was admitted to the cardiothoracic surgery under
the care of Dr. [**Last Name (STitle) 70**].  The patient was taken to the
operating room on [**2176-3-14**], where he has CABG times three and
MVR #31 carbomedical mechanical valve.  He was joined by
Dr. [**Last Name (STitle) 70**] and [**Doctor Last Name **].  Dr. [**Last Name (STitle) 70**] was the attending of
record.

Postoperatively, the patient was transferred to the
cardiothoracic Intensive Care Unit, where he was doing well.
After three units of packed red blood cells, platelets were
transfused, he was transferred to the floor.  The patient had
a good blood pressure.  Vancomycin was infused to the patient
secondary to a mitral valve Gram stain from the operative
session, which showed gram-positive cocci.

The Department of Infectious Disease recommended blood
cultures and the continuation of the Vancomycin initially.
Mitral valve cultures showed nothing and grew out negative.
Blood cultures failed to show any growth.  Multiple blood
cultures, were sent off during the hospitalization.

The patient continued on Vancomycin until [**2176-3-21**], when he
was switched over to Penicillin.  In light of his known
allergy to Ceftriaxone, the patient was first evaluated by
the allergy specialist who felt that his allergy to
Ceftriaxone was not a real allergy and that he would tolerate
Penicillin.  With the consultation and expert advice, we gave
him a test dose of Penicillin, which was tolerated well
without incident.  The patient had a MRI of the back done on
[**2176-3-19**], which showed some osteal changes suggestive of
osteomyelitis on T10 and then L5 to S1, possible small
epidural collection around S1 to the right side.  The
Infectious Disease was aware of this and we did a CAT scan
the following day.  The abdomen failed to show any focal area
of collection or lesions, however, multiple cyst were noted
in the liver and spleen, which could not be ruled out as
being microabscesses.  However, the patient was afebrile and
vital signs were stable.  The patient had anticoagulation
started during this admission to reach an INR of about 3 to
3??????, since the patient had a mechanical valve.  The patient is
on Lovenox, which will be discontinued until the INR is
therapeutic.

On [**2176-3-11**] it was noted that the patient's left leg was
inflamed during the course of his admission.  With
antibiotics his leg showed some resolution and no signs of
acute infection, which warranted a new opening of the wound.
The ultrasound done the same day showed that there was no DVT
and the patient had bruising and pain about the leg, most
likely due to the slightly inflamed left incision, which at
no time showed any pus or extensive cellulitis.

During the course of this stay, the patient also had chest
tube and wires discontinued, which was tolerated well with no
pneumothorax.  The patient is ready for discharge to home for
a total of four weeks of antibiotics, Penicillin, after a
PICC line was placed on [**3-19**] with cephalic vein position
around the midclavicular area.

The patient is being discharged home likely within the next
two days.  The patient will followup with MRI in four weeks
with x-ray of the abdomen and spine.  The patient will also
have an appointment with the Department of Infectious Disease
in four weeks for followup with Dr. [**Last Name (STitle) **].  The patient will
also followup with the primary care physician,
[**Last Name (NamePattern4) **].  [**Last Name (STitle) 29111**] [**Name (STitle) 24344**], who will manage his INR
anticoagulation.

CONDITION ON DISCHARGE:  Afebrile, good health.  The patient
will go home with home VNA and infusion pump.

ADDENDUM:  The patient is inhouse on [**2176-3-22**].  We will be
continuing anticoagulation and Lovenox until INR of 3 to 3??????
is reach.  This morning his leg was noted to be swollen
moreso and the incision was opened revealing a hematoma,
which was debrided.  He was started on b.i.d. wet-to-dry
dressing normal saline dressing changes.

The Department of Neurosurgery has also been contact[**Name (NI) **].  The
Department of Neurosurgery commented that nothing needed to
be done right now, and the patient should be continued per
the Department of Infectious Disease recommendations for
Penicilin four to six weeks and that no surgical intervention
was warranted.  The Department of Infectious Disease agreed
and the patient stayed till discharge on [**2176-3-22**] with the
following medications:

DISCHARGE MEDICATIONS:
1.  Penicillin 3 million units IV every four hours.
2.  Coumadin titrated to an INR of 3 to 3??????.
3.  Lopressor 50 mg p.o. b.i.d.
4.  Lovenox 50 mg subcutaneously b.i.d. unitl the INR of 3 to
3?????? is reached.
5.  Xanax .25 mg p.o.q.6h.p.r.n.; the patient received
20 tablets.
6.  Synthroid 50 mcg p.o.q.d.
7.  Percocet one to two tablets p.o. p.r.n.pain of which the
patient will get 40.
8.  Colace 100 mg p.o.b.i.d.
9.  Zantac 150 mg p.o.b.i.d.
10. Lasix 20 mg p.o.b.i.d. times five days.
11. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mEq p.o.b.i.d. times five days.
12. Aspirin 325 mg p.o.q.d.

The patient will go home with VNA for wet-to-dry dressing
normal saline changes twice a day.  The patient will have a
CBC sent to Dr. [**Last Name (STitle) **] every week at [**Hospital1 190**].  Fax #:  [**Telephone/Fax (1) 1419**].  The patient will
followup in the Infectious Disease Clinic in fours, as well
as having MRI.  The patient's INR is to be sent to
Dr.  [**Last Name (STitle) 11302**] at telephone #:  [**Telephone/Fax (1) 29110**].

VNA will take care of the blood draws.  The patient will
followup with Dr. [**Last Name (STitle) 70**] in four to six weeks and the PCP
in three to four weeks.  He will have MRI of his abdomen and
spine in four weeks per Infectious Disease recommendations.
The patient will contact the Infectious Disease Department
regarding same.

ADDENDUM:  [**Known firstname **] [**Known lastname **] is to followup in one week and visit
the floor, where he will be evaluated with respect to his leg
wound in addition to other followup appointments.




                                     [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.

Dictated By:[**Name8 (MD) 16758**]
MEDQUIST36

D:  [**2176-3-21**]  21:05
T:  [**2176-3-22**]  09:15
JOB#:  [**Job Number 38210**]/[**Numeric Identifier 38211**]/[**Numeric Identifier 34928**]


Admission Date:  [**2176-3-13**]       Discharge Date:

Date of Birth:   [**2117-2-17**]       Sex:  M

Service:

HISTORY OF THE PRESENT ILLNESS:  This is a 59-year-old man,
who was recently treated for endocarditis by Dr. [**First Name (STitle) 24344**].  He
was referred to [**Hospital1 69**] for an
outpatient cardiac catheterization prior to have mitral valve
surgery.  He was in his usual state of health until [**Month (only) 359**]
of last year, when he was running and noticed chest
tightness.  He went to bed that night and had nightsweats
throughout the night.  He lost over 20 pounds over the next
two months and he diagnosed with hypothyroidism and anemia at
[**Hospital3 4527**] Hospital.  He was diagnosed with
endocarditis and an echocardiogram on [**2176-2-2**]
showed moderate-to-severe mitral valve prolapse, partial
mitral leaflet failure and severe mitral regurgitation, and a
small pericardial effusion.  He was discharged in early
[**Month (only) 404**] and had one month of IV Ceftriaxone at home.  Since
then he has been feeling better.  He denied any chest pain,
shortness of breath, lightheadedness, and his lower extremity
edema have all resolved.  He denied claudication and edema,
however, he had two plus pillow orthopnea.  Risk factors for
coronary artery disease included hypertension and heavy
cigarette history.

PAST MEDICAL HISTORY:
1.  Rheumatic fever.
2.  Renal calculus.

PAST SURGICAL HISTORY:  The patient has a past surgical
history for tonsillectomy and adenoidectomy.  He denied any
blood in his stools, black stool, stroke, TIA, cancer.

ALLERGIES:  He had allergies to Ceftriaxone, which resulted
in extreme rash and no shellfish or dye allergies.

MEDICATIONS AT HOME:
1.  Synthroid 50 mg a day.
2.  Ferrous sulfate 325 mg three times a day.

LABORATORY DATA:  Laboratory data on [**2176-3-9**] revealed CBC of
7.5, 29.9, 202, chemistry of 139, 4.4, 102, 29, 19 and 1.4.
The INR is 1.  He is divorced.  He denied any alcohol abuse.

Cardiac catheterization done on [**2176-3-13**] showed three-vessel
coronary artery disease with severe stenosis in the RCA, LAD,
and the OM.  He had 4+ MR.

The patient was admitted to the cardiothoracic surgery under
the care of Dr. [**Last Name (STitle) 70**].  The patient was taken to the
operating room on [**2176-3-14**], where he has CABG times three and
MVR #31 carbomedical mechanical valve.  He was joined by
Dr. [**Last Name (STitle) 70**] and [**Doctor Last Name **].  Dr. [**Last Name (STitle) 70**] was the attending of
record.

Postoperatively, the patient was transferred to the
cardiothoracic Intensive Care Unit, where he was doing well.
After three units of packed red blood cells, platelets were
transfused, he was transferred to the floor.  The patient had
a good blood pressure.  Vancomycin was infused to the patient
secondary to a mitral valve Gram stain from the operative
session, which showed gram-positive cocci.

The Department of Infectious Disease recommended blood
cultures and the continuation of the Vancomycin initially.
Mitral valve cultures showed nothing and grew out negative.
Blood cultures failed to show any growth.  Multiple blood
cultures, were sent off during the hospitalization.

The patient continued on Vancomycin until [**2176-3-21**], when he
was switched over to Penicillin.  In light of his known
allergy to Ceftriaxone, the patient was first evaluated by
the allergy specialist who felt that his allergy to
Ceftriaxone was not a real allergy and that he would tolerate
Penicillin.  With the consultation and expert advice, we gave
him a test dose of Penicillin, which was tolerated well
without incident.  The patient had a MRI of the back done on
[**2176-3-19**], which showed some osteal changes suggestive of
osteomyelitis on T10 and then L5 to S1, possible small
epidural collection around S1 to the right side.  The
Infectious Disease was aware of this and we did a CAT scan
the following day.  The abdomen failed to show any focal area
of collection or lesions, however, multiple cyst were noted
in the liver and spleen, which could not be ruled out as
being microabscesses.  However, the patient was afebrile and
vital signs were stable.  The patient had anticoagulation
started during this admission to reach an INR of about 3 to
3??????, since the patient had a mechanical valve.  The patient is
on Lovenox, which will be discontinued until the INR is
therapeutic.

On [**2176-3-11**] it was noted that the patient's left leg was
inflamed during the course of his admission.  With
antibiotics his leg showed some resolution and no signs of
acute infection, which warranted a new opening of the wound.
The ultrasound done the same day showed that there was no DVT
and the patient had bruising and pain about the leg, most
likely due to the slightly inflamed left incision, which at
no time showed any pus or extensive cellulitis.

During the course of this stay, the patient also had chest
tube and wires discontinued, which was tolerated well with no
pneumothorax.  The patient is ready for discharge to home for
a total of four weeks of antibiotics, Penicillin, after a
PICC line was placed on [**3-19**] with cephalic vein position
around the midclavicular area.

The patient is being discharged home likely within the next
two days.  The patient will followup with MRI in four weeks
with x-ray of the abdomen and spine.  The patient will also
have an appointment with the Department of Infectious Disease
in four weeks for followup with Dr. [**Last Name (STitle) **].  The patient will
also followup with the primary care physician,
[**Last Name (NamePattern4) **].  [**Last Name (STitle) 29111**] [**Name (STitle) 24344**], who will manage his INR
anticoagulation.

CONDITION ON DISCHARGE:  Afebrile, good health.  The patient
will go home with home VNA and infusion pump.



                            DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 02-358


Dictated By:[**Name8 (MD) 16758**]
MEDQUIST36

D:  [**2176-3-21**]  21:05
T:  [**2176-3-22**]  09:15
JOB#:  [**Job Number 38210**]


Admission Date:  [**2176-3-13**]       Discharge Date:  [**2176-3-26**]

Date of Birth:   [**2117-2-17**]       Sex:  M

Service:

ADDENDUM TO FINAL DISCHARGE SUMMARY

The patient is being discharged home with a vat dressing with
VNA and will not require Lovenox at home.  His INRs as of
this date is 3.7, the INR goal being 3.5.  His INR will once
again be followed by Dr. [**First Name (STitle) 24344**] his PCP.

DISCHARGE MEDICATIONS:
1.  Zantac 150 mg b.i.d.
2.  Lasix 20 mg b.i.d. with potassium for five days.
3.  Aspirin 325 mg p.o. q day.
4.  Penicillin 2 million units q 4 h for four to six
    weeks per ID.
5.  Xanax .25 mg p.o. b.i.d. p.r.n. Given 20.
6.  Synthroid 50 mcg q day.
7.  Percocet one to two tabs p.o. p.r.n. and q 4 to 6 h
8.  Colace 100 mg p.o. b.i.d.
9.  Vac care.

Coumadin is to be adjusted per PCP.

The patient upon discharge is in good condition and is
afebrile.  His wound looks not infected.






                         DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 02-358

Dictated By:[**Dictator Info **]
MEDQUIST36

D:  [**2176-3-25**]  21:06
T:  [**2176-3-25**]  21:43
JOB#:  [**Job Number 38212**]
{'Rheumatic mitral insufficiency,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Unspecified osteomyelitis, other specified sites,Hematoma complicating a procedure,Unspecified acquired hypothyroidism,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified disc disorder, lumbar region'}


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: This is a 59-year-old man,
who was recently treated for endocarditis by Dr. [**First Name (STitle) 24344**].  He
was referred to [**Hospital1 69**] for an
outpatient cardiac catheterization prior to have mitral valve
surgery.  He was in his usual state of health until [**Month (only) 359**]
of last year, when he was running and noticed chest
tightness.  He went to bed that night and had nightsweats
throughout the night.  He lost over 20 pounds over the next
two months and he diagnosed with hypothyroidism and anemia at
[**Hospital3 4527**] Hospital.  He was diagnosed with
endocarditis and an echocardiogram on [**2176-2-2**]
showed moderate-to-severe mitral valve prolapse, partial
mitral leaflet failure and severe mitral regurgitation, and a
small pericardial effusion.  He was discharged in early
[**Month (only) 404**] and had one month of IV Ceftriaxone at home.  Since
then he has been feeling better.  He denied any chest pain,
shortness of breath, lightheadedness, and his lower extremity
edema have all resolved.  He denied claudication and edema,
however, he had two plus pillow orthopnea.  Risk factors for
coronary artery disease included hypertension and heavy
cigarette history.

MEDICAL HISTORY: 1.  Rheumatic fever.
2.  Renal calculus.

MEDICATION ON ADMISSION: 

ALLERGIES: He had allergies to Ceftriaxone, which resulted
in extreme rash and no shellfish or dye allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Rheumatic mitral insufficiency,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Unspecified osteomyelitis, other specified sites,Hematoma complicating a procedure,Unspecified acquired hypothyroidism,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified disc disorder, lumbar region'}
