CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 88 year old
female with 4+ tricuspid regurgitation, atrial fibrillation,
recently admitted to [**Hospital6 256**]
from [**2-19**] through [**3-3**] for increased shortness
of breath, dyspnea on exertion.  The patient was not diuresed
at this time as by laboratory data she was dry, prerenal.
She diuresed 2 liters on her own.  The patient was discharged
to follow up with her primary care physician as her shortness
of breath improved, status post 2 liters diuresis.  The
patient states that over the last two to three days Lasix has
not been effective and notes decreased urine output during
the daytime and increased abdominal swelling and lower
extremity edema, increasing shortness of breath, decreased
energy times one week and is now reliant again on her walker.
The patient denies palpitations.  She denies chest pain.  She
denies dietary changes.  She denies urgency but has decreased
urine output.

MEDICAL HISTORY: Atrial fibrillation, 4+ tricuspid
regurgitation following polyps, status post fall and rotator
cuff injury, hypertension, urinary retention.

MEDICATION ON ADMISSION: 

ALLERGIES: Question of intolerance to ACE inhibitors.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Rheumatic heart failure (congestive),Diseases of tricuspid valve,Mitral valve insufficiency and aortic valve insufficiency,Urinary tract infection, site not specified,Atrial fibrillation,Peripheral vascular complications, not elsewhere classified,Aneurysm of artery of lower extremity,Unspecified hereditary and idiopathic peripheral neuropathy
Rheumatic heart failure,Tricuspid valve disease,Mitral/aortic val insuff,Urin tract infection NOS,Atrial fibrillation,Surg comp-peri vasc syst,Lower extremity aneurysm,Idio periph neurpthy NOS
Admission Date:  [**2173-3-25**]       Discharge Date:  [**2173-4-16**]


Service:

HISTORY OF PRESENT ILLNESS:  The patient is an 88 year old
female with 4+ tricuspid regurgitation, atrial fibrillation,
recently admitted to [**Hospital6 256**]
from [**2-19**] through [**3-3**] for increased shortness
of breath, dyspnea on exertion.  The patient was not diuresed
at this time as by laboratory data she was dry, prerenal.
She diuresed 2 liters on her own.  The patient was discharged
to follow up with her primary care physician as her shortness
of breath improved, status post 2 liters diuresis.  The
patient states that over the last two to three days Lasix has
not been effective and notes decreased urine output during
the daytime and increased abdominal swelling and lower
extremity edema, increasing shortness of breath, decreased
energy times one week and is now reliant again on her walker.
The patient denies palpitations.  She denies chest pain.  She
denies dietary changes.  She denies urgency but has decreased
urine output.

PAST MEDICAL HISTORY:  Atrial fibrillation, 4+ tricuspid
regurgitation following polyps, status post fall and rotator
cuff injury, hypertension, urinary retention.

HOME MEDICATIONS:  Lasix 40 b.i.d.; Coumadin 2 q.h.s.;
Lopressor 25 t.i.d.; Losartan 50 q. AM; Fosamax one tablet q.
Sunday; Synthroid 75 mcg q.d.; Magnesium oxide 400 q. AM.

ALLERGIES:  Question of intolerance to ACE inhibitors.

PHYSICAL EXAMINATION:  Temperature 95.2, blood pressure
132/66, heartrate 92, respiratory rate 20.  Oxygen saturation
90% on room air.  General, the patient is in no acute
distress, alert and oriented times three.  Short of breath
with standing.  She is talking.  Head, eyes, ears, nose and
throat, pupils equal, round and reactive to light,
extraocular movements intact, jugulovenous distension to
earlobe.  Heart, irregularly irregular, II/VI systolic
ejection murmur.  Loud S3.  Lungs, bibasilar crackles, left
greater than right.  Abdomen soft, distended, tympanitic,
hepatomegaly 3 cm below the costal margin.  Chest x-ray 2 to
3+ pitting edema bilaterally.

LABORATORY DATA:  The patient's sodium was 126, creatinine
1.6 from a baseline of 1.4.

HOSPITAL COURSE:  The patient was admitted to [**Hospital6 1760**] on [**2173-3-25**].  The
patient was initially admitted to Internal Medicine Service,
Dr. [**Last Name (STitle) 73**] where she was treated medically for her
condition.  She was given Lasix, Nitracor, sodium-restricted
diet.  She was continued on Lopressor and Coumadin.
Cardiology and Congestive Heart Failure Services were
consulted.  The patient initially experienced an improvement
in her congestive heart failure, diuresing fluid fairly
efficiently with her medication regimen.  She was loaded on
Amiodarone for her atrial fibrillation.  A new echocardiogram
was performed which indicated severe pulmonary hypertension.
She had mild aortic regurgitation and mitral regurgitation
and indicated severe tricuspid regurgitation.  It was then
decided to consult the Cardiothoracic Surgery Service for
possible surgical intervention.  Her Coumadin was at that
time stopped.  The patient had a urinary tract infection.
She was Ciprofloxacin 500 mg q.d. times seven days.  The
patient was sent for cardiac catheterization which showed
tricuspid regurgitation 4+ and right-sided heart failure.
The patient was seen by the Vascular Service over the course
of her stay after an ultrasound showed a small pseudoaneurysm
at the site of cardiac catheterization.  Vascular recommended
that the groin be closely watched in the Operating Room for
hematoma formation or expansion, otherwise not to intervene
surgically or fibrin injection.  The patient was transfused a
unit of red blood cells for an anemia.  The patient was
allowed to recover from her urinary tract infection
presurgical intervention and on [**2173-4-5**], the patient
was taken to the Operating Room where a tricuspid valve
replacement with a 29 mm mosaic was performed.  The patient
appeared to tolerate the procedure well and was transferred
to the Cardiac Intensive Care Unit for close monitoring
postoperatively.  Postoperatively she was visited by Vascular
who were pleased by the lack of evidence for expansion of her
right groin pseudoaneurysm.  The patient received Vancomycin
postoperatively.  When stable the patient was transferred to
the regular cardiac floor for continued monitoring and
continued pharmacologic diuresis.  She was closely followed
by the Cardiac Heart Failure Service.  A number of
pharmacological agents were used including Nitracor, Lasix
were used.  The patient was restarted on Coumadin.  She was
treated with beta blockers.  The patient was seen and treated
by physical therapy.  Over the last few days of the patient's
stay in the hospital she waited for therapeutic Coumadin
levels with appropriate INR levels for atrial fibrillation.
She also continued rigorous diuresis managed by the
Congestive Heart Failure Team and finally on [**2173-4-16**]
the patient seemed to be ready to be discharged to
rehabilitation both per Congestive Heart Failure Service and
the Cardiothoracic Surgery Service.  The patient is therefore
now being discharged to rehabilitation on [**2173-4-16**].

CONDITION ON DISCHARGE:  She is in good condition.

FOLLOW UP:  She is to follow up with Dr. [**Last Name (STitle) **] in four
weeks, her primary care physician in one to two weeks and the
cardiologist in two to three weeks, Congestive Heart Failure
Team.

MEDICATIONS ON DISCHARGE:  The Nitracor will be discontinued.
Her Lasix will be discontinued.  She will be started on
Bumex 1 mg p.o. b.i.d.  She will be restarted on Losartan 25
mg q.d.  She will also be sent home on 4 mg of Warfarin q.d.,
polysaccharide iron complex 150 mg p.o. b.i.d., Lopressor 50
mg p.o. b.i.d., Levothyroxine 75 mcg p.o. q.d., Percocet 1 to
2 tablets p.o. 4 prn pain, potassium chloride 20 mEq p.o. q.
12 to be held for a potassium greater than 5.  Ranitidine 950
mg p.o. b.i.d., Colace 100 mg p.o. b.i.d.

DISCHARGE INSTRUCTIONS:  The patient may shower although she
should not take baths.  The patient should observe a
heart-healthy diet.  She should not drive on pain
medications.


                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern4) 12487**]
MEDQUIST36

D:  [**2173-4-16**]  14:45
T:  [**2173-4-16**]  17:26
JOB#:  [**Job Number 23811**]


Admission Date:  [**2173-3-25**]       Discharge Date:  [**2173-4-19**]


Service:

                        ADDENDUM

HOSPITAL COURSE:  The patient was kept in-house over the
weekend at the request of her primary care physician.  [**Name10 (NameIs) **] was
found on Saturday morning that the patient had a creatinine
bump of 1.6.  For that reason, her Bumex was held.  On
Sunday, the patient had a bump in her INR to 2.3 on Monday to
2.7.  For that reason, her Coumadin was held Sunday night and
will be held Monday and Tuesday as well.  Her creatinine on
Sunday and Monday continued to fall to her baseline of 1.1.

The patient is now being discharged to her rehabilitation
facility.

DISCHARGE MEDICATIONS:  Changes in her medication include
Bumex 1 mg q.d., hold Coumadin for Monday and Tuesday and
reassess on Wednesday for INR goal of 1.5-2.0.




                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern4) 12487**]
MEDQUIST36

D:  [**2173-4-19**]  10:04
T:  [**2173-4-19**]  10:06
JOB#:  [**Job Number 23812**]
{'Rheumatic heart failure (congestive),Diseases of tricuspid valve,Mitral valve insufficiency and aortic valve insufficiency,Urinary tract infection, site not specified,Atrial fibrillation,Peripheral vascular complications, not elsewhere classified,Aneurysm of artery of lower extremity,Unspecified hereditary and idiopathic peripheral neuropathy'}


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 an 88 year old
female with 4+ tricuspid regurgitation, atrial fibrillation,
recently admitted to [**Hospital6 256**]
from [**2-19**] through [**3-3**] for increased shortness
of breath, dyspnea on exertion.  The patient was not diuresed
at this time as by laboratory data she was dry, prerenal.
She diuresed 2 liters on her own.  The patient was discharged
to follow up with her primary care physician as her shortness
of breath improved, status post 2 liters diuresis.  The
patient states that over the last two to three days Lasix has
not been effective and notes decreased urine output during
the daytime and increased abdominal swelling and lower
extremity edema, increasing shortness of breath, decreased
energy times one week and is now reliant again on her walker.
The patient denies palpitations.  She denies chest pain.  She
denies dietary changes.  She denies urgency but has decreased
urine output.

MEDICAL HISTORY: Atrial fibrillation, 4+ tricuspid
regurgitation following polyps, status post fall and rotator
cuff injury, hypertension, urinary retention.

MEDICATION ON ADMISSION: 

ALLERGIES: Question of intolerance to ACE inhibitors.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Rheumatic heart failure (congestive),Diseases of tricuspid valve,Mitral valve insufficiency and aortic valve insufficiency,Urinary tract infection, site not specified,Atrial fibrillation,Peripheral vascular complications, not elsewhere classified,Aneurysm of artery of lower extremity,Unspecified hereditary and idiopathic peripheral neuropathy'}
