CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 65 year old woman with
atrial fibrillation who was on Coumadin, however, with an INR
of 1.2.  She was in her general state of good health the
night prior to admission at around 8 PM when she was last
found on the floor.  The patient speaks only Cantanese and
the history was acquired through an interpreter.  She has had
atrial fibrillation chronically but has not been compliant
with her medications in the past.  She also has a history of
rheumatic heart disease.

MEDICAL HISTORY: Atrial fibrillation, she was
cardioverted [**2135-12-27**].  She also has a history of
rheumatic heart disease.

MEDICATION ON ADMISSION: Coumadin, Lopressor and Amiodarone
PAST MEDICAL HISTORY:  Atrial fibrillation, she was
cardioverted [**2135-12-27**].  She also has a history of
rheumatic heart disease.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation
Crbl art ocl NOS w infrc,Atrial fibrillation
Admission Date:  [**2137-1-7**]       Discharge Date:  [**2137-1-12**]

Date of Birth:   [**2071-3-21**]       Sex:  F


HISTORY OF PRESENT ILLNESS:  This is a 65 year old woman with
atrial fibrillation who was on Coumadin, however, with an INR
of 1.2.  She was in her general state of good health the
night prior to admission at around 8 PM when she was last
found on the floor.  The patient speaks only Cantanese and
the history was acquired through an interpreter.  She has had
atrial fibrillation chronically but has not been compliant
with her medications in the past.  She also has a history of
rheumatic heart disease.

MEDICATIONS ON ADMISSION:  Coumadin, Lopressor and Amiodarone
PAST MEDICAL HISTORY:  Atrial fibrillation, she was
cardioverted [**2135-12-27**].  She also has a history of
rheumatic heart disease.

PHYSICAL EXAMINATION:  Blood pressure 121/76, heart rate 91,
oxygen 97, temperature afebrile, respiratory rate 26.  Her
chest showed bilateral rales with wheezing.  Cardiovascular,
regular rate and rhythm.  No murmur.  Abdomen soft,
nontender, nondistended.  Extremities, no cyanosis, clubbing
or edema.  Neurological, somnolent, able to tell the location
and name in Cantanese.  Naming, did not open eyes for naming.
Cards, repetitively mumbling.  Follows commands to touch,
right index finger to left ear with right and leg, and opened
her eyes briefly.  Cranial nerves, pupils are equal, round,
and reactive, 4 mm to 3 mm.  Fundi, unable to visualize
secondary to forced eye closing.  Extraocular motions,
conjugated deviation to the right, able to move eyes over
midline.  Left field does not respond to visual threat.
Cranial nerves VII, mild decrease in nasolabial fold, tongue
deviates to the left.  Motor, spastic tone in the left lower
extremity, left upper extremity was flaccid with extensive
tone on pain.  Left arm, no spontaneous movement, left lower
extremity, triple flexion, with spontaneous movements in the
right upper extremities and right lower extremities.  Lifts
right upper extremity on command finger-to-nose, no ataxia on
right heel-to-shin, not done.  Gait not examined.  Sensory,
extension on pain in the left upper extremity, triple flexion
on pain, withdrawing grimace on the right.

HOSPITAL COURSE:  The patient was seen in the Emergency
Department and TPA was initiated at 2 AM after informed consent
was obtained from the son.  [**Name (NI) **] was aware that there was a high
risk of bleed.  Her magnetic resonance imaging scan prior to the
TPA showed a right middle cerebral artery occlusion. Head
computerized tomography scan showed no ischemic sign but the
right middle cerebral artery was hyperdense.  The patient was
then admitted to the Intensive Care Unit and was followed there
for two days until she was transferred to the floor.  Cardiology
was consulted because it was found that she was actually in
atrial fibrillation with a low INR.  They recommended holding
Amiodarone until she was in normal sinus rhythm and started the
patient on heparin and restarting Coumadin in addition.  The
patient was stable and transferred out to the floor on [**2137-1-9**].

On transfer to the floor the patient had some decrease in oxygen
saturations and was given an Albuterol nebulizer with a
subsequent increase in her heart rate.  At that point in spite of
the Lopressor her heart rate continued in the 100s to 120s and
her pressure was in the low 100s.  The following day she was
started on Digoxin loaded with subsequent improvement in her
blood pressure to the 120s.  Thus, she was continued on Digoxin
0.125 p.o. q.d. as well as on Lopressor.  Carotid dopplers
are pending as of [**1-10**], but preliminary read was
negative.  No significant stenosis.  In addition she had a
cardiac echocardiogram done to evaluate her cardiac function
which showed on [**1-9**] of left atrium moderately dilated,
right atrium elongated, right ventricular systolic function
depressed, mitral leaflets moderately thickened.  Mitral
valve shows characteristic rheumatic deformity with huge
commissures and tethering of leaflet motion, moderate mitral
stenosis, moderate to severe tricuspid regurgitation and
deterioration of ventricular function, pulmonary artery
pressure was higher than the echocardiogram of [**2135-9-29**].  The ejection fraction on this echocardiogram was read
as 25-35% on this echocardiogram.  The patient was kept on
her heparin drip and was therapeutic throughout and started
on Coumadin.  She improved with regard to her mental status
and was able to eat a soft mechanical diet.

For cardiac status Captopril was started as well for
afterload reduction.  On [**2137-1-11**] she had full
strength on the right side, deltoid, biceps, triceps and
iliopsoas and her left side remained flaccid.

Magnetic resonance imaging scan showed a right ICA occlusion
with basal ganglia infarct, likely cardioembolic secondary to her
atrial fibrillation.

DISCHARGE DIAGNOSIS:
1.  Right basal ganglia infarct with right ICA occlusion
2.  Atrial fibrillation

DISCHARGE MEDICATIONS:
1.  Captopril 6.25 p.o. t.i.d.
2.  Lopressor 12.5 mg b.i.d.
3.  Heparin drip at 600/hr
4.  Digoxin .125 mg p.o. q.d.
5.  Aspirin as per Cardiology
6.  Zantac 150 mg p.o. b.i.d.

DISCHARGE STATUS:  Discharged to rehabilitation.




                            [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 396**] [**Name8 (MD) **], M.D.  [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern1) 8853**]
MEDQUIST36

D:  [**2137-1-11**]  16:42
T:  [**2137-1-11**]  19:06
JOB#:  [**Job Number 27626**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation'}


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 65 year old woman with
atrial fibrillation who was on Coumadin, however, with an INR
of 1.2.  She was in her general state of good health the
night prior to admission at around 8 PM when she was last
found on the floor.  The patient speaks only Cantanese and
the history was acquired through an interpreter.  She has had
atrial fibrillation chronically but has not been compliant
with her medications in the past.  She also has a history of
rheumatic heart disease.

MEDICAL HISTORY: Atrial fibrillation, she was
cardioverted [**2135-12-27**].  She also has a history of
rheumatic heart disease.

MEDICATION ON ADMISSION: Coumadin, Lopressor and Amiodarone
PAST MEDICAL HISTORY:  Atrial fibrillation, she was
cardioverted [**2135-12-27**].  She also has a history of
rheumatic heart disease.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation'}
