CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 64-year-old
female with a history of hypertension, atrial fibrillation,
who was admitted on Amiodarone and Coumadin, question of
chronic obstructive pulmonary disease, anemia and tachycardia
and cardiomyopathy, who presented with a two-week history of
increasing dyspnea on exertion and shortness of breath.

MEDICAL HISTORY: Paroxysmal atrial fibrillation.
Hypertension.  Anemia.  Cardiomyopathy.  Status post left
total knee replacement with postoperative MRSA infection.
Depression.  Status post appendectomy.  Status post cesarean
section.  Status post lumbar laminectomy.  Status post
carcinoma of the vulva.  Acute renal failure following
Vancomycin administration.

MEDICATION ON ADMISSION: Amiodarone 200 mg p.o. q.d.,
Celebrex, Paxil 20 mg p.o. q.d., Lopressor 25 mg p.o. b.i.d.,
Hydrochlorothiazide 50 mg p.o. q.d., Losartan 50 mg p.o.
q.d., Coumadin as needed to keep INR 2.0-2.5.

ALLERGIES: ACE INHIBITORS WHICH GIVE HER A COUGH AND RASH.
CALCIUM CHANNEL BLOCKERS GIVE HER EDEMA.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives with her son and works as a case
manager at [**First Name4 (NamePattern1) 9464**] [**Last Name (NamePattern1) **].  She is currently a nonsmoker,
although she does have a 30 pack-year history.  She drinks
alcohol socially.
Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Cardiac complications, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Intermediate coronary syndrome,Atrial fibrillation,Unspecified essential hypertension
Crnry athrscl natve vssl,Prim cardiomyopathy NEC,Surg compl-heart,Chr airway obstruct NEC,Mitral valve disorder,Intermed coronary synd,Atrial fibrillation,Hypertension NOS
Admission Date:  [**2122-1-19**]       Discharge Date:  [**2094-3-29**]

Date of Birth:   [**2057-1-22**]       Sex:  F

Service:

CONTINUATION OF HOSPITAL COURSE:  The patient on
postoperative day number 13 had an INR of 2.3 and was doing
well by physical therapy standpoint and it was felt she was
ready to be discharged to home with visiting nurse services.

DISCHARGE PHYSICAL EXAMINATION:  Her lungs were clear to
auscultation bilaterally.  Heart regular rate and rhythm.
Vital signs stable.  Her abdomen had positive bowel sounds,
soft, nontender, nondistended.  Her extremities show 1+
pitting edema and her incisions are clean, dry and intact.

DISCHARGE LABORATORIES:  White blood cell count 10.3,
hematocrit 34.2%, platelets 334,000, sodium 138, potassium
4.2, chloride 99, CO2 30, BUN 22, creatinine 1.1, glucose 94.
PT 18.8, INR 2.3, PTT of 36.  Discharge chest x-ray showed no
acute infiltrate and small bilateral effusions.

DISCHARGE STATUS:  She will be discharged to home in good
condition with visiting nurse services.

DISCHARGE MEDICATIONS:
1.  Protonix 40 mg po q.d.
2.  Aspirin 81 mg po q.d.
3.  Paxil 20 mg po q.d.
4.  Lasix 40 mg po b.i.d. for seven days.
5.  Potassium chloride 40 milliequivalents po b.i.d. for
seven days.
6.  Vicodin one to two tabs po q 4 to 6 hours prn pain.
7.  Lopressor 75 mg po t.i.d.
8.  Amiodarone 200 mg po b.i.d.
9.  Coumadin as directed to maintain an INR of 2 to 2.5.

FOLLOW UP:  She should follow up with Dr. [**Last Name (STitle) **] in one to
two weeks, Dr. [**Last Name (STitle) **] on [**2-18**] and with Dr. [**Last Name (STitle) 70**]
in six weeks.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1211**], M.D.  [**MD Number(1) 1212**]

Dictated By:[**Last Name (NamePattern1) 100688**]
MEDQUIST36

D:  [**2122-2-3**]  01:34
T:  [**2122-2-3**]  13:43
JOB#:  [**Job Number 100689**]


Admission Date:  [**2122-1-19**]       Discharge Date:  [**2122-2-3**]

Date of Birth:                    Sex:  F

Service:  CARDIOTHORACIC SURGERY

HISTORY OF PRESENT ILLNESS:  The patient is a 64-year-old
female with a history of hypertension, atrial fibrillation,
who was admitted on Amiodarone and Coumadin, question of
chronic obstructive pulmonary disease, anemia and tachycardia
and cardiomyopathy, who presented with a two-week history of
increasing dyspnea on exertion and shortness of breath.

She also reported crescendo angina over the last several days
prior to admission.  She had rest pain on the day prior to
and the day of admission.

PAST MEDICAL HISTORY:  Paroxysmal atrial fibrillation.
Hypertension.  Anemia.  Cardiomyopathy.  Status post left
total knee replacement with postoperative MRSA infection.
Depression.  Status post appendectomy.  Status post cesarean
section.  Status post lumbar laminectomy.  Status post
carcinoma of the vulva.  Acute renal failure following
Vancomycin administration.

SOCIAL HISTORY:  She lives with her son and works as a case
manager at [**First Name4 (NamePattern1) 9464**] [**Last Name (NamePattern1) **].  She is currently a nonsmoker,
although she does have a 30 pack-year history.  She drinks
alcohol socially.

ALLERGIES:  ACE INHIBITORS WHICH GIVE HER A COUGH AND RASH.
CALCIUM CHANNEL BLOCKERS GIVE HER EDEMA.

MEDICATIONS ON ADMISSION:  Amiodarone 200 mg p.o. q.d.,
Celebrex, Paxil 20 mg p.o. q.d., Lopressor 25 mg p.o. b.i.d.,
Hydrochlorothiazide 50 mg p.o. q.d., Losartan 50 mg p.o.
q.d., Coumadin as needed to keep INR 2.0-2.5.

REVIEW OF SYSTEMS:  Noncontributory.

PHYSICAL EXAMINATION:  General:  The patient was a pleasant
female in no apparent distress.  She was pain free at the
time of discharge.  Vital signs:  Stable with a heart rate of
55, blood pressure 138/61, respirations 18, oxygen saturation
96% on room air.  HEENT:  Pupils equal, round and reactive to
light.  Extraocular movements intact.  Anicteric.  Neck:
Supple.  No carotid bruits.  Heart:  Regular, rate and
rhythm.  No murmurs, rubs, or gallops.  Lungs:  Clear to
auscultation bilaterally.  Abdomen:  Soft, nontender,
nondistended.  Positive bowel sounds.  Extremities:  Warm
with 1-2+ pedal edema.  Pulses:  Carotid pulses 2+
bilaterally, radial artery 2+ on the left, unable to assess
on the right to a pressure bandage.  Femoral pulses 2+ on the
left, and unable to assess on the right secondary to
intra-aortic balloon pump.  Dorsalis pedis pulses 1+
bilaterally.  Neurological:  The patient was alert and
oriented times three.  She moved all extremities and followed
commands appropriately.  This was a nonfocal exam.

LABORATORY DATA:  On the day of admission white count was
6.8, hematocrit 26.4, platelet count 252,000; sodium 140,
potassium 3.3, chloride 107, CO2 22, BUN 10, creatinine 0.7,
glucose 157; LFTs were all within normal limits.

Chest x-ray showed no pneumonia or congestive heart failure.

HOSPITAL COURSE:  She awaited cardiac catheterization for her
INR to decrease.  On [**1-21**], she underwent cardiac
catheterization.  This test showed the left main to have 70%
ostial stenosis, left anterior descending artery 70% stenosis
after the second diagonal, left circumflex with mild disease,
right coronary artery with 95% stenosis at the midvessel and
long 405 stenosis.

She had an ejection fraction of 50% with mitral
regurgitation, and an intra-aortic balloon pump was placed at
the time of catheterization.  She was then transferred to the
CCU while awaiting surgery.

On [**1-22**], she underwent coronary artery bypass grafting
times three with a left internal mammary artery to the left
anterior descending artery, saphenous vein graft to the
posterior descending artery and a saphenous vein graft to the
diagonal.  She also had a mitral valve pair secondary to
intraoperative TEE findings.  The repair was done with a #28
mm CE ............ band, and she had a maze procedure.

The surgery was performed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] with Dr.
[**First Name4 (NamePattern1) 100636**] [**Last Name (NamePattern1) 14968**], [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], PA-C, and [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] PA-C as
assistants.  The surgery was performed under general
endotracheal anesthesia with a cardiopulmonary bypass time of
122 min, and a cross-clamp times of 96 min.  The patient
tolerated the procedure well and was transferred to the
Intensive Care Unit with two ventricular, one atrial and one
ground wire, and one mediastinal and one left pleural chest
tube.

She was transferred from the Operating Room sedated and on
Milrinone, Nitroglycerin, Neo-Synephrine and Propofol drips.
She did remain stable during the operative night, and
postoperative day #1, she was extubated without difficulty.
Also her intra-aortic balloon pump was discontinued without
incident along with her chest tubes.  She remained on
Milrinone, Insulin and Nipride drips for blood pressure
control over this time.

Over the first four days postoperatively, her Milrinone
continued to be weaned until it was off on postoperative day
#4.  She was noted to be in atrial fibrillation on
postoperative day #4 with a rapid ventricular rate.  She was
given Lopressor which did not help with rate control and
therefore was bolused with Amiodarone.  She was also started
on anticoagulation.

On postoperative day #5, she was transferred to the Surgical
Floor and again was noted to have atrial fibrillation with
rapid ventricular rate.  She was given intravenous Lopressor
and had good success with rate control.  She was thus started
on Coumadin 1 mg on this day.

Over the next couple of days, she continued to have issues
with her atrial fibrillation having poor rate control despite
increasing beta-blockade.  Electrophysiology Services was
consulted, and was therapeutic on her Heparin, was taken for
DC cardioversion on postoperative day #7.  She was
successfully cardioverted from atrial fibrillation to sinus
rhythm with a heart rate of 64 and continued on Amiodarone
200 mg p.o. t.i.d. and continued anticoagulation with Heparin
and Coumadin.

Following this, she continued to work with Physical Therapy
and remained in the hospital until her INR became therapeutic
while continuing Heparin drop.  On postoperative day #11, her
Heparin was discontinued, as her INR reached 1.6.  She
continued to receive Coumadin and cardiac rehabilitation per
Physical Therapy.

By postoperative day #





                            [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

Dictated By:[**Last Name (NamePattern1) 100637**]
MEDQUIST36

D:  [**2122-2-3**]  13:31
T:  [**2122-2-3**]  13:39
JOB#:  [**Job Number 100638**]
{'Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Cardiac complications, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Intermediate coronary syndrome,Atrial fibrillation,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 64-year-old
female with a history of hypertension, atrial fibrillation,
who was admitted on Amiodarone and Coumadin, question of
chronic obstructive pulmonary disease, anemia and tachycardia
and cardiomyopathy, who presented with a two-week history of
increasing dyspnea on exertion and shortness of breath.

MEDICAL HISTORY: Paroxysmal atrial fibrillation.
Hypertension.  Anemia.  Cardiomyopathy.  Status post left
total knee replacement with postoperative MRSA infection.
Depression.  Status post appendectomy.  Status post cesarean
section.  Status post lumbar laminectomy.  Status post
carcinoma of the vulva.  Acute renal failure following
Vancomycin administration.

MEDICATION ON ADMISSION: Amiodarone 200 mg p.o. q.d.,
Celebrex, Paxil 20 mg p.o. q.d., Lopressor 25 mg p.o. b.i.d.,
Hydrochlorothiazide 50 mg p.o. q.d., Losartan 50 mg p.o.
q.d., Coumadin as needed to keep INR 2.0-2.5.

ALLERGIES: ACE INHIBITORS WHICH GIVE HER A COUGH AND RASH.
CALCIUM CHANNEL BLOCKERS GIVE HER EDEMA.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives with her son and works as a case
manager at [**First Name4 (NamePattern1) 9464**] [**Last Name (NamePattern1) **].  She is currently a nonsmoker,
although she does have a 30 pack-year history.  She drinks
alcohol socially. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Cardiac complications, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Intermediate coronary syndrome,Atrial fibrillation,Unspecified essential hypertension'}
