CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 63-year-old
female with mitral insufficiency, pulmonary hypertension, and
new onset atrial fibrillation referred for cardiac
catheterization as part as a presurgical workup.  Ms. [**Known lastname **]
had a history of rheumatic heart disease as a child,
otherwise no known cardiac history.  For the past two months,
she had been experiencing increased exertional dyspnea on
activity and climbing a flight of stairs.  She was recently
found to be in atrial fibrillation and started on Coumadin.

MEDICAL HISTORY: 1. Right carotid bruit.
2. New onset atrial fibrillation.
3. Depression.
4. Past alcohol abuse.
5. Asthma.
6. Osteoporosis.
7. Rheumatic fever.
8. Fracture of left ankle.
9. Psoriasis.
10. Question of sarcoidosis.
11. Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin which causes a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Rheumatic mitral insufficiency,Atrial fibrillation,Alcoholic cirrhosis of liver,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Osteoporosis, unspecified
Crnry athrscl natve vssl,Rheumatic mitral insuff,Atrial fibrillation,Alcohol cirrhosis liver,Chr pulmon heart dis NEC,Hypertension NOS,Asthma NOS,Osteoporosis NOS
Admission Date:  [**2115-4-16**]       Discharge Date:  [**2115-4-26**]

Date of Birth:   [**2051-8-4**]       Sex:  F

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 63-year-old
female with mitral insufficiency, pulmonary hypertension, and
new onset atrial fibrillation referred for cardiac
catheterization as part as a presurgical workup.  Ms. [**Known lastname **]
had a history of rheumatic heart disease as a child,
otherwise no known cardiac history.  For the past two months,
she had been experiencing increased exertional dyspnea on
activity and climbing a flight of stairs.  She was recently
found to be in atrial fibrillation and started on Coumadin.

An echocardiogram on [**2115-2-25**] revealed mild mitral stenosis,
moderate to severe mitral insufficiency, marked left atrial
enlargement, moderate pulmonary hypertension, and moderate
right atrial enlargement.  The patient was referred for
cardiac catheterization followed by a Surgical consult.

The patient reported dyspnea improving since taking diltiazem
and Lasix.

PAST MEDICAL HISTORY:
1. Right carotid bruit.
2. New onset atrial fibrillation.
3. Depression.
4. Past alcohol abuse.
5. Asthma.
6. Osteoporosis.
7. Rheumatic fever.
8. Fracture of left ankle.
9. Psoriasis.
10. Question of sarcoidosis.
11. Hypertension.

PAST SURGICAL HISTORY:
1. Tonsillectomy.
2. Appendectomy.

ALLERGIES:  Penicillin which causes a rash.

MEDICATIONS AT HOME:
1. Diltiazem 60 mg q day.
2. Fosamax 70 mg q week.
3. Lisinopril 20 mg q day.
4. Lasix 20 mg q day.
5. Potassium chloride 10 mEq [**Hospital1 **].
6. Coumadin.

Hematocrit on admission was 23.6.

Patient had a catheterization which showed an ejection
fraction of 54%, hypokinetic anterolateral wall motion, 3+
mitral valve regurgitation, discrete 50% right coronary
artery proximal, 90% mid, 40% left main, 40% mid left
anterior descending artery, 40% on distal left anterior
descending artery, and 40% proximal circumflex.

The patient underwent a CABG x4 with a LIMA to the left
anterior descending artery, saphenous vein graft to the OM,
PD and D1 and mitral valve replacement with a 25 mm [**Company 1543**]
mosaic.  The patient tolerated the procedure without any
problems.  [**Name (NI) **] continued to do well in the CSRU.  Had an
episode of atrial fibrillation on postoperative day two.
Started on a Heparin drip, but was found to be HIT positive
and hematology consult was started on Lepirudin until
appropriately anticoagulated with Coumadin.

Repeat echocardiogram was done postoperative day #4 which
showed no mitral regurgitation and no effusion.  Ejection
fraction of 30-40%.  The patient was transferred to the floor
on postoperative day #7.

On[**Last Name (STitle) 14810**]perative day #10, the patient was felt to be ready
for discharge to home as he was cleared by Physical Therapy,
tolerating regular diet with good po pain control with INR at
goal of 1.9 or above, and patient to be going home follow up
with Dr. [**Last Name (Prefixes) **] on four weeks from discharge, Dr. [**Last Name (STitle) 3444**]
in [**2-7**] weeks, and also to be following up for readjustment of
Coumadin dosing on Monday, [**4-29**] for a check of PT/INR,
readjustment of dosing.

DISCHARGE MEDICATIONS:
1. Tums 400 mg tid.
2. Vioxx 75 mg q day.
3. Iron 325 mg q day.
4. Vitamin C 500 mg [**Hospital1 **].
5. Amiodarone 400 mg [**Hospital1 **] x1 week and then q day until
followup with cardiologist.
6. Percocet 1-2 tablets po q4-6h prn.
7. Ibuprofen 400 mg q6h prn.
8. Tylenol 650 mg po q4h prn.
9. Enteric coated aspirin 325 mg q day.
10. Zantac 150 mg [**Hospital1 **] until followup with surgeon.
11. Lopressor 25 mg [**Hospital1 **].
12. Lasix 20 mg [**Hospital1 **] x7 days.
13. Potassium chloride being held for two days and then
restarted at 20 mEq [**Hospital1 **] x5 days.
14. Colace 100 mg [**Hospital1 **].
15. Coumadin 2 mg x2 days and then recheck PT/INR to readjust
for a goal INR of 1.8 to 2.5.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  Home.

DIAGNOSIS:
1. Status post coronary artery bypass graft x4.
2. Mitral valve repair with a biovalve.




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

Dictated By:[**Name8 (MD) 5915**]
MEDQUIST36

D:  [**2115-4-26**]  11:50
T:  [**2115-4-26**]  12:01
JOB#:  [**Job Number 94326**]

cc:[**Last Name (Prefixes) 94327**]

Name:  [**Known lastname 1228**], [**Known firstname 1116**]                      Unit No:  [**Numeric Identifier 14930**]

Admission Date:  [**2115-4-16**]     Discharge Date:  [**2115-4-26**]

Date of Birth:   [**2051-8-4**]     Sex:  F

Service:

ADDENDUM:  This is an addendum for the period [**2115-4-16**] to
[**2115-4-26**].

MEDICATION UPDATE:
1.  Coumadin 2 mg q.d. to be followed-up on [**2115-4-29**] with a
blood test at her primary care provider's office, Dr. [**Last Name (STitle) **],
to check a PT, INR, potassium, and hematocrit and adjust
accordingly.
2.  Potassium chloride 20 mEq q.d. times seven days instead
of the aforementioned dosing.
3.  Lasix 20 mg b.i.d. times seven.

These follow-ups were relayed to her primary care doctor's
office at [**Telephone/Fax (1) 14931**] and the doctor is aware.  The patient
will be attending and necessitate some dosing changes.




                          [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Name8 (MD) 2182**]

MEDQUIST36

D:  [**2115-4-26**]  02:50
T:  [**2115-4-26**]  22:09
JOB#:  [**Job Number 14932**]
{'Coronary atherosclerosis of native coronary artery,Rheumatic mitral insufficiency,Atrial fibrillation,Alcoholic cirrhosis of liver,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Osteoporosis, unspecified'}


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 63-year-old
female with mitral insufficiency, pulmonary hypertension, and
new onset atrial fibrillation referred for cardiac
catheterization as part as a presurgical workup.  Ms. [**Known lastname **]
had a history of rheumatic heart disease as a child,
otherwise no known cardiac history.  For the past two months,
she had been experiencing increased exertional dyspnea on
activity and climbing a flight of stairs.  She was recently
found to be in atrial fibrillation and started on Coumadin.

MEDICAL HISTORY: 1. Right carotid bruit.
2. New onset atrial fibrillation.
3. Depression.
4. Past alcohol abuse.
5. Asthma.
6. Osteoporosis.
7. Rheumatic fever.
8. Fracture of left ankle.
9. Psoriasis.
10. Question of sarcoidosis.
11. Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin which causes a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Rheumatic mitral insufficiency,Atrial fibrillation,Alcoholic cirrhosis of liver,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Osteoporosis, unspecified'}
