CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75 year old
female with a mechanical mitral valve, on Coumadin, also with
hemolytic anemia and known gastrointestinal bleed with
pre-pyloric ulcer, who presented with a low hematocrit to 22.
The patient's hematocrit was noted incidentally at a routine
screening of her PT/PTT.  The patient endorsed a one day
history of lightheadedness, which was worse with ambulation
but resolved with being seated.  The patient denied nausea,
vomiting or abdominal pain.  She had a formed brown stool on
the morning of admission and denied bright red blood per
rectum.  The patient denied black stools, denied chest pain
or shortness of breath over baseline.  At baseline, the
patient does not walk stairs and sleeps on three pillows.
The patient is anticoagulated for her mechanical mitral
valve.

MEDICAL HISTORY: 1.  Type 2 diabetes mellitus.
2.  Congestive heart failure; [**2130-4-16**] echocardiogram showed
dilated atria, severe ventricular hypokinesis.
3.  Hemolytic anemia with a baseline hematocrit of 34.
4.  Mechanical prosthetic valve in [**2122**], status post
rheumatic heart disease.
5.  Hyperparathyroidism.
6.  History of alcohol abuse.
7.  History of gastrointestinal bleed.
8.  Varices.
9.  Peptic ulcer disease.
10. Nonsustained ventricular tachycardia.
11. Hypertension.
12. History of atrial fibrillation.
13. Transient ischemic attack in [**2121**].
14. Status post total abdominal hysterectomy.
15. Status post cholecystectomy.
16. Sigmoid diverticula.
17. Hypercholesterolemia.

MEDICATION ON ADMISSION: Atrovent, Coreg 12.5 mg
p.o.b.i.d., gemfibrozil 600 mg p.o.b.i.d., Lasix 20 mg p.o.
twice weekly, Diovan 40 mg p.o.q.d., iron 125 mg p.o.q.o.d.,
Coumadin 5 mg/7.5 mg alternating, Protonix 40 mg p.o.b.i.d.,
Accupril 2.5 mg p.o.q.d.

ALLERGIES: Erythromycin (cramps).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone.  She has three sons
and daughters.  She smoked one to two packs per day for 60
years and denies alcohol use currently.
Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Atrial fibrillation,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Gastrointest hemorr NOS,Ac posthemorrhag anemia,Chr airway obstruct NEC,CHF NOS,Atrial fibrillation,Heart valve replac NEC,Long-term use anticoagul,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2130-10-3**]     Discharge Date:  [**2130-10-6**]

Date of Birth:   [**2055-2-8**]     Sex:  F

Service:  [**Location (un) **]

HISTORY OF PRESENT ILLNESS:  The patient is a 75 year old
female with a mechanical mitral valve, on Coumadin, also with
hemolytic anemia and known gastrointestinal bleed with
pre-pyloric ulcer, who presented with a low hematocrit to 22.
The patient's hematocrit was noted incidentally at a routine
screening of her PT/PTT.  The patient endorsed a one day
history of lightheadedness, which was worse with ambulation
but resolved with being seated.  The patient denied nausea,
vomiting or abdominal pain.  She had a formed brown stool on
the morning of admission and denied bright red blood per
rectum.  The patient denied black stools, denied chest pain
or shortness of breath over baseline.  At baseline, the
patient does not walk stairs and sleeps on three pillows.
The patient is anticoagulated for her mechanical mitral
valve.

The patient was also admitted in [**Month (only) 359**] for a low hematocrit
and found to have a pre-pyloric ulcer on
esophagogastroduodenoscopy.  The patient has been on Protonix
since that time.  Upon admission to the Emergency Room, the
patient's hematocrit was noted to be 22.  On repeat check,
her hematocrit was noted to be 18 and the patient became
slightly hypotensive.  Due to this fact, the patient was
admitted first to the Medical Intensive Care Unit and then
transferred to the hospital floor upon stabilization.

PAST MEDICAL HISTORY:
1.  Type 2 diabetes mellitus.
2.  Congestive heart failure; [**2130-4-16**] echocardiogram showed
dilated atria, severe ventricular hypokinesis.
3.  Hemolytic anemia with a baseline hematocrit of 34.
4.  Mechanical prosthetic valve in [**2122**], status post
rheumatic heart disease.
5.  Hyperparathyroidism.
6.  History of alcohol abuse.
7.  History of gastrointestinal bleed.
8.  Varices.
9.  Peptic ulcer disease.
10. Nonsustained ventricular tachycardia.
11. Hypertension.
12. History of atrial fibrillation.
13. Transient ischemic attack in [**2121**].
14. Status post total abdominal hysterectomy.
15. Status post cholecystectomy.
16. Sigmoid diverticula.
17. Hypercholesterolemia.

ALLERGIES:  Erythromycin (cramps).

MEDICATIONS ON ADMISSION:  Atrovent, Coreg 12.5 mg
p.o.b.i.d., gemfibrozil 600 mg p.o.b.i.d., Lasix 20 mg p.o.
twice weekly, Diovan 40 mg p.o.q.d., iron 125 mg p.o.q.o.d.,
Coumadin 5 mg/7.5 mg alternating, Protonix 40 mg p.o.b.i.d.,
Accupril 2.5 mg p.o.q.d.

SOCIAL HISTORY:  The patient lives alone.  She has three sons
and daughters.  She smoked one to two packs per day for 60
years and denies alcohol use currently.

LABORATORY DATA:   On admission, the patient had a white
blood cell count of 4.3, hematocrit 22.7, INR 2.9.
Electrocardiogram revealed sinus bradycardia with premature
atrial contractions, no ST-T wave changes.  Colonoscopy on
[**2130-8-22**] had revealed sigmoid diverticula and internal
hemorrhoids.  EGD on the same day revealed a pre-pyloric 3 mm
ulcer.

PHYSICAL EXAMINATION:  On physical examination on admission,
the patient had a temperature of 97.5, blood pressure 92/53,
pulse 70, respiratory rate 16 and oxygen saturation 95% to
98% in room air.  General:  Pale elderly female in no acute
distress.  Cardiovascular:  Regular rate and rhythm.
Respiratory:  Lungs clear to auscultation bilaterally.
Abdomen:  Soft, nontender, nondistended, positive bowel
sounds.  Extremities:  1+ pitting edema bilaterally, dorsalis
pedis pulses 2+.

HOSPITAL COURSE:  1.  Anemia:  Patient with decreased
hematocrit, likely acute/chronic with baseline hemolytic
anemia, haptoglobin less than 20 at baseline.  Likely acute
hematocrit drop secondary to gastrointestinal source, known
pre-pyloric ulcer.  The patient was transfused until her
hematocrit remained above 30.  At that time, she was
discharged to the hospital floor.  She underwent an upper
endoscopy to evaluate for source of bleeding, however, no
evidence of bleeding was found on EGD.  The patient's
hematocrit remained stable at the time of discharge for 24
hours.  The patient will follow up for further investigation
for the source of gastrointestinal bleeding.  TSH was checked
and was within normal limits.

2.  Gastrointestinal:  Patient with a know pre-pyloric ulcer,
which was not appreciated on repeat EGD.  There was a benign
appearing mass noted in the stomach on EGD, a biopsy of which
was taken and will be followed up further as an outpatient.

3.  Cardiovascular:  Patient with no known coronary artery
disease but a left ventricular ejection fraction of 25% and
ventricular hypokinesis.  Given evidence of coronary artery
disease, the patient's blood pressure medications were
originally held in the setting of her gastrointestinal bleed,
however, these were restarted when her blood pressure was
stable.  For her mechanical valve, the patient was maintained
on Coumadin with a goal INR of 2.5 to 3.5, however, at the
time of discharge, her INR was 1.7 as her Coumadin had been
held during the period of acute bleed.  The patient was
started on Lovenox as a bridge to becoming therapeutic on
Coumadin.

4.  Diabetes mellitus:  The patient had stable blood sugars
throughout her hospital course.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:
1.  Anemia.
2.  Gastrointestinal bleed.
3.  Valve replacement.
4.  Chronic obstructive pulmonary disease.
5.  Diabetes mellitus.

DISCHARGE MEDICATIONS:
Atrovent meter dose inhaler.
Carvedilol 12.5 mg p.o.b.i.d.
Valsartan 40 mg p.o.q.d.
Lovenox 40 mg s.c.q.12h. until therapeutic.
Gemfibrozil 600 mg p.o.b.i.d.
Coumadin 7.5 mg p.o.q.d.
Pantoprazole 40 mg p.o.b.i.d.

FOLLOW-UP PLANS:  The patient was instructed to follow up
with Dr. [**Last Name (STitle) 5293**] on Monday for blood pressure check as well
as hematocrit and INR check.  Dr. [**Last Name (STitle) 5293**] will monitor the
patient's INR and adjust Coumadin and Lovenox as needed.  The
patient was also suggested to follow up with her primary care
physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Name (STitle) 1395**], within the next few weeks.  In
addition to this, the patient was instructed to follow up
with gastroenterology.  She was scheduled for an upper GI
study and small bowel follow-through on [**2130-10-16**],
with follow-up with Dr. [**Last Name (STitle) 12590**] on [**2130-10-24**].



                          [**First Name8 (NamePattern2) 1176**] [**Name8 (MD) 1177**], M.D.  [**MD Number(1) 1178**]

Dictated By:[**Name8 (MD) 12502**]

MEDQUIST36

D:  [**2130-10-6**]  09:50
T:  [**2130-10-7**]  18:19
JOB#:  [**Job Number 101589**]
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Atrial fibrillation,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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 75 year old
female with a mechanical mitral valve, on Coumadin, also with
hemolytic anemia and known gastrointestinal bleed with
pre-pyloric ulcer, who presented with a low hematocrit to 22.
The patient's hematocrit was noted incidentally at a routine
screening of her PT/PTT.  The patient endorsed a one day
history of lightheadedness, which was worse with ambulation
but resolved with being seated.  The patient denied nausea,
vomiting or abdominal pain.  She had a formed brown stool on
the morning of admission and denied bright red blood per
rectum.  The patient denied black stools, denied chest pain
or shortness of breath over baseline.  At baseline, the
patient does not walk stairs and sleeps on three pillows.
The patient is anticoagulated for her mechanical mitral
valve.

MEDICAL HISTORY: 1.  Type 2 diabetes mellitus.
2.  Congestive heart failure; [**2130-4-16**] echocardiogram showed
dilated atria, severe ventricular hypokinesis.
3.  Hemolytic anemia with a baseline hematocrit of 34.
4.  Mechanical prosthetic valve in [**2122**], status post
rheumatic heart disease.
5.  Hyperparathyroidism.
6.  History of alcohol abuse.
7.  History of gastrointestinal bleed.
8.  Varices.
9.  Peptic ulcer disease.
10. Nonsustained ventricular tachycardia.
11. Hypertension.
12. History of atrial fibrillation.
13. Transient ischemic attack in [**2121**].
14. Status post total abdominal hysterectomy.
15. Status post cholecystectomy.
16. Sigmoid diverticula.
17. Hypercholesterolemia.

MEDICATION ON ADMISSION: Atrovent, Coreg 12.5 mg
p.o.b.i.d., gemfibrozil 600 mg p.o.b.i.d., Lasix 20 mg p.o.
twice weekly, Diovan 40 mg p.o.q.d., iron 125 mg p.o.q.o.d.,
Coumadin 5 mg/7.5 mg alternating, Protonix 40 mg p.o.b.i.d.,
Accupril 2.5 mg p.o.q.d.

ALLERGIES: Erythromycin (cramps).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone.  She has three sons
and daughters.  She smoked one to two packs per day for 60
years and denies alcohol use currently. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Atrial fibrillation,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
