CHIEF COMPLAINT: Recently diagnosed a-fib and increasing fatigue over several
months.

PRESENT ILLNESS: 60 yo Chinese man who was recently diagnosed with a-fib, started
on coumadin, and is now presenting with increasing fatigue.
Echo on [**2150-2-9**] showed EF 50-55%, MVA 0.8, LA enlargement, 2+
AR, 2+ TR, and mitral valve c/w rheumatic deformity.  Cardiac
cath on [**2150-3-10**] showed normal coronaries.

MEDICAL HISTORY: 1. Atrial fibrillation
2. Mitral stenosis
3. Mitral regurgitation
4. Low back pain
5. Varicose veins

MEDICATION ON ADMISSION: 1. Coumadin 5 mg alternating with 3 mg PO QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile, VSS]
NAD, alert
Neck: soft, supple, no JVD, no bruits
Chest: Irregularly irregular, +SEM; CTAB
Abd: soft, NT, ND
Ext: no edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Tobacco: 30 pack-year (quit 1 year ago)
EtOH: denies
Multiple involvement of mitral and aortic valves,Atrial fibrillation,Thrombocytopenia, unspecified,Other vascular complications of medical care, not elsewhere classified,Other chronic pulmonary heart diseases,Phlebitis and thrombophlebitis of superficial veins of upper extremities
Mitr/aortic mult involv,Atrial fibrillation,Thrombocytopenia NOS,Vasc comp med care NEC,Chr pulmon heart dis NEC,Phlbts sprfc vn up extrm
Admission Date:  [**2150-3-10**]              Discharge Date:   [**2150-3-18**]

Date of Birth:  [**2089-9-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 14964**]
Chief Complaint:
Recently diagnosed a-fib and increasing fatigue over several
months.

Major Surgical or Invasive Procedure:
1. AVR (21mm [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**])
2. MVR (29mm [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**])
3. Maze procedure


History of Present Illness:
60 yo Chinese man who was recently diagnosed with a-fib, started
on coumadin, and is now presenting with increasing fatigue.
Echo on [**2150-2-9**] showed EF 50-55%, MVA 0.8, LA enlargement, 2+
AR, 2+ TR, and mitral valve c/w rheumatic deformity.  Cardiac
cath on [**2150-3-10**] showed normal coronaries.

Past Medical History:
1. Atrial fibrillation
2. Mitral stenosis
3. Mitral regurgitation
4. Low back pain
5. Varicose veins

Social History:
Tobacco: 30 pack-year (quit 1 year ago)
EtOH: denies

Family History:
Noncontributory

Physical Exam:
Afebrile, VSS]
NAD, alert
Neck: soft, supple, no JVD, no bruits
Chest: Irregularly irregular, +SEM; CTAB
Abd: soft, NT, ND
Ext: no edema

Pertinent Results:
[**2150-3-10**] 11:30AM   PT-17.0* PTT-38.0* INR(PT)-1.8

Brief Hospital Course:
60 yo Chinese man who was recently diagnosed with a-fib, started
on coumadin, and is now presenting with increasing fatigue.
Echo on [**2150-2-9**] showed EF 50-55%, MVA 0.8, LA enlargement, 2+
AR, 2+ TR, and mitral valve c/w rheumatic deformity.  Cardiac
cath on [**2150-3-10**] showed normal coronaries.

Pt was taken to the OR [**2150-3-12**] for AVR (21mm [**First Name8 (NamePattern2) **] [**Male First Name (un) 923**]), MVR (29mm
[**First Name8 (NamePattern2) **] [**Male First Name (un) 923**]), and Maze procedure.  For more detailed account, please
see operative report.  Post-op, he was transferred to the CSRU
where he was extubated and weaned off his vasopressors on POD 0.
 He was transferred to the floor on POD 1.  He was started on
coumadin on POD 2 both for a-fib and double mechanical valve.
On POD 2, his telemetry read either as a wandering atrial
pacemaker or some sort of heart block, which EP consult deemed
not necessary to treat.  He went into sinus shortly afterwards.
He was also noted to have a R upper extremity thrombophlebitis,
which promptly resolved with IV ancef.  The remainder of his
hospital stay consisted of INR monitoring.  This will be
followed by the PCP's office on discharge.

Medications on Admission:
1. Coumadin 5 mg alternating with 3 mg PO QHS

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
[**Male First Name (un) **]:*60 Capsule(s)* Refills:*0*
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
[**Male First Name (un) **]:*60 Tablet(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
[**Male First Name (un) **]:*20 Tablet(s)* Refills:*0*
4. Amiodarone HCl 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
[**Male First Name (un) **]:*30 Tablet(s)* Refills:*1*
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
[**Male First Name (un) **]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
[**Male First Name (un) **]:*30 Tablet(s)* Refills:*2*
7. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 7 days.
[**Male First Name (un) **]:*28 Capsule(s)* Refills:*0*
8. Coumadin 5 mg Tablet Sig: One (1) Tablet PO at bedtime: Check
INR with PCP.
[**Name Initial (NameIs) **]:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
1. Atrial fibrillation
2. Mitral stenosis
3. Mitral regurgitation


Discharge Condition:
Good

Discharge Instructions:
1. Resume medications as directed.
2. F/U as directed.
3. INR check with PCP for adjustment of coumadin dosage.
4. Please call office or go to ER if fever/chills, drainage from
sternal incision, chest pain, shortness of breath.

Followup Instructions:
PCP, 2 weeks, please call for appointment.  INR to be called
into office please.

Cardiologist, 2 weeks, please call for appointment.

Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 170**]  Call to schedule
appointment in 6 weeks.
{'Multiple involvement of mitral and aortic valves,Atrial fibrillation,Thrombocytopenia, unspecified,Other vascular complications of medical care, not elsewhere classified,Other chronic pulmonary heart diseases,Phlebitis and thrombophlebitis of superficial veins of upper extremities'}


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: Recently diagnosed a-fib and increasing fatigue over several
months.

PRESENT ILLNESS: 60 yo Chinese man who was recently diagnosed with a-fib, started
on coumadin, and is now presenting with increasing fatigue.
Echo on [**2150-2-9**] showed EF 50-55%, MVA 0.8, LA enlargement, 2+
AR, 2+ TR, and mitral valve c/w rheumatic deformity.  Cardiac
cath on [**2150-3-10**] showed normal coronaries.

MEDICAL HISTORY: 1. Atrial fibrillation
2. Mitral stenosis
3. Mitral regurgitation
4. Low back pain
5. Varicose veins

MEDICATION ON ADMISSION: 1. Coumadin 5 mg alternating with 3 mg PO QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile, VSS]
NAD, alert
Neck: soft, supple, no JVD, no bruits
Chest: Irregularly irregular, +SEM; CTAB
Abd: soft, NT, ND
Ext: no edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Tobacco: 30 pack-year (quit 1 year ago)
EtOH: denies 

### Response:
{'Multiple involvement of mitral and aortic valves,Atrial fibrillation,Thrombocytopenia, unspecified,Other vascular complications of medical care, not elsewhere classified,Other chronic pulmonary heart diseases,Phlebitis and thrombophlebitis of superficial veins of upper extremities'}
