CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 4127**] is a [**Age over 90 **] year old
man with a past medical history significant for atrial
flutter, rotator cuff tendonitis, taking NSAIDs, prostatitis,
and aortic stenosis, who presented to the [**Hospital1 346**] Emergency Department and complained
of dizziness, abdominal discomfort, nausea and multiple loose
dark stools.  He had developed lightheadedness, but no loss
of consciousness.  He was found on the toilet, pale, and
close to passing out and was transported to the Emergency
[**Hospital1 **].

MEDICAL HISTORY: 1.  Aortic stenosis.
2.  Atrial flutter.
3.  Prostatitis, on Bactrim starting [**3-4**].
4.  Rotator cuff injury.
5.  Cholecystectomy [**44**] years prior.

MEDICATION ON ADMISSION: 1.  Aspirin 81 mg p.o. q. day.
2.  Multivitamins one tablet q. day.
3.  Naproxen.
4.  Bactrim, one double strength q. day since [**3-4**].
5.  Metamucil q. day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Occasional alcohol; no tobacco.  Lives at
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**Location (un) **].
Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Helicobacter pylori [H. pylori],Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Mitral valve insufficiency and aortic valve stenosis,Iron deficiency anemia secondary to blood loss (chronic),Atrial flutter,Congestive heart failure, unspecified
Chr stomach ulc w hem,Chr duoden ulcer w hem,Helicobacter pylori,Adv eff analgesic NOS,Mitral insuf/aort stenos,Chr blood loss anemia,Atrial flutter,CHF NOS
Admission Date:  [**2116-3-8**]       Discharge Date:  [**2116-3-12**]


Service:

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 4127**] is a [**Age over 90 **] year old
man with a past medical history significant for atrial
flutter, rotator cuff tendonitis, taking NSAIDs, prostatitis,
and aortic stenosis, who presented to the [**Hospital1 346**] Emergency Department and complained
of dizziness, abdominal discomfort, nausea and multiple loose
dark stools.  He had developed lightheadedness, but no loss
of consciousness.  He was found on the toilet, pale, and
close to passing out and was transported to the Emergency
[**Hospital1 **].

Two to three weeks prior to this admission, he had developed
a stiff shoulder for which he had been taking
over-the-counter NSAIDs (Naproxen two tablets twice a day per
report).  He did report occasional diarrhea during the two
weeks prior to admission and had taken Imodium leading to
constipation.

In the Emergency Department, he was hypotensive to 100/50
with a tachycardia to 110.  He received fluids and one unit
of packed red blood cells.  NG lavage showed coffee grounds.
He was started on Protonix intravenously and admitted to the
Medical Intensive Care Unit.

PAST MEDICAL HISTORY:
1.  Aortic stenosis.
2.  Atrial flutter.
3.  Prostatitis, on Bactrim starting [**3-4**].
4.  Rotator cuff injury.
5.  Cholecystectomy [**44**] years prior.

MEDICATIONS ON ADMISSION:
1.  Aspirin 81 mg p.o. q. day.
2.  Multivitamins one tablet q. day.
3.  Naproxen.
4.  Bactrim, one double strength q. day since [**3-4**].
5.  Metamucil q. day.

ALLERGIES:   No known drug allergies.

SOCIAL HISTORY:  Occasional alcohol; no tobacco.  Lives at
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**Location (un) **].

PHYSICAL EXAMINATION:  On admission, vital signs with blood
pressure 90/60; respiratory rate 24; heart rate 110;
saturation at 93% on four liters nasal cannula.  Alert,
oriented, pleasant, talking in full sentences, comfortable.
Anicteric.  Pupils equally round and reactive to light.
Extraocular muscles are intact.  Oral mucosa dry.  No
jaundice.  Heart rate irregularly irregular.  II/III systolic
murmur with radiation to the carotids noticed.  Lungs with
bilateral coarse rhonchi; no crackles, no wheezing.  Abdomen
soft, nontender, nondistended.  Positive bowel sounds.
Positive epigastric tenderness, no rebound, no guarding.
Rectal was OB positive.  Extremities with trace edema.  No
calf tenderness.  Neurological examination with intact
strength five through five throughout; nonfocal otherwise.

LABORATORY DATA:  On admission, white blood cell count of
12.5, hemoglobin 7.2, hematocrit 21.8, platelets 186.  Sodium
136, potassium 5.2, chloride 104, bicarbonate 19, BUN 46,
creatinine 1.9, glucose 141, ALT 23, AST 26, CK 53, alkaline
phosphatase 29; amylase 393, total bilirubin 0.3.

Urinalysis, yellow, clear; otherwise negative.

IMAGING:  On admission, chest x-ray from [**2116-1-9**], showing
hyperinflated lungs with the question of congestive heart
failure, prominent pulmonary arteries, heart mildly enlarged
with left ventricular prominence consistent with aortic
stenosis.  No pleural effusion, no pneumothorax, no focal
consolidation, no pulmonary edema.

EKG on admission:  Atrial flutter with a heart rate of
approximately 106, left axis deviation.  No Q waves.  Right
bundle branch block, early R wave progression; no ST changes.

Chest x-ray from [**2116-3-8**], right prominent hilum, upper
zone redistribution, no effusion.

BRIEF HOSPITAL COURSE:  Mr. [**Known lastname 4127**] was initially admitted
to the Medical Intensive Care Unit where he was transfused
with two additional units of packed red blood cells.  The
following morning, he received an esophagogastroduodenoscopy
showing ulcers in the pre-pyloric region, the anterior and
posterior bulb, consistent with NSAID-induced ulcers.  No
active bleed was seen.  While in the Unit, for the subsequent
24 hours he continued to have guaiac positive stools, but no
overt blood.  H. pylori and gastrin levels were sent and H.
pylori was positive and he was started on triple therapy of
Clarithromycin, Amoxicillin and Protonix.  He will be
continued on this as an outpatient for full therapy.

He was called out of the Medical Intensive Care Unit the
subsequent day to the medical floor with a stable hematocrit
of 30.5.  Throughout his stay, his hematocrit remained stable
at this level and he had no repeat episodes of bright red
blood.

The night following his transfer to the floor, he had an
episode of shortness of breath not associated with any chest
pain.  He also complained of anxiety at this point.  A
routine EKG was checked and while unchanged significantly
from prior EKGs in the Medical Intensive Care Unit, it was
felt that there was an element of ST depressions present in
the precordial and lateral leads.  This had developed while
in the Intensive Care Unit and was presumed secondary to rate
related low-level ischemia.  Given these findings, cardiac
enzymes were cycled.  CKs were negative times three, however,
troponin I returned at 22.  It was felt that Mr. [**Known lastname 4127**]
may have suffered an infarction in the setting of profound
anemia, tachycardia and outflow obstruction from his aortic
stenosis.  However, given his age and his poor candidacy for
either cardiac catheterization based revascularization or
surgery, the decision was made not to pursue further work-up
of this.

Two days later, the day of discharge, a repeat troponin was
checked and had declined to 8.0.  An echocardiogram was
obtained to assess both the degree of aortic stenosis and
assess for any potential wall motion abnormality.  This was
significant for mild symmetric left ventricular hypertrophy
with a normal cavity size.  Left ventricular systolic
function was assessed as normal.  There was mild dilatation
of the ascending aorta.  The aortic valve leaflets were
moderately thickened with probable moderate to severe aortic
stenosis.  Moderate aortic regurgitation was seen.  The
mitral valve leaflets were mildly thickened with moderate to
severe regurgitation.  There was mild pulmonary artery
systolic hypertension and no pericardial effusion.  Compared
to a prior report of [**2106-1-12**], the aortic stenosis was felt
to be more severe.

Given the probable rate related changes, he was started on a
low dose of beta blocker, Lopressor 12.5 three times a day.
This option had been discussed and initially held while in
the Intensive Care Unit secondary to the fact that he was
felt to be dependent upon his rate for perfusion secondary to
his profound anemia in the setting of blood loss.

Throughout his stay on the medical floor, he had no further
shortness of breath and no further GI bleed or bright red
blood per rectum.  He will be followed up by the
Gastroenterology Service and will need an
esophagogastroduodenoscopy in two months at the [**Hospital **] Clinic,
phone number [**Telephone/Fax (1) 1954**].

Again, he will be continued on triple therapy for H. pylori.
He should avoid NSAIDs in the future and if need be take
Tylenol for pain.

Again, given his history of recent prostatitis, a routine
urinalysis was again checked on the floor.  It was negative
for indications of infection and he was not continued on his
Bactrim.

DISCHARGE DIAGNOSES:
1.  Upper gastrointestinal bleed secondary to non-steroidal
anti-inflammatories.
2.  Aortic stenosis.
3.  Atrial flutter.
4.  Prostatitis.

DISCHARGE DISPOSITION:   To [**Hospital 3058**] rehabilitation.

DISCHARGE MEDICATIONS:
1.  Multivitamin, one tablet q. day.
2.  Protonix 40 mg p.o. q. day.
3.  Atenolol 50 mg p.o. q. day.
4.  Amoxicillin 1 gram twice a day for ten days.
5.  Clarithromycin 500 mg p.o. twice a day times ten days.
6.  Ambien 5 mg p.o. q. h.s. p.r.n. while at [**Hospital 3058**]
rehabilitation.
7.  Tylenol 650 mg p.o. q. six hours p.r.n.

DISCHARGE INSTRUCTIONS:
1.  The patient should follow-up with his primary care
physician after discharge from [**Hospital 3058**] rehabilitation.
2.  Should follow-up with the [**Hospital **] Clinic for a
repeat esophagogastroduodenoscopy and follow-up on his
gastrin level.


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

Dictated By:[**Name8 (MD) 4733**]
MEDQUIST36

D:  [**2116-3-12**]  11:23
T:  [**2116-3-12**]  13:10
JOB#:  [**Job Number **]
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Helicobacter pylori [H. pylori],Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Mitral valve insufficiency and aortic valve stenosis,Iron deficiency anemia secondary to blood loss (chronic),Atrial flutter,Congestive heart failure, 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: Mr. [**Known lastname 4127**] is a [**Age over 90 **] year old
man with a past medical history significant for atrial
flutter, rotator cuff tendonitis, taking NSAIDs, prostatitis,
and aortic stenosis, who presented to the [**Hospital1 346**] Emergency Department and complained
of dizziness, abdominal discomfort, nausea and multiple loose
dark stools.  He had developed lightheadedness, but no loss
of consciousness.  He was found on the toilet, pale, and
close to passing out and was transported to the Emergency
[**Hospital1 **].

MEDICAL HISTORY: 1.  Aortic stenosis.
2.  Atrial flutter.
3.  Prostatitis, on Bactrim starting [**3-4**].
4.  Rotator cuff injury.
5.  Cholecystectomy [**44**] years prior.

MEDICATION ON ADMISSION: 1.  Aspirin 81 mg p.o. q. day.
2.  Multivitamins one tablet q. day.
3.  Naproxen.
4.  Bactrim, one double strength q. day since [**3-4**].
5.  Metamucil q. day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Occasional alcohol; no tobacco.  Lives at
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**Location (un) **]. 

### Response:
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Helicobacter pylori [H. pylori],Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Mitral valve insufficiency and aortic valve stenosis,Iron deficiency anemia secondary to blood loss (chronic),Atrial flutter,Congestive heart failure, unspecified'}
