CHIEF COMPLAINT: Transferred from outside hospital,
congestive heart failure exacerbation.

PRESENT ILLNESS: Ms. [**Known lastname 35080**] is a 64-year-old
woman with coronary artery disease, mitral valve stenosis
with recent admission to [**Hospital1 69**]
for congestive heart failure, coronary artery disease,
requiring mitral valve replacement, however, was deemed not a
surgical candidate who underwent an attempted valvuloplasty
at [**Hospital6 1129**].  Her postoperative course
is complicated by failure to extubate, hypotension requiring
pressors, Heparin induced thrombocytopenia, atrial
fibrillation requiring amiodarone.

MEDICAL HISTORY: 1. Coronary artery disease, 50% mid right coronary artery,
100% mid left anterior descending artery, 90% D1, 80% distal
circ.
2. Mitral valve stenosis, valve area of 0.7 cm with history
of valvuloplasty x2.
3. Mitral regurgitation.
4. 2+ aortic stenosis, mild congestive heart failure,
ejection fraction 51%.
5. Kyphoscoliosis with severe restrictive lung disease.
6. Breast cancer status post radical left mastectomy in [**2153**]
with treatment with chemotherapy and radiation.
7. History of alcohol abuse, although no use in the past 20
years.
8. Status post tonsillectomy.
9. C section x2 and gout.

MEDICATION ON ADMISSION: 

ALLERGIES: Heparin causing thrombocytopenia, and pork, and
clams.  Tolerates IV contrast.

PHYSICAL EXAM: 

FAMILY HISTORY: No early coronary disease.

SOCIAL HISTORY: Patient worked as an attorney.  She is now
retired and lives alone.  She has no tobacco use, distant
alcohol abuse.
Rheumatic heart failure (congestive),Atrial fibrillation,Mitral valve stenosis and aortic valve stenosis,Other specified septicemias,Other shock without mention of trauma,Unspecified pleural effusion,Methicillin susceptible pneumonia due to Staphylococcus aureus,Mixed acid-base balance disorder
Rheumatic heart failure,Atrial fibrillation,Mitral/aortic stenosis,Septicemia NEC,Shock w/o trauma NEC,Pleural effusion NOS,Meth sus pneum d/t Staph,Mixed acid-base bal dis
Admission Date:  [**2182-4-10**]     Discharge Date:  [**2182-5-3**]

Date of Birth:   [**2118-2-18**]     Sex:  F

Service:

CHIEF COMPLAINT:  Transferred from outside hospital,
congestive heart failure exacerbation.

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 35080**] is a 64-year-old
woman with coronary artery disease, mitral valve stenosis
with recent admission to [**Hospital1 69**]
for congestive heart failure, coronary artery disease,
requiring mitral valve replacement, however, was deemed not a
surgical candidate who underwent an attempted valvuloplasty
at [**Hospital6 1129**].  Her postoperative course
is complicated by failure to extubate, hypotension requiring
pressors, Heparin induced thrombocytopenia, atrial
fibrillation requiring amiodarone.

Was transferred to rehabilitation facility on [**4-6**].  Patient
was recovering until [**4-9**] when she developed increased
dyspnea.  Chest x-ray there demonstrated large left and small
right effusion.  Patient was then transferred to [**Hospital6 3426**], where she was intubated for respiratory distress,
and noted to have a heart rate in the 120s, rhythm atrial
fibrillation.  At [**Hospital3 **], the patient received digoxin
for rate control, noted to have a temperature of 106 with
blood cultures drawn.  Had a limited echocardiogram which
demonstrated preserved LV/RV function without effusion from
which time per patient's family request, the patient was
transferred.

PAST MEDICAL HISTORY:
1. Coronary artery disease, 50% mid right coronary artery,
100% mid left anterior descending artery, 90% D1, 80% distal
circ.
2. Mitral valve stenosis, valve area of 0.7 cm with history
of valvuloplasty x2.
3. Mitral regurgitation.
4. 2+ aortic stenosis, mild congestive heart failure,
ejection fraction 51%.
5. Kyphoscoliosis with severe restrictive lung disease.
6. Breast cancer status post radical left mastectomy in [**2153**]
with treatment with chemotherapy and radiation.
7. History of alcohol abuse, although no use in the past 20
years.
8. Status post tonsillectomy.
9. C section x2 and gout.

MEDICATIONS AT REHABILITATION CENTER:
1. Nitropaste.
2. Coumadin.
3. Aspirin.
4. Amiodarone.
5. Xanax.
6. Lopressor.
7. Multivitamin.
8. Allopurinol.
9. Pepcid.

MEDICATIONS ON TRANSFER:
1. Neo 5.2.
2. Vitamin K.
3. Digoxin 0.125 mg IV q day.
4. Zantac 50.
5. Ativan 1 mg IV prn.

SOCIAL HISTORY:  Patient worked as an attorney.  She is now
retired and lives alone.  She has no tobacco use, distant
alcohol abuse.

FAMILY HISTORY:  No early coronary disease.

ALLERGIES:  Heparin causing thrombocytopenia, and pork, and
clams.  Tolerates IV contrast.

REVIEW OF SYSTEMS:  Not available.

PHYSICAL EXAMINATION:  Temperature 101.6, blood pressure
77-85/40-58, heart rate 86-91, respirations 20, and 100%.
General:  Middle-aged woman intubated, slightly agitated,
alert.  HEENT:  Normocephalic, atraumatic.  Pupils are equal,
round, and reactive to light.  Noted with G tube in place.
Neck is supple, obese.  Cardiovascular:  Distant holosystolic
murmur at apex and intermittently audible diastolic murmur at
upper sternal border.  Pulmonary:  Coarse breath sounds,
positive rhonchi anteriorly.  Abdomen:  Mild distention,
normoactive bowel sounds, soft, nontender, nondistended,
positive hernia. Extremities:  No edema; thready dorsalis
pedis and posterior tibialis;  bilaterally warm.  Neurologic:
Alert and not following commands.  Skin:  Positive erythema
and scaling.

LABORATORIES ON ADMISSION:  White count 12.7.  Differential:
86 neutrophils, 7 lymphocytes, 5 monocytes, 1 eosinophil.
Hematocrit 30.5, platelets 508.  Sodium 138, potassium 4.5,
chloride 99, bicarb 26, BUN 17, creatinine 0.8, glucose 74,
calcium 7.3, magnesium 1.4, phosphorus 3.2.  LFTs within
normal limits.  Urinalysis:  Large blood, 30 protein, trace
ketones, and small bile, moderate leukocyte esterase.

HOSPITAL COURSE:  Dr [**Last Name (STitle) **] was attending of record on
 evening of initMs. Schitial intense evaluation. On [**2182-4-11**],
CCU attending of record was Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. Mrs [**Known lastname 35080**] was
monitored in the admission evening in the Coronary
Care Unit and underwent evaluation of her congestive heart
failure and mitral stenosis.  Her mitral stenosis was
evaluated by emergency echo was found to be severe, despite
prior effort at percutaneous valvuloplasty at [**Hospital1 2025**]. Here,
formal surgical consultation was obtained  and again
she was determined to not be a candidate
for surgery given her history of radiation treatment in the
chest, her anatomic abnormalities with a kyphoscoliosis, and
generalized deconditioning, and sepsis.

She underwent evaluation for any other improvement in cardiac
hemodynamics including cardiac catheterization with
shuntogram which demonstrated trivial left to right shunting
from a perforated atrial septum.  Her aortic stenosis was
deemed mild.  It was determined she would unlikely benefit
from further intervention.

She was maintained on Neo-Synephrine for hypotension with
eventual switch to Levophed.  She was eventually poorly
responsive though to Neo-Synephrine.  Eventually, her
Levophed was gently weaned off with stable blood pressures by
[**2182-4-25**].  She maintained normal sinus rhythm throughout
hospitalization, was maintained on amiodarone.

2. Pulmonary:  The patient required full ventilatory support
through [**2182-4-25**].  She was persistently febrile with initial
sputum samples demonstrating MSSA pneumonia.  She was
maintained on Vancomycin throughout hospitalization as well
as Zosyn.

On [**4-25**], she was essentially able to be successfully
extubated, however, continued to require significant levels
of Morphine for tachypnea.

Infectious Disease:  Patient with persistent fevers and
hypotension of unclear etiology.  Patient was cultured
repeatedly.  She underwent tap of bilateral pleural effusions
which demonstrated transudative fluid only.  She had no skin
breakdown.  Liver function tests remained stable with modest
elevations in her total bilirubin which were self limited.
She had no evidence of skin breakdown.

The patient underwent significant diuresis initially.  She
was made negative approximately 5-6 liters.  However, she
developed severe contraction, alkalosis at this level of
diuresis without significant improvement in her hemodynamics
or pulmonary function.  Then gently allowed to equilibrate
and further treatment of her congestive heart failure
included therapeutic drainage of her bilateral pleural
effusions.  Eventually, patient's metabolic alkalosis
corrected sufficiently for extubation.

Neurologic:  Patient was initially, alert and appropriate and
following commands, however, on approximately [**4-20**], she
began developing tremors.  Patient's Versed and Reglan were
discontinued at this time as they were felt to be possible
contributors.  She no longer was able to appropriately follow
commands even after extubation.  All sedation was weaned.
She continued to have intermittent tremors.  The patient
declined further evaluation with head CT scan and neurologic
examination given overall poor prognosis.

On [**4-25**] at time of extubation, patient's family made the
decision to continue her care at comfort measures only given
her poor long-term prognosis.  She was continued only on
Morphine drip.  Her medications at this time with
discontinuation of any further congestive heart failure
management and antibiotics.

On [**2182-5-2**], she deceased peacefully with the family at her
bedside.

CAUSE OF DEATH:
1. Sepsis.
2. Congestive heart failure.
3. Mitral stenosis, severe.




                    DR.[**Last Name (STitle) **],[**First Name3 (LF) 420**] 11-628

Dictated By:[**Last Name (NamePattern1) 7485**]

MEDQUIST36

D:  [**2182-5-3**]  14:58
T:  [**2182-5-7**]  08:24
JOB#:  [**Job Number 35081**]
{'Rheumatic heart failure (congestive),Atrial fibrillation,Mitral valve stenosis and aortic valve stenosis,Other specified septicemias,Other shock without mention of trauma,Unspecified pleural effusion,Methicillin susceptible pneumonia due to Staphylococcus aureus,Mixed acid-base balance disorder'}


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: Transferred from outside hospital,
congestive heart failure exacerbation.

PRESENT ILLNESS: Ms. [**Known lastname 35080**] is a 64-year-old
woman with coronary artery disease, mitral valve stenosis
with recent admission to [**Hospital1 69**]
for congestive heart failure, coronary artery disease,
requiring mitral valve replacement, however, was deemed not a
surgical candidate who underwent an attempted valvuloplasty
at [**Hospital6 1129**].  Her postoperative course
is complicated by failure to extubate, hypotension requiring
pressors, Heparin induced thrombocytopenia, atrial
fibrillation requiring amiodarone.

MEDICAL HISTORY: 1. Coronary artery disease, 50% mid right coronary artery,
100% mid left anterior descending artery, 90% D1, 80% distal
circ.
2. Mitral valve stenosis, valve area of 0.7 cm with history
of valvuloplasty x2.
3. Mitral regurgitation.
4. 2+ aortic stenosis, mild congestive heart failure,
ejection fraction 51%.
5. Kyphoscoliosis with severe restrictive lung disease.
6. Breast cancer status post radical left mastectomy in [**2153**]
with treatment with chemotherapy and radiation.
7. History of alcohol abuse, although no use in the past 20
years.
8. Status post tonsillectomy.
9. C section x2 and gout.

MEDICATION ON ADMISSION: 

ALLERGIES: Heparin causing thrombocytopenia, and pork, and
clams.  Tolerates IV contrast.

PHYSICAL EXAM: 

FAMILY HISTORY: No early coronary disease.

SOCIAL HISTORY: Patient worked as an attorney.  She is now
retired and lives alone.  She has no tobacco use, distant
alcohol abuse. 

### Response:
{'Rheumatic heart failure (congestive),Atrial fibrillation,Mitral valve stenosis and aortic valve stenosis,Other specified septicemias,Other shock without mention of trauma,Unspecified pleural effusion,Methicillin susceptible pneumonia due to Staphylococcus aureus,Mixed acid-base balance disorder'}
