CHIEF COMPLAINT: 

PRESENT ILLNESS: Briefly, this is a 79 year old
woman with a previous history of scarlet fever status post
[**Last Name (un) 3843**]-[**Doctor Last Name **] mitral valve for mitral stenosis in [**2126**].
At the time of her surgery, she was found to have normal
coronaries with normal aortic valve.  She also had a history
of atrial fibrillation which had been managed on Coumadin.
In the past year, she had been complaining of fatigue and
increasing shortness of breath while walking and exertion.
She denied any chest pain, palpitations, dizziness or
syncope.  Echocardiogram revealed biatrial enlargement,
severe aortic stenosis with an aortic valve area of 0.6
centimeters, concentric left ventricular hypertrophy with
normal left ventricular function, moderate tricuspid
regurgitation and moderate pulmonic regurgitation.

MEDICAL HISTORY: 1.  Scarlet fever.
2.  Atrial fibrillation.
3.  Prior transient ischemic attacks with mild carotid
disease noted on recent testing.
4.  Hypertension.
5.  High cholesterol.
6.  Obstructive pulmonary disease noted on chest x-ray.

MEDICATION ON ADMISSION: 1.  Aspirin 81 mg p.o. q. day.
2.  Lipitor 10 mg p.o. q. day.
3.  Toprol 100 mg p.o. twice a day.
4.  Coumadin 2.5 mg Monday through Saturday and none on
Sunday.
5   Fosamax one tablet a week.

ALLERGIES: She had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Rheumatic aortic stenosis,Heart valve replaced by transplant,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Pure hypercholesterolemia,Unspecified essential hypertension
Rheumat aortic stenosis,Heart valve transplant,Atrial fibrillation,Chr airway obstruct NEC,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2133-9-9**]       Discharge Date:  [**2133-9-15**]


Service: cardiothoracic surgery.

HISTORY OF PRESENT ILLNESS:   Briefly, this is a 79 year old
woman with a previous history of scarlet fever status post
[**Last Name (un) 3843**]-[**Doctor Last Name **] mitral valve for mitral stenosis in [**2126**].
At the time of her surgery, she was found to have normal
coronaries with normal aortic valve.  She also had a history
of atrial fibrillation which had been managed on Coumadin.
In the past year, she had been complaining of fatigue and
increasing shortness of breath while walking and exertion.
She denied any chest pain, palpitations, dizziness or
syncope.  Echocardiogram revealed biatrial enlargement,
severe aortic stenosis with an aortic valve area of 0.6
centimeters, concentric left ventricular hypertrophy with
normal left ventricular function, moderate tricuspid
regurgitation and moderate pulmonic regurgitation.

The patient was taken to the Cardiac Catheterization
Laboratory for evaluation of her aortic valve as well as
evaluation of her coronary arteries.

PAST MEDICAL HISTORY:
1.  Scarlet fever.
2.  Atrial fibrillation.
3.  Prior transient ischemic attacks with mild carotid
disease noted on recent testing.
4.  Hypertension.
5.  High cholesterol.
6.  Obstructive pulmonary disease noted on chest x-ray.

PAST SURGICAL HISTORY:
1.  Hernia repair.
2.  Mitral valve replacement.
3.  Elbow surgery.

ALLERGIES:   She had no known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Aspirin 81 mg p.o. q. day.
2.  Lipitor 10 mg p.o. q. day.
3.  Toprol 100 mg p.o. twice a day.
4.  Coumadin 2.5 mg Monday through Saturday and none on
Sunday.
5   Fosamax one tablet a week.

LABORATORY:  On admission white blood cell count was 9.1,
hematocrit was 38.0 and her platelets were 299.  Her sodium
was 140, potassium of 4.8, chloride 104, bicarbonate of 29,
BUN of 24, creatinine 1.1 with an INR of 1.3.

PHYSICAL EXAMINATION:   On physical examination, the patient
was afebrile and her vital signs were stable.  Her lungs were
clear to auscultation bilaterally.  Her neck was supple with
no jugular venous distention.  Her heart was irregularly
irregular with a loud systolic ejection murmur.

HOSPITAL COURSE:   The patient was taken to the Cardiac
Catheterization Laboratory and cardiac surgery consultation
at that time.  The patient was taken to the Operating Room on
[**2133-9-10**], where an aortic valve replacement was done using
a 19 centimeter pericardial valve.  The patient was
transferred to the CSRU postoperatively where she did well.

She was slowly weaned from her ventilator and extubated, all
of her drips of epinephrine and Nitroglycerin were stopped.
The patient was started on beta blockers and lasix at that
time.  The patient was transferred to the Floor
postoperatively where she continued to improve.

On postoperative day number two her chest tubes were removed
and her wires were removed.  The patient was started back on
her Coumadin for her atrial fibrillation and a chest x-ray
was done which was normal, however, showed a slightly
enlarged heart on x-ray.

Physical Therapy was consulted at this time for testing of
ambulation and it was felt that the patient could possible be
able to be discharged home.  The patient continued to improve
and Coumadin was continued at her regular dose and was
followed, and her INR was slowly increased.  The patient did
well with Physical Therapy and it was felt that that time
that the patient could be discharged home when medically
cleared. A cardiac echo performed [**2133-9-14**] showed normal LV
function and good aortic and mitral prosthetic valve function.

DISCHARGE MEDICATIONS:
1.  Aspirin 81 mg p.o. q. day.
2.  Albuterol one nebulizer q. six hours p.r.n.
3.  Lipitor 10 mg p.o. q. day.
4.  Coumadin 2.5 mg p.o. q. h.s. times six days a week.
5.  Percocet one to two tablets p.o. q. four hours p.r.n.
6.  Zantac 150 p.o. twice a day.
7.  Colace 100 mg p.o. twice a day.
8.  [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mEq p.o. twice a day.
9.  Lasix 20 mg p.o. twice a day.
10. Lopressor 25 mg p.o. twice a day.

CONDITION ON DISCHARGE:   The patient is discharged home in
stable condition.

DISCHARGE INSTRUCTIONS:
1.  She is instructed to follow-up with Dr. [**Last Name (STitle) **] in four
weeks.
2.  She is instructed to follow-up with her primary care
physician in one to two weeks.
3.  To follow-up with Cardiology in two to four weeks.

DISCHARGE DIAGNOSES:
1.  Scarlet fever.
2.  Atrial fibrillation.
3.  Mitral valve regurgitation status post mitral valve
repair.
4.  Aortic stenosis status post aortic valve repair.
5.  Prior transient ischemic attacks.
6.  Hypertension.
7.  High cholesterol.
8.  Chronic obstructive pulmonary disease on chest x-ray.

The patient is discharged home in stable condition.

Please see Addendum for any changes in medications and
correct discharge date.


                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern4) 7148**]
MEDQUIST36

D:  [**2133-9-13**]  22:10
T:  [**2133-9-14**]  05:02
JOB#:  [**Job Number 41721**]
1
1
1
DR
{'Rheumatic aortic stenosis,Heart valve replaced by transplant,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Pure hypercholesterolemia,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: Briefly, this is a 79 year old
woman with a previous history of scarlet fever status post
[**Last Name (un) 3843**]-[**Doctor Last Name **] mitral valve for mitral stenosis in [**2126**].
At the time of her surgery, she was found to have normal
coronaries with normal aortic valve.  She also had a history
of atrial fibrillation which had been managed on Coumadin.
In the past year, she had been complaining of fatigue and
increasing shortness of breath while walking and exertion.
She denied any chest pain, palpitations, dizziness or
syncope.  Echocardiogram revealed biatrial enlargement,
severe aortic stenosis with an aortic valve area of 0.6
centimeters, concentric left ventricular hypertrophy with
normal left ventricular function, moderate tricuspid
regurgitation and moderate pulmonic regurgitation.

MEDICAL HISTORY: 1.  Scarlet fever.
2.  Atrial fibrillation.
3.  Prior transient ischemic attacks with mild carotid
disease noted on recent testing.
4.  Hypertension.
5.  High cholesterol.
6.  Obstructive pulmonary disease noted on chest x-ray.

MEDICATION ON ADMISSION: 1.  Aspirin 81 mg p.o. q. day.
2.  Lipitor 10 mg p.o. q. day.
3.  Toprol 100 mg p.o. twice a day.
4.  Coumadin 2.5 mg Monday through Saturday and none on
Sunday.
5   Fosamax one tablet a week.

ALLERGIES: She had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Rheumatic aortic stenosis,Heart valve replaced by transplant,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Pure hypercholesterolemia,Unspecified essential hypertension'}
