CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75 year-old
female who was initially admitted to the Coronary Care Unit
and then transferred to the [**Hospital Unit Name 196**] Service.  She has a history
of chronic atrial fibrillation, congestive heart failure,
mitral regurgitation, hypertension, BOOP and status post
recent left hip fracture repair.  The patient presented with
persistent worsening of shortness of breath.  In the
Emergency Department the patient was noted to be in rapid
atrial fibrillation and congestive heart failure.  After a
CTA to rule out PE was done the patient at that time
developed worsening hypoxia and was transiently on BiPAP and
went to the Coronary Care Unit.  After she was appropriately
rate controlled and diuresed the patient was transferred to
the floor for further management of her atrial fibrillation.

MEDICAL HISTORY: 1.  Congestive heart failure EF of 40 to 50%
2.  Moderate to severe mitral regurgitation.
3.  Hypertension.
4.  Chronic atrial fibrillation.
5.  BOOP treated with steroids complicated by steroid
psychosis.
6.  Glaucoma.
7.  OSA.
8.  History of falls.
9.  History of angiopathy.
10.  Status post cerebrovascular accident times three.
11.  Left hip fracture.

MEDICATION ON ADMISSION: 

ALLERGIES: Prednisone causes psychosis.  Tape and
Bacitracin

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Chronic airway obstruction, not elsewhere classified,Other specified alveolar and parietoalveolar pneumonopathies,Unspecified essential hypertension,Pure hypercholesterolemia
Atrial fibrillation,CHF NOS,Mitral valve disorder,Chr airway obstruct NEC,Alveol pneumonopathy NEC,Hypertension NOS,Pure hypercholesterolem
Name:  [**Known lastname 682**], [**Known firstname **] H                      Unit No:  [**Numeric Identifier 683**]

Admission Date:  [**2167-8-27**]     Discharge Date:  [**2167-9-2**]

Date of Birth:   [**2092-2-10**]     Sex:  F

Service:

Patient was watched overnight [**2167-9-1**] because of
some mental status changes.  The patient had two episodes of
vomiting without nausea that was treated with IV Zofran.
After Zofran was administered, patient had some somnolence
and nonfocal mental status changes consistent with delirium
secondary to medication.  Because of anticoagulation on
Coumadin and history of CVA, the patient was sent for head CT
which was negative for acute bleed and mass effect.

The patient was then watched overnight.  This a.m. the
patient was much improved with return of normal mental status
and nonfocal examination.  She was then discharged on
previous medications [**2167-9-2**] with appropriate
followup.


                      DR.[**First Name (STitle) 684**],[**First Name3 (LF) 448**] 12-953


Dictated By:[**Last Name (NamePattern1) 685**]

MEDQUIST36

D:  [**2167-9-2**]  08:29
T:  [**2167-9-2**]  08:36
JOB#:  [**Job Number 686**]


Admission Date:  [**2167-8-27**]     Discharge Date:  [**2167-9-2**]

Date of Birth:   [**2092-2-10**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 75 year-old
female who was initially admitted to the Coronary Care Unit
and then transferred to the [**Hospital Unit Name 196**] Service.  She has a history
of chronic atrial fibrillation, congestive heart failure,
mitral regurgitation, hypertension, BOOP and status post
recent left hip fracture repair.  The patient presented with
persistent worsening of shortness of breath.  In the
Emergency Department the patient was noted to be in rapid
atrial fibrillation and congestive heart failure.  After a
CTA to rule out PE was done the patient at that time
developed worsening hypoxia and was transiently on BiPAP and
went to the Coronary Care Unit.  After she was appropriately
rate controlled and diuresed the patient was transferred to
the floor for further management of her atrial fibrillation.

PAST MEDICAL HISTORY:
1.  Congestive heart failure EF of 40 to 50%
2.  Moderate to severe mitral regurgitation.
3.  Hypertension.
4.  Chronic atrial fibrillation.
5.  BOOP treated with steroids complicated by steroid
psychosis.
6.  Glaucoma.
7.  OSA.
8.  History of falls.
9.  History of angiopathy.
10.  Status post cerebrovascular accident times three.
11.  Left hip fracture.

ALLERGIES:  Prednisone causes psychosis.  Tape and
Bacitracin

MEDICATIONS AS AN OUTPATIENT:
1.  Lasix 20.
2.  Diltiazem 120 once a day.
3.  Lipitor 10 once a day.
4.  Coumadin 3 mg alternating with 1.5 mg every other day.
5.  Synthroid.
6.  Advair.
7.  Albuterol.
8.  Methazolamide.

PHYSICAL EXAMINATION:  The patient was afebrile 97.8.  Blood
pressure 140/70.  Heart rate 100.  Sating 96% on 2 liters
nasal cannula.  In general, the patient was calm and in no
acute distress.  Head and neck examination JVD noted 10 to 11
cm.  Heart irregular irregular, rapid heart with a systolic
murmur radiating to the apex.  Lungs crackles at bases
bilaterally.  Abdomen soft and nontender.  Extremities show
1+ edema bilaterally.

LABORATORY:  The patient had a hematocrit of 35.2, platelets
385, sodium 140, potassium 3.1, which went to 4.0 with
repletion, chloride 101, bicarb 28, BUN 15, creatinine .8,
glucose 84.  Negative cardiac enzymes.  TSH 3.2.  Chest x-ray
slight improvement in pulmonary edema.  More confluent area
of opacity in the right upper lobe zone.  CTA showed no
pulmonary embolism and patchy areas of ground glass
opacities.  Electrocardiogram on admission showed atrial
fibrillation with rapid ventricular response at 151, left
axis deviation.

HOSPITAL COURSE:  The patient was appropriately rate
controlled with Diltiazem and Lopressor.  The patient was
anticoagulated on heparin and sent for AV nodal ablation and
pacer placement.  The patient tolerated the procedure well
and had no further drop in hematocrit and was placed on a
three day course of antibiotics with follow up in the device
clinic.

Shortness of breath, the patient responded well with diuresis
with good O2 saturations and saturated well on room air.  She
is discharged on outpatient Lasix.

Urinary tract infection, the patient was found to have a
urinary tract infection on admission.  Will follow up with
course of Levofloxacin.

CONDITION ON DISCHARGE:  Fair.

DISCHARGE STATUS:  Home with services.

PRIMARY DIAGNOSIS:
Atrial fibrillation status post AV nodal ablation and pacer
placement.

SECONDARY DIAGNOSIS:
1.  Mitral regurgitation.
2.  Hypertension.
3.  BOOP.
4.  Glaucoma.
5.  Falls.
6.  Angiopathy.
7.  Cerebrovascular accident.
8.  Left hip fracture.
9.  Saphenous vein thrombosis.

DISCHARGE MEDICATIONS:
1.  Lipitor 10 mg once a day.
2.  Levofloxacin 88 micrograms alternating with 100
micrograms once a day.
3.  Ipratropium meter dose inhaler.
4.  Methazolamide 25 mg twice a day.
5.  Bromanantine drops twice a day.
6.  Prednisolone drops once a day and twice a day.
7.  Coumadin 3 mg once a day, please follow up at PT/[**Hospital 263**]
clinic in one week.
8.  Promethazine 25 mg q 6 hours as needed for nausea and
vomiting.
9.  Lisinopril 20 mg once a day.
10.  Levofloxacin 500 mg once a day times three days.
11.  Protonix 40 mg once a day.
12.  Docusate 100 mg twice a day as needed for constipation.
13.  Aspirin enteric coated 325 mg once a day.

FOLLOW UP PLANS:  The patient will follow up with her primary
care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 120**], call to schedule an appointment
within one week for check for PT/INR.  The patient will also
follow up at the vice clinic.  The patient will have home
services, which included skilled nursing, medical social work
and physical therapy.  The patient was told that if she had
any shortness of breath, recurrent nausea, vomiting, chest
pain, or other concerning symptoms that she should call her
primary care physician or return to the Emergency Department.







                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D.  [**MD Number(1) 5211**]

Dictated By:[**Last Name (NamePattern1) 5815**]

MEDQUIST36

D:  [**2167-9-2**]  04:20
T:  [**2167-9-4**]  12:39
JOB#:  [**Job Number 5816**]
{'Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Chronic airway obstruction, not elsewhere classified,Other specified alveolar and parietoalveolar pneumonopathies,Unspecified essential hypertension,Pure hypercholesterolemia'}


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 who was initially admitted to the Coronary Care Unit
and then transferred to the [**Hospital Unit Name 196**] Service.  She has a history
of chronic atrial fibrillation, congestive heart failure,
mitral regurgitation, hypertension, BOOP and status post
recent left hip fracture repair.  The patient presented with
persistent worsening of shortness of breath.  In the
Emergency Department the patient was noted to be in rapid
atrial fibrillation and congestive heart failure.  After a
CTA to rule out PE was done the patient at that time
developed worsening hypoxia and was transiently on BiPAP and
went to the Coronary Care Unit.  After she was appropriately
rate controlled and diuresed the patient was transferred to
the floor for further management of her atrial fibrillation.

MEDICAL HISTORY: 1.  Congestive heart failure EF of 40 to 50%
2.  Moderate to severe mitral regurgitation.
3.  Hypertension.
4.  Chronic atrial fibrillation.
5.  BOOP treated with steroids complicated by steroid
psychosis.
6.  Glaucoma.
7.  OSA.
8.  History of falls.
9.  History of angiopathy.
10.  Status post cerebrovascular accident times three.
11.  Left hip fracture.

MEDICATION ON ADMISSION: 

ALLERGIES: Prednisone causes psychosis.  Tape and
Bacitracin

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Chronic airway obstruction, not elsewhere classified,Other specified alveolar and parietoalveolar pneumonopathies,Unspecified essential hypertension,Pure hypercholesterolemia'}
