CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 3234**] is 46-year-old
Spanish speaking male with a past medical history of
rheumatic heart disease who on admission was postoperative
day number 11, status post mitral valve replacement and
aortic valve replacement after having been ruled out for
infectious endocarditis.  His postoperative course was
complicated by atrial fibrillation.  This was first noticed
on postoperative day number one with rapid atrial
fibrillation at 140 with left bundle branch block and the
patient was started on amiodarone 400 mg po t.i.d. on that
day [**2104-10-23**].  The patient was then discharged to
home five days prior to admission, and then three days prior
to this admission, the patient presented to his primary care
physician complaining of palpitations and was directed to
decrease his amiodarone to 400 mg b.i.d. and increase his
Lopressor dose to 75 mg b.i.d.  For the next two days until
the day of admission, the patient complained of feeling more
lethargic and not himself.

MEDICAL HISTORY: Rheumatic heart disease diagnosed at
age 15, status post aortic valve replacement, mitral valve
replacement on [**2104-10-22**].  Cardiac catheterization
on [**2104-10-17**] showed normal coronary arteries.
Echocardiogram Obtained [**2104-9-16**] in [**Male First Name (un) 1056**] showed
left ventricular function of 40-45% with diminished aortic
and mitral valve areas.

MEDICATION ON ADMISSION: Amiodarone 400 mg b.i.d., Coumadin
and Lopressor 75 mg b.i.d.

ALLERGIES: Patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has a remote history of tobacco
use, stopped 23 years ago and a remote history of ethanol
use, stopped 20 years ago.  Patient has recently moved from
[**Male First Name (un) 1056**] for his valve surgery and lives with his wife and
children.  He is presently disabled.
First degree atrioventricular block,Atrial fibrillation,Acquired hemolytic anemia, unspecified,Other complications due to other cardiac device, implant, and graft,Functional disturbances following cardiac surgery,Rheumatic heart disease, unspecified,Heart valve replaced by other means,Hypocalcemia,Other antihypertensive agents causing adverse effects in therapeutic use
Atriovent block-1st degr,Atrial fibrillation,Acq hemolytic anemia NOS,Comp-oth cardiac device,Hrt dis postcardiac surg,Rheumatic heart dis NOS,Heart valve replac NEC,Hypocalcemia,Adv eff antihyperten agt
Admission Date:  [**2104-11-2**]     Discharge Date:  [**2104-11-13**]

Date of Birth:   [**2057-11-6**]     Sex:  M

Service:  CARDIOLOGY

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 3234**] is 46-year-old
Spanish speaking male with a past medical history of
rheumatic heart disease who on admission was postoperative
day number 11, status post mitral valve replacement and
aortic valve replacement after having been ruled out for
infectious endocarditis.  His postoperative course was
complicated by atrial fibrillation.  This was first noticed
on postoperative day number one with rapid atrial
fibrillation at 140 with left bundle branch block and the
patient was started on amiodarone 400 mg po t.i.d. on that
day [**2104-10-23**].  The patient was then discharged to
home five days prior to admission, and then three days prior
to this admission, the patient presented to his primary care
physician complaining of palpitations and was directed to
decrease his amiodarone to 400 mg b.i.d. and increase his
Lopressor dose to 75 mg b.i.d.  For the next two days until
the day of admission, the patient complained of feeling more
lethargic and not himself.

On the morning of admission, he became lightheaded, called
EMT and was found to be bradycardic with a heart rate in the
20s.  EMTs suspected beta blocker overdose, gave glucagon
which resulted in stabilization of heart rate to the 60s.
The patient was then brought to [**Hospital6 2018**].  The patient had recently been admitted on [**2104-10-8**] for fevers and endocarditis was suspected.  Blood
cultures were negative but erythrocyte sedimentation rate and
C reactive protein were high.  The patient was presumptively
treated with antibiotics after being ruled out for
endocarditis by blood cultures and echocardiography, the
patient underwent aortic valve replacement and mitral valve
replacement.  Catheterization results showed a calcific
valvulopathy and rare growth of coag negative Staph from the
aortic valve.

REVIEW OF SYSTEMS:  The patient complained of subjective
fevers at night twice since his discharge on [**10-28**]
without cough, headache, chest pain, nausea, vomiting and he
denied noticing any blood and urine or stools.

PAST MEDICAL HISTORY:  Rheumatic heart disease diagnosed at
age 15, status post aortic valve replacement, mitral valve
replacement on [**2104-10-22**].  Cardiac catheterization
on [**2104-10-17**] showed normal coronary arteries.
Echocardiogram Obtained [**2104-9-16**] in [**Male First Name (un) 1056**] showed
left ventricular function of 40-45% with diminished aortic
and mitral valve areas.

ALLERGIES:  Patient has no known drug allergies.

MEDICATIONS ON ADMISSION:  Amiodarone 400 mg b.i.d., Coumadin
and Lopressor 75 mg b.i.d.

SOCIAL HISTORY:  The patient has a remote history of tobacco
use, stopped 23 years ago and a remote history of ethanol
use, stopped 20 years ago.  Patient has recently moved from
[**Male First Name (un) 1056**] for his valve surgery and lives with his wife and
children.  He is presently disabled.

PHYSICAL EXAM ON ADMISSION:  He was afebrile.  Temperature of
96.5.  Pulse 57-60.  Blood pressure 105/66.  Respiratory rate
16, breathing 97% on two liters.  In general, he appeared his
stated age, was in no apparent distress.  His lungs were
clear to auscultation bilaterally.  His jugular venous pulse
was at 5-6 cm.  Carotids had no bruits.  Heart was regular
rate and rhythm, metallic S1, decrescendo [**3-4**] murmur, did not
radiate, metallic S2.  TMI was diffuse laterally displaced
and his chest wound was clean, dry and intact.  Abdomen
exhibited normal active bowel sounds, soft, nontender,
nondistended, no hepatosplenomegaly.  Extremities were
without edema.  Radial pulses were 2+ bilaterally.

LABORATORIES ON ADMISSION:  Remarkable for potassium 4.5,
creatinine 1.0, hematocrit of 28.3 with 6.4% eosinophils.
His INR was 4.3.  Albumin was 3.2.  His electrocardiogram on
admission was sinus rate at 63, PR interval was prolonged,
280-312 ms, QRS 176 ms.  [**Name14 (STitle) **] 500 ms.  Axis was slightly left
deviated at -33 with a left bundle branch block and marked
left atrial enlargement.

Echocardiography from [**2104-10-9**] showed left atrium
5.4 x 8 cm.  Right atrium 6.6 cm.  LV 6.0/4.5.  Left
ventricular ejection fraction of 50-55%, a dilated left
ventricle, 2+ aortic regurgitation, 3+ mitral regurgitation,
mild to moderate aortic stenosis, 1+ tricuspid regurgitation.
Note that this echocardiogram was obtained prior to his
mitral valve replacement and aortic valve replacement.

HOSPITAL COURSE:  The patient was admitted for observation of
his heart block and evaluation by the Electrophysiology
Service.  For his cardiac issues number one was history of
atrial fibrillation.  Patient was deemed to need to continue
treatment with amiodarone and beta blocker and thus it was
decided that he would need a DDD pacer since he was
exhibiting sensitivity to amiodarone and Lopressor in terms
of his AV node function.  Once the patient's INR was less
than 1.5, the patient underwent pacemaker implantation on
[**2104-11-7**].  The patient tolerated the procedure
without event and his heart rate remained AV paced in the 70s
with blood pressures 100-110 systolic/50s-60s diastolic
throughout his admission.  His other issue on admission was
complaint of subjective fevers with a history of rheumatic
heart disease and previously being ruled out for
endocarditis, so, it was decided to obtain three sets of
blood cultures 12 hours apart to again check for endocarditis
which were negative throughout his stay.  He also received a
transesophageal echocardiogram which was negative for
valvular vegetations and negative for a valve leak.

Hematology:  During the hospitalization, the patient
exhibited a hemolytic anemia with low haptoglobin, high LDH
and a reticulocyte index that suggested an inadequate marrow
response.  There was no perivalvular leak which could explain
the hemolytic anemia and it is recommended that the patient's
hematocrit be followed and his anemia worked up as an
outpatient.  The patient received two units of packed red
blood cells to keep his hematocrit above 25% during this
admission.  The patient also was found during this admission
to have a right upper lobe friction rub.  By chest x-ray,
there was no evidence of infiltrate or other abnormality and
it was suggested that this patient has post pericardotomy
syndrome with a pleural pericarditis that would explain the
friction rub, erythrocyte sedimentation rate, high C reactive
protein and intermittent subjective fevers.  The patient was
briefly treated with Motrin 800 mg times two doses which
caused an elevation in his creatinine from 0.9 to 1.7.  The
Motrin was held.  The patient was given one liter of normal
saline intravenous fluids.  Urinalysis was consistent with
non-steroidal anti-inflammatory drugs toxicity, positive for
eosinophils.

Following discontinuation of Motrin, the patient's creatinine
returned to baseline and was 1.0 on the day of discharge.
The [**Hospital 228**] hospital course was also complicated by
hematoma in the pacer pocket in the setting of heparin and
Coumadin.  The hematoma was observed, immobilized with a
pressure dressing and stabilized on [**11-11**] with an INR of
2.3.  The heparin was discontinued.  The INR remained
therapeutic through the day of discharge [**11-13**] with an
INR of 3.0.  Goal INR because of this patient's mechanical
valves is 2.5 to 3.5.  It was also noted during this hospital
stay, that this patient's heart rate is extremely sensitive
to beta blockers and it is recommended that his Atenolol dose
not be increased above 25 mg po q.d.  The patient remained in
normal sinus rhythm AV paced during  his hospital stay with
no evidence of atrial fibrillation.  He was discharged in
good condition with follow-up Monday, [**11-17**] at 12 noon
with the Pacemaker Device Clinic and with Dr. [**First Name (STitle) **] of [**Hospital6 6613**] East on [**11-27**], at 4 p.m.

DISCHARGE DIAGNOSES:
1.  Heart block, status post pacemaker implantation.
2.  Post pericardotomy, pleural pericarditis syndrome.
3   Rheumatic heart disease, status post aortic valve
replacement, mitral valve replacement.
4   Pacemaker pocket hematoma.

MEDICATIONS ON DISCHARGE:
1.  Zestril 10 mg po per day.
2.  Coumadin 3 mg po per day with target INR of 2.5 to 3.5.
3   Amiodarone 400 mg po per day.
4.  Atenolol 25 mg po per day.

FOLLOW-UP:  Patient will need follow-up with [**Hospital 197**] Clinic
and it was recommended that he have VNA visits for a few days
after discharge for medication teaching and pacer pocket
follow-up.  Pressure dressing to stay in place until
appointment with the [**Hospital 19721**] Clinic on [**11-17**].

DISCHARGE STATUS:  Full code.








                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4582**], M.D.  [**MD Number(1) 4992**]

Dictated By:[**Name8 (MD) 4430**]

MEDQUIST36

D:  [**2104-11-13**]  14:16
T:  [**2104-11-13**]  14:16
JOB#:  [**Job Number 94837**]
{'First degree atrioventricular block,Atrial fibrillation,Acquired hemolytic anemia, unspecified,Other complications due to other cardiac device, implant, and graft,Functional disturbances following cardiac surgery,Rheumatic heart disease, unspecified,Heart valve replaced by other means,Hypocalcemia,Other antihypertensive agents causing adverse effects in therapeutic use'}


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 3234**] is 46-year-old
Spanish speaking male with a past medical history of
rheumatic heart disease who on admission was postoperative
day number 11, status post mitral valve replacement and
aortic valve replacement after having been ruled out for
infectious endocarditis.  His postoperative course was
complicated by atrial fibrillation.  This was first noticed
on postoperative day number one with rapid atrial
fibrillation at 140 with left bundle branch block and the
patient was started on amiodarone 400 mg po t.i.d. on that
day [**2104-10-23**].  The patient was then discharged to
home five days prior to admission, and then three days prior
to this admission, the patient presented to his primary care
physician complaining of palpitations and was directed to
decrease his amiodarone to 400 mg b.i.d. and increase his
Lopressor dose to 75 mg b.i.d.  For the next two days until
the day of admission, the patient complained of feeling more
lethargic and not himself.

MEDICAL HISTORY: Rheumatic heart disease diagnosed at
age 15, status post aortic valve replacement, mitral valve
replacement on [**2104-10-22**].  Cardiac catheterization
on [**2104-10-17**] showed normal coronary arteries.
Echocardiogram Obtained [**2104-9-16**] in [**Male First Name (un) 1056**] showed
left ventricular function of 40-45% with diminished aortic
and mitral valve areas.

MEDICATION ON ADMISSION: Amiodarone 400 mg b.i.d., Coumadin
and Lopressor 75 mg b.i.d.

ALLERGIES: Patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has a remote history of tobacco
use, stopped 23 years ago and a remote history of ethanol
use, stopped 20 years ago.  Patient has recently moved from
[**Male First Name (un) 1056**] for his valve surgery and lives with his wife and
children.  He is presently disabled. 

### Response:
{'First degree atrioventricular block,Atrial fibrillation,Acquired hemolytic anemia, unspecified,Other complications due to other cardiac device, implant, and graft,Functional disturbances following cardiac surgery,Rheumatic heart disease, unspecified,Heart valve replaced by other means,Hypocalcemia,Other antihypertensive agents causing adverse effects in therapeutic use'}
