CHIEF COMPLAINT: Nose bleed.

PRESENT ILLNESS: The patient is a 51-year-old man
who developed epistaxis in the right naris three days prior
to presentation on blowing his nose.  The patient takes
warfarin to maintain anticoagulation after aortic valve
replacement secondary to rheumatic heart disease.  The
patient's neighbor brought him to the [**Name (NI) 4527**]
Hospital where his INR was found 12.2.  His nose was packed
there.  He received two units of fresh frozen plasma and two
units of packed red blood cells.  On presentation his
hematocrit was 28 and it dropped to a nadir of 22.  He had an
epistaxis balloon placed temporarily, however, he developed
dizziness and lightheadedness and had to have it removed.  He
also reports having had black stools and melena.

MEDICAL HISTORY: 1.  Rheumatic heart disease status post aortic valve
replacement on [**2114-9-20**].  He has a 23 St. [**Male First Name (un) 923**]
mechanical valve.  The procedure was complicated by right eye
blindness secondary to embolization perioperatively.
2.  Cardiac catheterization revealed moderate to severe
pulmonary hypertension with dilation of the ascending aorta.
3.  Congenital absence of the right kidney.
4.  Left shoulder injury sustained in [**2111**] after a mechanical
fall.

MEDICATION ON ADMISSION: 1.  Warfarin 5 to 7.5 mg q. day.  The patient states his last
INR check was two weeks prior to admission at the outside
hospital.
2.  Metoprolol unknown dose.

ALLERGIES: No known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His mother died of a myocardial infarction
at age 56.

SOCIAL HISTORY: The patient is an investment specialist for
a bank.  He last held a job in [**2114-9-2**].  He is a heavy
drinker of approximately two quarts per day of rum and Coke.
He smokes two packs per day of tobacco.  He started smoking
at age 25.  He is divorced and has an 18-year-old daughter
and 16-year-old son and a girlfriend.  His ex-wife is
supportive.
Blood in stool,Acute posthemorrhagic anemia,Other and unspecified alcohol dependence, unspecified,Epistaxis,Enthesopathy of hip region,Abnormal coagulation profile,Long-term (current) use of anticoagulants,Tobacco use disorder,Unspecified essential hypertension
Blood in stool,Ac posthemorrhag anemia,Alcoh dep NEC/NOS-unspec,Epistaxis,Enthesopathy of hip,Abnrml coagultion prfile,Long-term use anticoagul,Tobacco use disorder,Hypertension NOS
Admission Date:  [**2114-12-25**]       Discharge Date:  [**2115-1-6**]

Date of Birth:                    Sex:  M

Service:

CHIEF COMPLAINT:  Nose bleed.

HISTORY OF PRESENT ILLNESS:  The patient is a 51-year-old man
who developed epistaxis in the right naris three days prior
to presentation on blowing his nose.  The patient takes
warfarin to maintain anticoagulation after aortic valve
replacement secondary to rheumatic heart disease.  The
patient's neighbor brought him to the [**Name (NI) 4527**]
Hospital where his INR was found 12.2.  His nose was packed
there.  He received two units of fresh frozen plasma and two
units of packed red blood cells.  On presentation his
hematocrit was 28 and it dropped to a nadir of 22.  He had an
epistaxis balloon placed temporarily, however, he developed
dizziness and lightheadedness and had to have it removed.  He
also reports having had black stools and melena.

Of note, the patient is a chronic alcohol abuser.  His last
drink was two to three days prior to presentation.  In
addition to the blood products stated above, the patient
received subcutaneous vitamin K (5 mg on [**2114-12-24**]).

PAST MEDICAL HISTORY:
1.  Rheumatic heart disease status post aortic valve
replacement on [**2114-9-20**].  He has a 23 St. [**Male First Name (un) 923**]
mechanical valve.  The procedure was complicated by right eye
blindness secondary to embolization perioperatively.
2.  Cardiac catheterization revealed moderate to severe
pulmonary hypertension with dilation of the ascending aorta.
3.  Congenital absence of the right kidney.
4.  Left shoulder injury sustained in [**2111**] after a mechanical
fall.

MEDICATIONS ON ADMISSION:
1.  Warfarin 5 to 7.5 mg q. day.  The patient states his last
INR check was two weeks prior to admission at the outside
hospital.
2.  Metoprolol unknown dose.

ALLERGIES:  No known allergies.

FAMILY HISTORY:  His mother died of a myocardial infarction
at age 56.

SOCIAL HISTORY:  The patient is an investment specialist for
a bank.  He last held a job in [**2114-9-2**].  He is a heavy
drinker of approximately two quarts per day of rum and Coke.
He smokes two packs per day of tobacco.  He started smoking
at age 25.  He is divorced and has an 18-year-old daughter
and 16-year-old son and a girlfriend.  His ex-wife is
supportive.

In addition to the blood products stated above, the patient
was placed on a CIWA scale for ethanol withdrawal.  He was
transferred to the [**Hospital1 69**] for
further evaluation.

PHYSICAL EXAMINATION:  Temperature 97.2, heart rate 93, blood
pressure 124/69, oxygen saturation 99%.  Generally, he is a
very pleasant middle-aged man in no acute distress.  HEENT:
Crusted blood in the right nostril.  Oropharynx clear and
moist.  Chest clear to auscultation bilaterally.  Heart
regular rate and rhythm.  Normal S1.  Loud mechanical S2.
There are no murmurs.  Abdomen soft, non-tender,
non-distended.  There is no organomegaly.  Extremities:
There is no edema.

LABORATORY EVALUATION:  White blood cell count 5.7,
hematocrit 26.9, platelets 107, INR 2.5.  Chemistry panel is
unremarkable.

HOSPITAL COURSE:  Initially the patient was admitted to the
Medical Intensive Care Unit for treatment of his acute lower
gastrointestinal bleed and reversal of anticoagulation.  His
hematocrit remained stable and he was then transferred to the
medical floor one day after admission.

Of note, the patient's INR had a nadir of 0.9 because of the
aggressive reversal of anticoagulation received at the
outside hospital.  He was started on a continuous heparin
infusion for the remainder of the hospital course until the
INR approached 2.0.  It was 1.9 on the day of discharge.

The remainder of his hospital course was marked by the
absence of any withdrawal symptoms.  CIWA scale was
discontinued shortly after transfer to the Medical floor.
Metoprolol was continued for his heart disease.  On hospital
day eight the patient complained of hip pain and was
diagnosed with trochanteric bursitis.  He underwent injection
of the joint with adequate relief.  He was discharged with
follow up two days after discharge to recheck his INR.

DISCHARGE DIAGNOSES:
1.  Lower gastrointestinal bleed secondary to
supratherapeutic INR.
2.  Rheumatic heart disease status post aortic valve
replacement on [**2114-9-20**].  He has a 23 St. [**Male First Name (un) 923**]
mechanical valve.  The procedure was complicated by right eye
blindness secondary to embolization perioperatively.
3.  Cardiac catheterization revealed moderate to severe
pulmonary hypertension with dilation of the ascending aorta.
4.  Congenital absence of the right kidney.
5.  Left shoulder injury sustained in [**2111**] after a mechanical
fall.




                            [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**], M.D.  [**MD Number(1) 736**]

Dictated By:[**Name8 (MD) 7102**]
MEDQUIST36

D:  [**2115-4-25**]  15:07
T:  [**2115-4-25**]  13:58
JOB#:  [**Job Number 44002**]
{'Blood in stool,Acute posthemorrhagic anemia,Other and unspecified alcohol dependence, unspecified,Epistaxis,Enthesopathy of hip region,Abnormal coagulation profile,Long-term (current) use of anticoagulants,Tobacco use disorder,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: Nose bleed.

PRESENT ILLNESS: The patient is a 51-year-old man
who developed epistaxis in the right naris three days prior
to presentation on blowing his nose.  The patient takes
warfarin to maintain anticoagulation after aortic valve
replacement secondary to rheumatic heart disease.  The
patient's neighbor brought him to the [**Name (NI) 4527**]
Hospital where his INR was found 12.2.  His nose was packed
there.  He received two units of fresh frozen plasma and two
units of packed red blood cells.  On presentation his
hematocrit was 28 and it dropped to a nadir of 22.  He had an
epistaxis balloon placed temporarily, however, he developed
dizziness and lightheadedness and had to have it removed.  He
also reports having had black stools and melena.

MEDICAL HISTORY: 1.  Rheumatic heart disease status post aortic valve
replacement on [**2114-9-20**].  He has a 23 St. [**Male First Name (un) 923**]
mechanical valve.  The procedure was complicated by right eye
blindness secondary to embolization perioperatively.
2.  Cardiac catheterization revealed moderate to severe
pulmonary hypertension with dilation of the ascending aorta.
3.  Congenital absence of the right kidney.
4.  Left shoulder injury sustained in [**2111**] after a mechanical
fall.

MEDICATION ON ADMISSION: 1.  Warfarin 5 to 7.5 mg q. day.  The patient states his last
INR check was two weeks prior to admission at the outside
hospital.
2.  Metoprolol unknown dose.

ALLERGIES: No known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His mother died of a myocardial infarction
at age 56.

SOCIAL HISTORY: The patient is an investment specialist for
a bank.  He last held a job in [**2114-9-2**].  He is a heavy
drinker of approximately two quarts per day of rum and Coke.
He smokes two packs per day of tobacco.  He started smoking
at age 25.  He is divorced and has an 18-year-old daughter
and 16-year-old son and a girlfriend.  His ex-wife is
supportive. 

### Response:
{'Blood in stool,Acute posthemorrhagic anemia,Other and unspecified alcohol dependence, unspecified,Epistaxis,Enthesopathy of hip region,Abnormal coagulation profile,Long-term (current) use of anticoagulants,Tobacco use disorder,Unspecified essential hypertension'}
