CHIEF COMPLAINT: AS, PAF

PRESENT ILLNESS: Patient is a 84 year old female with a history of PAF, HTN and
AS who presented to an OSH one day PTA with SOB and
palpitations. SHw was found to be in afib in the 150s. She was
transferred to [**Hospital1 18**] for cardiac catheterization and surgical
evaluation.

MEDICAL HISTORY: HTN
AF
s/p TAH [**2099**]
s/p right ORIF [**2121**]
AS

MEDICATION ON ADMISSION: Digoxin, verapamil, lopressor, colace, levoxyl, coumadin(3 alt
with 4), lasix

ALLERGIES: Heparin Agents

PHYSICAL EXAM: On discharge:
Afebrile, BP 128/88, HR 89, AFib, 93% on RA
Irreg, irreg, no m/r/g
Lungs CTAB, min crackles
+1 BLE edema, some mottling (baseline), large ecchymotic area on
LUE
Neurologically grossly intact
Abdomin soft non tender and nondistended
Midsternal incision clean dry and intact

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: retired
No tobacco
No Etoh
No IVDA
Mitral valve insufficiency and aortic valve stenosis,Atrial fibrillation,Rheumatic heart failure (congestive),Urinary tract infection, site not specified,Other vascular complications of medical care, not elsewhere classified,Phlebitis and thrombophlebitis of upper extremities, unspecified,Cellulitis and abscess of upper arm and forearm,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified acquired hypothyroidism
Mitral insuf/aort stenos,Atrial fibrillation,Rheumatic heart failure,Urin tract infection NOS,Vasc comp med care NEC,Phlbts vn NOS up extrm,Cellulitis of arm,Abnrml coagultion prfile,Adv eff anticoagulants,Crnry athrscl natve vssl,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2123-7-4**]              Discharge Date:   [**2123-7-28**]


Service: CARDIOTHORACIC

Allergies:
Heparin Agents

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
AS, PAF

Major Surgical or Invasive Procedure:
[**7-16**] AVR, MVRepair, MAZE


History of Present Illness:
Patient is a 84 year old female with a history of PAF, HTN and
AS who presented to an OSH one day PTA with SOB and
palpitations. SHw was found to be in afib in the 150s. She was
transferred to [**Hospital1 18**] for cardiac catheterization and surgical
evaluation.

Past Medical History:
HTN
AF
s/p TAH [**2099**]
s/p right ORIF [**2121**]
AS

Social History:
retired
No tobacco
No Etoh
No IVDA


Family History:
Non contributory

Physical Exam:
On discharge:
Afebrile, BP 128/88, HR 89, AFib, 93% on RA
Irreg, irreg, no m/r/g
Lungs CTAB, min crackles
+1 BLE edema, some mottling (baseline), large ecchymotic area on
LUE
Neurologically grossly intact
Abdomin soft non tender and nondistended
Midsternal incision clean dry and intact


Pertinent Results:
[**2123-7-27**] 01:12AM BLOOD WBC-9.2 RBC-4.19* Hgb-12.7 Hct-37.4
MCV-89 MCH-30.4 MCHC-34.0 RDW-13.9 Plt Ct-215
[**2123-7-27**] 01:12AM BLOOD PT-16.3* INR(PT)-1.8
[**2123-7-27**] 01:12AM BLOOD Glucose-83 UreaN-30* Creat-0.9 Na-138
K-4.1 Cl-99 HCO3-31 AnGap-12

Brief Hospital Course:
An Echo done on [**7-5**] demonstrated AS with peak gradient 102,
mean gradient of 72, estimated valve area of 0.6cm2, 3+ MR, and
EF of 55%. Held coumadin in prep for cardiac cath, which she
received on [**7-7**], demonstrating AO valve area of 0.4 cm, peak
grad 50; CO/CI of 2.99/1.71 (3.63/2.99 with dobuta); RA 11; RV
38/10; PA 38/30; PCWP 24. LV gram with preserved Ef and inf
apical and mid ant-lat HK. Coronary angiogram revealed nl LMCA,
50-60% small diag off of lad and 40-50% rca without any flow
limiting dz.
After results of the cath were known, cardiothoracic surgery was
consulted for AVR/MVR surgery.  She awaited preop workup, and
normalization of INR.

Post operatively she was transferred to the icu in critical but
stable condition on epi, milrinone, norepi, amio and propofol.
She was extubated on post op day 4, and her drips were weaned to
off by post op day 6, however she was placed on natrecor.
She was seen in consultation by electrophysiology for rate
control who recommended diltiazem beta blockade and amiodarone,
with follow up in 6 weeks for possible cardioversion.

She was given a 7 day course of vancomycin and levofloxacin for
sputum cultures positive for MRSA and gram negative rods.

She was HIT + without clinical signs and was anticoagulated with
coumadin already for her atrial fibbrilation.

Medications on Admission:
Digoxin, verapamil, lopressor, colace, levoxyl, coumadin(3 alt
with 4), lasix

Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 5 days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
8. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
9. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
Disp:*1 Inh* Refills:*2*
10. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 Inh* Refills:*2*
11. Levothyroxine Sodium 25 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Warfarin Sodium 1 mg Tablet Sig: Three (3) Tablet PO once a
day for 1 doses: Please check INR on [**7-29**], and PRN.
Disp:*30 Tablet(s)* Refills:*0*
13. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 5
days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
Lifecare of [**Location 15289**]

Discharge Diagnosis:
AS, MR, Afib
PAF
CHF
HTN
Hypothyroid
s/p TAH
s/p hip and leg surgery


Discharge Condition:
Good.

Discharge Instructions:
No driving or lifting more than 10 pounds until follow up
appointment or while taking pain medication.
Call with temperature more than 100.5, redness or drainage from
incision, or weight gain greater than 2 pounds in 1 day or 5 in
1 week.
Shower, wash incision with mild soap and water and pat dry, no
lotions, creams or powders, no baths, keep covered when in the
sun.

Followup Instructions:
Dr. [**Last Name (STitle) **] 4 weeks
Dr. [**Last Name (STitle) 29478**] 1-2 weeks
Dr. [**Last Name (STitle) **] 1-2 weeks



Completed by:[**2123-7-28**]
{'Mitral valve insufficiency and aortic valve stenosis,Atrial fibrillation,Rheumatic heart failure (congestive),Urinary tract infection, site not specified,Other vascular complications of medical care, not elsewhere classified,Phlebitis and thrombophlebitis of upper extremities, unspecified,Cellulitis and abscess of upper arm and forearm,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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: AS, PAF

PRESENT ILLNESS: Patient is a 84 year old female with a history of PAF, HTN and
AS who presented to an OSH one day PTA with SOB and
palpitations. SHw was found to be in afib in the 150s. She was
transferred to [**Hospital1 18**] for cardiac catheterization and surgical
evaluation.

MEDICAL HISTORY: HTN
AF
s/p TAH [**2099**]
s/p right ORIF [**2121**]
AS

MEDICATION ON ADMISSION: Digoxin, verapamil, lopressor, colace, levoxyl, coumadin(3 alt
with 4), lasix

ALLERGIES: Heparin Agents

PHYSICAL EXAM: On discharge:
Afebrile, BP 128/88, HR 89, AFib, 93% on RA
Irreg, irreg, no m/r/g
Lungs CTAB, min crackles
+1 BLE edema, some mottling (baseline), large ecchymotic area on
LUE
Neurologically grossly intact
Abdomin soft non tender and nondistended
Midsternal incision clean dry and intact

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: retired
No tobacco
No Etoh
No IVDA 

### Response:
{'Mitral valve insufficiency and aortic valve stenosis,Atrial fibrillation,Rheumatic heart failure (congestive),Urinary tract infection, site not specified,Other vascular complications of medical care, not elsewhere classified,Phlebitis and thrombophlebitis of upper extremities, unspecified,Cellulitis and abscess of upper arm and forearm,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
