CHIEF COMPLAINT: Dyspnea and fatigue

PRESENT ILLNESS: Pt. is an 81 yo female with pmh of diastolic HF, HTN, afib, and
tchy/brday syndrome s/p pacer placement [**2-20**] recently admitted
this month for dyspnea who comes in complaining of one week of
increasing fatigue, dyspnea, and productive cough. She reports
that she was improved upon last discharge last week, but since
has noted worsening SOB at rest and upon exertion, fatigue, and
productive cough. She reports that she has been taking her
medications as directed. She denies other upper respiratory
symptoms, PND, LE edema, CP, palpitations, abd pain, f/c, n/v,
other focal signs of infection. She chronically unable to lay
flat because of dizziness. She reports constipation with no BM
for the past week. Because of this her appetitie has been
decreased, though she is still taking PO fluid.
.
In the ED her CXR was unchanged. First set of CEs were flat. EKG
revealed baseline LBBB. She was seen by cardiology who requested
admission to check pacer.
.
ROS: Negative for fevers, chills, chest pain, shortness of
breath, cough, abdominal pain, nausea, vomiting, diarrhea,
dysuria. Otherwise negative in detail.

MEDICAL HISTORY: 1. Chronic diastolic heart failure
2. Hypertension
3. Paroxysmal atrial fibrillation - on amiodarone treatment
between [**1-/2153**] and [**2-/2153**], then discontinued due to her
history of lung interstitial disease
4. Tachy-brady syndrome s/p dual chamber pacemaker placement
[**2-20**]
3. TIA 17 years ago
4. Hypercholesterolemia
5. Osteoporosis
6. Hypothyroidism (recently diagnosed)
7. Left cataract surgery in [**2149**]
8. Left ankle surgery status post fracture 20 years ago
9. S/p appendectomy

MEDICATION ON ADMISSION: 1. Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.3 104/48 65 18 93%RA
GEN: Well-appearing, NAD
HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM
NECK: Supple, no LAD, no increased jvd
CV: RRR, distant, no M/G/R
PULM: CTAB, no W/R/R
ABD: Soft, distended, NT, ND, +BS
EXT: No C/C/E
NEURO: AAOx3, CN II-XII grossly intact, moving all extremities
well

FAMILY HISTORY: There is no family history of premature coronary artery disease

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
Chronic diastolic heart failure,Acute respiratory failure,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Acidosis,Acute kidney failure, unspecified,Cardiogenic shock,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified essential hypertension,Postinflammatory pulmonary fibrosis,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Chronic airway obstruction, not elsewhere classified,Constipation, unspecified
Chr diastolic hrt fail,Acute respiratry failure,Urin tract infection NOS,Parox ventric tachycard,Acidosis,Acute kidney failure NOS,Cardiogenic shock,Long-term use anticoagul,Hx TIA/stroke w/o resid,Hypertension NOS,Postinflam pulm fibrosis,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Hypothyroidism NOS,Status cardiac pacemaker,Chr airway obstruct NEC,Constipation NOS
Admission Date:  [**2153-6-5**]              Discharge Date:   [**2153-6-8**]

Date of Birth:  [**2071-9-16**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Dyspnea and fatigue

Major Surgical or Invasive Procedure:
Shocked x1 when in VT

History of Present Illness:
Pt. is an 81 yo female with pmh of diastolic HF, HTN, afib, and
tchy/brday syndrome s/p pacer placement [**2-20**] recently admitted
this month for dyspnea who comes in complaining of one week of
increasing fatigue, dyspnea, and productive cough. She reports
that she was improved upon last discharge last week, but since
has noted worsening SOB at rest and upon exertion, fatigue, and
productive cough. She reports that she has been taking her
medications as directed. She denies other upper respiratory
symptoms, PND, LE edema, CP, palpitations, abd pain, f/c, n/v,
other focal signs of infection. She chronically unable to lay
flat because of dizziness. She reports constipation with no BM
for the past week. Because of this her appetitie has been
decreased, though she is still taking PO fluid.
.
In the ED her CXR was unchanged. First set of CEs were flat. EKG
revealed baseline LBBB. She was seen by cardiology who requested
admission to check pacer.
.
ROS: Negative for fevers, chills, chest pain, shortness of
breath, cough, abdominal pain, nausea, vomiting, diarrhea,
dysuria. Otherwise negative in detail.

Past Medical History:
1. Chronic diastolic heart failure
2. Hypertension
3. Paroxysmal atrial fibrillation - on amiodarone treatment
between [**1-/2153**] and [**2-/2153**], then discontinued due to her
history of lung interstitial disease
4. Tachy-brady syndrome s/p dual chamber pacemaker placement
[**2-20**]
3. TIA 17 years ago
4. Hypercholesterolemia
5. Osteoporosis
6. Hypothyroidism (recently diagnosed)
7. Left cataract surgery in [**2149**]
8. Left ankle surgery status post fracture 20 years ago
9. S/p appendectomy

Social History:
Social history is significant for the absence of current tobacco

use. The patient had smoked previously and quit 24 years ago.
There is no history of alcohol abuse. The patient is retired and

lives in an independent living community. Had worked as a
bookkeeper.


Family History:
There is no family history of premature coronary artery disease

or sudden death. Her mother passed away at 88 years of age from

Alzheimer's disease. Father passed away at 88 years of age from

Parkinson's disease. Brother passed away at 60 years of age from

myocardial infarction. Brother passed away at 87 years of age
from a stroke.


Physical Exam:
VS: 98.3 104/48 65 18 93%RA
GEN: Well-appearing, NAD
HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM
NECK: Supple, no LAD, no increased jvd
CV: RRR, distant, no M/G/R
PULM: CTAB, no W/R/R
ABD: Soft, distended, NT, ND, +BS
EXT: No C/C/E
NEURO: AAOx3, CN II-XII grossly intact, moving all extremities
well


Pertinent Results:
STUDIES:
CXR [**2153-6-5**]:  (dictation). pacemaker with unchanged leads. minor
linear atelectasis. No acute cardiopulmonary abnormality
.
CXR [**2153-6-7**]:
FINDINGS: In comparison with the study of [**6-7**], there is a
somewhat better
inspiration but otherwise little change. Again there is evidence
of elevated pulmonary venous pressure with bilateral pleural
effusions and bibasilar atelectasis. The cardiac silhouette is
at the upper limits of normal in size and the pacemaker device
remains in place. Endotracheal tube and nasogastric tube are in
similar position.
.
Abdominal film [**2153-6-7**]:
IMPRESSION: Progressive distention of small and large bowel,
most likely
representing worsening ileus. However, given this interval
progression, close interval follow up is recommended, as a
mechanical bowel obstruction cannot be entirely excluded.
.
Cardiac cath [**2153-6-7**]:
FINAL DIAGNOSIS:
1. Coronary arteries are normal.
2. Reduced left ventricular function with apical hypokinesis.
3. Cardiogenic shock with cardiac index from 1.8-2.0 l/min/m2.
4. Slight improvement in pulmonary artery saturation and cardiac
index
with reduction of alpha pressor agents.
.
Echo [**2153-6-7**]:
IMPRESSION: Hyperdynamic biventricular systolic function with
moderate LVOT obstruction and moderate mitral regurgitation at
the pacing rate of 100 bpm. Lessened LVOT obstruction and mitral
regurgitation with pacing rate of 80 bpm.
Compared with the prior study (images reviewed) of [**2153-1-26**], LV
function is more hyperdynamic and LVOT obstruction is
identified. Mitral regurgitation is now more severe.
.
Labs
[**2153-6-5**] 06:00PM BLOOD CK-MB-6 proBNP-371
[**2153-6-5**] 06:10PM BLOOD cTropnT-<0.01
[**2153-6-6**] 01:15AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2153-6-6**] 10:25AM BLOOD CK-MB-5 cTropnT-<0.01
[**2153-6-5**] 06:00PM BLOOD CK(CPK)-138
[**2153-6-6**] 01:15AM BLOOD CK(CPK)-67
[**2153-6-6**] 10:25AM BLOOD CK(CPK)-65
.
[**2153-6-5**] 06:00PM BLOOD WBC-9.8# RBC-4.41 Hgb-13.0 Hct-39.1
MCV-89 MCH-29.4 MCHC-33.2 RDW-13.6 Plt Ct-279
[**2153-6-5**] 06:00PM BLOOD Glucose-69* UreaN-31* Creat-1.2* Na-129*
K-6.6* Cl-92* HCO3-22 AnGap-22*
[**2153-6-5**] 06:00PM BLOOD PT-38.0* PTT-44.9* INR(PT)-4.1*
.
[**2153-6-8**] 03:22AM BLOOD WBC-5.1# RBC-2.99*# Hgb-9.0* Hct-28.6*
MCV-96 MCH-30.1 MCHC-31.4 RDW-14.0 Plt Ct-94*#
[**2153-6-8**] 03:22AM BLOOD Glucose-266* UreaN-42* Creat-2.6* Na-140
K-4.4 Cl-102 HCO3-13* AnGap-29*
[**2153-6-8**] 03:22AM BLOOD Calcium-6.0* Phos-5.0* Mg-1.8
[**2153-6-8**] 03:22AM BLOOD PT-97.6* PTT-91.4* INR(PT)-12.9*
[**2153-6-8**] 03:22AM BLOOD ALT-[**Numeric Identifier 95461**]* AST-8452* LD(LDH)-9135*
AlkPhos-54 TotBili-0.7 DirBili-0.3 IndBili-0.4
[**2153-6-8**] 04:01AM BLOOD Lactate-13.3*
[**2153-6-8**] 04:01AM BLOOD Type-ART pO2-62* pCO2-25* pH-7.19*
calTCO2-10* Base XS--16

Brief Hospital Course:
The patient was an 81 yo female with h/o diastolic HF(EF 70%),
HTN, afib, and tachy/brady syndrome s/p pacer placement [**2-20**] who
was admitted for lethargy and SOB with plans to interrogate her
pacemaker to look for an arrhythmia. Her pacemaker was
interrogated and no abnormalities were found.  She was ruled out
for an MI with 3 sets of negative cardiac enzymes.  Her CXR was
negative for PNA.  Her cough and SOB was thought to be secondary
to bronchitis.  She complained of urinary frequency and
suprapubic tenderness and had a UTI with no signs of an upper
tract infection.  Her UTI was treated with ciprofloxacin.
.
During her hospitalization she was constipated with abdominal
distention and a KUB revealed dilated loops of small bowel.  She
had not had a bowel movement for one week prior to admission and
was started on colace, senna, miralax, and a bisacodyl
suppository. On the evening of the [**2153-6-6**] she complained of
nausea and on the morning of [**2153-6-7**] she had an episode of
straining in the bathroom and was found down in her room.  Code
blue was called and she was coded for PEA arrest. She received
3mg epinephrine, 1 mg atropine, 3 amps of bicarb, dextrose,
insulin, calcium for a potassium of 5.7 which was 3.8 upon
rechecking. During her PEA arrest, she had an episode of VT
which was shocked x 1 to sinus rhythm. EP was called to bedside
and paced her at 110. After aproximately 15 minutes of CPR, she
regained her pulse. She was started on dopamine, levophed on the
floor. BP stabilized in the systolic 80-90s, she was intubated
on AC and requiring high levels of PEEP. She was transferred to
the CCU.
.
While in the CCU she was in NSR in the 80s and captured at 60.
Her abdomen was distended and she required multiple pressors.
The event precipitating the PEA arrest was unclear.  [**Name2 (NI) **] shock
was treated with pressors and IVF.  She was emprirically covered
with vancomycin, cipro, and flagyl.  She also received a bicarb
drip for mixed acidosis.  Her CXR showed fluid overload but she
continued to be given IVF aggresively due to her hypotension.
The patient was also in ARF in the setting of her shock.  A KUB
showed dilated loops of small bowel with no clear evidence of
obstruction but it could not be excluded. Surgery was consulted
but the patient was not stable enough for any surgical
intervention.  A CT scan of her abdomen was necessary to
evaluate her adominal process however despite frequent
re-evaluations the patient was never stable enough to tolerate
going for a CT scan.
.
We communicated with her daughter, [**Name (NI) **] [**Name (NI) **], throughout her
stay in the CCU and initially the patient was full code.  During
the course of the evening and early morning the patient required
blood transfusions for a dropping HCT.  In the early morning of
[**2153-6-8**] when the patient was requiring blood transfusions and
continuing to require pressors, the daughter told the team over
the phone that her mother would not want this and that she
wanted to change her mother's code status to CMO and DNR.  The
daughter came into the hospital accompanied by other family
members.  At that point the family requested we stop her
pressors and the blood transfusions.  The patient remained
intubated.   The patient expired shortly afterwords and the
family decided not to have an autopsy.


Medications on Admission:
1. Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable

PO DAILY (Daily).
3. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
4. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1)

Capsule, Sustained Release PO DAILY (Daily).
Disp:*30 Capsule, Sustained Release(s)* Refills:*2*
5. Metoprolol Tartrate 100 mg Tablet Sig: One (1) Tablet PO
twice a day.
6. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Calcium Oral
9. Vitamin D Oral
10. Disopyramide 100 mg Capsule, Sustained Release Sig: Two (2)

Capsule, Sustained Release PO Q12H (every 12 hours).
Disp:*120 Capsule, Sustained Release(s)* Refills:*2*
11. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO

DAILY (Daily).
12. Aldactone 25 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Medications:
Patient expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient Expired

Discharge Condition:
Patient Expired

Discharge Instructions:
Patient Expired


Followup Instructions:
Patient Expired


Completed by:[**2153-8-6**]
{'Chronic diastolic heart failure,Acute respiratory failure,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Acidosis,Acute kidney failure, unspecified,Cardiogenic shock,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified essential hypertension,Postinflammatory pulmonary fibrosis,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Chronic airway obstruction, not elsewhere classified,Constipation, unspecified'}


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: Dyspnea and fatigue

PRESENT ILLNESS: Pt. is an 81 yo female with pmh of diastolic HF, HTN, afib, and
tchy/brday syndrome s/p pacer placement [**2-20**] recently admitted
this month for dyspnea who comes in complaining of one week of
increasing fatigue, dyspnea, and productive cough. She reports
that she was improved upon last discharge last week, but since
has noted worsening SOB at rest and upon exertion, fatigue, and
productive cough. She reports that she has been taking her
medications as directed. She denies other upper respiratory
symptoms, PND, LE edema, CP, palpitations, abd pain, f/c, n/v,
other focal signs of infection. She chronically unable to lay
flat because of dizziness. She reports constipation with no BM
for the past week. Because of this her appetitie has been
decreased, though she is still taking PO fluid.
.
In the ED her CXR was unchanged. First set of CEs were flat. EKG
revealed baseline LBBB. She was seen by cardiology who requested
admission to check pacer.
.
ROS: Negative for fevers, chills, chest pain, shortness of
breath, cough, abdominal pain, nausea, vomiting, diarrhea,
dysuria. Otherwise negative in detail.

MEDICAL HISTORY: 1. Chronic diastolic heart failure
2. Hypertension
3. Paroxysmal atrial fibrillation - on amiodarone treatment
between [**1-/2153**] and [**2-/2153**], then discontinued due to her
history of lung interstitial disease
4. Tachy-brady syndrome s/p dual chamber pacemaker placement
[**2-20**]
3. TIA 17 years ago
4. Hypercholesterolemia
5. Osteoporosis
6. Hypothyroidism (recently diagnosed)
7. Left cataract surgery in [**2149**]
8. Left ankle surgery status post fracture 20 years ago
9. S/p appendectomy

MEDICATION ON ADMISSION: 1. Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.3 104/48 65 18 93%RA
GEN: Well-appearing, NAD
HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM
NECK: Supple, no LAD, no increased jvd
CV: RRR, distant, no M/G/R
PULM: CTAB, no W/R/R
ABD: Soft, distended, NT, ND, +BS
EXT: No C/C/E
NEURO: AAOx3, CN II-XII grossly intact, moving all extremities
well

FAMILY HISTORY: There is no family history of premature coronary artery disease

SOCIAL HISTORY: Social history is significant for the absence of current tobacco 

### Response:
{'Chronic diastolic heart failure,Acute respiratory failure,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Acidosis,Acute kidney failure, unspecified,Cardiogenic shock,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified essential hypertension,Postinflammatory pulmonary fibrosis,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Cardiac pacemaker in situ,Chronic airway obstruction, not elsewhere classified,Constipation, unspecified'}
