CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 71F PMH DM, HTN, hyperchol, CRI, presented to the ED c/o SOB,
congestion, and pleuritic chest "pressure," since Sunday.  No
chest pain. She had apparently had a viral-like infection on
Sunday, with URI symptoms, vomiting, and diarrhea, with
resolution of the GI symptoms but persistence of the congestion.
 She appeared short of breath when she saw her nephrologist
today, and was sent to the ED. When seen in the ED, she was
chest pain free and blood pressure was 150/77. Sats were 92-94%
on RA.  D-dimer was 1017, and given concern for PE she was sent
for VQ scan.  While returning she became diaphoretic and was
noted to have SBP 270/140. EKG revealed ST elevations in
anterior precordial leads. Trop/CK/MB was 0.10/112/3 initially,
and repeat values were 0.8/102/pending.  She was given NTG SL
x3, and started on a nitro gtt. She was started on NRB, with
sats in high 90s with crackles on lung exam and JVP 8 cm, and
given lasix to which she put out 2+L of urine.  Echo performed
showed no RV strain, and symmetric wall hypertrophy without
focal motion abnormalities. Also notable on admission was a Hct
of 25 (pt has history of anemia (Fe def and CRI) with baseline
Hct 26 - 28), and a Cr of 2.5 (baseline 1.7 - 2.0).
Pt was then admitted to CCU for hypertensive emergency given SBP
260s and ST elev V2-V4.

MEDICAL HISTORY: 1) chronic renal insufficiency: followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**]
at [**Last Name (un) **]. (baseline creatinine 1.0 - 1.5)
2) small hiatal hernia with severe GERD sx.
3) HTN: difficult to control, MRA [**2155**] with 1 out of 3 renal
arteries with mod stenosis but not likely to cause renal
insufficiency or sig HTN per rads report, urine metanephrines
negative in the past
4) DM2
5) Osteoporosis.
6) Vertebral fractures.
7) History of depression.
8) Anxiety.
9) Hypercholesterolemia
10) Chronic constipation.
11) Sickle cell trait.
12) Osteoarthritis.
13) Status post left knee replacement.
14) History of mechanical falls.
15) Total hysterectomy - about 20 years ago.
Mammogram [**4-5**] negative, Colonoscopy [**2154**] negative except for
diverticulosis

MEDICATION ON ADMISSION: Lasix 30 [**Hospital1 **]
Hydralazine 50 TID
Glucophage 500 [**Hospital1 **]
Glyburide 5 [**Hospital1 **]
Labetalol 40 [**Hospital1 **]
HCTZ 25 daily
Cozaar 100 daily
Lisinopril 40 [**Hospital1 **]
Clonidine 0.6 [**Hospital1 **]
Protonix 40 [**Hospital1 **]
Procrit
Lipitor 10 daily
Iron
MVI
Klonopin 1 HS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Initial exam in CCU:
G: NAD, slightly cachectic female with bitemporal wasting
HEENT: MMM, Clear OP, fundi were notable for some
neovascularization with sharp optic disks
Neck: JVP ~8cm
Lungs: Crackles BL to [**1-2**] lung fields.  No W/R
CV: RRR S1S2 No murmurs +S4
Abd: Soft, NT, ND, BS+
Ext: 1+ pitting edema
Neuro: A&Ox3, Appropriate, CN 2-12 intact, No sensory/motor
deficits, 2+ reflexes, coordination intact, gait deferred.

FAMILY HISTORY: Father died of old age, mother had DM, HTN

SOCIAL HISTORY: Patient from Barbados, lives with husband, never used tobacco,
no EtOH.
Acute kidney failure, unspecified,Acute diastolic heart failure,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Other acute and subacute forms of ischemic heart disease, other,Atherosclerosis of renal artery,Pure hypercholesterolemia,Osteoporosis, unspecified,Anemia in chronic kidney disease
Acute kidney failure NOS,Ac diastolic hrt failure,Mal hyp ht/kd stg V w hf,DMII renl nt st uncntrld,Ac ischemic hrt dis NEC,Renal artery atheroscler,Pure hypercholesterolem,Osteoporosis NOS,Anemia in chr kidney dis
Admission Date:  [**2157-5-18**]              Discharge Date:   [**2157-5-23**]

Date of Birth:  [**2085-6-27**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 19193**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
None

History of Present Illness:
71F PMH DM, HTN, hyperchol, CRI, presented to the ED c/o SOB,
congestion, and pleuritic chest "pressure," since Sunday.  No
chest pain. She had apparently had a viral-like infection on
Sunday, with URI symptoms, vomiting, and diarrhea, with
resolution of the GI symptoms but persistence of the congestion.
 She appeared short of breath when she saw her nephrologist
today, and was sent to the ED. When seen in the ED, she was
chest pain free and blood pressure was 150/77. Sats were 92-94%
on RA.  D-dimer was 1017, and given concern for PE she was sent
for VQ scan.  While returning she became diaphoretic and was
noted to have SBP 270/140. EKG revealed ST elevations in
anterior precordial leads. Trop/CK/MB was 0.10/112/3 initially,
and repeat values were 0.8/102/pending.  She was given NTG SL
x3, and started on a nitro gtt. She was started on NRB, with
sats in high 90s with crackles on lung exam and JVP 8 cm, and
given lasix to which she put out 2+L of urine.  Echo performed
showed no RV strain, and symmetric wall hypertrophy without
focal motion abnormalities. Also notable on admission was a Hct
of 25 (pt has history of anemia (Fe def and CRI) with baseline
Hct 26 - 28), and a Cr of 2.5 (baseline 1.7 - 2.0).
Pt was then admitted to CCU for hypertensive emergency given SBP
260s and ST elev V2-V4.

Past Medical History:
1) chronic renal insufficiency: followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**]
at [**Last Name (un) **]. (baseline creatinine 1.0 - 1.5)
2) small hiatal hernia with severe GERD sx.
3) HTN: difficult to control, MRA [**2155**] with 1 out of 3 renal
arteries with mod stenosis but not likely to cause renal
insufficiency or sig HTN per rads report, urine metanephrines
negative in the past
4) DM2
5) Osteoporosis.
6) Vertebral fractures.
7) History of depression.
8) Anxiety.
9) Hypercholesterolemia
10) Chronic constipation.
11) Sickle cell trait.
12) Osteoarthritis.
13) Status post left knee replacement.
14) History of mechanical falls.
15) Total hysterectomy - about 20 years ago.
Mammogram [**4-5**] negative, Colonoscopy [**2154**] negative except for
diverticulosis

Social History:
Patient from Barbados, lives with husband, never used tobacco,
no EtOH.


Family History:
Father died of old age, mother had DM, HTN

Physical Exam:
Initial exam in CCU:
G: NAD, slightly cachectic female with bitemporal wasting
HEENT: MMM, Clear OP, fundi were notable for some
neovascularization with sharp optic disks
Neck: JVP ~8cm
Lungs: Crackles BL to [**1-2**] lung fields.  No W/R
CV: RRR S1S2 No murmurs +S4
Abd: Soft, NT, ND, BS+
Ext: 1+ pitting edema
Neuro: A&Ox3, Appropriate, CN 2-12 intact, No sensory/motor
deficits, 2+ reflexes, coordination intact, gait deferred.

ON transfer to floor:
T 98.3  BP 144/56 (144-178/61-81) P 65-74  P17-22 Sat 100% RA
wt = 65 kg  I/O: LOS neg 3.6 L, yest -895 cc, since midnight
till now -500
Gen: thin woman, pleasant, NAD
HEENT: PERRL, EOMI, OP clear with MMM
Neck: JVP flat, supple, NT, no thyromegaly
Chest: CTA bilaterally
CV: RRR, no murmurs
Abd: s/nt, mildly protuberant, +BS
Ext: no edema, +2 DP pulses bilat
Neuro: CN 2-12 intact, DTRs 2+ throughout, strength 5/5 equal
and symm bilat

Pertinent Results:
Admission Labs:
[**2157-5-18**] 12:00PM BLOOD WBC-6.9 RBC-3.39* Hgb-8.1* Hct-25.2*
MCV-74* MCH-24.0* MCHC-32.3 RDW-15.1 Plt Ct-214
Neuts-81.2* Bands-0 Lymphs-12.4* Monos-4.4 Eos-1.7 Baso-0.2
Hypochr-NORMAL Anisocy-1+ Poiklo-NORMAL Macrocy-NORMAL
Microcy-2+ Polychr-NORMAL
Plt Smr-NORMAL Plt Ct-214
PT-13.3 PTT-26.8 INR(PT)-1.2
Glucose-253* UreaN-57* Creat-2.5* Na-133 K-5.4* Cl-100 HCO3-26
AnGap-12
[**2157-5-18**] 11:10PM BLOOD Neuts-90.5* Bands-0 Lymphs-5.6* Monos-2.8
Eos-0.9 Baso-0.2
7:00PM CK(CPK)-112
09:40PM CK(CPK)-102
cTropnT-0.08*
CK-MB-4
Lipase-40
CK-MB-3
cTropnT-0.10*
[**2157-5-19**] 05:38AM BLOOD WBC-7.4 RBC-3.31* Hgb-8.2* Hct-24.7*
MCV-74* MCH-24.6* MCHC-33.1 RDW-15.2 Plt Ct-207
CK(CPK)-71
CK-MB-NotDone cTropnT-0.10*
.
EKG: ST @ 102. NL axis. Biatrial enlargement. LVH. Deep TWI
V1-V4, with ST elevations of about 1mm in V1-V3, new vs EKG from
[**11-4**], but decreased vs EKG at 12PM today.
.
VQ Scan: Normal lung perfusion, no evidence of pulmonary
embolus.
.
On transfer to floor:
CBC: wbc 8.4, Hct 31.0, plt 223
Chem 7: BUN/creat 55/2.5
[**2157-5-20**] 03:37AM BLOOD Glucose-117* UreaN-55* Creat-2.6* Na-136
K-3.5 Cl-99 HCO3-27 AnGap-14

WBC-7.5 RBC-3.73* Hgb-9.4* Hct-28.8* MCV-77* MCH-25.3* MCHC-32.8
RDW-16.4* Plt Ct-225

Brief Hospital Course:
1. hypertensive emergency:  Pt noted to have concerning ST
elevations on admission EKG, which were not concerning for acute
thrombotic event, but rather consistent with ischemia in the
setting of HTN.  Pt ruled out for MI.  Pt was placed on
labetalol gtt, cardiac enzymes with peak trop of 0.10 (prev
baseline 0.05), CK and MB flat.  In CCU, was transfused 2 units
PRBCs and was subsequently titrated off labetalol drip and
placed on outpatient meds.  Her ACE I and [**Last Name (un) **] were initially
held due to concerns about renal failure, but these meds were
subsequently restarted.  In addition, candesartan and Norvasc
were added, and labetalol was increased to 800mg po tid.  Her
hydrochlorothiazide was discontinued, and lasix started in its
place.  SBP improved to 150s-170s, and were in 120s on day of
discharge.  Pt denied any dizziness or lightheadedness at this
BP.  Given her EKG changes with hypertension, she will need a
stress test in the near future, when her BP is better
controlled.

2. acute on chronic renal failure: Pt's creatinine was noted on
admission to be elevated above her baseline (1.7 - 2.0).  For
evaluation of her chronic renal insufficiency, pt has had renal
biopsy in the past consistent with diabetic nephropathy.  [**Last Name (un) **]
and ACE I were initially held, then restarted.  Pt maintained
good UOP.  Cr remained stable at 2.5, thought possibly due to
progression of disease.  Pt will follow up with nephrologist
through the [**Last Name (un) **] to further assess this issue.

3. DM type 2: Glyburide and metformin held on admission given
worsening creatinine clearance.  Pt was started on glipizide.
Fingersticks were checked four times daily; insulin sliding
scale was given.  Pt will follow up at the [**Last Name (un) **].

4. anemia: Pt has had chronic (microcytic) anemia with baseline
Hct 24-28, and was anemic on admission with Hct 25. Pt was
guaiac negative in ED. Per PCP, [**Name10 (NameIs) **] has been on Procrit in the
past as anemia is thought to be due to renal disease.  Iron
studies c/w anemia of chronic disease.  Some concern for
malignancy, as well, given h/o 25lb weight loss over the last
few months.  Pt is up-to-date with routine cancer screening.
Hemoglobin electrophoresis was sent to r/o thalassemia.  Pt was
transfused with 2 units PRBCs with stable Hct (>25).

5. Constipation - Pt with a history of chronic constipation,
with constipation in the hospital, as well.  Pt had good
response to mineral oil and tap water enemas.


Medications on Admission:
Lasix 30 [**Hospital1 **]
Hydralazine 50 TID
Glucophage 500 [**Hospital1 **]
Glyburide 5 [**Hospital1 **]
Labetalol 40 [**Hospital1 **]
HCTZ 25 daily
Cozaar 100 daily
Lisinopril 40 [**Hospital1 **]
Clonidine 0.6 [**Hospital1 **]
Protonix 40 [**Hospital1 **]
Procrit
Lipitor 10 daily
Iron
MVI
Klonopin 1 HS

Discharge Medications:
1. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
2. Candesartan Cilexetil 16 mg Tablet Sig: One (1) Tablet PO
once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. Furosemide 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO once
a day.
7. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
once a day.
8. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

9. Psyllium     Packet Sig: One (1) Packet PO BID (2 times a
day).
10. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
11. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
12. Clonidine HCl 0.2 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
13. Hydralazine HCl 50 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
14. Glipizide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
15. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
16. Labetalol HCl 200 mg Tablet Sig: Four (4) Tablet PO TID (3
times a day).
Disp:*360 Tablet(s)* Refills:*2*
17. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)) as needed.
18. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)) as needed.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary
1.  hypertensive emergency
Secondary
1.  chronic kidney disease
2.  diabetes mellitus, type 2


Discharge Condition:
stable, tolerating po

Discharge Instructions:
Please follow up with all your appointments as instructed (Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**], Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 16258**]). Please follow your blood
pressure with the help of your visiting nurse. Report to the
Emergency Department if you develop the following: significant
shortness of breath, chest pain, increased lower extremity
swelling, severe headache, fainting, changes in consciousness,
confusion, specific weaknesses, numbness, tingling, speech
changes, severely decreased urine production or any other
worrisome signs.

Followup Instructions:
1. Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**], [**Last Name (un) **] Center (nephrology) Wednesday [**5-25**] at 10:30AM. ([**Telephone/Fax (1) 817**]
2. Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 16258**], [**Hospital1 18**] Monday [**6-6**] at 1:15PM.  ([**Telephone/Fax (1) 22124**]
{'Acute kidney failure, unspecified,Acute diastolic heart failure,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Other acute and subacute forms of ischemic heart disease, other,Atherosclerosis of renal artery,Pure hypercholesterolemia,Osteoporosis, unspecified,Anemia in chronic kidney disease'}


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: Shortness of breath

PRESENT ILLNESS: 71F PMH DM, HTN, hyperchol, CRI, presented to the ED c/o SOB,
congestion, and pleuritic chest "pressure," since Sunday.  No
chest pain. She had apparently had a viral-like infection on
Sunday, with URI symptoms, vomiting, and diarrhea, with
resolution of the GI symptoms but persistence of the congestion.
 She appeared short of breath when she saw her nephrologist
today, and was sent to the ED. When seen in the ED, she was
chest pain free and blood pressure was 150/77. Sats were 92-94%
on RA.  D-dimer was 1017, and given concern for PE she was sent
for VQ scan.  While returning she became diaphoretic and was
noted to have SBP 270/140. EKG revealed ST elevations in
anterior precordial leads. Trop/CK/MB was 0.10/112/3 initially,
and repeat values were 0.8/102/pending.  She was given NTG SL
x3, and started on a nitro gtt. She was started on NRB, with
sats in high 90s with crackles on lung exam and JVP 8 cm, and
given lasix to which she put out 2+L of urine.  Echo performed
showed no RV strain, and symmetric wall hypertrophy without
focal motion abnormalities. Also notable on admission was a Hct
of 25 (pt has history of anemia (Fe def and CRI) with baseline
Hct 26 - 28), and a Cr of 2.5 (baseline 1.7 - 2.0).
Pt was then admitted to CCU for hypertensive emergency given SBP
260s and ST elev V2-V4.

MEDICAL HISTORY: 1) chronic renal insufficiency: followed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10083**]
at [**Last Name (un) **]. (baseline creatinine 1.0 - 1.5)
2) small hiatal hernia with severe GERD sx.
3) HTN: difficult to control, MRA [**2155**] with 1 out of 3 renal
arteries with mod stenosis but not likely to cause renal
insufficiency or sig HTN per rads report, urine metanephrines
negative in the past
4) DM2
5) Osteoporosis.
6) Vertebral fractures.
7) History of depression.
8) Anxiety.
9) Hypercholesterolemia
10) Chronic constipation.
11) Sickle cell trait.
12) Osteoarthritis.
13) Status post left knee replacement.
14) History of mechanical falls.
15) Total hysterectomy - about 20 years ago.
Mammogram [**4-5**] negative, Colonoscopy [**2154**] negative except for
diverticulosis

MEDICATION ON ADMISSION: Lasix 30 [**Hospital1 **]
Hydralazine 50 TID
Glucophage 500 [**Hospital1 **]
Glyburide 5 [**Hospital1 **]
Labetalol 40 [**Hospital1 **]
HCTZ 25 daily
Cozaar 100 daily
Lisinopril 40 [**Hospital1 **]
Clonidine 0.6 [**Hospital1 **]
Protonix 40 [**Hospital1 **]
Procrit
Lipitor 10 daily
Iron
MVI
Klonopin 1 HS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Initial exam in CCU:
G: NAD, slightly cachectic female with bitemporal wasting
HEENT: MMM, Clear OP, fundi were notable for some
neovascularization with sharp optic disks
Neck: JVP ~8cm
Lungs: Crackles BL to [**1-2**] lung fields.  No W/R
CV: RRR S1S2 No murmurs +S4
Abd: Soft, NT, ND, BS+
Ext: 1+ pitting edema
Neuro: A&Ox3, Appropriate, CN 2-12 intact, No sensory/motor
deficits, 2+ reflexes, coordination intact, gait deferred.

FAMILY HISTORY: Father died of old age, mother had DM, HTN

SOCIAL HISTORY: Patient from Barbados, lives with husband, never used tobacco,
no EtOH. 

### Response:
{'Acute kidney failure, unspecified,Acute diastolic heart failure,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Other acute and subacute forms of ischemic heart disease, other,Atherosclerosis of renal artery,Pure hypercholesterolemia,Osteoporosis, unspecified,Anemia in chronic kidney disease'}
