CHIEF COMPLAINT: Chest pain and abdominal pain

PRESENT ILLNESS: Most of the interview was conducted with telephone interpretor
as patient is
Russian speaking only.

MEDICAL HISTORY: 1. Sick sinus syndrome s/p pacemaker placement.
2. Coronary artery disease.
3. CHF with EF of 25%
4. Atrial fibrillation.
5. Hypertension.
6. Osteoporosis.
7. Dementia
8. R hemicolectomy for mussinous colon CA
1. Sick sinus syndrome s/p pacemaker placement.
2. Coronary artery disease.
3. CHF with EF of 25%
4. Atrial fibrillation.
5. Hypertension.
6. Osteoporosis.
7. Dementia
8. R hemicolectomy for mussinous colon CA

MEDICATION ON ADMISSION: 1.  Metoprolol 100mg [**Hospital1 **]
2.  Amiodarone HCl 200mg PO once daily
3.  Lisinopril 5mg once daily
4.  Furosemide 40mg once daily
5.  Pantoprazole 40mg Q24 hours
6.  Albuterol neb Q6hrs PRN
7.  Ipratroprium Bromide 0.02% neb Q6 hours

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
VS: Tc: 97.8   HR: 80   BP: 134/47 on left and 141/57 on right
RR: 19   SaO2: 93% on 2L
Gen: elderly women lying in bed at 30 degree angle with nasal
canula in place.  The patient appears to be relatively
comfortable, in NAD.  poor skin turgor
HEENT: temporal wasting.  pupils are 2mm bilaterally, reactive?,
EOMI.  mucous membranes very dry.
Neck: supple, full ROM, JVP 8-10cm
CV: RRR, S1, S2, no murmurs, rubs, gallops
Chest: [**Month (only) **] breath sounds on R>L.  Egophony on R>L up 1/3 up
scapula.  bibasilar crackles.
Abd: soft, NT, ND, BS+ bilaterally, no rebound, guarding,
peritoneal signs.  negative [**Doctor Last Name **] signs.
Ext: warm to palpation, with trace pulses, [**Doctor First Name 15799**] stasis, no
c/c/e
Neuro: pt appeared appropriate throughout. A+O not assess due to
difficulty with language barrier.

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has never smoked cigarettes.She lives in the [**Hospital1 10151**] Center secondary to an inability to take care of
herself.  She is retired.  She has a large family.  She is
Russian speaking.
Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Congestive heart failure, unspecified,Other and unspecified angina pectoris,Pressure ulcer, lower back,Unspecified essential hypertension,Cardiac pacemaker in situ,Coronary atherosclerosis of native coronary artery,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of large intestine,Osteoporosis, unspecified
Food/vomit pneumonitis,Atrial fibrillation,CHF NOS,Angina pectoris NEC/NOS,Pressure ulcer, low back,Hypertension NOS,Status cardiac pacemaker,Crnry athrscl natve vssl,Mental disor NEC oth dis,Hx of colonic malignancy,Osteoporosis NOS
Admission Date:  [**2163-10-30**]              Discharge Date:   [**2163-11-3**]


Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
Chest pain and abdominal pain

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Most of the interview was conducted with telephone interpretor
as patient is
Russian speaking only.

   [**Age over 90 **]yo female Russian speaking only resident of [**Hospital1 5595**] with CAD,
CHF (EF 25%), HTN, and Afib, recently admitted with episode of
PNA vs. CHF exacerbation on [**2163-9-29**], now presents with chest
pain, abdominal pain and hypotension.  The chest pain is located
in the right side of the chest and radiates to the back.  The
pain is characterized as the same chest pain she has had for
most of her life and is rated [**2169-5-5**], no radiations and
nonpositional, no associated diaphoresis.  She had one episode
of n/v, early today.  The emesis was clear without signs of
blood or coffee grounds. She describes her abdominal pain as
generalized, diffuse, x 2d. She denies any current abdominal
pain. Her last bowel movement was three days prior to admission.

   In the ED, her BP was 98/66 and dropped to 60/40 sitting and
80/60 lying after ASA, SL NTG and lasix (given for ?ACS, CHF)
->1400 cc u/o. She begun dopamine to avoid fluid boluses given
her CHF. The patient was subsequently given morphine for chest
pain refractory to nitro which lead to further decrease in BP to
46/24 (15 min. after morphine was given).  She failed a weaning
trial of dopamine with BP of 79/50.  She then received decadron
10mg IV along with levofloxacin 500mg IVx1 and Flagyl 500mg IV
x1 for ?PNA, and sent to [**Hospital Unit Name 153**] for w/u.
   The patient also reports some baseline shortness of breath
with a chronic cough that has been present for 2 years.  The
cough has periods of improvement and worsening.  Recently, the
cough has worsened over the last two weeks with some clear
sputum production (since her recent discharge).  The patient
also reports some subjective fevers, and chills, but denies
rigors. She is DNR/DNI.

Past Medical History:
1. Sick sinus syndrome s/p pacemaker placement.
2. Coronary artery disease.
3. CHF with EF of 25%
4. Atrial fibrillation.
5. Hypertension.
6. Osteoporosis.
7. Dementia
8. R hemicolectomy for mussinous colon CA
1. Sick sinus syndrome s/p pacemaker placement.
2. Coronary artery disease.
3. CHF with EF of 25%
4. Atrial fibrillation.
5. Hypertension.
6. Osteoporosis.
7. Dementia
8. R hemicolectomy for mussinous colon CA

Social History:
The patient has never smoked cigarettes.She lives in the [**Hospital1 10151**] Center secondary to an inability to take care of
herself.  She is retired.  She has a large family.  She is
Russian speaking.

Physical Exam:
PE:
VS: Tc: 97.8   HR: 80   BP: 134/47 on left and 141/57 on right
RR: 19   SaO2: 93% on 2L
Gen: elderly women lying in bed at 30 degree angle with nasal
canula in place.  The patient appears to be relatively
comfortable, in NAD.  poor skin turgor
HEENT: temporal wasting.  pupils are 2mm bilaterally, reactive?,
EOMI.  mucous membranes very dry.
Neck: supple, full ROM, JVP 8-10cm
CV: RRR, S1, S2, no murmurs, rubs, gallops
Chest: [**Month (only) **] breath sounds on R>L.  Egophony on R>L up 1/3 up
scapula.  bibasilar crackles.
Abd: soft, NT, ND, BS+ bilaterally, no rebound, guarding,
peritoneal signs.  negative [**Doctor Last Name **] signs.
Ext: warm to palpation, with trace pulses, [**Doctor First Name 15799**] stasis, no
c/c/e
Neuro: pt appeared appropriate throughout. A+O not assess due to
difficulty with language barrier.

Pertinent Results:
[**2163-10-30**] 11:20AM   WBC-11.0# RBC-3.79* HGB-11.1* HCT-33.8*
MCV-89 MCH-29.4 MCHC-32.9 RDW-16.4*
[**2163-10-30**] 11:20AM   NEUTS-82.2* LYMPHS-12.4* MONOS-4.9 EOS-0.2
BASOS-0.2
[**2163-10-30**] 11:20AM   PT-13.1 PTT-24.2 INR(PT)-1.1
[**2163-10-30**] 11:20AM   ALBUMIN-3.1* CALCIUM-8.8 PHOSPHATE-3.7
MAGNESIUM-1.4*
[**2163-10-30**] 11:20AM   ALT(SGPT)-15 AST(SGOT)-28 CK(CPK)-82 ALK
PHOS-73 AMYLASE-51 TOT BILI-0.6
[**2163-10-30**] 11:20AM   GLUCOSE-154* UREA N-56* CREAT-2.8*#
SODIUM-135 POTASSIUM-3.3 CHLORIDE-91* TOTAL CO2-30* ANION GAP-17
[**2163-10-30**] 12:45PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.015
[**2163-10-30**] 12:45PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-0.2 PH-5.0
LEUK-NEG
[**2163-10-30**] 12:45PM URINE  RBC-0-2 WBC-0 BACTERIA-MOD YEAST-NONE
EPI-0
[**2163-10-30**] 01:20PM   LACTATE-1.6
[**2163-10-30**] 11:20AM   CK-MB-NotDone
[**2163-10-30**] 11:20AM   cTropnT-0.02*
[**2163-10-30**] 05:36PM   CK(CPK)-91
[**2163-10-30**] 05:36PM   CK-MB-NotDone
[**2163-10-30**] 05:37PM   cTropnT-0.02*
.
.
[**2163-10-30**] CXR:
"1. Cardiomegaly and calcified unfolded aorta. There is no
disproportionate
mediastional widening.
2. Probable CHF.
3. More confluent opacity right apex --- question atypical
distribution of
CHF vs. pneumonia.
4. Osteopenia with partial wedging of multiple vertebral bodies.
"
.
.


Brief Hospital Course:
A/P: [**Age over 90 **]yo female resident of [**Hospital1 5595**] with CAD, HTN and recent admit
for PNA and CHF exacerbation (admitted [**2163-9-27**]-discharged
[**2163-9-29**]) presents with CP, abd pain and hypotension.

1: Hypoxia: We thought that her hypoxia might have been
secondary to fluid overload/CHF or a pneumonia.  We thus
broadened her coverage by adding zosyn. She also received small
doses of IV lasix with a small improvement.  She eventually
weaned from a NRB to 6L nasal cannula on the day of discharge.
We advise continued weaning of her oxygen as tolerated by the
patient.

2.  Hypotension: We thought that the patient's hypotension was
secondary to volume depletion as demonstrated by its rapid
response with IV fluids.  We held her antihypertensive
medications initally and slowly added them as her pressure
stabilized.

3.  Chest pain: We were concerned that her chest pain might have
been secondary to an acute coronary syndrome.  She was ruled out
with negative serial cardiac enzymes and the absence or ECG
changes. We increased her

3.  PNA: The patient was first started on levoquin but in light
of her increasing hypoxia she was switched to zosyn to broaden
her coverage. She remained afebrile and without a leukoctyosis
was thus discharged on a 7 day course of levofloxacin.

4.  Abd pain:  The occurance of abdominal pain is conincident
with her recent onset of constipation.  The abd on exam is soft,
and completely benign, without a suggestion of a surgical
abdomen.  The pain is most likely secondary to constipation.
Her abdominal pain and distension improved significantly with
the administration of an enema which resulted in a successful
bowel movement.

5.  Afib/Sick Sinus:  Pt is s/p pacemaker placement.  While in
the ICU she was on telemetry and her heart rate did not
decreased to less than 80.

6.  CHF: We held her cardiac meds in light of her hypotension.
On the day of discharge we had restarted metoprolol and we
advise that the other medications be slowly added as her blood
pressure tolerates.

7.  Prophylaxis:  The patient was continued on heparin SQ for
DVT prophylaxis along with a PPI as per her outpatient regimen.


Medications on Admission:
1.  Metoprolol 100mg [**Hospital1 **]
2.  Amiodarone HCl 200mg PO once daily
3.  Lisinopril 5mg once daily
4.  Furosemide 40mg once daily
5.  Pantoprazole 40mg Q24 hours
6.  Albuterol neb Q6hrs PRN
7.  Ipratroprium Bromide 0.02% neb Q6 hours

Discharge Medications:
1. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day) as needed.
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
5. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-31**]
Puffs Inhalation every four (4) hours.
6. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 7 days.
7. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
8. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
9. Carbamide Peroxide 6.5 % Drops Sig: 5-10 Drops Otic [**Hospital1 **] (2
times a day) for 4 days.
10. Oxycodone HCl 5 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed.
11. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
12. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
13. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours).
14. Quetiapine Fumarate 25 mg Tablet Sig: One (1) Tablet PO QHS
(once a day (at bedtime)).
15. Flagyl 500 mg Tablet Sig: One (1) Tablet PO three times a
day for 7 days.
16. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) mL PO twice a
day.
17. Trazodone HCl 50 mg Tablet Sig: 0.5 Tablet PO at bedtime as
needed for insomnia.
18. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - LTC

Discharge Diagnosis:
Aspiration Pneumonia
Hypertension
Congestive Heart Failure
Atrial Fibrillation


Discharge Condition:
Fair

Discharge Instructions:
Please take all of your medications as prescribed.


Followup Instructions:
Primary Care: Please follow up with a physician within one week
of discharge from the hospital.  At the time, please have your
oxygen saturation checked and a CXR within two weeks to verify
improvement of your pneumonia.

Laboratory: Please have the levels of your potassium checked at
[**Hospital1 5595**] with the results sent to the house physician.
{'Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Congestive heart failure, unspecified,Other and unspecified angina pectoris,Pressure ulcer, lower back,Unspecified essential hypertension,Cardiac pacemaker in situ,Coronary atherosclerosis of native coronary artery,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of large intestine,Osteoporosis, 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: Chest pain and abdominal pain

PRESENT ILLNESS: Most of the interview was conducted with telephone interpretor
as patient is
Russian speaking only.

MEDICAL HISTORY: 1. Sick sinus syndrome s/p pacemaker placement.
2. Coronary artery disease.
3. CHF with EF of 25%
4. Atrial fibrillation.
5. Hypertension.
6. Osteoporosis.
7. Dementia
8. R hemicolectomy for mussinous colon CA
1. Sick sinus syndrome s/p pacemaker placement.
2. Coronary artery disease.
3. CHF with EF of 25%
4. Atrial fibrillation.
5. Hypertension.
6. Osteoporosis.
7. Dementia
8. R hemicolectomy for mussinous colon CA

MEDICATION ON ADMISSION: 1.  Metoprolol 100mg [**Hospital1 **]
2.  Amiodarone HCl 200mg PO once daily
3.  Lisinopril 5mg once daily
4.  Furosemide 40mg once daily
5.  Pantoprazole 40mg Q24 hours
6.  Albuterol neb Q6hrs PRN
7.  Ipratroprium Bromide 0.02% neb Q6 hours

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
VS: Tc: 97.8   HR: 80   BP: 134/47 on left and 141/57 on right
RR: 19   SaO2: 93% on 2L
Gen: elderly women lying in bed at 30 degree angle with nasal
canula in place.  The patient appears to be relatively
comfortable, in NAD.  poor skin turgor
HEENT: temporal wasting.  pupils are 2mm bilaterally, reactive?,
EOMI.  mucous membranes very dry.
Neck: supple, full ROM, JVP 8-10cm
CV: RRR, S1, S2, no murmurs, rubs, gallops
Chest: [**Month (only) **] breath sounds on R>L.  Egophony on R>L up 1/3 up
scapula.  bibasilar crackles.
Abd: soft, NT, ND, BS+ bilaterally, no rebound, guarding,
peritoneal signs.  negative [**Doctor Last Name **] signs.
Ext: warm to palpation, with trace pulses, [**Doctor First Name 15799**] stasis, no
c/c/e
Neuro: pt appeared appropriate throughout. A+O not assess due to
difficulty with language barrier.

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has never smoked cigarettes.She lives in the [**Hospital1 10151**] Center secondary to an inability to take care of
herself.  She is retired.  She has a large family.  She is
Russian speaking. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Congestive heart failure, unspecified,Other and unspecified angina pectoris,Pressure ulcer, lower back,Unspecified essential hypertension,Cardiac pacemaker in situ,Coronary atherosclerosis of native coronary artery,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of large intestine,Osteoporosis, unspecified'}
