CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a 55 yo female with hx of HTN and venous stasis
who presents with acute oxygen desaturation. Patient reports
that 2.5 weeks ago she had a cold, with a scratchy throat,
non-productive cough that was worse at night, and a "tight"
feeling with breathing. She denies any fevers, chills, N/V,
diarrhea, chest pain, or worsening of her cold when lying down.
Then 1.5 weeks ago she began to feel SOB with exertion. Until
1.5 weeks ago she could walk 6 steps to her car and to her
office down a long corridor at work without any SOB. However,
1.5 weeks ago the long corridor at work was more difficult, and
she had to stop to rest frequently to catch her breath. When she
was SOB, she would note her heart was racing. She denies CP,
dizziness, N/V, jaw pain or diaphoreis during these episodes of
SOB. She went to her PCP's office [**2-1**] c/o this SOB, and he Rx'd
her Flovent 110mcg [**Hospital1 **], which pt reports did "nothing". Of note,
on that PCP visit, her BP was noted to be elevated (although
specific number is not given in PCP note, pt believes it was
180), and she was also Rx'd amlodipine 5mg QD. Patient then
noted that 3 days ago she woke up, and felt SOB and had heart
palpitations just in getting out of bed. She then felt it was
almost too difficult to walk 6 steps to her car. She then went
to work today, and the elevator was broken. She realized she
couldn't climb the stairs as she felt she could barely walk, and
was going to go home and rest. However, a coworker brought her
to an ambulance that happened to be on the street, they took her
vitals and told her her "oxygen is too low and blood pressure is
too high", and took her to the hospital.
.
In the ED, initial vs were: 99.2 HR:119 BP:173/73 Resp:40
O(2)Sat:33%, and pt was noted to have "blue fingers". She was
put on BIPAP at FiO2 of 50% and her O2 sats improved to 100%.
She was given CTX x1, azithromycin x1, duoneb x1, Magnesium 2gm,
methlypred 125mg IV as well as put on a nitro gtt for her BP.
She was able to be weaned off of BIPAP to 6L NC and was satting
93%. CXR gotten, which showed pulm edema and bibasilar
atelectasis. She was admitted to the ICU for BIPAP and workup of
sudden O2 desaturation.
.
In the ICU, patient reported she felt "much better".
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.

MEDICAL HISTORY: HTN, venous statis, s/p radiofrequency ablation [**12/2123**],
umbilical hernia repair [**2121**].

MEDICATION ON ADMISSION: 

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T:99.3 BP: 135/70 P:97 R:25 18 O2: 99% on 6L
General: Alert, oriented, no acute distress, facemask in place
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP difficult to visualize [**12-29**] body habitus
Lungs: Distant breath sounds,likely [**12-29**] body habitus, faint
crackles heard throuhgout all lung fields
CV: Faint heart sounds, likely [**12-29**] body habitus, regular rate
and rhythm, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, bowel sounds minimally
audible, no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, venous stasis changes
bilaterally on shins, 1+ pitting edema to mid-shins bilaterally

FAMILY HISTORY: mother is 82, has a hx of arrythmia, but no MI, father died at
67 of emphysema after a 50 year smoking hx

SOCIAL HISTORY: Works as a secretary at a law office
- Tobacco: Denies
- Alcohol: Denies
- Illicits: Denies
Acute diastolic heart failure,Obesity hypoventilation syndrome,Acidosis,Acute kidney failure, unspecified,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Hypoxemia,Chronic obstructive asthma, unspecified,Venous (peripheral) insufficiency, unspecified
Ac diastolic hrt failure,Obesity hypovent synd,Acidosis,Acute kidney failure NOS,Obstructive sleep apnea,Hypertension NOS,Hypoxemia,Chronic obst asthma NOS,Venous insufficiency NOS
Admission Date:  [**2124-2-7**]              Discharge Date:   [**2124-2-10**]

Date of Birth:  [**2068-3-29**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2186**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
[**Known firstname **] [**Known lastname **] is a 55 yo female with hx of HTN and venous stasis
who presents with acute oxygen desaturation. Patient reports
that 2.5 weeks ago she had a cold, with a scratchy throat,
non-productive cough that was worse at night, and a "tight"
feeling with breathing. She denies any fevers, chills, N/V,
diarrhea, chest pain, or worsening of her cold when lying down.
Then 1.5 weeks ago she began to feel SOB with exertion. Until
1.5 weeks ago she could walk 6 steps to her car and to her
office down a long corridor at work without any SOB. However,
1.5 weeks ago the long corridor at work was more difficult, and
she had to stop to rest frequently to catch her breath. When she
was SOB, she would note her heart was racing. She denies CP,
dizziness, N/V, jaw pain or diaphoreis during these episodes of
SOB. She went to her PCP's office [**2-1**] c/o this SOB, and he Rx'd
her Flovent 110mcg [**Hospital1 **], which pt reports did "nothing". Of note,
on that PCP visit, her BP was noted to be elevated (although
specific number is not given in PCP note, pt believes it was
180), and she was also Rx'd amlodipine 5mg QD. Patient then
noted that 3 days ago she woke up, and felt SOB and had heart
palpitations just in getting out of bed. She then felt it was
almost too difficult to walk 6 steps to her car. She then went
to work today, and the elevator was broken. She realized she
couldn't climb the stairs as she felt she could barely walk, and
was going to go home and rest. However, a coworker brought her
to an ambulance that happened to be on the street, they took her
vitals and told her her "oxygen is too low and blood pressure is
too high", and took her to the hospital.
.
In the ED, initial vs were: 99.2 HR:119 BP:173/73 Resp:40
O(2)Sat:33%, and pt was noted to have "blue fingers". She was
put on BIPAP at FiO2 of 50% and her O2 sats improved to 100%.
She was given CTX x1, azithromycin x1, duoneb x1, Magnesium 2gm,
methlypred 125mg IV as well as put on a nitro gtt for her BP.
She was able to be weaned off of BIPAP to 6L NC and was satting
93%. CXR gotten, which showed pulm edema and bibasilar
atelectasis. She was admitted to the ICU for BIPAP and workup of
sudden O2 desaturation.
.
In the ICU, patient reported she felt "much better".
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.


Past Medical History:
HTN, venous statis, s/p radiofrequency ablation [**12/2123**],
umbilical hernia repair [**2121**].

Social History:
Works as a secretary at a law office
- Tobacco: Denies
- Alcohol: Denies
- Illicits: Denies


Family History:
mother is 82, has a hx of arrythmia, but no MI, father died at
67 of emphysema after a 50 year smoking hx

Physical Exam:
Admission Physical Exam:
Vitals: T:99.3 BP: 135/70 P:97 R:25 18 O2: 99% on 6L
General: Alert, oriented, no acute distress, facemask in place
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP difficult to visualize [**12-29**] body habitus
Lungs: Distant breath sounds,likely [**12-29**] body habitus, faint
crackles heard throuhgout all lung fields
CV: Faint heart sounds, likely [**12-29**] body habitus, regular rate
and rhythm, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, bowel sounds minimally
audible, no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, venous stasis changes
bilaterally on shins, 1+ pitting edema to mid-shins bilaterally



Pertinent Results:
Imaging:

CTA chest [**2124-2-7**]:
1. No evidence of acute pulmonary embolus or acute aortic
syndrome.
2. Mild pulmonary edema with small bilateral pleural effusions
with adjacent areas of compressive atelectasis.
3. Bibasilar and left upper lobe patchy opacities, which may be
attributed to atelectasis; however, superimposed infection
should be considered in the appropriate clinical setting.
4. Left adrenal gland adenoma.
5. Right adrenal gland nodule which does not meet strict
criteria for an
adenoma on this study, but in the absence of any history of
malignancy, is
likely benign. A 1 year follow-up exam with adrenal CT or MR is
recommended to ensure stability of this finding and for better
characterization.

TTE [**2124-2-8**]:
The left atrium is moderately dilated. Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF 75%). Right ventricular chamber size and free wall
motion are not grossly abnormal, but the right ventricle was
very poorly visualized. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
stenosis. Trace aortic regurgitation is seen. The mitral valve
appears structurally normal with trivial mitral regurgitation.
There is no mitral valve prolapse. The pulmonary artery systolic
pressure could not be determined. There is a small pericardial
effusion. The effusion appears circumferential. There are no
echocardiographic signs of tamponade.
If there is a suspicion for an atrial septal defect with
right-to-left shunt as cause of arterial desaturation, a
transesophageal echocardiographic study with agitated saline
contrast is recommended.

CXRv [**2124-2-7**]: Mild pulmonary edema and probable bibasilar
atelectasis, but
infection is not excluded.


Brief Hospital Course:
Ms [**Known lastname **] is a 55 yo woman h/o obesity, venous stasis who was
admitted to the ICU for hypoxia and congestive heart failure.

# Hypoxia: Patient desatted to the 30's on arrival to the ED
with an ABG showed CO2 retention. She was also noted to be
hypertensive.  CXR and CTA showed bilateral pulmonary edema and
atelectasis, and BNP was elevated in the 700s.
   Her O2 sat dramatically improved on BIPAP. And an Echo showed
mod dilated left atrium and LVEF >75% consistent with diastolic
CHF.  She improved with lasix and BiPAP over night.
   Her symptoms were most consistent with diastolic CHF -
probably arising from chronic HTN which itself may be attributed
to OSA.  She also has a component of obesity hypoventilation
syndrome.
   She was given metoprolol, lasix, and BiPAP/CPAP over night.
The setting was 14/8 on the bipap.
   On the day of discharge, she was able to ambulate without
difficulty.  She will be followed by her PCP and with the sleep
clinic (number provided by the Sleep physicians in the ICU).
She understands that compliance with the CPAP machine is
important and that reducing weight (through exercise and diet
changes) would help with her overall condition.




Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation Q6  as needed for shortness of breath or
wheezing.
Disp:*1 inhaler bottle* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Diastolic congestive heart failure
Obstructive sleep apnea
Hypertension


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the ICU with shortness of breath and low
oxygen levels.  You were diagnosed with hypertension, congestive
heart failure (diastolic), and obstructive sleep apnea.  Your
symptoms improved with better blood pressure control,
medications to help you urinate, and a CPAP (for sleep apnea).
   Please be sure to continue to take the blood pressure
medications (metoprolol) and to continue with the CPAP machine
over night.
   We encourage you to exercise, avoid salty foods, and to keep
track of your weight.

Followup Instructions:
Department: [**State **]When: MONDAY [**2124-2-21**] at 4:40 PM
With: [**First Name11 (Name Pattern1) 2946**] [**Last Name (NamePattern4) 6564**], MD [**Telephone/Fax (1) 2205**]
Building: [**State **] ([**Location (un) **], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: On Street Parking
{'Acute diastolic heart failure,Obesity hypoventilation syndrome,Acidosis,Acute kidney failure, unspecified,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Hypoxemia,Chronic obstructive asthma, unspecified,Venous (peripheral) insufficiency, 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: shortness of breath

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a 55 yo female with hx of HTN and venous stasis
who presents with acute oxygen desaturation. Patient reports
that 2.5 weeks ago she had a cold, with a scratchy throat,
non-productive cough that was worse at night, and a "tight"
feeling with breathing. She denies any fevers, chills, N/V,
diarrhea, chest pain, or worsening of her cold when lying down.
Then 1.5 weeks ago she began to feel SOB with exertion. Until
1.5 weeks ago she could walk 6 steps to her car and to her
office down a long corridor at work without any SOB. However,
1.5 weeks ago the long corridor at work was more difficult, and
she had to stop to rest frequently to catch her breath. When she
was SOB, she would note her heart was racing. She denies CP,
dizziness, N/V, jaw pain or diaphoreis during these episodes of
SOB. She went to her PCP's office [**2-1**] c/o this SOB, and he Rx'd
her Flovent 110mcg [**Hospital1 **], which pt reports did "nothing". Of note,
on that PCP visit, her BP was noted to be elevated (although
specific number is not given in PCP note, pt believes it was
180), and she was also Rx'd amlodipine 5mg QD. Patient then
noted that 3 days ago she woke up, and felt SOB and had heart
palpitations just in getting out of bed. She then felt it was
almost too difficult to walk 6 steps to her car. She then went
to work today, and the elevator was broken. She realized she
couldn't climb the stairs as she felt she could barely walk, and
was going to go home and rest. However, a coworker brought her
to an ambulance that happened to be on the street, they took her
vitals and told her her "oxygen is too low and blood pressure is
too high", and took her to the hospital.
.
In the ED, initial vs were: 99.2 HR:119 BP:173/73 Resp:40
O(2)Sat:33%, and pt was noted to have "blue fingers". She was
put on BIPAP at FiO2 of 50% and her O2 sats improved to 100%.
She was given CTX x1, azithromycin x1, duoneb x1, Magnesium 2gm,
methlypred 125mg IV as well as put on a nitro gtt for her BP.
She was able to be weaned off of BIPAP to 6L NC and was satting
93%. CXR gotten, which showed pulm edema and bibasilar
atelectasis. She was admitted to the ICU for BIPAP and workup of
sudden O2 desaturation.
.
In the ICU, patient reported she felt "much better".
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.

MEDICAL HISTORY: HTN, venous statis, s/p radiofrequency ablation [**12/2123**],
umbilical hernia repair [**2121**].

MEDICATION ON ADMISSION: 

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T:99.3 BP: 135/70 P:97 R:25 18 O2: 99% on 6L
General: Alert, oriented, no acute distress, facemask in place
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP difficult to visualize [**12-29**] body habitus
Lungs: Distant breath sounds,likely [**12-29**] body habitus, faint
crackles heard throuhgout all lung fields
CV: Faint heart sounds, likely [**12-29**] body habitus, regular rate
and rhythm, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, bowel sounds minimally
audible, no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, venous stasis changes
bilaterally on shins, 1+ pitting edema to mid-shins bilaterally

FAMILY HISTORY: mother is 82, has a hx of arrythmia, but no MI, father died at
67 of emphysema after a 50 year smoking hx

SOCIAL HISTORY: Works as a secretary at a law office
- Tobacco: Denies
- Alcohol: Denies
- Illicits: Denies 

### Response:
{'Acute diastolic heart failure,Obesity hypoventilation syndrome,Acidosis,Acute kidney failure, unspecified,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Hypoxemia,Chronic obstructive asthma, unspecified,Venous (peripheral) insufficiency, unspecified'}
