CHIEF COMPLAINT: Transferred from [**Hospital 47**] hospital for balloon pericardiotomy

PRESENT ILLNESS: Patient is a 75 yo woman with PMH of Lung cancer
(adenocarcinoma) diagnosed in [**2176**], on maintenance XRT and
chemotherapy, history of HTN, diastolic dysfunction, and CRI who
presents from [**Hospital 47**] hospital with newly noted pericardial
effusion for balloon pericardiotomy. Patient states that she was
feeling in her USOH until 2 weeks prior to presentation at
[**Hospital 47**] hospital, when began feeling sick with cough,
described as dry cough productive of only scant amounts of
yellow sputum. Per patient, has cough at baseline productive of
white, foamy sputum, from her lung ca, but this cough was
different. Over the next 2 weeks, her cough progressed, was
associated with fever to around 100 on-and-off, SOB with
exertion, and on day of presentation to [**Location (un) 47**], had episode
of nausea and vomiting. 2 days PTA, she started on doxycycline
prescribed by her outpatient physician, [**Name10 (NameIs) **] improvement and
in fact worsening of her symptoms. She denies any orthopnea,
PND, LE swelling, change in weight, palpitations,
lightheadedness/dizziness, change in bowel habits, urinary
symptoms during this time.
.
On presentation to the OSH on [**2180-2-12**], patient was found to be
hypoxic, requiring oxygen through nasal cannula. During
[**Hospital 228**] hospital course at [**Location (un) 47**], she had an admission
CXR demonstrating large RUL and RML consolidation, mass like
lesion in R hilum c/w pneumonia, ?post-obstructive, ?recurrent
ca. Patient was treated with azithromycin and clindamycin.
Patient also had ECHO done in the ED that demonstrated small
pericardial effusion of 1.1 cm, no evidence of tamponade. Follow
up ECHO 5 days after admission demonstrated increase of her
pericardial effusion, still no evidence of tamponade, and
therefore patient was transferred for balloon pericardiotomy.
Hospital course otherwise notable for transfusion of 2 units
pRBC that brought her Hct from 26-> 30.2. Patient was also noted
at one point to be hypoglycemic with FSBS=36 for unknown reasons
- resolved with D50, and subsequently had normal FSBS. Patient
also had episode of desaturation to 80's, which resolved with
administration of 20mg IV lasix.
.
Currently, post-balloon pericardiotomy, patient feels well.
Denies any chest pain/pressure, shortness of [**Last Name (LF) 1440**], [**First Name3 (LF) 691**] other
complaints at this time.

MEDICAL HISTORY: 1.) Lung cancer (adenocarcinoma) - diagnosed in [**2176**], currently
on maintenance XRT and chemotherapy
2.) HTN
3.) Diastolic heart failure (cath in [**2176**] w/ elevated filling
pressures - RA 19, PA 52/26, mean PCWP 26)
4.) CRI (?baseline Cr=1.8-2.2)
Last cardiac cath in [**2176**] w/ clean coronary arteries

MEDICATION ON ADMISSION: lasix 40 qd
spironolactone 25 qd
atenolol 100mg qd
tarceva 100mg qd
azithromycin 250mg qd
clindamycin 300mg q8hr
protonix 40mg qd
albuterol/atrovent nebs

ALLERGIES: Percocet

PHYSICAL EXAM: Vitals - HR 82, BP 121/60, RR 27, O2 96% on 0.5L NC
General - awake, alert, oriented, NAD
HEENT - PERRL, dry MM
Neck - JVD at approximately 7cm
CVS - RRR, nl S1,S2, no M/R/G
Chest - pericardial drain in place, drainage bag w/
approximately 75cc serosanguinous drainage
Lungs - scattered wheezes diffusely, decreased BS at lateral
bases b/l
Abd - obese, soft, non-tender, +BS
Groin - R groin w/ bandage in place, some sanguinous staining of
bandage site, tender to palpation, no noted hematoma
Ext - 2+ DP pulses b/l, no LE edema b/l

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with son in [**Name (NI) 47**], MA, used to smoke, quit 25 years
ago, rare EtOH, no drug use.
Secondary malignant neoplasm of other specified sites,Chronic diastolic heart failure,Chronic kidney disease, unspecified,Bronchopneumonia, organism unspecified,Diseases of tricuspid valve,Hypoglycemia, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Other specified cardiac dysrhythmias
Secondary malig neo NEC,Chr diastolic hrt fail,Chronic kidney dis NOS,Bronchopneumonia org NOS,Tricuspid valve disease,Hypoglycemia NOS,Hypertension NOS,Hx-bronchogenic malignan,Cardiac dysrhythmias NEC
Admission Date:  [**2180-2-18**]              Discharge Date:   [**2180-2-21**]

Date of Birth:  [**2100-6-12**]             Sex:   F

Service: MEDICINE

Allergies:
Percocet

Attending:[**First Name3 (LF) 7055**]
Chief Complaint:
Transferred from [**Hospital 47**] hospital for balloon pericardiotomy

Major Surgical or Invasive Procedure:
balloon pericardiotomy

History of Present Illness:
Patient is a 75 yo woman with PMH of Lung cancer
(adenocarcinoma) diagnosed in [**2176**], on maintenance XRT and
chemotherapy, history of HTN, diastolic dysfunction, and CRI who
presents from [**Hospital 47**] hospital with newly noted pericardial
effusion for balloon pericardiotomy. Patient states that she was
feeling in her USOH until 2 weeks prior to presentation at
[**Hospital 47**] hospital, when began feeling sick with cough,
described as dry cough productive of only scant amounts of
yellow sputum. Per patient, has cough at baseline productive of
white, foamy sputum, from her lung ca, but this cough was
different. Over the next 2 weeks, her cough progressed, was
associated with fever to around 100 on-and-off, SOB with
exertion, and on day of presentation to [**Location (un) 47**], had episode
of nausea and vomiting. 2 days PTA, she started on doxycycline
prescribed by her outpatient physician, [**Name10 (NameIs) **] improvement and
in fact worsening of her symptoms. She denies any orthopnea,
PND, LE swelling, change in weight, palpitations,
lightheadedness/dizziness, change in bowel habits, urinary
symptoms during this time.
.
On presentation to the OSH on [**2180-2-12**], patient was found to be
hypoxic, requiring oxygen through nasal cannula. During
[**Hospital 228**] hospital course at [**Location (un) 47**], she had an admission
CXR demonstrating large RUL and RML consolidation, mass like
lesion in R hilum c/w pneumonia, ?post-obstructive, ?recurrent
ca. Patient was treated with azithromycin and clindamycin.
Patient also had ECHO done in the ED that demonstrated small
pericardial effusion of 1.1 cm, no evidence of tamponade. Follow
up ECHO 5 days after admission demonstrated increase of her
pericardial effusion, still no evidence of tamponade, and
therefore patient was transferred for balloon pericardiotomy.
Hospital course otherwise notable for transfusion of 2 units
pRBC that brought her Hct from 26-> 30.2. Patient was also noted
at one point to be hypoglycemic with FSBS=36 for unknown reasons
- resolved with D50, and subsequently had normal FSBS. Patient
also had episode of desaturation to 80's, which resolved with
administration of 20mg IV lasix.
.
Currently, post-balloon pericardiotomy, patient feels well.
Denies any chest pain/pressure, shortness of [**Last Name (LF) 1440**], [**First Name3 (LF) 691**] other
complaints at this time.

Past Medical History:
1.) Lung cancer (adenocarcinoma) - diagnosed in [**2176**], currently
on maintenance XRT and chemotherapy
2.) HTN
3.) Diastolic heart failure (cath in [**2176**] w/ elevated filling
pressures - RA 19, PA 52/26, mean PCWP 26)
4.) CRI (?baseline Cr=1.8-2.2)
Last cardiac cath in [**2176**] w/ clean coronary arteries


Social History:
Lives with son in [**Name (NI) 47**], MA, used to smoke, quit 25 years
ago, rare EtOH, no drug use.

Family History:
NC

Physical Exam:
Vitals - HR 82, BP 121/60, RR 27, O2 96% on 0.5L NC
General - awake, alert, oriented, NAD
HEENT - PERRL, dry MM
Neck - JVD at approximately 7cm
CVS - RRR, nl S1,S2, no M/R/G
Chest - pericardial drain in place, drainage bag w/
approximately 75cc serosanguinous drainage
Lungs - scattered wheezes diffusely, decreased BS at lateral
bases b/l
Abd - obese, soft, non-tender, +BS
Groin - R groin w/ bandage in place, some sanguinous staining of
bandage site, tender to palpation, no noted hematoma
Ext - 2+ DP pulses b/l, no LE edema b/l

Pertinent Results:
[**2180-2-18**] 04:25PM BLOOD WBC-8.3 RBC-3.88* Hgb-9.8* Hct-31.6*
MCV-82# MCH-25.3*# MCHC-31.0 RDW-19.0* Plt Ct-582*#
[**2180-2-19**] 05:40AM BLOOD WBC-7.2 RBC-3.85* Hgb-9.6* Hct-31.4*
MCV-81* MCH-25.0* MCHC-30.7* RDW-18.9* Plt Ct-585*
[**2180-2-18**] 04:25PM BLOOD Neuts-90.7* Lymphs-4.4* Monos-3.3 Eos-1.4
Baso-0.3
[**2180-2-18**] 04:25PM BLOOD PT-14.9* PTT-36.2* INR(PT)-1.3*
[**2180-2-18**] 11:40AM BLOOD Glucose-79 UreaN-60* Creat-2.4* Na-137
K-6.0* Cl-101 HCO3-24 AnGap-18
[**2180-2-19**] 05:40AM BLOOD Glucose-99 UreaN-57* Creat-2.3* Na-140
K-5.1 Cl-103 HCO3-25 AnGap-17
[**2180-2-19**] 08:53PM BLOOD Glucose-150* UreaN-59* Creat-2.2* Na-134
K-4.3 Cl-100 HCO3-23 AnGap-15
[**2180-2-18**] 04:25PM BLOOD ALT-123* AST-76* LD(LDH)-278*
AlkPhos-148* TotBili-0.6
[**2180-2-19**] 05:40AM BLOOD ALT-92* AST-54* LD(LDH)-247 AlkPhos-141*
TotBili-0.5
[**2180-2-19**] 05:40AM BLOOD Albumin-3.1* Calcium-9.4 Phos-4.2 Mg-2.1
[**2180-2-19**] 05:40AM BLOOD HBsAg-PND HBsAb-PND HBcAb-PND IgM HAV-PND
[**2180-2-19**] 05:40AM BLOOD HCV Ab-PND
.
CXR [**2-18**]: IMPRESSION:
Interval development of marked right-sided upper lung volume
loss. At least partial obstruction of the right upper and right
middle lobe bronchi is not excluded.
Airspace opacity, most evident in the left mid and lower lung
zones, with left-sided small pleural effusion. The findings
represent mild pulmonary edema.
Pericardial drain projecting over the cardiac apex.
These findings would all be better assessed with
contrast-enhanced CT examination of the chest.
.
Echo [**2-18**]: Conclusions:
1. The left atrium is normal in size.
2.There is mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
3.Right ventricular chamber size is normal. Right ventricular
systolic
function is normal.
4.The aortic valve leaflets are mildly thickened. No aortic
regurgitation is seen.
5.The mitral valve leaflets are structurally normal. No mitral
regurgitation is seen.
6.Moderate [2+] tricuspid regurgitation is seen.
7.There is mild pulmonary artery systolic hypertension.
8.There is a large circumferential pericardial effusion. There
are no
echocardiographic signs of tamponade.
.
Echo [**2-18**]: Conclusions:
1. Overall left ventricular systolic function is normal
(LVEF>55%).
2.There is a trivial/physiologic pericardial effusion.

Brief Hospital Course:
75 yo woman with PMH of lung cancer, diastolic dysfxn, CRI, who
presented with pericardial effusion for pericaricentesis and
pericardiotomy.
.
# Pericardial effusion:
pt had successful balloon pericardiotomy performed, 300cc
removed during procedure, 300cc additionally via drain, this was
kept in place until output was < 500cc/8hr and removed on [**2-19**],
repeat echo prior to removal showed trace effusion remaining.
The fluid was serosanguinous, labs showed [**Numeric Identifier 102834**] RBCs, 3000
WBCs, 85 polys, 11 lymps, 2 monos, 1 eo, 1 macro.  Cytology
pending at time of discharge, although most likely cause felt to
be malignancy given hx of lung CA.  Pt received 1 dose of Kefzol
after procedure.
.
# Cardiac:
A. Coronaries: Patient without evidence of ischemic heart
disease, last cath per OSH records in [**2176**] w/ clean coronary
arteries, no signs/sxs of ischemic heart disease currently.
.
B. Pump: Patient w/ hx of diastolic heart failure, on lasix 40mg
PO QD as outpt. Currently appears euvolemic. Continued regular
dose lasix and spironolactone.
.
C. Rhythm: patient initially in NSR, on [**2-19**] she developed sinus
tachycardia - ? [**1-13**] infection vs pericardial irritation.  Pt
thereafter was noted to have periods of tachycardia up to 130s
with underlying atrial tachycardial/multifocal atrial
tachycardia.  She was additionally noted to have episodes of
AVNRT with well visualized retrograde p waves.  Her electrolytes
were within normal limits.  Her metoprolol was increased to 67.5
TID, and may need to be titrated further.  Overnight [**2-19**] she
continued having episode of tachycardia to 120s, BP stable,
asymptomatic, resolving spontaneously.
.
# Pneumonia: Per patient, c/o cough and fever on presentation to
OSH. Per OSH records, ? RUL and RML pna on CXR c/w possible
post-obstructive pna. Was treated w/ azithromycin (started [**2-12**])
and clindamycin (started [**2-13**]) at OSH. On presentation, got
repeat CXR that demonstrated severe consolidation of RUL, RML,
upper part of RLL. Chest CT performed at OSH, so not repeated
here, but this was presumed to be post-obstructive pna.  Pt was
placed on clindamycin 300mg q6hr, levofloxacin 250mg q24hr.
.
# Hx lung ca: Patient with hx lung ca (adenocarcinoma) diagnosed
in [**2176**], currently on maintenance XRT and chemo (tarceva).
Likely cancer recurrence as etiology of pericardial effusion as
above, and w/ CXR findings from OSH and here, and references to
Chest CT findings from OSH. Continued tarceva.  Plan to:
- f/u cytology of pericardial effusion
.
# Resp: Patient w/ no documented hx of COPD. However + wheezes
on exam, and per OSH records, receiving albuterol/atrovent nebs
PRN.  Continued atrovent nebs PRN, oxygenation remained stable
of 2L NC.
.
# CRI: Pt w/ hx of CRI, unknown baseline Cr, ?1.8-2.2. On
admission, Cr=2.4, trended down to baseline of 2.2, rec'd one
addition dose of 20mg lasix for period of shortness of [**Year (4 digits) 1440**],
but otherwise continued previous doses of lasix/spironolactone.
.
# Transaminitis: On admission, pt noted to have elevated
transaminases (AST 76, ALT 123, Alk Phos 148, LDH 278). T. bili
WNL. Abd exam non-tender. Noted to be trending down. Possible
[**1-13**] congestion vs lung mets, hepatitis panel sent, pending at
time of discharge.  Consider abdominal CT if they trend up.
.
# HTN: On atenolol 100mg qd as outpt. Pt was placed on
metoprolol during admission to allow for better titration in
face of arrhythmias.  Would not restart atenolol in face of
renal insufficiency, would favor toprol XL.
.
# FEN: Cardiac diet
.
# PPX: VD boots, Protonix (outpt med), bowel regimen
.
# Access: Midline placed [**2180-2-18**] for ongoing antibiotics
.
# Code status: Full
.
# Communication: Son, [**Name (NI) **], ([**Telephone/Fax (1) 102835**]

Medications on Admission:
lasix 40 qd
spironolactone 25 qd
atenolol 100mg qd
tarceva 100mg qd
azithromycin 250mg qd
clindamycin 300mg q8hr
protonix 40mg qd
albuterol/atrovent nebs

Discharge Medications:
1. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Tarceva 100 mg Tablet Sig: One (1) Tablet PO QD ().
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb
Inhalation Q4H (every 4 hours) as needed.
7. Clindamycin HCl 150 mg Capsule Sig: Two (2) Capsule PO Q6H
(every 6 hours).
8. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
9. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
11. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) mL
Injection TID (3 times a day).
12. Metoprolol Tartrate 25 mg Tablet Sig: 2.5 Tablets PO TID (3
times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] - [**Location (un) 47**]

Discharge Diagnosis:
Primary:
Pericardial effusion
Post-obstructive pneumonia
Secondary:
Lung CA
Narrow complex tachycardia

Discharge Condition:
fair


Discharge Instructions:
Please follow up with your primary care doctor as needed.  Take
your medications as prescribed.  Continue your antibiotics as
recommended by your doctors.

Followup Instructions:
Follow up with your primary care doctor as needed



Completed by:[**2180-2-20**]

Name:  [**Known lastname 400**],[**Known firstname 16611**]                 Unit No:   [**Numeric Identifier 16612**]

Admission Date:  [**2180-2-18**]              Discharge Date:   [**2180-2-21**]

Date of Birth:  [**2100-6-12**]             Sex:   F

Service: MEDICINE

Allergies:
Percocet

Attending:[**First Name3 (LF) 3753**]
Addendum:
On day prior to discharge, the patient developed bursts of
junctional tachycardia and multifocal atrial tachycardia.  Given
her COPD and tachycardia, she was switched from metoprolol 62.5
[**Hospital1 **] to diltiazem 30 mg QID.  She tolerated this well without
repeat occurences of her tachycardia.
Patient had a repeat echocardiogram prior to transfer back to
[**Location (un) 4887**] to ensure no re-accumulation of her pericardial
effusion.  ECHO demonstrated trivial pericardial effusion,
confirming no re-accumulation.
Pericardial effusion studies noted in discharge summary -
cytology pending at time of transfer.p
She was transferred, to the service of Dr. [**Last Name (STitle) 13747**], back to
[**Location (un) 4887**] to complete IV antibiotics course for
post-obstructive pneumonia and for further monitoring.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 2057**] - [**Location (un) 4887**]

                             [**First Name11 (Name Pattern1) 399**] [**Last Name (NamePattern4) 3754**] MD [**MD Number(1) 3755**]

Completed by:[**2180-2-21**]
{'Secondary malignant neoplasm of other specified sites,Chronic diastolic heart failure,Chronic kidney disease, unspecified,Bronchopneumonia, organism unspecified,Diseases of tricuspid valve,Hypoglycemia, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Other specified cardiac dysrhythmias'}


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: Transferred from [**Hospital 47**] hospital for balloon pericardiotomy

PRESENT ILLNESS: Patient is a 75 yo woman with PMH of Lung cancer
(adenocarcinoma) diagnosed in [**2176**], on maintenance XRT and
chemotherapy, history of HTN, diastolic dysfunction, and CRI who
presents from [**Hospital 47**] hospital with newly noted pericardial
effusion for balloon pericardiotomy. Patient states that she was
feeling in her USOH until 2 weeks prior to presentation at
[**Hospital 47**] hospital, when began feeling sick with cough,
described as dry cough productive of only scant amounts of
yellow sputum. Per patient, has cough at baseline productive of
white, foamy sputum, from her lung ca, but this cough was
different. Over the next 2 weeks, her cough progressed, was
associated with fever to around 100 on-and-off, SOB with
exertion, and on day of presentation to [**Location (un) 47**], had episode
of nausea and vomiting. 2 days PTA, she started on doxycycline
prescribed by her outpatient physician, [**Name10 (NameIs) **] improvement and
in fact worsening of her symptoms. She denies any orthopnea,
PND, LE swelling, change in weight, palpitations,
lightheadedness/dizziness, change in bowel habits, urinary
symptoms during this time.
.
On presentation to the OSH on [**2180-2-12**], patient was found to be
hypoxic, requiring oxygen through nasal cannula. During
[**Hospital 228**] hospital course at [**Location (un) 47**], she had an admission
CXR demonstrating large RUL and RML consolidation, mass like
lesion in R hilum c/w pneumonia, ?post-obstructive, ?recurrent
ca. Patient was treated with azithromycin and clindamycin.
Patient also had ECHO done in the ED that demonstrated small
pericardial effusion of 1.1 cm, no evidence of tamponade. Follow
up ECHO 5 days after admission demonstrated increase of her
pericardial effusion, still no evidence of tamponade, and
therefore patient was transferred for balloon pericardiotomy.
Hospital course otherwise notable for transfusion of 2 units
pRBC that brought her Hct from 26-> 30.2. Patient was also noted
at one point to be hypoglycemic with FSBS=36 for unknown reasons
- resolved with D50, and subsequently had normal FSBS. Patient
also had episode of desaturation to 80's, which resolved with
administration of 20mg IV lasix.
.
Currently, post-balloon pericardiotomy, patient feels well.
Denies any chest pain/pressure, shortness of [**Last Name (LF) 1440**], [**First Name3 (LF) 691**] other
complaints at this time.

MEDICAL HISTORY: 1.) Lung cancer (adenocarcinoma) - diagnosed in [**2176**], currently
on maintenance XRT and chemotherapy
2.) HTN
3.) Diastolic heart failure (cath in [**2176**] w/ elevated filling
pressures - RA 19, PA 52/26, mean PCWP 26)
4.) CRI (?baseline Cr=1.8-2.2)
Last cardiac cath in [**2176**] w/ clean coronary arteries

MEDICATION ON ADMISSION: lasix 40 qd
spironolactone 25 qd
atenolol 100mg qd
tarceva 100mg qd
azithromycin 250mg qd
clindamycin 300mg q8hr
protonix 40mg qd
albuterol/atrovent nebs

ALLERGIES: Percocet

PHYSICAL EXAM: Vitals - HR 82, BP 121/60, RR 27, O2 96% on 0.5L NC
General - awake, alert, oriented, NAD
HEENT - PERRL, dry MM
Neck - JVD at approximately 7cm
CVS - RRR, nl S1,S2, no M/R/G
Chest - pericardial drain in place, drainage bag w/
approximately 75cc serosanguinous drainage
Lungs - scattered wheezes diffusely, decreased BS at lateral
bases b/l
Abd - obese, soft, non-tender, +BS
Groin - R groin w/ bandage in place, some sanguinous staining of
bandage site, tender to palpation, no noted hematoma
Ext - 2+ DP pulses b/l, no LE edema b/l

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with son in [**Name (NI) 47**], MA, used to smoke, quit 25 years
ago, rare EtOH, no drug use. 

### Response:
{'Secondary malignant neoplasm of other specified sites,Chronic diastolic heart failure,Chronic kidney disease, unspecified,Bronchopneumonia, organism unspecified,Diseases of tricuspid valve,Hypoglycemia, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Other specified cardiac dysrhythmias'}
