CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 5057**] is 77M with h/o HTN, HLD, COPD, and newly diagnosed
NSCLC c/b pericardial effusion wtih tamponade s/p
pericardiocentesis in [**8-/2132**] and s/p one round of
taxol/carboplatin chemotherapy, recent new heart failure
diagnosed in [**9-/2132**] (EF 40-45%), who is presenting with
worsening SOB and DOE for the last few days.  As per the
patient's wife, the patient has been having worsening dyspnea on
exertion for the last few days, that acutely worsened earlier
today when he was walking up the stairs.  In addition, also
reports having worsening orthopnea over the last few days as
well (he usually uses one pillow at night, but reports that for
the last few days he has been using two pillows).  Pt also
reports decreased PO intake for the last few days.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia,
+Hypertension
2. CARDIAC HISTORY:
- CABG:
- PERCUTANEOUS CORONARY INTERVENTIONS:
- PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
HTN
HLD
NSCLC
Gout

MEDICATION ON ADMISSION: 1. allopurinol 100 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).

ALLERGIES: Beta-Blockers (Beta-Adrenergic Blocking Agts)

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
VS: 98.6 105/62 103 22 98 on 3L
General: pleasant elderly gentleman, NAD, sitting up comfortably
in bed, breathing comfortably with NC
HEENT: scleral anicteric, moist mucous membranes
Neck: supple, no JVP appreciated
CV: RRR, normal S1, S2, no murmurs/rubs/gallops appreciated
lungs: bronchial breath sounds throughout, inspiratory crackles
at the bases b/l
abdomen: soft, nontender, nondistended, +BS
extremities: no LE edema, cool toes b/l with some purple tinging
of his toes and soles of his feet
PULSES:
Right: Carotid 2+ DP 1+ PT dopp
Left: Carotid 2+ DP 1+ PT dopp
Neuro: CN 2-12 grossly intact (except hard of hearing), normal
strength and sensation throughout
.
DISCHARGE PHYSICAL EXAM:
VS: 97.8 139/88 95 26 96% on 2L
General: pleasant elderly gentleman, NAD, sitting up comfortably
in chair, breathing comfortably with NC
HEENT: scleral anicteric, moist mucous membranes
Neck: supple, no JVP appreciated
CV: RRR, normal S1, S2, no murmurs/rubs/gallops appreciated
lungs: slight inspiratory crackles as bases, bronchial breath
sounds throughout
abdomen: soft, nontender, nondistended, +BS
extremities: no LE edema, cool toes b/l
PULSES:
Right: Carotid 2+ DP 1+ PT dopp
Left: Carotid 2+ DP 1+ PT dopp
Neuro: CN 2-12 grossly intact (except hard of hearing), normal
strength and sensation throughout

FAMILY HISTORY: Family: MI when 50 y/o, pancreatic cancer in father, paternal
grandfather with MI, maternal grandfather with MI

SOCIAL HISTORY: Lives with his wife, 1.5 ppd for 60 years, still currently
smoking a few cigarettes a day; has two children, involved in
his care, one lives in MA, another in CT. 1 glass of wine/night.
No illicit drugs.
Other specified diseases of pericardium,Acute kidney failure, unspecified,Secondary hypercoagulable state,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Bacteremia,Malignant neoplasm of upper lobe, bronchus or lung,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Chronic obstructive asthma, unspecified,Do not resuscitate status,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Subendocardial infarction, subsequent episode of care,Gout, unspecified,Hypoxemia,Chronic kidney disease, unspecified,Personal history of colonic polyps,Personal history of urinary calculi,Personal history of tobacco use
Pericardial disease NEC,Acute kidney failure NOS,Sec hypercoagulable st,Chr systolic hrt failure,Hy kid NOS w cr kid I-IV,Bacteremia,Mal neo upper lobe lung,Other staphylococcus,Chronic obst asthma NOS,Do not resusctate status,Anemia NOS,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Subendo infarct, subseq,Gout NOS,Hypoxemia,Chronic kidney dis NOS,Prsnl hst colonic polyps,Prsnl hst urnr dsrd calc,History of tobacco use
Admission Date:  [**2132-11-13**]              Discharge Date:   [**2132-11-18**]

Date of Birth:  [**2054-12-31**]             Sex:   M

Service: MEDICINE

Allergies:
Beta-Blockers (Beta-Adrenergic Blocking Agts)

Attending:[**Name (NI) 9308**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
Pericardiocentesis
Pericardial Window
Thoracostomy


History of Present Illness:
Mr. [**Known lastname 5057**] is 77M with h/o HTN, HLD, COPD, and newly diagnosed
NSCLC c/b pericardial effusion wtih tamponade s/p
pericardiocentesis in [**8-/2132**] and s/p one round of
taxol/carboplatin chemotherapy, recent new heart failure
diagnosed in [**9-/2132**] (EF 40-45%), who is presenting with
worsening SOB and DOE for the last few days.  As per the
patient's wife, the patient has been having worsening dyspnea on
exertion for the last few days, that acutely worsened earlier
today when he was walking up the stairs.  In addition, also
reports having worsening orthopnea over the last few days as
well (he usually uses one pillow at night, but reports that for
the last few days he has been using two pillows).  Pt also
reports decreased PO intake for the last few days.

Denies any chest pain, no anginal like symptoms, denies any
increasing swelling in legs.  Denies any wheezing, reports that
this shortness of breath does not feel like his COPD.  Denies
increasing use of his nebs.  He uses 2L NC at home at his
baseline.
..
Of note, the patient was admitted to CCU at the end of [**Month (only) 216**]
for pericardial effusion with e/o tamponade physiology s/p
pericardiocentesis taking out ~1L of bloody fluid, malignant
cells found on cytology.  The patient was also found to have new
heart failure in [**9-/2132**], with EF 40-45% (previous ECHOs with EF
>55%).  Was thought that his heart dysfunction could be
secondary to mid LAD ischemia, with suggestion of cardiac cath.
..
Denies any chest pain, shortness of breath, recent
fevers/chills, coughing.  Does report having L shoulder and arm
pain yesterday, that self resolved in 20 minutes; reports having
this pain in the past, but usually responds to Tylenol.  Does
not report any associated diaphoresis, chest pain.  Denies any
n/v, abdominal pain, no changes in his BMs, no numbness or
tingling, no headache, no changes in vision, no night sweats.
..
On initial evaluation in the ED, the patient was in respiratory
distress, breathing at a rate of 30 and was triggered for
hypoxia.  Was started on NRB at 10-15L, satting mid 90s.
..
EKG in ED showing RBBB, no STE, mild depression V4-6, HR 106,
NSR.  There was question of irregular rhythm while patient en
route to ED, but has been in NSR since he has been here.
D-dimer elevated to 19,998 and BNP 8510.  Trop 0.55, creat 1.9.
Heparin drip was started out of concern for PE; no CTA done
because of ARF.  A bedside ECHO showed no recurrence of
pericardial effusion.  Pt was admitted to CCU for possible cath
out of concern for latent LAD thrombosis.
..
On transfer to CCU, patient satting 100% on 3L NC, with HR in
low 100s, breathing at 20-22.

Past Medical History:
PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia,
+Hypertension
2. CARDIAC HISTORY:
- CABG:
- PERCUTANEOUS CORONARY INTERVENTIONS:
- PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
HTN
HLD
NSCLC
Gout

Social History:
Lives with his wife, 1.5 ppd for 60 years, still currently
smoking a few cigarettes a day; has two children, involved in
his care, one lives in MA, another in CT. 1 glass of wine/night.
No illicit drugs.

Family History:
Family: MI when 50 y/o, pancreatic cancer in father, paternal
grandfather with MI, maternal grandfather with MI

Physical Exam:
ADMISSION PHYSICAL EXAM:
VS: 98.6 105/62 103 22 98 on 3L
General: pleasant elderly gentleman, NAD, sitting up comfortably
in bed, breathing comfortably with NC
HEENT: scleral anicteric, moist mucous membranes
Neck: supple, no JVP appreciated
CV: RRR, normal S1, S2, no murmurs/rubs/gallops appreciated
lungs: bronchial breath sounds throughout, inspiratory crackles
at the bases b/l
abdomen: soft, nontender, nondistended, +BS
extremities: no LE edema, cool toes b/l with some purple tinging
of his toes and soles of his feet
PULSES:
Right: Carotid 2+ DP 1+ PT dopp
Left: Carotid 2+ DP 1+ PT dopp
Neuro: CN 2-12 grossly intact (except hard of hearing), normal
strength and sensation throughout
.
DISCHARGE PHYSICAL EXAM:
VS: 97.8 139/88 95 26 96% on 2L
General: pleasant elderly gentleman, NAD, sitting up comfortably
in chair, breathing comfortably with NC
HEENT: scleral anicteric, moist mucous membranes
Neck: supple, no JVP appreciated
CV: RRR, normal S1, S2, no murmurs/rubs/gallops appreciated
lungs: slight inspiratory crackles as bases, bronchial breath
sounds throughout
abdomen: soft, nontender, nondistended, +BS
extremities: no LE edema, cool toes b/l
PULSES:
Right: Carotid 2+ DP 1+ PT dopp
Left: Carotid 2+ DP 1+ PT dopp
Neuro: CN 2-12 grossly intact (except hard of hearing), normal
strength and sensation throughout


Pertinent Results:
ADMISSION LABS:
.
[**2132-11-13**] 07:05PM BLOOD WBC-10.6# RBC-2.85* Hgb-8.9* Hct-27.5*
MCV-97 MCH-31.4 MCHC-32.5 RDW-17.8* Plt Ct-105*
[**2132-11-13**] 07:05PM BLOOD Neuts-84.0* Lymphs-11.5* Monos-3.4
Eos-0.8 Baso-0.3
[**2132-11-13**] 07:05PM BLOOD PT-18.6* PTT-27.0 INR(PT)-1.7*
[**2132-11-13**] 07:05PM BLOOD Plt Ct-105*
[**2132-11-13**] 07:05PM BLOOD Glucose-176* UreaN-50* Creat-1.9* Na-137
K-4.8 Cl-97 HCO3-25 AnGap-20
[**2132-11-13**] 07:05PM BLOOD ALT-49* AST-47* AlkPhos-138* TotBili-0.4
[**2132-11-13**] 07:05PM BLOOD Calcium-9.2 Phos-3.4 Mg-1.6
[**2132-11-13**] 07:05PM BLOOD D-Dimer-[**Numeric Identifier 45280**]*
[**2132-11-13**] 07:05PM BLOOD CK-MB-5 proBNP-8510*
[**2132-11-13**] 07:05PM BLOOD cTropnT-0.55*
[**2132-11-13**] 07:20PM BLOOD Lactate-3.4*
.
PERTINENT LABS:
.
[**2132-11-13**] 07:05PM BLOOD CK-MB-5 proBNP-8510*
[**2132-11-13**] 07:05PM BLOOD cTropnT-0.55*
[**2132-11-14**] 03:31AM BLOOD CK-MB-4 cTropnT-0.44*
[**2132-11-13**] 07:05PM BLOOD D-Dimer-[**Numeric Identifier 45280**]*
[**2132-11-13**] 07:20PM BLOOD Lactate-3.4*
[**2132-11-14**] 09:34AM BLOOD Lactate-2.4*
[**2132-11-14**] 07:20AM OTHER BODY FLUID WBC-[**Numeric Identifier 961**]* Hct,Fl-42.0*
Polys-73* Bands-1* Lymphs-11* Monos-2* Eos-1* Other-12*
[**2132-11-14**] 07:20AM OTHER BODY FLUID TotProt-6.2 Glucose-1
LD(LDH)-1214 Amylase-257 Albumin-3.6
.
DISCHARGE LABS:
[**2132-11-17**] 01:58AM BLOOD WBC-11.5* RBC-3.54* Hgb-10.8* Hct-32.0*
MCV-90 MCH-30.3 MCHC-33.6 RDW-18.8* Plt Ct-69*
[**2132-11-18**] 03:36AM BLOOD WBC-12.5* RBC-3.55* Hgb-10.8* Hct-32.3*
MCV-91 MCH-30.3 MCHC-33.2 RDW-18.7* Plt Ct-72*
[**2132-11-18**] 03:36AM BLOOD PT-17.4* PTT-26.4 INR(PT)-1.5*
[**2132-11-17**] 01:58AM BLOOD Glucose-79 UreaN-34* Creat-1.2 Na-138
K-4.2 Cl-101 HCO3-32 AnGap-9
[**2132-11-18**] 03:36AM BLOOD Glucose-125* UreaN-30* Creat-1.1 Na-135
K-4.8 Cl-98 HCO3-29 AnGap-13
[**2132-11-18**] 03:36AM BLOOD ALT-24 AST-52* AlkPhos-109 TotBili-1.2
[**2132-11-17**] 01:58AM BLOOD Calcium-8.5 Phos-2.4*# Mg-1.9
[**2132-11-18**] 03:36AM BLOOD Albumin-2.9* Calcium-8.6 Phos-2.8 Mg-2.0
.
.
MICRO/PATH:
.

Blood Culture x 2 [**11-13**]:
.
[**2132-11-13**]:
   Blood Culture, Routine (Preliminary):
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.
         Isolated from only one set in the previous five days.

   Anaerobic Bottle Gram Stain (Final [**2132-11-15**]):
      Reported to and read back by DR. [**Last Name (STitle) **]. KOTOVA ON [**2132-11-15**] AT
0245.
      GRAM POSITIVE COCCI IN CLUSTERS.

   Aerobic Bottle Gram Stain (Final [**2132-11-15**]):
      GRAM POSITIVE COCCI IN CLUSTERS.

.
Pericardial Cultures 11/4:
[**2132-11-14**] 7:20 am FLUID,OTHER      PERECARDIAL.

   GRAM STAIN (Final [**2132-11-14**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   FLUID CULTURE (Preliminary):    NO GROWTH.

   ANAEROBIC CULTURE (Preliminary):    NO ANAEROBES ISOLATED.

   ACID FAST SMEAR (Final [**2132-11-15**]):
      NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.

   ACID FAST CULTURE (Preliminary):    NO MYCOBACTERIA ISOLATED.


   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.
.
[**2132-11-14**] 7:20 am FLUID RECEIVED IN BLOOD CULTURE BOTTLES
      PERECARDIAL.

   Fluid Culture in Bottles (Preliminary):
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    STRAIN 1.
         FINAL SENSITIVITIES.
         Staphylococcus species may develop resistance during
prolonged
         therapy with quinolones.   Therefore, isolates that are
initially
         susceptible may become resistant within three to four
days after
         initiation of therapy.  Testing of repeat isolates may
be
         warranted.
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    STRAIN 2.
         FINAL SENSITIVITIES.
         Staphylococcus species may develop resistance during
prolonged
         therapy with quinolones.   Therefore, isolates that are
initially
         susceptible may become resistant within three to four
days after
         initiation of therapy.  Testing of repeat isolates may
be
         warranted.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPHYLOCOCCUS, COAGULASE NEGATIVE
                             |          STAPHYLOCOCCUS,
COAGULASE NEGATIVE
                             |          |
CLINDAMYCIN-----------<=0.25 S   <=0.25 S
ERYTHROMYCIN----------   =>8 R   <=0.25 S
GENTAMICIN------------ <=0.5 S    <=0.5 S
LEVOFLOXACIN----------   0.5 S   <=0.12 S
OXACILLIN-------------<=0.25 S   <=0.25 S
TETRACYCLINE----------   <=1 S      <=1 S
VANCOMYCIN------------                1 S

   Anaerobic Bottle Gram Stain (Final [**2132-11-16**]):
      Reported to and read back by [**Doctor First Name **] CROSS @ 1:02A
[**2132-11-16**].
      GRAM POSITIVE COCCI.
      IN PAIRS AND CLUSTERS.

Urine Culture [**11-15**]: <10,000 organisms/ml.
.
IMAGING/STUDIES:
.
.


Brief Hospital Course:
Mr. [**Known lastname 5057**] is 77M with h/o HTN, HLD, COPD, and newly diagnosed
NSCLC c/b pericardial effusion wtih tamponade s/p
pericardiocentesis in [**8-/2132**] and s/p one round of
taxol/carboplatin chemotherapy, who presented with worsening SOB
and DOE from recurrent pericardial effusion
.
#Pericardial effusion: On [**11-14**] the patient had an echo that
revealed signs of tamponade. He was brought to the cardiac
catheterization lab for pericardial drainage. 750cc's of fluid
was drained and the tamponade releived, he was then brought to
the operating room with Dr [**First Name (STitle) **] for pericardial window, please
see operative report for details. In summary he had a small left
anterior chest incision with pericardial window created and
drainage tube placed. He tolerated the operation well and was
transferred from the operating room to the CVICU in stable
condition. He was extubated on the day of surgery and remained
hemodynamically stable throughout his stay in the CVICU. He was
slated to be transferred to the cardiac surgery floor after his
pericardial drain was removed however these tubes continued to
drain significant amounts of serosanguinous fluid and on POD3 he
was transferred to the cardiology ICU instead of remaining in
the CVICU. In the CCU his pericardial drain stopped draining and
was removed. His chest tube continued to have a small amount of
drainage. Thoracic surgery was consulted for possible placement
of a pleurex catheter. However they recommended removing the
drain because the output was low and not placing another drain.
The chest tube was removed and per the patients request he was
discharged with hospice.
.
#Non-small cell lung cancer: He had stage stage IV lung cancer
with recurrent malignant pericardial effusion. Prior to
admission he underwent on cycle of cisplatin and taxol. However
afterwards the patient declined further chemotherapy. After his
drains were removed he was discharged with hospice.


Medications on Admission:
1. allopurinol 100 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).

2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. beclomethasone dipropionate 80 mcg/Actuation Aerosol Sig: One

(1) Spray Inhalation twice a day.
4. colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
6. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device
Sig: One (1) Capsule Inhalation once a day.
Disp:*30 capsules* Refills:*2*
7. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
[**1-13**] puff Inhalation every four (4) hours as needed for shortness

of breath or wheezing.
8. lisinopril 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
9. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
10. Home Oxygen
1-4 liters per minute continuous oxygen via nasal cannula [**Male First Name (un) **]:
99 months
Diagnosis: COPD
11. Lasix 20 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*0*

Discharge Medications:
1. morphine concentrate 100 mg/5 mL (20 mg/mL) Solution Sig:
2-20 mg PO q1hr as needed for pain / dyspnea.
Disp:*30 mL* Refills:*2*
2. Ativan 0.5 mg Tablet Sig: 1-2 Tablets PO every four (4) hours
as needed for anxiety.
Disp:*30 Tablet(s)* Refills:*2*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day as needed for constipation.
Disp:*60 Capsule(s)* Refills:*2*
4. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for constipation.
Disp:*60 Tablet(s)* Refills:*2*
5. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
8. allopurinol 300 mg Tablet Sig: 0.5 Tablet PO once a day.
9. colchicine 0.6 mg Tablet Sig: One (1) Tablet PO once a day as
needed for Gout.
10. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
One (1)  Inhalation four times a day as needed for shortness of
breath or wheezing.
11. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device
Sig: One (1)  Inhalation once a day.


Discharge Disposition:
Home With Service

Facility:
Hospice of the Good [**Doctor Last Name 9995**]

Discharge Diagnosis:
Primary Diagnoses:
Pericardial effusion with cardiac tamponade
Pulmonary effusion
.
Secondary Diagnoses:
Non-small cell lung cancer


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


Discharge Instructions:
Dear Mr. [**Known lastname 5057**],

It was a pleasure taking care of you while you were hospitalized
at [**Hospital1 18**].  You were admitted to the hospital because of
worsening shortness of breath at home.  An echocardiogram showed
that you had fluid surrounding your heart and a drain was placed
by the cardiologists to drain the extra fluid.  We think that
your lung cancer is the reason the fluid accumulated around your
heart and because we thought that it would likely recur, the
heart surgeons did a procedure called a pericardial window to
stop fluid from accumulating. During that procudure they also
placed a tube in your chest. This stopped draining fluid and we
removed the tube. If you begin to feel shortness of breath, this
may be because of fluid reaccumulation. There was also a small
amount of bacteria in the fluid from around your heart. The
infectious disease specialist thought that this is most likley
contamination and did not need to be treated. If you start to
develop fevers shortness of breath or any other concerning
symptoms you can come back to the hospital for evaluation and
treatment if you want to.
.
Medication changes:
Please stop atorvastatin
Please stop aspirin
.
Please take morphine as directed by hospice
Please take lorazepam (ativan) as directed by hospice
.
Please start docusate 100 mg twice a day as needed for
constipation
Please start senna 8.6 mg twice a day as needed for constipation
Please continue taking all other medications as you have been

Followup Instructions:
Please follow up with your home hospice team. They will help you
set up an appointment with your doctor if you wish to see them.
{'Other specified diseases of pericardium,Acute kidney failure, unspecified,Secondary hypercoagulable state,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Bacteremia,Malignant neoplasm of upper lobe, bronchus or lung,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Chronic obstructive asthma, unspecified,Do not resuscitate status,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Subendocardial infarction, subsequent episode of care,Gout, unspecified,Hypoxemia,Chronic kidney disease, unspecified,Personal history of colonic polyps,Personal history of urinary calculi,Personal history of tobacco use'}


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: Mr. [**Known lastname 5057**] is 77M with h/o HTN, HLD, COPD, and newly diagnosed
NSCLC c/b pericardial effusion wtih tamponade s/p
pericardiocentesis in [**8-/2132**] and s/p one round of
taxol/carboplatin chemotherapy, recent new heart failure
diagnosed in [**9-/2132**] (EF 40-45%), who is presenting with
worsening SOB and DOE for the last few days.  As per the
patient's wife, the patient has been having worsening dyspnea on
exertion for the last few days, that acutely worsened earlier
today when he was walking up the stairs.  In addition, also
reports having worsening orthopnea over the last few days as
well (he usually uses one pillow at night, but reports that for
the last few days he has been using two pillows).  Pt also
reports decreased PO intake for the last few days.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia,
+Hypertension
2. CARDIAC HISTORY:
- CABG:
- PERCUTANEOUS CORONARY INTERVENTIONS:
- PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
HTN
HLD
NSCLC
Gout

MEDICATION ON ADMISSION: 1. allopurinol 100 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).

ALLERGIES: Beta-Blockers (Beta-Adrenergic Blocking Agts)

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
VS: 98.6 105/62 103 22 98 on 3L
General: pleasant elderly gentleman, NAD, sitting up comfortably
in bed, breathing comfortably with NC
HEENT: scleral anicteric, moist mucous membranes
Neck: supple, no JVP appreciated
CV: RRR, normal S1, S2, no murmurs/rubs/gallops appreciated
lungs: bronchial breath sounds throughout, inspiratory crackles
at the bases b/l
abdomen: soft, nontender, nondistended, +BS
extremities: no LE edema, cool toes b/l with some purple tinging
of his toes and soles of his feet
PULSES:
Right: Carotid 2+ DP 1+ PT dopp
Left: Carotid 2+ DP 1+ PT dopp
Neuro: CN 2-12 grossly intact (except hard of hearing), normal
strength and sensation throughout
.
DISCHARGE PHYSICAL EXAM:
VS: 97.8 139/88 95 26 96% on 2L
General: pleasant elderly gentleman, NAD, sitting up comfortably
in chair, breathing comfortably with NC
HEENT: scleral anicteric, moist mucous membranes
Neck: supple, no JVP appreciated
CV: RRR, normal S1, S2, no murmurs/rubs/gallops appreciated
lungs: slight inspiratory crackles as bases, bronchial breath
sounds throughout
abdomen: soft, nontender, nondistended, +BS
extremities: no LE edema, cool toes b/l
PULSES:
Right: Carotid 2+ DP 1+ PT dopp
Left: Carotid 2+ DP 1+ PT dopp
Neuro: CN 2-12 grossly intact (except hard of hearing), normal
strength and sensation throughout

FAMILY HISTORY: Family: MI when 50 y/o, pancreatic cancer in father, paternal
grandfather with MI, maternal grandfather with MI

SOCIAL HISTORY: Lives with his wife, 1.5 ppd for 60 years, still currently
smoking a few cigarettes a day; has two children, involved in
his care, one lives in MA, another in CT. 1 glass of wine/night.
No illicit drugs. 

### Response:
{'Other specified diseases of pericardium,Acute kidney failure, unspecified,Secondary hypercoagulable state,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Bacteremia,Malignant neoplasm of upper lobe, bronchus or lung,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Chronic obstructive asthma, unspecified,Do not resuscitate status,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Subendocardial infarction, subsequent episode of care,Gout, unspecified,Hypoxemia,Chronic kidney disease, unspecified,Personal history of colonic polyps,Personal history of urinary calculi,Personal history of tobacco use'}
