CHIEF COMPLAINT: Ascites

PRESENT ILLNESS: 89 yo M history of CHF, afib, CAD, HTN, CRI, PAH, CMY (EF 25%),
transferred from OSH with large ascites and significant left
sided pleural effusion.  Patient states that he had been in
subacute rehab and was transferred to [**Hospital3 417**] for CT scan
on Friday which was read this morning and he was subsequently
transferred here for further management of his ascites and
pleural effusion.
.
Patient complains of left-sided headache above his eye.
Intermittent lightheadedness and dizziness, SOB on exertion and
increased abdominal girth.  He does note, however, that he still
has a good appetite.

MEDICAL HISTORY: CHF
Right-sided heart failure
Cardiac amyloidosis
Mild pulmonary hypertension
Moderate MR
Hyperlipidemia
CRI (baseline Cr 2.0)
CAD s/p MI and s/p angioplasty in [**2191**]
CLL diagnosed [**2169**]
glaucoma
Undescended testicle
Hernia repair

MEDICATION ON ADMISSION: Milk of Magnesia 10 ml PO HS
Aluminum-Magnesium Hydrox.-Simethicone 15-30 ml PO QID:PRN
Multivitamins 1 CAP PO DAILY
Aspirin 325 mg PO DAILY
Oxazepam 10 mg PO HS
Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES DAILY
Pilocarpine 1% 1 DROP BOTH EYES Q6H
Carvedilol 12.5 mg PO BID
Potassium Chloride 40 mEq PO DAILY Duration: 24 Hours
Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES [**Hospital1 **]
Senna 2 TAB PO HS
Docusate Sodium 100 mg PO BID
Simvastatin 20 mg PO DAILY with supper at 1800
Erythromycin 0.5% Ophth Oint 0.25 in OU HS
Furosemide 80 mg po BID

ALLERGIES: Coumadin / Heparin Agents

PHYSICAL EXAM: VS - T: 95.3 BP: 102/60 P:69 R:20 O2 94%RA
Gen: elderly, cachectic male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: brother with copd, sister with liver ca, father died age [**Age over 90 **],
mother died of cirrhosis in her 70s.

SOCIAL HISTORY: Lives with his wife. quit tobacco 30y ago but had 20-40 pack
year history. Very rare alcohol. Pt is a WW2 veteran who was in
the infantry. Has 2 adopted sons.
Congestive heart failure, unspecified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Hallucinations,Unspecified pleural effusion,Chronic lymphoid leukemia, without mention of having achieved remission,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified disease of pericardium,Atrial fibrillation,Mitral valve disorders,Unspecified glaucoma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Long-term (current) use of anticoagulants
CHF NOS,Acute kidney failure NOS,Urin tract infection NOS,Hallucinations,Pleural effusion NOS,Ch lym leuk wo achv rmsn,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Pericardial disease NOS,Atrial fibrillation,Mitral valve disorder,Glaucoma NOS,DMII wo cmp nt st uncntr,Aortocoronary bypass,Long-term use anticoagul
Admission Date:  [**2197-7-31**]              Discharge Date:   [**2197-8-16**]


Service: MEDICINE

Allergies:
Coumadin / Heparin Agents

Attending:[**First Name3 (LF) 134**]
Chief Complaint:
Ascites

Major Surgical or Invasive Procedure:
Thoracentesis
Cardiocentesis

History of Present Illness:
89 yo M history of CHF, afib, CAD, HTN, CRI, PAH, CMY (EF 25%),
transferred from OSH with large ascites and significant left
sided pleural effusion.  Patient states that he had been in
subacute rehab and was transferred to [**Hospital3 417**] for CT scan
on Friday which was read this morning and he was subsequently
transferred here for further management of his ascites and
pleural effusion.
.
Patient complains of left-sided headache above his eye.
Intermittent lightheadedness and dizziness, SOB on exertion and
increased abdominal girth.  He does note, however, that he still
has a good appetite.

Past Medical History:
CHF
Right-sided heart failure
Cardiac amyloidosis
Mild pulmonary hypertension
Moderate MR
Hyperlipidemia
CRI (baseline Cr 2.0)
CAD s/p MI and s/p angioplasty in [**2191**]
CLL diagnosed [**2169**]
glaucoma
Undescended testicle
Hernia repair

Social History:
Lives with his wife. quit tobacco 30y ago but had 20-40 pack
year history. Very rare alcohol. Pt is a WW2 veteran who was in
the infantry. Has 2 adopted sons.


Family History:
brother with copd, sister with liver ca, father died age [**Age over 90 **],
mother died of cirrhosis in her 70s.

Physical Exam:
VS - T: 95.3 BP: 102/60 P:69 R:20 O2 94%RA
Gen: elderly, cachectic male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

Neck: no JVD.
CV: Distant hear sounds, III/VI holosystolic murmur. RR, normal
S1, S2. No thrills, lifts.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, scattered
bilateral crackles and expiratory wheezes
Abd: protruberant, + ascites and fluid wave, hepatosplenomegaly,
erythema around umbilicus.
Ext: 2+ pitting pedal edema. cool to touch
Skin: extensive bruising, irritated skin tag on back

Pertinent Results:
Admission Labs:
[**2197-7-31**] 05:31PM   WBC-4.7 RBC-4.46* HGB-13.1* HCT-40.5 MCV-91
MCH-29.3 MCHC-32.3 RDW-17.2*
[**2197-7-31**] 05:31PM   PLT COUNT-187
[**2197-7-31**] 05:31PM   ALT(SGPT)-11 AST(SGOT)-23 LD(LDH)-214 ALK
PHOS-225* TOT BILI-0.8
[**2197-7-31**] 05:31PM   ALBUMIN-3.7 CALCIUM-9.4 PHOSPHATE-4.9*
MAGNESIUM-3.1*
[**2197-7-31**] 05:31PM   GLUCOSE-90 UREA N-56* CREAT-2.2* SODIUM-140
POTASSIUM-5.3* CHLORIDE-98 TOTAL CO2-30 ANION GAP-17
[**2197-7-31**] 05:31PM   PT-17.5* PTT-32.9 INR(PT)-1.6*

Admission Echo:
Biventricular hypertrophy with echogenic myocardium, restrictive

filling pattern, thickened valvular structures, and a large
circumferential pericardial effusion without overt echo signs of
tamponade (which may be masked in the setting of severe
pulmonary hypertension and right ventricular hypertrophy).
Findings consistent with amyloid cardiomyopathy.

Compared with the prior study (images reviewed) of [**2197-1-23**],
the pericardial effusion is slightly larger. The estimated
pulmonary artery pressures are higher.

Post Pericardial Effusion Drainage:
There is severe symmetric left ventricular hypertrophy. The left
ventricular cavity is unusually small. LV systolic function
appears depressed. Right ventricular systolic function appears
depressed. There is mild pulmonary artery systolic hypertension.
There is a small pericardial effusion. The effusion appears
circumferential. There are no echocardiographic signs of
tamponade. No right atrial or right ventricular diastolic
collapse is seen.

Compared with the findings of the prior study (images reviewed)
of [**2197-8-1**], a small circumferential pericardial effusion
has reaccumulated; no evidence of cardiac tamponade.


Brief Hospital Course:
Patient is a 89 yo M history of CHF, afib, CAD, HTN, CRI, PAH,
CMY (EF 25%), transferred from OSH with large ascites and
significant left sided pleural effusion for therapeutic
intervention.
.
#. CAD - h/o cardiac cath with occluded RCA, unable to
recanulize
- on ASA, BB and statin, no ACEI [**1-13**] hypotension
.
#. Pump - h/o CHF predominantly right-sided failure secondary to
probable cardiac amyloidosis - not biopsy-proven.  EF 40%,
Severe biventricular diastolic dysfunction with low cardiac
output.  Major volume overload, pleural effusion and ascites on
admission with pericardical effusion that responded well to
pericardiocentesis.  Echo revealed a large pericardial effusion
that was also noted in [**1-18**], although appeared larger. Though no
echocardiographic signs of tamponade were seen, it was thought
that tamponade could be masked in setting of RV hypertrophy and
pulmonary htn.  The pt was taken to cath lab and was found to
have hemodynamics midly suggestive of tamponade with cvp 22, PA
67/29, wedge 28, pericardium 14, with mild improvement in CI
from 1.42 to 1.48 after resolving tamponade. Follow-up ECHO
after pericardiocentesis did not reveal reaccumulation.  Patinet
initially on Lasix gtt for peripheral volume overload after the
pericardiocentesis with good diuresis and transitioned to PO
lasix with continued improvemnet.  Patient was also continued on
BB and Aldactone.  ACE was held in setting of hypotension.
Patient remained normotensive while in house and was discharged
in stable condition.  Patient was discharged on Lasix 40 mg [**Hospital1 **]
and was getting Lasix 80 mg [**Hospital1 **] in house.  If patient appears to
be getting volume overloaded patient can be transitioned back to
Lasix 8- mg [**Hospital1 **]. Patient was close to his dry weight upon
discharge.

.
#. Rhythm - irreg, irreg, chronic afib
- on BB, ASA
- no coumadin [**1-13**] allergy/sensitivity
.
Pleural effusion:
Thoracentesis was done which revealed a transudate with WBC 615,
RBC 1475 though gram stain showed no PMNs, no microorganisms.
The patient was sent to CCU for pericardial drain management
.
Ascites: Patinet with ascites in absence of liver disease,
likely due to poor cardiac output.  This was not intervened on
as it was not bothersome to the patient and it actually
responded slightly to aggressive diuresis.
.
#.Renal Failure - likely acute on chronic.  This improved with
improved cardiac output after pericardiocentesis and diuresis.
Patient's nadir with respect to Cr was 1.5 and was discharged at
1.6 suggesting good diuresis.  Patient was close to his dry
weight upon discharge.
.
.
After discussion with the patient and the medical staff, all
were in agreement that Mr. [**Known lastname 15905**] was a suitable candidate for
discharge.

Medications on Admission:
Milk of Magnesia 10 ml PO HS
Aluminum-Magnesium Hydrox.-Simethicone 15-30 ml PO QID:PRN
Multivitamins 1 CAP PO DAILY
Aspirin 325 mg PO DAILY
Oxazepam 10 mg PO HS
Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES DAILY
Pilocarpine 1% 1 DROP BOTH EYES Q6H
Carvedilol 12.5 mg PO BID
Potassium Chloride 40 mEq PO DAILY Duration: 24 Hours
Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES [**Hospital1 **]
Senna 2 TAB PO HS
Docusate Sodium 100 mg PO BID
Simvastatin 20 mg PO DAILY with supper at 1800
Erythromycin 0.5% Ophth Oint 0.25 in OU HS
Furosemide 80 mg po BID

Discharge Medications:
1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24
hours).
2. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed.
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic DAILY
(Daily).
5. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Erythromycin 5 mg/g Ointment Sig: One (1)  Ophthalmic QHS
(once a day (at bedtime)).
8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
9. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
10. Oxazepam 10 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

12. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
13. Pilocarpine HCl 1 % Drops Sig: One (1) Drop Ophthalmic Q6H
(every 6 hours).
14. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
15. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
17. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day.



Discharge Disposition:
Extended Care

Facility:
[**Last Name (un) **] Center - [**Location (un) 701**]

Discharge Diagnosis:
Primary Diagnosis: CHF, pericardial effusions
.
Secondary Diagnoses:
CHF
Right-sided heart failure
Cardiac amyloidosis
Mild pulmonary hypertension
Moderate MR
Hyperlipidemia
CRI (baseline Cr 2.0)
CAD s/p MI and s/p angioplasty in [**2191**]
CLL diagnosed [**2169**]
glaucoma
Undescended testicle
Hernia repair


Discharge Condition:
Afebrile, stable vital signs, tolerating POs, ambulating with
assistance.


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1200 cc
.
1. Please take all medication as prescribed.
2. Please attempt to make all medical appointments.
3. Please return to the Emergency Room if you have any
concerning symptoms.

Followup Instructions:
Please call Dr. [**Last Name (STitle) **] @ [**Telephone/Fax (1) 4022**] to make a follow-up
appointment.
.
Please call your PCP, [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 25694**] to make
a follow-up appointment.
{'Congestive heart failure, unspecified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Hallucinations,Unspecified pleural effusion,Chronic lymphoid leukemia, without mention of having achieved remission,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified disease of pericardium,Atrial fibrillation,Mitral valve disorders,Unspecified glaucoma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Long-term (current) use of anticoagulants'}


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: Ascites

PRESENT ILLNESS: 89 yo M history of CHF, afib, CAD, HTN, CRI, PAH, CMY (EF 25%),
transferred from OSH with large ascites and significant left
sided pleural effusion.  Patient states that he had been in
subacute rehab and was transferred to [**Hospital3 417**] for CT scan
on Friday which was read this morning and he was subsequently
transferred here for further management of his ascites and
pleural effusion.
.
Patient complains of left-sided headache above his eye.
Intermittent lightheadedness and dizziness, SOB on exertion and
increased abdominal girth.  He does note, however, that he still
has a good appetite.

MEDICAL HISTORY: CHF
Right-sided heart failure
Cardiac amyloidosis
Mild pulmonary hypertension
Moderate MR
Hyperlipidemia
CRI (baseline Cr 2.0)
CAD s/p MI and s/p angioplasty in [**2191**]
CLL diagnosed [**2169**]
glaucoma
Undescended testicle
Hernia repair

MEDICATION ON ADMISSION: Milk of Magnesia 10 ml PO HS
Aluminum-Magnesium Hydrox.-Simethicone 15-30 ml PO QID:PRN
Multivitamins 1 CAP PO DAILY
Aspirin 325 mg PO DAILY
Oxazepam 10 mg PO HS
Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES DAILY
Pilocarpine 1% 1 DROP BOTH EYES Q6H
Carvedilol 12.5 mg PO BID
Potassium Chloride 40 mEq PO DAILY Duration: 24 Hours
Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES [**Hospital1 **]
Senna 2 TAB PO HS
Docusate Sodium 100 mg PO BID
Simvastatin 20 mg PO DAILY with supper at 1800
Erythromycin 0.5% Ophth Oint 0.25 in OU HS
Furosemide 80 mg po BID

ALLERGIES: Coumadin / Heparin Agents

PHYSICAL EXAM: VS - T: 95.3 BP: 102/60 P:69 R:20 O2 94%RA
Gen: elderly, cachectic male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: brother with copd, sister with liver ca, father died age [**Age over 90 **],
mother died of cirrhosis in her 70s.

SOCIAL HISTORY: Lives with his wife. quit tobacco 30y ago but had 20-40 pack
year history. Very rare alcohol. Pt is a WW2 veteran who was in
the infantry. Has 2 adopted sons. 

### Response:
{'Congestive heart failure, unspecified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Hallucinations,Unspecified pleural effusion,Chronic lymphoid leukemia, without mention of having achieved remission,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified disease of pericardium,Atrial fibrillation,Mitral valve disorders,Unspecified glaucoma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Long-term (current) use of anticoagulants'}
