CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 70M who presented to [**Hospital 1727**] Medical Center earlier today with
complaints of shortness of breath and chest pain. The chest pain
began last night and was relieved temporarily by sublingual
nitroglycerin, but recurred this morning. He also felt very
short
of breath this morning. He was coincidentally scheduled for a CT
scan of the chest today and when he arrived at the radiology
scanner, 911 was called because of his severe dyspnea. EMS
arrived and found that the patient was in atrial fibrillation
with rapid ventricular rate and he was taken to the ED. He was
briefly on a diltiazem gtt for rate control but converted back
to
NSR (which he remains in) prior to transfer to [**Hospital1 18**].

MEDICAL HISTORY: NIDDM, HTN, Hyperlipidemia, Rheumatoid arthritis, Obesity,
Chest pain s/p cardiac cath [**10-29**] with 50% occlusion of obtuse
marginal and 50% occlusion of RCA

MEDICATION ON ADMISSION: Metformin 500 QID, Metoprolol 100 [**Hospital1 **], Furosemide 20 [**Hospital1 **],
Glipizide 20 QAM, Enalapril 2.5 QD, Folic acid 1 QD, Zetia 10
QD,
Lipitor 80 QHS, Trilipix 135 QD, Methotrexate 17.5 [**Last Name (LF) **], [**First Name3 (LF) **] QD,
Diovan 320 QD, Oxycodone 5 PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.5, BP 113/71, pulse 81, RR 20, 88% RA, 98% on 2LNC
Physical Exam:
Gen: pleasant in NAD
Lungs: diminshed t/o
CV: RRR S1, S2, no MRG
Abd: soft, NT, ND
Ext: warm, no edema.

FAMILY HISTORY: Mother died of GI bleed, father of unidentified cancer

SOCIAL HISTORY: Retired from [**Company **]. Former smoker, approx 40
pack year history of smoking, no alcohol, no drugs, endorses
asbestos exposure
Malignant neoplasm of main bronchus,Bronchopneumonia, organism unspecified,Secondary malignant neoplasm of adrenal gland,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Secondary malignant neoplasm of pleura,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Obesity, unspecified,Rheumatoid arthritis
Malig neo main bronchus,Bronchopneumonia org NOS,Second malig neo adrenal,Mal neo lymph-intrathor,Second malig neo pleura,Atrial fibrillation,Hyperlipidemia NEC/NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Obesity NOS,Rheumatoid arthritis
Admission Date:  [**2142-12-7**]              Discharge Date:   [**2142-12-10**]

Date of Birth:  [**2072-2-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 492**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
[**2142-12-8**]:
1. Rigid bronchoscopy using the black Dumon bronchoscope.
2. Flexible bronchoscopy.
3. Endobronchial biopsy and tumor debridement of the left
    main stem.
4. Placement of covered metal stent [**44**] x 40 mm in the left
    main stem.


History of Present Illness:
70M who presented to [**Hospital 1727**] Medical Center earlier today with
complaints of shortness of breath and chest pain. The chest pain
began last night and was relieved temporarily by sublingual
nitroglycerin, but recurred this morning. He also felt very
short
of breath this morning. He was coincidentally scheduled for a CT
scan of the chest today and when he arrived at the radiology
scanner, 911 was called because of his severe dyspnea. EMS
arrived and found that the patient was in atrial fibrillation
with rapid ventricular rate and he was taken to the ED. He was
briefly on a diltiazem gtt for rate control but converted back
to
NSR (which he remains in) prior to transfer to [**Hospital1 18**].

The patient reports 2 months of intermittent chest pain, general
malaise, and non-productive cough. The cough was empirically
treated with cipro in [**Month (only) 359**] without improvement. He also
endorses a 30lb weight loss and loss of appetite over the past
2-3 months and has drenching night sweats most nights.


Past Medical History:
NIDDM, HTN, Hyperlipidemia, Rheumatoid arthritis, Obesity,
Chest pain s/p cardiac cath [**10-29**] with 50% occlusion of obtuse
marginal and 50% occlusion of RCA


Social History:
Retired from [**Company **]. Former smoker, approx 40
pack year history of smoking, no alcohol, no drugs, endorses
asbestos exposure

Family History:
Mother died of GI bleed, father of unidentified cancer


Physical Exam:
VS: T 98.5, BP 113/71, pulse 81, RR 20, 88% RA, 98% on 2LNC
Physical Exam:
Gen: pleasant in NAD
Lungs: diminshed t/o
CV: RRR S1, S2, no MRG
Abd: soft, NT, ND
Ext: warm, no edema.

Pertinent Results:
[**2142-12-9**] 08:00AM BLOOD WBC-9.8 RBC-3.70* Hgb-8.9* Hct-28.5*
MCV-77* MCH-24.2* MCHC-31.4 RDW-19.3* Plt Ct-350
[**2142-12-9**] 08:00AM BLOOD Glucose-159* UreaN-14 Creat-1.0 Na-137
K-4.0 Cl-99 HCO3-28 AnGap-14
[**2142-12-8**] 01:12AM BLOOD Calcium-9.5 Phos-2.9 Mg-2.1

Brief Hospital Course:
Mr. [**Known lastname **] [**Last Name (Titles) 1834**] rigid bronchoscopy, flexible
bronchoscopy, endobronchial biopsy and tumor debridement of the
left main stem, and placement of covered metal stent [**44**] x 40 mm
in the left main stem on [**2142-12-8**] by Dr. [**Last Name (STitle) **] for a large
mediastinal mass with left main stem obstruction. The patient
was observed over the weekend, and discharged home on [**2142-12-11**],
after deemed safe by PT. His home medications were resumed and
needs follow up with medical oncology, which the patient and
family are aware of and will set up locally. His oxygen
saturations dropped to 88% on RA with ambulation, so he was set
up with portable home oxygen. He was sent home with a 7 day
course of levaquin for post obstructive pneumonia.

The frozen section performed in the operating room revealed the
possibility of small-cell carcinoma versus lymphoma. We will
await the final analysis by the pathologist
to determine the next step in treatment.


Medications on Admission:
Metformin 500 QID, Metoprolol 100 [**Hospital1 **], Furosemide 20 [**Hospital1 **],
Glipizide 20 QAM, Enalapril 2.5 QD, Folic acid 1 QD, Zetia 10
QD,
Lipitor 80 QHS, Trilipix 135 QD, Methotrexate 17.5 [**Last Name (LF) **], [**First Name3 (LF) **] QD,
Diovan 320 QD, Oxycodone 5 PRN


Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*0 Tablet(s)* Refills:*0*
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*0 Tablet(s)* Refills:*0*
3. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*0 Tablet(s)* Refills:*0*
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*0 Tablet(s)* Refills:*0*
5. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*0 Tablet(s)* Refills:*0*
6. Metformin 500 mg Tablet Sig: One (1) Tablet PO QID (4 times a
day).
Disp:*0 Tablet(s)* Refills:*0*
7. Glipizide 10 mg Tablet Sig: Two (2) Tablet PO QAM (once a day
(in the morning)): hold this med until you are done taking
levaquin. Monitor your blood sugar and talk to your primary care
about resuming.
Disp:*0 Tablet(s)* Refills:*0*
8. Metoprolol Tartrate 100 mg Tablet Sig: One (1) Tablet PO
twice a day.
9. Enalapril Maleate 2.5 mg Tablet Sig: One (1) Tablet PO once a
day.
10. Diovan 320 mg Tablet Sig: One (1) Tablet PO once a day.
11. Methotrexate Sodium 10 mg Tablet Sig: One (1) Tablet PO once
a week.
12. Methotrexate Sodium 7.5 mg Tablet Sig: One (1) Tablet PO
once a week.
13. Trilipix 135 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO at bedtime.
14. Mucinex 1,200 mg Tab, Multiphasic Release 12 hr Sig: One (1)
Tab, Multiphasic Release 12 hr PO twice a day: take while stent
is in place.
Disp:*60 Tab, Multiphasic Release 12 hr(s)* Refills:*0*
15. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
16. home oxygen
2 liters/min continous oxygen for portability pulse dose system
17. Levaquin 750 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*6 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] health care

Discharge Diagnosis:
left mediastinal mass


Discharge Condition:
Mental status: good
Ambulation: with assistance
Voiding to toilet
Tolerating diabetic diet
Pain controlled with PO pain medications


Discharge Instructions:
Please call Dr.[**Name (NI) 5070**] office [**Telephone/Fax (1) 10084**] if you develop
increased shortness of breath, cough or sputum production,
fevers more than 101.5, shakes, chills.
You may resume all of your home medications, and take all new
medications as prescribed. Follow the instructions provided to
you regarding your diet and activity. You may shower and bathe
today.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 2 weeks; Call on Monday for an
appointment.


Followup Instructions:
1) local radiation oncology as outpatient- see your local
oncologist within the next week.
2) Dr. [**Last Name (STitle) **] - please follow-up in 2 weeks. Please call his
office for an appointment.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**Doctor First Name 494**]

Completed by:[**2142-12-10**]
{'Malignant neoplasm of main bronchus,Bronchopneumonia, organism unspecified,Secondary malignant neoplasm of adrenal gland,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Secondary malignant neoplasm of pleura,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Obesity, unspecified,Rheumatoid arthritis'}


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: 70M who presented to [**Hospital 1727**] Medical Center earlier today with
complaints of shortness of breath and chest pain. The chest pain
began last night and was relieved temporarily by sublingual
nitroglycerin, but recurred this morning. He also felt very
short
of breath this morning. He was coincidentally scheduled for a CT
scan of the chest today and when he arrived at the radiology
scanner, 911 was called because of his severe dyspnea. EMS
arrived and found that the patient was in atrial fibrillation
with rapid ventricular rate and he was taken to the ED. He was
briefly on a diltiazem gtt for rate control but converted back
to
NSR (which he remains in) prior to transfer to [**Hospital1 18**].

MEDICAL HISTORY: NIDDM, HTN, Hyperlipidemia, Rheumatoid arthritis, Obesity,
Chest pain s/p cardiac cath [**10-29**] with 50% occlusion of obtuse
marginal and 50% occlusion of RCA

MEDICATION ON ADMISSION: Metformin 500 QID, Metoprolol 100 [**Hospital1 **], Furosemide 20 [**Hospital1 **],
Glipizide 20 QAM, Enalapril 2.5 QD, Folic acid 1 QD, Zetia 10
QD,
Lipitor 80 QHS, Trilipix 135 QD, Methotrexate 17.5 [**Last Name (LF) **], [**First Name3 (LF) **] QD,
Diovan 320 QD, Oxycodone 5 PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.5, BP 113/71, pulse 81, RR 20, 88% RA, 98% on 2LNC
Physical Exam:
Gen: pleasant in NAD
Lungs: diminshed t/o
CV: RRR S1, S2, no MRG
Abd: soft, NT, ND
Ext: warm, no edema.

FAMILY HISTORY: Mother died of GI bleed, father of unidentified cancer

SOCIAL HISTORY: Retired from [**Company **]. Former smoker, approx 40
pack year history of smoking, no alcohol, no drugs, endorses
asbestos exposure 

### Response:
{'Malignant neoplasm of main bronchus,Bronchopneumonia, organism unspecified,Secondary malignant neoplasm of adrenal gland,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Secondary malignant neoplasm of pleura,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Obesity, unspecified,Rheumatoid arthritis'}
