CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 69-year-old woman with
a history of coronary artery disease, status post coronary
artery bypass graft in [**2135-12-27**], diabetes complicated
by end stage renal disease on hemodialysis, severe
hypertension and hypercholesterolemia who presents with
shortness of breath.  She had a recent coronary artery bypass
graft in [**2135-12-27**] with a left internal mammary artery to
LAD and then had another admission in early [**2136-1-27**]
with shortness of breath and pleuritic chest pain that was
felt to be post pericardiotomy syndrome.  She received NSAID
for treatment.  An echocardiogram at that time revealed an
ejection fraction of 65% to 70%, mildly dilated left atrium,
mild left ventricular hypertrophy and mild to moderate 2+
mitral regurgitation.

MEDICAL HISTORY: 1.  Coronary artery disease, status post coronary artery
bypass graft [**2136-1-11**] with an echocardiogram showing an
ejection fraction of 65% to 75%.
2.  Diabetes mellitus x3 years
3.  End stage renal disease on hemodialysis, previously on
peritoneal dialysis.
4.  Hypercholesterolemia
5.  Status post cerebrovascular accident
6.  Seizure disorder
7.  Multi-infarct dementia
8.  Status post total abdominal hysterectomy
9.  Hypertension

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN CAUSES PRURITUS.

PHYSICAL EXAM: VITAL SIGNS:  She was afebrile with a temperature of 98?????? and
a blood pressure on admission of 210/110 that was brought
down to 155/85.  Her heart rate was 80.  Her respiratory rate
was 35 and came down to 25 with measures.  Her oxygen was 91%
on 100% on room air which increased to 94% on 100% face mask.
GENERAL:  This was an elderly African-American female in mild
respiratory distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Unremarkable.  She had no
jugular venous distention.  Her right IJ Port-A-Cath showed
no erythema and was nontender.
HEART:  Regular with a 2/6 systolic ejection murmur at the
right upper sternal border and S4.
LUNGS:  Dullness to percussion at the right base as well as
decreased fremitus.  She also had bibasilar crackles half of
the way up.  There were no wheezes.
ABDOMEN:  Benign, except that she was guaiac positive.  She
had no rashes.
NEUROLOGIC:  Her cranial nerves were intact.  She had 4/5
strength in bilateral lower extremities.  There was no
asterixis or pronator drift.
EXTREMITIES:  Without edema and were warm although we were
unable to palpate pulses.  Pulses were Dopplerable.

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking or intravenous drug use.  She
quit smoking in [**2118**] after a 90 pack year history.  No
alcohol use.  She is able to perform activities of daily
living.  Her proxy is her friend, Ms. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], whose phone
number is ([**Telephone/Fax (1) 102230**].  She receives her hemodialysis at
Gambero.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hemorrhage of gastrointestinal tract, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Hyperpotassemia
Subendo infarct, initial,Crnry athrscl natve vssl,CHF NOS,Chr blood loss anemia,Gastrointest hemorr NOS,DMI renl nt st uncntrld,Hyp kid NOS w cr kid V,Mitral valve disorder,Hyperpotassemia
Admission Date:  [**2136-2-25**]     Discharge Date:  [**2136-2-29**]

Date of Birth:   [**2066-5-29**]     Sex:  F

Service:  [**Hospital1 **]

HISTORY OF PRESENT ILLNESS:  This is a 69-year-old woman with
a history of coronary artery disease, status post coronary
artery bypass graft in [**2135-12-27**], diabetes complicated
by end stage renal disease on hemodialysis, severe
hypertension and hypercholesterolemia who presents with
shortness of breath.  She had a recent coronary artery bypass
graft in [**2135-12-27**] with a left internal mammary artery to
LAD and then had another admission in early [**2136-1-27**]
with shortness of breath and pleuritic chest pain that was
felt to be post pericardiotomy syndrome.  She received NSAID
for treatment.  An echocardiogram at that time revealed an
ejection fraction of 65% to 70%, mildly dilated left atrium,
mild left ventricular hypertrophy and mild to moderate 2+
mitral regurgitation.

During her last admission, she had some mild congestive heart
failure with a pleural effusion that was tapped of 600 cc.
Also of note, during her admission in [**2135-12-27**] prior to
her coronary artery bypass graft, her course was complicated
by peritonitis which grew out coagulase positive
Staphylococcus.  Her peritoneal catheter was removed at that
point and she received vancomycin.

On the day prior to admission, she felt increasingly short of
breath.  She had no chest pain.  She was also unable to
sleep.  There was no swelling in her lower extremities.  Her
last hemodialysis was the Thursday prior to admission and she
was next scheduled fr Saturday.  She makes a small amount of
urine.  She has no nausea, vomiting, diarrhea, fever, chills
or night sweats.  She is taking all of her medicines.  She
noted some blood in her stool while at [**Hospital3 537**], but
said that the nurse there said that it was not blood.  She
was admitted to the MICU with severe shortness of breath and
a rule in myocardial infarction.

PAST MEDICAL HISTORY:
1.  Coronary artery disease, status post coronary artery
bypass graft [**2136-1-11**] with an echocardiogram showing an
ejection fraction of 65% to 75%.
2.  Diabetes mellitus x3 years
3.  End stage renal disease on hemodialysis, previously on
peritoneal dialysis.
4.  Hypercholesterolemia
5.  Status post cerebrovascular accident
6.  Seizure disorder
7.  Multi-infarct dementia
8.  Status post total abdominal hysterectomy
9.  Hypertension

ALLERGIES:  PENICILLIN CAUSES PRURITUS.

MEDICATIONS:
1.  Norvasc 10 mg q day
2.  NPH 12 units q a.m.
3.  Lopressor 50 mg [**Hospital1 **]
4.  Aspirin 325 mg q day
5.  Nephrocaps 1 q day
6.  Losartan 50 mg q day
7.  Ranitidine 15 mg q day
8.  Clonidine 0.2 mg q day
9.  Regular insulin sliding scale

SOCIAL HISTORY:  No smoking or intravenous drug use.  She
quit smoking in [**2118**] after a 90 pack year history.  No
alcohol use.  She is able to perform activities of daily
living.  Her proxy is her friend, Ms. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], whose phone
number is ([**Telephone/Fax (1) 102230**].  She receives her hemodialysis at
Gambero.

PHYSICAL EXAM:
VITAL SIGNS:  She was afebrile with a temperature of 98?????? and
a blood pressure on admission of 210/110 that was brought
down to 155/85.  Her heart rate was 80.  Her respiratory rate
was 35 and came down to 25 with measures.  Her oxygen was 91%
on 100% on room air which increased to 94% on 100% face mask.
GENERAL:  This was an elderly African-American female in mild
respiratory distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Unremarkable.  She had no
jugular venous distention.  Her right IJ Port-A-Cath showed
no erythema and was nontender.
HEART:  Regular with a 2/6 systolic ejection murmur at the
right upper sternal border and S4.
LUNGS:  Dullness to percussion at the right base as well as
decreased fremitus.  She also had bibasilar crackles half of
the way up.  There were no wheezes.
ABDOMEN:  Benign, except that she was guaiac positive.  She
had no rashes.
NEUROLOGIC:  Her cranial nerves were intact.  She had 4/5
strength in bilateral lower extremities.  There was no
asterixis or pronator drift.
EXTREMITIES:  Without edema and were warm although we were
unable to palpate pulses.  Pulses were Dopplerable.

X-RAYS:  Chest x-ray showed an obscured hemidiaphragm
encephalization.  Electrocardiogram was sinus at 88 beats per
minute with normal axis and intervals and ST depressions in 1
and 2, as well as in V4 to V6.  There were no acute
electrocardiogram changes.

LABS:  White count of 13.7 with a left shift with 86%
neutrophils and 7% bands.  Her hematocrit was 17.3.  Her
platelet count was 94.  Her chem-7 was remarkable for a
potassium of 6.3.  Her creatinine was 6.3 as well.  Her
coagulases were within normal limits.  Her first set of
cardiac enzymes showed a CK of 98 and a troponin of less than
0.4.  She eventually ruled in for a myocardial infarction
with a CK peak of 321 and a troponin of 41.5.

HOSPITAL COURSE:  This 69-year-old woman with end stage renal
disease status post coronary artery bypass graft was admitted
from [**Hospital3 537**] with a congestive heart failure
exacerbation and a rule in myocardial infarction.  She was
very hypertensive initially and severely anemic.  She
received 3 units of packed red blood cells with an increase
in her hematocrit to 36.  She was also emergently dialyzed
and removed 3 kg of fluid with significant improvement in her
breathing.  She has a history of guaiac positive stools which
lead to a concern for gastrointestinal bleeding, but as she
ruled in with a CK peak of 321 and a troponin of 41.5, it was
unable to be evaluated further during this admission.

Her acute myocardial infarction was in the setting of severe
hypertension and a low hematocrit and so was felt to be due
to demand ischemia.  She was admitted to the MICU and
stabilized from a fluid and hemodynamic standpoint.  Once she
had a better blood pressure and hematocrit, she was called
out to the floor for further management.  She did well on the
floor with no further shortness of breath after the initial
dialysis.  She was dialyzed a few days in a row and then
returned to a normal hemodialysis level.  He CKs and troponin
continued to trend down and return to normal range.
Gastrointestinal saw her and stated that there was a high
risk in the setting of acute myocardial infarction for
endoscopy and so she would need a follow up with
gastrointestinal for anemia work up as an outpatient in the
next few weeks.  She received erythropoietin during her stay
which also helped improve her hematocrit which, at the time
of discharge, was 41.1.

Of note, she was found to have a TSH of 40 and was started on
low dose levothyroxine at 50 mcg per day.  She will need a
TSH rechecked in four to six weeks with adjustment of her
dose as needed.  Also of note, she continued to have poor
blood pressure control and so the doses of her medicines were
changed and Minoxidil was added to her regimen.  After close
monitoring post myocardial infarction, she was returned to
[**Hospital3 537**] to follow up with gastrointestinal as an
outpatient in two to four weeks for further work up of her
anemia.  She will continue to receive hemodialysis 3x a week,
receiving Epogen during dialysis.

DISCHARGE CONDITION:  Improved

DISCHARGE STATUS:  To [**Hospital3 537**].

DISCHARGE DIAGNOSES:
1.  Rule in myocardial infarction
2.  Congestive heart failure exacerbation
3.  Hypothyroidism
4.  Coronary artery disease, status post coronary artery
bypass graft
5.  Diabetes
6.  End stage renal disease on hemodialysis
7.  Hypertension

DISCHARGE MEDICATIONS:
1.  NPH 12 units subcutaneous q a.m.
2.  Regular insulin sliding scale
3.  Enteric coated aspirin 325 mg q day
4.  Lopressor 50 mg [**Hospital1 **]
5.  Losartan 100 mg q day
6.  Norvasc 10 mg q day
7.  Protonix 40 mg q day
8.  Clonidine 0.2 mg [**Hospital1 **]
9.  Epogen 5000 units at hemodialysis
10. PhosLo 2 tablets po tid
11. Nephrocaps 1 q day
12. Colace 100 mg [**Hospital1 **]
13. Minoxidil 10 mg q day
14. Levothyroxine 15 mcg q day




                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 4263**]

Dictated By:[**Name8 (MD) 1552**]

MEDQUIST36

D:  [**2136-2-29**]  08:26
T:  [**2136-2-29**]  08:32
JOB#:  [**Job Number **]
RT [**2136-2-29**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hemorrhage of gastrointestinal tract, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Hyperpotassemia'}


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: 

PRESENT ILLNESS: This is a 69-year-old woman with
a history of coronary artery disease, status post coronary
artery bypass graft in [**2135-12-27**], diabetes complicated
by end stage renal disease on hemodialysis, severe
hypertension and hypercholesterolemia who presents with
shortness of breath.  She had a recent coronary artery bypass
graft in [**2135-12-27**] with a left internal mammary artery to
LAD and then had another admission in early [**2136-1-27**]
with shortness of breath and pleuritic chest pain that was
felt to be post pericardiotomy syndrome.  She received NSAID
for treatment.  An echocardiogram at that time revealed an
ejection fraction of 65% to 70%, mildly dilated left atrium,
mild left ventricular hypertrophy and mild to moderate 2+
mitral regurgitation.

MEDICAL HISTORY: 1.  Coronary artery disease, status post coronary artery
bypass graft [**2136-1-11**] with an echocardiogram showing an
ejection fraction of 65% to 75%.
2.  Diabetes mellitus x3 years
3.  End stage renal disease on hemodialysis, previously on
peritoneal dialysis.
4.  Hypercholesterolemia
5.  Status post cerebrovascular accident
6.  Seizure disorder
7.  Multi-infarct dementia
8.  Status post total abdominal hysterectomy
9.  Hypertension

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN CAUSES PRURITUS.

PHYSICAL EXAM: VITAL SIGNS:  She was afebrile with a temperature of 98?????? and
a blood pressure on admission of 210/110 that was brought
down to 155/85.  Her heart rate was 80.  Her respiratory rate
was 35 and came down to 25 with measures.  Her oxygen was 91%
on 100% on room air which increased to 94% on 100% face mask.
GENERAL:  This was an elderly African-American female in mild
respiratory distress.
HEAD, EARS, EYES, NOSE AND THROAT:  Unremarkable.  She had no
jugular venous distention.  Her right IJ Port-A-Cath showed
no erythema and was nontender.
HEART:  Regular with a 2/6 systolic ejection murmur at the
right upper sternal border and S4.
LUNGS:  Dullness to percussion at the right base as well as
decreased fremitus.  She also had bibasilar crackles half of
the way up.  There were no wheezes.
ABDOMEN:  Benign, except that she was guaiac positive.  She
had no rashes.
NEUROLOGIC:  Her cranial nerves were intact.  She had 4/5
strength in bilateral lower extremities.  There was no
asterixis or pronator drift.
EXTREMITIES:  Without edema and were warm although we were
unable to palpate pulses.  Pulses were Dopplerable.

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking or intravenous drug use.  She
quit smoking in [**2118**] after a 90 pack year history.  No
alcohol use.  She is able to perform activities of daily
living.  Her proxy is her friend, Ms. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], whose phone
number is ([**Telephone/Fax (1) 102230**].  She receives her hemodialysis at
Gambero. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hemorrhage of gastrointestinal tract, unspecified,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Hyperpotassemia'}
