CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 70-year-old male
with a history of chronic obstructive pulmonary disease with
most recent exacerbation in [**2-/2188**], who was admitted to the
MICU after he passed out early yesterday morning in the lobby
of his apartment complex.  The patient woke up in the early
morning with shortness of breath and went to the window to
catch some fresh air.  He continued to be dyspneic and
subsequently went down to get some water and he passed out.
He remembers feeling that he was going to lose consciousness.
He was then intubated and brought to the MICU.  Blood gas was
7.07/74/381.  He was tachycardiac to the 140s.  In the MICU,
he was started on Solu-Medrol and Levofloxacin.  After an
overnight stay in the MICU, he was extubated successfully and
transferred to the floor for further management.  He reports
that over the past one week he has had progressively
worsening shortness of breath and a nonproductive cough.  He
has had several episodes of chronic obstructive pulmonary
disease exacerbation in the past, which culminated in
hospitalizations.  He denied any chest pain, fevers, chills,
nausea, vomiting, diarrhea, or bright red blood per rectum.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease.  The patient had
bronchitis as a child.  Most recent pulmonary function tests
were in [**4-/2187**], which showed FEV1 of 1.62 or 60%; FVC of 3.46
or 87%; FEV1/FVC ratio of 69%; DLCO 77%; and total lung
capacity of 13.2.
2.  Hypothyroidism.
3.  Depression.
4.  Echocardiogram recently showing 1+ MR.  EKG with
incomplete right bundle branch block.

MEDICATION ON ADMISSION: 1.  Serevent 2 puffs b.i.d.
2.  Flovent 110 mcg two puffs b.i.d.
3.  Levoxyl 125 mcg p.o.q.d.
4.  Paxil 20 mg p.o.
5.  Folate 1 mg p.o.q.d.
6.  Atrovent MDI with spacer two puffs q.i.d.p.r.n.
7.  Albuterol MDI with spacer two puffs q.i.d.p.r.n.
8.  Protonix 40 mg p.o.q.d.

ALLERGIES: The patient is allergic to PENICILLIN, WHICH
CAUSES SWELLING.

PHYSICAL EXAM: 

FAMILY HISTORY: History is unknown.

SOCIAL HISTORY: The patient works at [**Company **]in the
food services section.  He has a history of smoking one pack
per day for 40 years, but quit greater than one year ago.  He
denies alcohol use.  He denies having pets in the house.  He
recently had pneumovacs approximately one year ago, but he
has never had influenza vaccine.
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acidosis,Unspecified acquired hypothyroidism,Coronary atherosclerosis of native coronary artery
Acute respiratry failure,Obs chr bronc w(ac) exac,Acidosis,Hypothyroidism NOS,Crnry athrscl natve vssl
Admission Date:  [**2188-4-13**]       Discharge Date:  [**2188-4-18**]

Date of Birth:   [**2118-2-8**]       Sex:  M

Service:

HISTORY OF THE PRESENT ILLNESS:  This is a 70-year-old male
with a history of chronic obstructive pulmonary disease with
most recent exacerbation in [**2-/2188**], who was admitted to the
MICU after he passed out early yesterday morning in the lobby
of his apartment complex.  The patient woke up in the early
morning with shortness of breath and went to the window to
catch some fresh air.  He continued to be dyspneic and
subsequently went down to get some water and he passed out.
He remembers feeling that he was going to lose consciousness.
He was then intubated and brought to the MICU.  Blood gas was
7.07/74/381.  He was tachycardiac to the 140s.  In the MICU,
he was started on Solu-Medrol and Levofloxacin.  After an
overnight stay in the MICU, he was extubated successfully and
transferred to the floor for further management.  He reports
that over the past one week he has had progressively
worsening shortness of breath and a nonproductive cough.  He
has had several episodes of chronic obstructive pulmonary
disease exacerbation in the past, which culminated in
hospitalizations.  He denied any chest pain, fevers, chills,
nausea, vomiting, diarrhea, or bright red blood per rectum.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease.  The patient had
bronchitis as a child.  Most recent pulmonary function tests
were in [**4-/2187**], which showed FEV1 of 1.62 or 60%; FVC of 3.46
or 87%; FEV1/FVC ratio of 69%; DLCO 77%; and total lung
capacity of 13.2.
2.  Hypothyroidism.
3.  Depression.
4.  Echocardiogram recently showing 1+ MR.  EKG with
incomplete right bundle branch block.

MEDICATIONS ON ADMISSION:
1.  Serevent 2 puffs b.i.d.
2.  Flovent 110 mcg two puffs b.i.d.
3.  Levoxyl 125 mcg p.o.q.d.
4.  Paxil 20 mg p.o.
5.  Folate 1 mg p.o.q.d.
6.  Atrovent MDI with spacer two puffs q.i.d.p.r.n.
7.  Albuterol MDI with spacer two puffs q.i.d.p.r.n.
8.  Protonix 40 mg p.o.q.d.

ALLERGIES:  The patient is allergic to PENICILLIN, WHICH
CAUSES SWELLING.

SOCIAL HISTORY:  The patient works at [**Company **]in the
food services section.  He has a history of smoking one pack
per day for 40 years, but quit greater than one year ago.  He
denies alcohol use.  He denies having pets in the house.  He
recently had pneumovacs approximately one year ago, but he
has never had influenza vaccine.

FAMILY HISTORY:  History is unknown.

PHYSICAL EXAMINATION:  Temperature 98.7, pulse 106, blood
pressure 112/66, respiratory rate 24, saturations 97% on room
air.  GENERAL:  The patient is alert and oriented times three
in no apparent distress.  HEENT:  Pupils equal, round, and
reactive to light, extraocular muscles are intact.  No
lymphadenopathy, supple.  NECK:  Mucous membranes moist,
oropharynx clear.  CARDIOVASCULAR:  S1 and S2 tachycardiac,
regular.  PULMONARY:  Mild expiratory wheezing, otherwise,
clear to auscultation.  ABDOMEN:  Nontender, nondistended,
soft, positive bowel sounds.  EXTREMITIES:  No cyanosis,
erythema, or edema; pulses 2+ bilaterally.  NEUROLOGICAL:
Cranial nerves II through XII intact.

LABORATORY DATA:  When transferred to the [**Hospital1 139**] Service,
white blood cell count was 19.3, hematocrit 32.5, platelet
count 179,000, sodium 141, potassium 4.7, chloride 111,
bicarbonate 20, BUN 18, creatinine 0.6, glucose 122.  EKG:
Sinus tachycardia at 138, left axis deviation, right bundle
branch block.  Radiographic data:  CT angiogram showed no
evidence of PE, three nodules noted in the right apex, and
some colonic diverticulosis.

HOSPITAL COURSE:
#1.  PULMONARY:  Trigger for patient's COPD exacerbations
unclear (environmental versus upper respiratory tract
infection).  The clinical picture is most consistent with
chronic bronchitis.  After transfer from the MICU, the
patient was continued on metered dose inhalers and Prednisone
taper.  The Levofloxacin was discontinued.  The patient's
white blood cell count was elevated likely secondary to
Prednisone.  He remained afebrile throughout the course of
his stay in the hospital.  He also remained stable from a
respiratory standpoint throughout the course of his stay in
the hospital.  The patient is to followup with the Pulmonary
Clinic for further management and workup of his chronic
obstructive pulmonary disease.

#2.  CARDIOVASCULAR:  The patient had elevated CKs, however,
they were though to be secondary to muscle injury from his
fall.  The patient was stable from a respiratory standpoint
post extubation.  It seemed that the respiratory
decompression could not fully explained by pleurisy or COPD.
The sequence of his exacerbations were unusual and it was
thought that there might be a cardiac component to his
respiratory distress, which included tachycardiac from
Albuterol that may have lead to pulmonary edema in the
setting of diastolic dysfunction.

Additionally, the patient's EKG showed T-wave inversions in
V1 through V6.  Cardiology consult was obtained and it was
decided for the patient to have stress echocardiogram.  The
stress echocardiogram showed anterior abnormalities (please
see stress report for further details).  Due to this atrial
abnormality, the patient had cardiac catheterization, which
showed mild-to-moderate CAD with no flow-limiting lesions;
normal filling pressures, left ventricular ejection fraction
of 55%. The patient was started on aspirin, however, beta
blockers were held due to the patient's respiratory disease.
The patient was also started on folic acid.

CONDITION ON DISCHARGE:  Stable.  The patient was discharged
to home.

DISCHARGE DIAGNOSES:  Chronic obstructive pulmonary disease
exacerbation in the setting of URI.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg p.o.b.i.d.
2.  Levoxyl 100 mcg p.o.q.d.
3.  Folate 1 mg p.o.q.d.
4.  Prednisone taper.
5.  Protonix 40 mg p.o.q.d.
6.  Albuterol p.r.n.
7.  Atrovent p.r.n..
8.  Serevent two puffs b.i.d.
9.  Flovent two puffs b.i.d.

The patient was discharged to home.  The patient will
followup with his primary care physician next week and with
the pulmonary clinic.
                            DR.[**Last Name (STitle) 313**],[**First Name3 (LF) 312**] 12-766

Dictated By:[**Name8 (MD) 5753**]
MEDQUIST36

D:  [**2188-5-19**]  14:42
T:  [**2188-5-19**]  15:02
JOB#:  [**Job Number 96128**]
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acidosis,Unspecified acquired hypothyroidism,Coronary atherosclerosis of native coronary artery'}


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 70-year-old male
with a history of chronic obstructive pulmonary disease with
most recent exacerbation in [**2-/2188**], who was admitted to the
MICU after he passed out early yesterday morning in the lobby
of his apartment complex.  The patient woke up in the early
morning with shortness of breath and went to the window to
catch some fresh air.  He continued to be dyspneic and
subsequently went down to get some water and he passed out.
He remembers feeling that he was going to lose consciousness.
He was then intubated and brought to the MICU.  Blood gas was
7.07/74/381.  He was tachycardiac to the 140s.  In the MICU,
he was started on Solu-Medrol and Levofloxacin.  After an
overnight stay in the MICU, he was extubated successfully and
transferred to the floor for further management.  He reports
that over the past one week he has had progressively
worsening shortness of breath and a nonproductive cough.  He
has had several episodes of chronic obstructive pulmonary
disease exacerbation in the past, which culminated in
hospitalizations.  He denied any chest pain, fevers, chills,
nausea, vomiting, diarrhea, or bright red blood per rectum.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease.  The patient had
bronchitis as a child.  Most recent pulmonary function tests
were in [**4-/2187**], which showed FEV1 of 1.62 or 60%; FVC of 3.46
or 87%; FEV1/FVC ratio of 69%; DLCO 77%; and total lung
capacity of 13.2.
2.  Hypothyroidism.
3.  Depression.
4.  Echocardiogram recently showing 1+ MR.  EKG with
incomplete right bundle branch block.

MEDICATION ON ADMISSION: 1.  Serevent 2 puffs b.i.d.
2.  Flovent 110 mcg two puffs b.i.d.
3.  Levoxyl 125 mcg p.o.q.d.
4.  Paxil 20 mg p.o.
5.  Folate 1 mg p.o.q.d.
6.  Atrovent MDI with spacer two puffs q.i.d.p.r.n.
7.  Albuterol MDI with spacer two puffs q.i.d.p.r.n.
8.  Protonix 40 mg p.o.q.d.

ALLERGIES: The patient is allergic to PENICILLIN, WHICH
CAUSES SWELLING.

PHYSICAL EXAM: 

FAMILY HISTORY: History is unknown.

SOCIAL HISTORY: The patient works at [**Company **]in the
food services section.  He has a history of smoking one pack
per day for 40 years, but quit greater than one year ago.  He
denies alcohol use.  He denies having pets in the house.  He
recently had pneumovacs approximately one year ago, but he
has never had influenza vaccine. 

### Response:
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acidosis,Unspecified acquired hypothyroidism,Coronary atherosclerosis of native coronary artery'}
