CHIEF COMPLAINT: transfer from [**Hospital **] Hospital with shortness of breath

PRESENT ILLNESS: 45 yo female w/ hx of of SVT (? avnrt vs avrt) who presented to
OSH six days post-partum with shortness of breath. Patient
states that she noticed being short of breath with exertion for
several days prior to her delivery six days ago.  She then had
an uncomplicated vaginal delivery on [**2199-3-2**].  No hypertension,
pre-eclampsia during her pregnancy. Placenta was normal. Patient
noticed increasing shortness of breath in the days following
delivery, which became acutely worse 2-3 days ago.  She noticed
decreased exercise tolerance and soon was short of breath just
walking across the room.  Also noted orthopnea and could not
sleep lying flat. She denies chest pain, cough, hemoptysis. No
fevers or chills. No syncope. Had some rhinorrhea a few weeks
ago, which had completely resolved.
.
At OSH patient was noted to be hemodynamically stable. She had a
CTA which was negative for PE but did demonstrate bilateral
pleural effusions and evidence of pulmonary edema.  She had an
echo performed - EF 15%, mild LV enlargement, global
hypokinesis, MR 2+, TR 2+.  Patient was given lasix 20 mg IV x
2, digoxin 0.5 mg IV x 1, nitro paste, and was started on a
heparin gtt.  She was transferred to [**Hospital1 18**] for further
evaluation.
.
On arrival here, she was feeling relatively well.  Denied
shortness of breath at rest.  No chest pain.

MEDICAL HISTORY: paroxysmal SVT - has had episdoes of SVT for 20+ years, usually
last a few minutes, had one prolonged episode which persisted
overnight. She was treated with digoxin and metoprolol in the
past.  During her pregnancy she was treated with labetolol,
although had discontinued at some point in the last nine months.
Patient reports that she can always feel when her tachycardia
starts and stops, sometimes has dizziness associated with it.
Has never had syncope/loss of consciousness.

MEDICATION ON ADMISSION: prenatal vitamins

ALLERGIES: Erythromycin Base / Flagyl

PHYSICAL EXAM: Gen: NAD, comfortable, speaking in full sentences
HEENT: perrla, op - clear, mmm
Neck: neck veins flat, no lad
Lungs: decreased breath sounds at right base, bilateral crackles
ni the lower thirds of her lungs
Card: reg, + S3, [**2-26**] sys murmur @ apex
Abd: + bs, mildly distended, mildy tender to palp over
supra-pubic area
Ext: DP 2+ bilat, no edema
Neuro: alert and oriented x3, sensation and motor function
grossly intact, CN II-XII intact.

FAMILY HISTORY: father - MI in 50s, then developed a cardiomyopathy that
resulted in a hreat transplant in late 60s
mother - breast ca
daughter - post-partum cardiomyopathy folloing her first
pregnancy

SOCIAL HISTORY: Lives in [**Hospital1 **] with her husband.  Stopped working [**2-22**]
pregnancy, but she was working on an assembly line prior to
delivery.
No Etoh.  Former smoker - smoked 1/2PPD for 20+ years, wuit 8
yrs ago.
Peripartum cardiomyopathy, postpartum condition or complication,Congestive heart failure, unspecified,Paroxysmal supraventricular tachycardia,Pure hypercholesterolemia
Peripartum card-postpart,CHF NOS,Parox atrial tachycardia,Pure hypercholesterolem
Admission Date:  [**2199-3-8**]              Discharge Date:   [**2199-3-11**]

Date of Birth:  [**2153-12-17**]             Sex:   F

Service: MEDICINE

Allergies:
Erythromycin Base / Flagyl

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
transfer from [**Hospital **] Hospital with shortness of breath


Major Surgical or Invasive Procedure:
none


History of Present Illness:
45 yo female w/ hx of of SVT (? avnrt vs avrt) who presented to
OSH six days post-partum with shortness of breath. Patient
states that she noticed being short of breath with exertion for
several days prior to her delivery six days ago.  She then had
an uncomplicated vaginal delivery on [**2199-3-2**].  No hypertension,
pre-eclampsia during her pregnancy. Placenta was normal. Patient
noticed increasing shortness of breath in the days following
delivery, which became acutely worse 2-3 days ago.  She noticed
decreased exercise tolerance and soon was short of breath just
walking across the room.  Also noted orthopnea and could not
sleep lying flat. She denies chest pain, cough, hemoptysis. No
fevers or chills. No syncope. Had some rhinorrhea a few weeks
ago, which had completely resolved.
.
At OSH patient was noted to be hemodynamically stable. She had a
CTA which was negative for PE but did demonstrate bilateral
pleural effusions and evidence of pulmonary edema.  She had an
echo performed - EF 15%, mild LV enlargement, global
hypokinesis, MR 2+, TR 2+.  Patient was given lasix 20 mg IV x
2, digoxin 0.5 mg IV x 1, nitro paste, and was started on a
heparin gtt.  She was transferred to [**Hospital1 18**] for further
evaluation.
.
On arrival here, she was feeling relatively well.  Denied
shortness of breath at rest.  No chest pain.


Past Medical History:
paroxysmal SVT - has had episdoes of SVT for 20+ years, usually
last a few minutes, had one prolonged episode which persisted
overnight. She was treated with digoxin and metoprolol in the
past.  During her pregnancy she was treated with labetolol,
although had discontinued at some point in the last nine months.
Patient reports that she can always feel when her tachycardia
starts and stops, sometimes has dizziness associated with it.
Has never had syncope/loss of consciousness.


Social History:
Lives in [**Hospital1 **] with her husband.  Stopped working [**2-22**]
pregnancy, but she was working on an assembly line prior to
delivery.
No Etoh.  Former smoker - smoked 1/2PPD for 20+ years, wuit 8
yrs ago.


Family History:
father - MI in 50s, then developed a cardiomyopathy that
resulted in a hreat transplant in late 60s
mother - breast ca
daughter - post-partum cardiomyopathy folloing her first
pregnancy


Physical Exam:
Gen: NAD, comfortable, speaking in full sentences
HEENT: perrla, op - clear, mmm
Neck: neck veins flat, no lad
Lungs: decreased breath sounds at right base, bilateral crackles
ni the lower thirds of her lungs
Card: reg, + S3, [**2-26**] sys murmur @ apex
Abd: + bs, mildly distended, mildy tender to palp over
supra-pubic area
Ext: DP 2+ bilat, no edema
Neuro: alert and oriented x3, sensation and motor function
grossly intact, CN II-XII intact.

Pertinent Results:
Labs:
[**2199-3-8**] 10:54PM BLOOD WBC-15.6* RBC-4.10* Hgb-13.0 Hct-36.7
MCV-90 MCH-31.7 MCHC-35.4* RDW-14.1 Plt Ct-430
[**2199-3-8**] 10:54PM BLOOD Neuts-76.5* Lymphs-15.8* Monos-7.1
Eos-0.5 Baso-0.2
[**2199-3-8**] 10:54PM BLOOD Glucose-109* UreaN-16 Creat-0.6 Na-141
K-3.4 Cl-103 HCO3-25 AnGap-16
[**2199-3-8**] 10:54PM BLOOD ALT-48* AST-33 CK(CPK)-80 AlkPhos-137*
TotBili-0.3
[**2199-3-8**] 10:54PM BLOOD cTropnT-<0.01
[**2199-3-8**] 10:54PM BLOOD Calcium-9.2 Phos-4.1 Mg-2.2 Iron-27*
[**2199-3-9**] 06:19AM BLOOD Calcium-9.7 Phos-4.0 Mg-2.4 Cholest-343*
[**2199-3-8**] 10:54PM BLOOD calTIBC-484* Ferritn-35 TRF-372*
[**2199-3-9**] 06:19AM BLOOD Triglyc-151* HDL-119 CHOL/HD-2.9
LDLcalc-194*
[**2199-3-8**] 10:54PM BLOOD TSH-1.8
[**2199-3-9**] 06:19AM BLOOD HCV Ab-NEGATIVE
.
EKG: 84 bpm, Sinus rhythm. T wave inversion in leads VI-V2 with
ST-T wave flattening in leads I and aVL. The right precordial T
wave inversion may be a normal variant.
.
CHEST (PORTABLE AP)  [**2199-3-9**] 1:19 PM
The cardiomediastinal silhouette is within normal limits. There
is no CHF or effusion. There is some prominence of interstitial
markings in the right cardiophrenic angle, without frank
consolidation. Compared with earlier the same day, there has
been considerable improvement at right base and in the small
amount of right costophrenic sulcus blunting.

Rapid improvement suggests that this represent residua from
earlier CHF. Correlation with clinical symptoms is requested for
full assessment.
.
CHEST (PORTABLE AP)  [**2199-3-9**] 12:19 AM
The heart is not enlarged. The aortic contour and superior
mediastinum are within normal limits. There is no upper zone
redistribution to suggest CHF. There is some patchy increased
density at the right base which could represent a pneumonic
infiltrate. No frank consolidation is identified. Thereis
possible minimal blunting of the right costophrenic angle.
Otherwise, no effusions are seen.
IMPRESSION: Patchy opacity in the right lower lobe medially,
which could represent an infectious infiltrate. Possible minimal
blunting of the right costophrenic angle. No chf or gross
effusion.
.
TTE [**2199-3-9**]:
LVEF 25%.  The left atrium is mildly dilated. Left ventricular
wall thicknesses are  normal. The left ventricular cavity is
moderately dilated. There is severe  global left ventricular
hypokinesis. Overall left ventricular systolic function is
severely depressed. [Intrinsic left ventricular systolic
function  is likely more depressed given the severity of
valvular regurgitation.]  Transmitral Doppler and tissue
velocity imaging are consistent with Grade III/IV (severe) LV
diastolic dysfunction. Right ventricular chamber size and free
wall motion are normal. The aortic valve leaflets (3) appear
structurally  normal with good leaflet excursion and no aortic
regurgitation. The mitral  valve leaflets are mildly thickened.
Moderate (2+) mitral regurgitation is
seen. The left ventricular inflow pattern suggests a restrictive
filling
abnormality, with elevated left atrial pressure. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion.


Brief Hospital Course:
45 yo female w/ HX of paroxysmal SVT who presents with worsening
shortness of breath since her delivery on [**2199-3-2**].  Seen at OSH
and found to have significantly depressed EF and global
hypokinesis.
.
1. CHF: Patient presenting with shortness of breath and
depressed EF 6 days post-partum.  Given time of onset, most
likely has developed post-partum cardiomyopathy. Viral
cardiomyopathy is another possible cause of her presentation
given recent URI symptoms.  HCV AB was negative and the patient
reports a negative HIV test recently done during prenatal
course.  Her triglycerides were also not highly elevated.  The
patient has a history of paroxysmal SVT, however given the short
duration of these symptoms, their symptomatic nature, it is
unlikely that she would have had a persistent extended episode
of tachycardia resulting in cardiomyopathy.  She has a normal
TSH making hypothyroidism unlikely and a normal ferritin and
iron level making hemochromatosis unlikely.  Ischemia is another
cause for her symptoms although it is unlikely given normal
cardiac enzymes and few risk factors for heart disease in this
patient.  Digoxin and nitropaste which were started at the OSH
were discontinued.  Echo showed hypokinesis but no akinesis and
heparin was discontinued.  She was treated with aspirin,
lisinopril, low dose beta blocker, Statin, and Lasix.
.
2. Hx of paroxysmal SVT: She presented to [**Hospital1 18**] in sinus rhythm
and was monitored on telemetry.
.
3. Leukocytosis: Although she had leukocytosis, she was afebrile
and without localizing signs or symptoms of infection. Urine and
blood cultures were negative.  Leukocytosis was most likely [**2-22**]
recent delivery.
.
4. Post-partum: Vaginal bleeding has been mild/moderate.  She
was started on an ACEi for cardiomyopathy and was advised not to
breast feed given the potential adverse side effects of this
medication in infants.  The patient reports that she understands
the adverse reactions and will not breast feed.
.
5. Code: full.


Medications on Admission:
prenatal vitamins

Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable
PO DAILY (Daily).
Disp:*60 Tablet, Chewable(s)* Refills:*2*
2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
6. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
7. Outpatient Lab Work
Check chem 10 in 1 week.  Have results sent to Dr.[**Name (NI) 12389**]
office, ([**Telephone/Fax (1) 7437**]


Discharge Disposition:
Home

Discharge Diagnosis:
Post partum cardiomyopathy


Discharge Condition:
Good, ambulatory, respiratory status stable


Discharge Instructions:
Please take all medications as directed.
.
You will be taking some medications that are important for your
heart but are not compatible with breast feeding. Please do not
breast feed.
.
If you develop shortness of breath, chest pain, palpitations, or
any other symptoms that concerns you, call your doctor or go to
the emergency room.

Followup Instructions:
Make a follow up appointment with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 6073**] for [**1-22**]
weeks from now.  You can call his office at ([**Telephone/Fax (1) 7437**]
.
Make an appointmet to get a transthoracic echo in 1 month.  The
phone number is ([**Telephone/Fax (1) 19380**].
.
Have your lab work checked in 1 week.
{'Peripartum cardiomyopathy, postpartum condition or complication,Congestive heart failure, unspecified,Paroxysmal supraventricular tachycardia,Pure hypercholesterolemia'}


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: transfer from [**Hospital **] Hospital with shortness of breath

PRESENT ILLNESS: 45 yo female w/ hx of of SVT (? avnrt vs avrt) who presented to
OSH six days post-partum with shortness of breath. Patient
states that she noticed being short of breath with exertion for
several days prior to her delivery six days ago.  She then had
an uncomplicated vaginal delivery on [**2199-3-2**].  No hypertension,
pre-eclampsia during her pregnancy. Placenta was normal. Patient
noticed increasing shortness of breath in the days following
delivery, which became acutely worse 2-3 days ago.  She noticed
decreased exercise tolerance and soon was short of breath just
walking across the room.  Also noted orthopnea and could not
sleep lying flat. She denies chest pain, cough, hemoptysis. No
fevers or chills. No syncope. Had some rhinorrhea a few weeks
ago, which had completely resolved.
.
At OSH patient was noted to be hemodynamically stable. She had a
CTA which was negative for PE but did demonstrate bilateral
pleural effusions and evidence of pulmonary edema.  She had an
echo performed - EF 15%, mild LV enlargement, global
hypokinesis, MR 2+, TR 2+.  Patient was given lasix 20 mg IV x
2, digoxin 0.5 mg IV x 1, nitro paste, and was started on a
heparin gtt.  She was transferred to [**Hospital1 18**] for further
evaluation.
.
On arrival here, she was feeling relatively well.  Denied
shortness of breath at rest.  No chest pain.

MEDICAL HISTORY: paroxysmal SVT - has had episdoes of SVT for 20+ years, usually
last a few minutes, had one prolonged episode which persisted
overnight. She was treated with digoxin and metoprolol in the
past.  During her pregnancy she was treated with labetolol,
although had discontinued at some point in the last nine months.
Patient reports that she can always feel when her tachycardia
starts and stops, sometimes has dizziness associated with it.
Has never had syncope/loss of consciousness.

MEDICATION ON ADMISSION: prenatal vitamins

ALLERGIES: Erythromycin Base / Flagyl

PHYSICAL EXAM: Gen: NAD, comfortable, speaking in full sentences
HEENT: perrla, op - clear, mmm
Neck: neck veins flat, no lad
Lungs: decreased breath sounds at right base, bilateral crackles
ni the lower thirds of her lungs
Card: reg, + S3, [**2-26**] sys murmur @ apex
Abd: + bs, mildly distended, mildy tender to palp over
supra-pubic area
Ext: DP 2+ bilat, no edema
Neuro: alert and oriented x3, sensation and motor function
grossly intact, CN II-XII intact.

FAMILY HISTORY: father - MI in 50s, then developed a cardiomyopathy that
resulted in a hreat transplant in late 60s
mother - breast ca
daughter - post-partum cardiomyopathy folloing her first
pregnancy

SOCIAL HISTORY: Lives in [**Hospital1 **] with her husband.  Stopped working [**2-22**]
pregnancy, but she was working on an assembly line prior to
delivery.
No Etoh.  Former smoker - smoked 1/2PPD for 20+ years, wuit 8
yrs ago. 

### Response:
{'Peripartum cardiomyopathy, postpartum condition or complication,Congestive heart failure, unspecified,Paroxysmal supraventricular tachycardia,Pure hypercholesterolemia'}
