CHIEF COMPLAINT: 59F h/o presents with SOB.

PRESENT ILLNESS: HPI: 59F h/o ESRD on HD [**2-21**] IgA nephropathy s/p failed cadaveric
transplant, malignant HTN complicated by seizures, diastolic
CHF, Afib, h/o medical non-complaince presents with SOB.
.
The patient receives HD 3x per week, last session was Saturday.
Sunday she felt more fatigued in the AM, but was able to work
12-6pm and perform physical labor. Ate dinner of fried fish
around 8pm and took all of her medications (reports no lapses
recently). At 10pm, she went to bed and noted a 'gurgling'
sensation in her chest/throat with fluid 'dripping from her
mouth' that she has had before with CHF exacerbations. While she
usually only uses 1 pillow at night, she had to sit nearly
upright to fall asleep. She awoke 1 hour later with SOB acutely
and called 911. Denies associated CP or nausea, but did feel
diaphoretic. No recent PND or peripheral edema. Of note, her BP
regimen was recently simplified [**9-28**] from 4 agents to only
toprol XL and diltiazem ER, and she wonders if her BP is being
effectively controlled.

MEDICAL HISTORY: Past Medical History:
1. ESRD secondary to IgA nephropathy in [**2169**] s/p renal
transplant [**2173**] with acute on chronic rejection, resumed HD
[**1-25**]; per priro renal notes, there may have been a component of
non-compliance with immunosupression meds
2. Malignant HTN complicated by seizures ([**5-26**]) not on
anti-epileptics and seizure free since this time; denies h/o CVA
3. Depression
4. Rheumatic fever in childhood
5. Diastolic CHF
6. Afib (recently diagnosed [**9-28**], not on coumadin)
7. h/o bleeding duodenal ulcer

MEDICATION ON ADMISSION: Renagel 2400 tid w/ meals
Protonix 40 daily
ASA 81 daily
Phoslo 667 [**Hospital1 **] w/ meals
Sensipar at dinner ?dose
Toprol XL qhs ?dose
Diltiazem ER ?dose

ALLERGIES: Dilantin

PHYSICAL EXAM: Physical Exam:
T  HR  BP  RR  SaO2  Weight
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD
Cardiac: RRR, s1s2 normal, no m/r/g, JVP 8cm
Pulmonary: Bibasilar crackles (R>L), no wheeze
Abdomen: +BS, soft, nontender, nondistended, no HSM
Extremities: warm, 2+ DP pulses, no edema, left AV fistula
Neuro: A&Ox3, speech clear and logical, CNII-XII intact, moves
all extremities, no focal deficits noted

FAMILY HISTORY: Family History:
Father died age 80.
Mother with lung Ca, died @64.
Many aunts/uncles with Ca.
Sister with breast Ca, survived.
No family hx renal problems.

SOCIAL HISTORY: Social History: Single, never married British female with no
children. Lives alone in her own apartment with cats. No family
in the area and few social supports. Has 2 sisters, one in
[**Location (un) **] she speaks with infrequently and one in [**Country 26467**] from
which she is estranged. Former smoker. Denies current tobacco,
EtOH, illicits. Works part-time as asst coffee shop manager.
Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Acute on chronic diastolic heart failure,Complications of transplanted kidney,End stage renal disease,Atrial fibrillation,Epilepsy, unspecified, without mention of intractable epilepsy,Depressive disorder, not elsewhere classified,Personal history of peptic ulcer disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Renal dialysis status
Mal hyp ht/kd stg V w hf,Ac on chr diast hrt fail,Compl kidney transplant,End stage renal disease,Atrial fibrillation,Epilep NOS w/o intr epil,Depressive disorder NEC,Prsnl hst peptic ulcr ds,Abn react-org transplant,Renal dialysis status
Admission Date:  [**2195-11-10**]              Discharge Date:   [**2195-11-13**]

Date of Birth:  [**2134-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Dilantin

Attending:[**First Name3 (LF) 5129**]
Chief Complaint:
59F h/o presents with SOB.

Major Surgical or Invasive Procedure:
None

History of Present Illness:
HPI: 59F h/o ESRD on HD [**2-21**] IgA nephropathy s/p failed cadaveric
transplant, malignant HTN complicated by seizures, diastolic
CHF, Afib, h/o medical non-complaince presents with SOB.
.
The patient receives HD 3x per week, last session was Saturday.
Sunday she felt more fatigued in the AM, but was able to work
12-6pm and perform physical labor. Ate dinner of fried fish
around 8pm and took all of her medications (reports no lapses
recently). At 10pm, she went to bed and noted a 'gurgling'
sensation in her chest/throat with fluid 'dripping from her
mouth' that she has had before with CHF exacerbations. While she
usually only uses 1 pillow at night, she had to sit nearly
upright to fall asleep. She awoke 1 hour later with SOB acutely
and called 911. Denies associated CP or nausea, but did feel
diaphoretic. No recent PND or peripheral edema. Of note, her BP
regimen was recently simplified [**9-28**] from 4 agents to only
toprol XL and diltiazem ER, and she wonders if her BP is being
effectively controlled.

In the ED, afebrile, 200/100, 90, 100% on NRB. Labs notable
normal CK, trop at baseline, BNP>[**Numeric Identifier **]. ECG with ? ST segment
changes in V1,2 thought to be due to J-point elevation. CXR
showed mild congestion consistent with CHF although PNA could
not be excluded. Started on nitro gtt, and also given ASA 325
and tylenol for ?PNA. Renal consulted from ED, no emergent need
for dialysis, planned for AM. Admitted for CHF, hypertensive
urgency.
.
Currently SOB completely resolved. Notes headache that coincided
with initiation of nitro gtt in the ED. No nausea, CP,
diaphoresis, or other complaints.

Past Medical History:
Past Medical History:
1. ESRD secondary to IgA nephropathy in [**2169**] s/p renal
transplant [**2173**] with acute on chronic rejection, resumed HD
[**1-25**]; per priro renal notes, there may have been a component of
non-compliance with immunosupression meds
2. Malignant HTN complicated by seizures ([**5-26**]) not on
anti-epileptics and seizure free since this time; denies h/o CVA
3. Depression
4. Rheumatic fever in childhood
5. Diastolic CHF
6. Afib (recently diagnosed [**9-28**], not on coumadin)
7. h/o bleeding duodenal ulcer

Social History:
Social History: Single, never married British female with no
children. Lives alone in her own apartment with cats. No family
in the area and few social supports. Has 2 sisters, one in
[**Location (un) **] she speaks with infrequently and one in [**Country 26467**] from
which she is estranged. Former smoker. Denies current tobacco,
EtOH, illicits. Works part-time as asst coffee shop manager.


Family History:
Family History:
Father died age 80.
Mother with lung Ca, died @64.
Many aunts/uncles with Ca.
Sister with breast Ca, survived.
No family hx renal problems.


Physical Exam:
Physical Exam:
T  HR  BP  RR  SaO2  Weight
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD
Cardiac: RRR, s1s2 normal, no m/r/g, JVP 8cm
Pulmonary: Bibasilar crackles (R>L), no wheeze
Abdomen: +BS, soft, nontender, nondistended, no HSM
Extremities: warm, 2+ DP pulses, no edema, left AV fistula
Neuro: A&Ox3, speech clear and logical, CNII-XII intact, moves
all extremities, no focal deficits noted


Pertinent Results:
[**2195-11-10**] 10:10PM   CK(CPK)-57
[**2195-11-10**] 10:10PM   cTropnT-0.18*
[**2195-11-10**] 01:46PM   CK(CPK)-84
[**2195-11-10**] 01:46PM   CK-MB-NotDone cTropnT-0.23*
[**2195-11-10**] 09:24AM   CK(CPK)-71
[**2195-11-10**] 09:24AM   CK-MB-NotDone cTropnT-0.20*
[**2195-11-10**] 04:10AM   LACTATE-1.3
[**2195-11-10**] 02:05AM   GLUCOSE-95 UREA N-95* CREAT-11.9*# SODIUM-138
POTASSIUM-4.9 CHLORIDE-93* TOTAL CO2-26 ANION GAP-24*
[**2195-11-10**] 02:05AM   estGFR-Using this
[**2195-11-10**] 02:05AM   CK(CPK)-85
[**2195-11-10**] 02:05AM   cTropnT-0.07*
[**2195-11-10**] 02:05AM   CK-MB-NotDone proBNP-GREATER TH
[**2195-11-10**] 02:05AM   CALCIUM-9.1 PHOSPHATE-6.6* MAGNESIUM-2.6
[**2195-11-10**] 02:05AM   WBC-10.8 RBC-3.60* HGB-11.9* HCT-36.0
MCV-100* MCH-33.1* MCHC-33.1 RDW-15.1
[**2195-11-10**] 02:05AM   NEUTS-74.5* LYMPHS-17.4* MONOS-3.5 EOS-3.9
BASOS-0.7
[**2195-11-10**] 02:05AM   PLT COUNT-271
[**2195-11-10**] 02:05AM   PT-14.1* PTT-26.8 INR(PT)-1.2*

ECG: sinus, 85bpm, LVH w/ repolarization V1-3, TWI I/AVl,
similar to prior tracing except ST changes V1-3 are slightly
more pronounced
.
CXR: *prelim* prominent vascular markings with ?slight increase
in right base opacity compared to [**2195-8-31**], improved left lung
aeration
.
Prior studies -
.
Echo ([**3-28**]): The left atrium is mildly dilated. The right atrial
pressure is indeterminate. There is moderate symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Regional left ventricular wall motion is normal. Overall
left ventricular systolic function is normal (LVEF>55%). Tissue
Doppler imaging suggests an increased left ventricular filling
pressure (PCWP>18mmHg). Right ventricular chamber size and free
wall motion are normal. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Trace aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. Mild (1+) mitral regurgitation is seen.
There is moderate pulmonary artery systolic hypertension. There
is a trivial/physiologic pericardial effusion.

Brief Hospital Course:
A/P: 59F h/o ESRD on HD [**2-21**] IgA nephropathy s/p failed cadaveric
transplant, malignant HTN complicated by seizures, diastolic
CHF, Afib, h/o medical non-compliance presented with SOB and
hypertensive urgency.  BP's and SOB normalized after dialysis x2
and patient was discharged home in stable condition.
.
# CHF: Diastolic. EF>55% on [**3-28**] echo. Euvolemic on discharge.
Exacerbation likely due to dietary indiscretion. Also h/o med
noncompliance although denies currently and seems reliable.
Severe HTN contributed to exacerbation.  Patient was started on
a nitro gtt and place on oxygen on arrival to the ICU, both of
which were quickly weaned.  During hemodialysis 3L of fluid
taken off with subsequent resolution in respiratory symptoms.
Repeat dialysis removed an additional 2.2 kg.
.
# Hypertensive urgency: History of med noncompliance and HTN
emergency complicated by seizures. BP 200/100 in the ED without
focal symptoms, improved on nitro gtt. Question of ECG changes
although appear to be consisent with priors and no other
symptoms consistent with angina.  Cardiac enzymes were cycled,
and she received morphine PRN for pain serial ECGs, and fluid
and Na restricted diet with monitoring of both.  Nitro gtt
weaned as pt transitioned to her home medications.  Second round
of HD further improved BPs to 130-150 which is the patient's
baseline pressures.  She was discharged on her home medications
of Toprol XL, Diltiazem ER and a new medication of Lisinopril
20mg.
.
# ESRD: Due to IgA nephropathy s/p failed transplant. On HD as
outpatient, TuThSat, Dr. [**First Name (STitle) 805**] is nephrologist. Does not
produce urine. Renal consulted in ED, and received HD the
morning after presentation and then on out patient schedule.
Continued home renal regimen.  Patient to return to regular
dialysis schedule upon discharge.  Per renal, an additional
0.5kg was removed while in-patient and they suspect patient
needs to be at a slightly lower dry weight.
.
# Headache: Likely due to nitro gtt and temporally coincided and
worsened with improved control of HTN. No other neurologic
symtpoms.  Resolved prior to discharge.
.
# Afib: Stroke risk factors include HTN, currently on ASA 325
daily. Could consider coumadin as likely beneficial, however
defer to outpatient providers. Also has h/o bleeding duodenal
ulcer.
.
# Code Status: DNR/DNI per patient.


Medications on Admission:
Renagel 2400 tid w/ meals
Protonix 40 daily
ASA 81 daily
Phoslo 667 [**Hospital1 **] w/ meals
Sensipar at dinner ?dose
Toprol XL qhs ?dose
Diltiazem ER ?dose

Discharge Medications:
1. Sevelamer HCl 800 mg Tablet Sig: Three (3) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO BID
WITH BREAKFAST, LUNCH ().
4. Cinacalcet 30 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

5. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
8. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).



Discharge Disposition:
Home

Discharge Diagnosis:
Hypertensive Urgency
CHF Exacerbation
.
End Stage Renal Disease [**2-21**] IgA Nephropathy
Atrial Fibrilaltion

Discharge Condition:
Stable


Discharge Instructions:
You were admitted with hypertensive urgency and a heart failure
exacerabation to the intensive care unit.  You were treated
there with dialysis and your breathing difficulty resolved.  You
were transferred to the general medical floor where your blood
pressure came back down to your baseline.  You were also
continued on your home blood pressure medication.
.
No medication changes were made.  You should continue taking all
your home medications as directed.
.
You should continue your regular dialysis schedule of Tuesday,
Thursday, Saturday.
.
If you have shortness of breath, fever, chest pain or other
concerning symptom, please seek medical care immediately.
.
It was a pleasure meeting you and participating in your care.

Followup Instructions:
Please follow up with your PCP as necessary.
{'Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Acute on chronic diastolic heart failure,Complications of transplanted kidney,End stage renal disease,Atrial fibrillation,Epilepsy, unspecified, without mention of intractable epilepsy,Depressive disorder, not elsewhere classified,Personal history of peptic ulcer disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Renal dialysis status'}


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: 59F h/o presents with SOB.

PRESENT ILLNESS: HPI: 59F h/o ESRD on HD [**2-21**] IgA nephropathy s/p failed cadaveric
transplant, malignant HTN complicated by seizures, diastolic
CHF, Afib, h/o medical non-complaince presents with SOB.
.
The patient receives HD 3x per week, last session was Saturday.
Sunday she felt more fatigued in the AM, but was able to work
12-6pm and perform physical labor. Ate dinner of fried fish
around 8pm and took all of her medications (reports no lapses
recently). At 10pm, she went to bed and noted a 'gurgling'
sensation in her chest/throat with fluid 'dripping from her
mouth' that she has had before with CHF exacerbations. While she
usually only uses 1 pillow at night, she had to sit nearly
upright to fall asleep. She awoke 1 hour later with SOB acutely
and called 911. Denies associated CP or nausea, but did feel
diaphoretic. No recent PND or peripheral edema. Of note, her BP
regimen was recently simplified [**9-28**] from 4 agents to only
toprol XL and diltiazem ER, and she wonders if her BP is being
effectively controlled.

MEDICAL HISTORY: Past Medical History:
1. ESRD secondary to IgA nephropathy in [**2169**] s/p renal
transplant [**2173**] with acute on chronic rejection, resumed HD
[**1-25**]; per priro renal notes, there may have been a component of
non-compliance with immunosupression meds
2. Malignant HTN complicated by seizures ([**5-26**]) not on
anti-epileptics and seizure free since this time; denies h/o CVA
3. Depression
4. Rheumatic fever in childhood
5. Diastolic CHF
6. Afib (recently diagnosed [**9-28**], not on coumadin)
7. h/o bleeding duodenal ulcer

MEDICATION ON ADMISSION: Renagel 2400 tid w/ meals
Protonix 40 daily
ASA 81 daily
Phoslo 667 [**Hospital1 **] w/ meals
Sensipar at dinner ?dose
Toprol XL qhs ?dose
Diltiazem ER ?dose

ALLERGIES: Dilantin

PHYSICAL EXAM: Physical Exam:
T  HR  BP  RR  SaO2  Weight
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD
Cardiac: RRR, s1s2 normal, no m/r/g, JVP 8cm
Pulmonary: Bibasilar crackles (R>L), no wheeze
Abdomen: +BS, soft, nontender, nondistended, no HSM
Extremities: warm, 2+ DP pulses, no edema, left AV fistula
Neuro: A&Ox3, speech clear and logical, CNII-XII intact, moves
all extremities, no focal deficits noted

FAMILY HISTORY: Family History:
Father died age 80.
Mother with lung Ca, died @64.
Many aunts/uncles with Ca.
Sister with breast Ca, survived.
No family hx renal problems.

SOCIAL HISTORY: Social History: Single, never married British female with no
children. Lives alone in her own apartment with cats. No family
in the area and few social supports. Has 2 sisters, one in
[**Location (un) **] she speaks with infrequently and one in [**Country 26467**] from
which she is estranged. Former smoker. Denies current tobacco,
EtOH, illicits. Works part-time as asst coffee shop manager. 

### Response:
{'Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Acute on chronic diastolic heart failure,Complications of transplanted kidney,End stage renal disease,Atrial fibrillation,Epilepsy, unspecified, without mention of intractable epilepsy,Depressive disorder, not elsewhere classified,Personal history of peptic ulcer disease,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Renal dialysis status'}
