CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 60 yo F with RA (only on plaquenil), HTN, pulm fibrosis, PVD,
OA, tobacco use presents to ED with 2-3 wk h/o malaise, dry
cough, and progressive SOB.  Denies any F/C/NS.  Nearly
intubated in the ED for hypoxic respiratory failure (O2 sats
80s, RR 40s), with significant wheeze.  However, with IV
steroids and continuous albuterol nebs, improved and
stablilized, though still tachypnic with wheeze.  CTA
demonstrated no PE, though large mass (taking up much of RUL,
some of RML that compresses the RUL and RML bronchi, with
?extension into the pretrachial/subcarinial space vs associated
lymphadenopathy, innumerable bilateral nodules and thick
interstitial markings.  In addition, hypodensities were
visualized in the liver.  Started on empiric levo/azithro in the
ED.

MEDICAL HISTORY: RA
pulmonary fibrosis
PVD
tobacco use (>20 years)
OA
HTN
prior Cardiomyopathy, with EF now 55% (was 30-40% [**2095**], etiology
unknown)
Recent p-mibi, with no perfusion defects, no [**Last Name (LF) **], [**First Name3 (LF) **] 58%
s/p appy
s/p cervical fusion [**2095**]
s/p lumbar fusion
OA

MEDICATION ON ADMISSION: lopressor
oxycontin
vioxx
plaquenil
fosamax
mvi

ALLERGIES: Penicillins

PHYSICAL EXAM: T 97.9 HR 127  BP 138/63 RR 25  98% NRB
Gen: Female, sitting up, tachypnic, w/ acc muscle use
HEENT/Neck: +JVD, +cervical LAD, EOMI, MM dry,
CV: irregular, tachy, no m/r/g
Pul: diffuse wheezes, poor a/m b/l
abd: soft, nt, nd.
Ext: no edema, from

FAMILY HISTORY: N.C.

SOCIAL HISTORY: Very relgious, former heavy smoker.
Acute respiratory failure,Bronchopneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of lung,Postinflammatory pulmonary fibrosis,Other primary cardiomyopathies,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Rheumatoid arthritis,Unspecified essential hypertension,Neoplasm of uncertain behavior of larynx,Peripheral vascular disease, unspecified
Acute respiratry failure,Bronchopneumonia org NOS,Mal neo bronch/lung NEC,Secondary malig neo lung,Postinflam pulm fibrosis,Prim cardiomyopathy NEC,CHF NOS,Acute kidney failure NOS,Rheumatoid arthritis,Hypertension NOS,Unc behav neo larynx,Periph vascular dis NOS
Admission Date:  [**2101-10-18**]              Discharge Date:   [**2101-10-25**]

Date of Birth:  [**2041-10-12**]             Sex:   F

Service: MED

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1850**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
60 yo F with RA (only on plaquenil), HTN, pulm fibrosis, PVD,
OA, tobacco use presents to ED with 2-3 wk h/o malaise, dry
cough, and progressive SOB.  Denies any F/C/NS.  Nearly
intubated in the ED for hypoxic respiratory failure (O2 sats
80s, RR 40s), with significant wheeze.  However, with IV
steroids and continuous albuterol nebs, improved and
stablilized, though still tachypnic with wheeze.  CTA
demonstrated no PE, though large mass (taking up much of RUL,
some of RML that compresses the RUL and RML bronchi, with
?extension into the pretrachial/subcarinial space vs associated
lymphadenopathy, innumerable bilateral nodules and thick
interstitial markings.  In addition, hypodensities were
visualized in the liver.  Started on empiric levo/azithro in the
ED.

ED course also notable for MAT as high as 170 bpm, in part
exacerbated by albuterol, with rate-related lateral ischemic
changes (st dep V3-V6, lateral TWI).  ruling out for MI with
serial neg cardiac enzymes.


Past Medical History:
RA
pulmonary fibrosis
PVD
tobacco use (>20 years)
OA
HTN
prior Cardiomyopathy, with EF now 55% (was 30-40% [**2095**], etiology
unknown)
Recent p-mibi, with no perfusion defects, no [**Last Name (LF) **], [**First Name3 (LF) **] 58%
s/p appy
s/p cervical fusion [**2095**]
s/p lumbar fusion
OA

Social History:
Very relgious, former heavy smoker.

Family History:
N.C.

Physical Exam:
T 97.9 HR 127  BP 138/63 RR 25  98% NRB
Gen: Female, sitting up, tachypnic, w/ acc muscle use
HEENT/Neck: +JVD, +cervical LAD, EOMI, MM dry,
CV: irregular, tachy, no m/r/g
Pul: diffuse wheezes, poor a/m b/l
abd: soft, nt, nd.
Ext: no edema, from


Pertinent Results:
[**2101-10-18**] 02:22PM   TYPE-ART TEMP-37.0 RATES-/30 O2-60 PO2-118*
PCO2-40 PH-7.36 TOTAL CO2-24 BASE XS--2 INTUBATED-NOT INTUBA
[**2101-10-25**] 03:02AM BLOOD WBC-17.2* RBC-3.61* Hgb-9.9* Hct-31.9*
MCV-88 MCH-27.5 MCHC-31.1 RDW-15.0 Plt Ct-95*
[**2101-10-25**] 03:02AM BLOOD Glucose-150* UreaN-56* Creat-1.2* Na-145
K-4.5 Cl-111* HCO3-25 AnGap-14
[**2101-10-25**] 09:40AM BLOOD Type-ART Temp-36.4 O2 Flow-4 pO2-70*
pCO2-51* pH-7.26* calHCO3-24 Base XS--4 Intubat-NOT INTUBA

Brief Hospital Course:
Pt was admitted to the [**Hospital Unit Name 153**] in respiratory distress.
CT/angiogram results showed a large right lung mass, likely to
be lung cancer, with metastasis to the left lung and liver.  The
prognosis of this cancer was discussed with the patient and her
sister, [**Name (NI) **], her healthcare proxy.  [**Name (NI) **] the patient's
respiratory distress seemed to improve, her blood gases
demonstrated that she was tiring out.  On [**10-24**] and [**10-25**] family
meetings were held to discuss the patient's progress and dismal
prognosis.  At this time the patient was made DNR/DNI but
treatment was continued.  Later on in the night, the patient
became hypotensive and increasingly short of breath.  After
speaking with [**Doctor Last Name **], her healthcare proxy, comfort measures
were started with morphine.  Shortly thereafter, she became more
hypoxic and bradycardic.  The patient had no corneal reflexes,
and had no heart sounds or breath sounds for one minute.  Time
of death was 7:10pm.  The family was present.  Autopsy consent
was granted.

Medications on Admission:
lopressor
oxycontin
vioxx
plaquenil
fosamax
mvi

Discharge Medications:
expired

Discharge Disposition:
Home

Facility:
expired

Discharge Diagnosis:
pneumonia
metastatic lung cancer

Discharge Condition:
deceased

Discharge Instructions:
deceased

Followup Instructions:
deceased

                             [**First Name8 (NamePattern2) 1176**] [**Name8 (MD) 1177**] MD [**MD Number(2) 1851**]
{'Acute respiratory failure,Bronchopneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of lung,Postinflammatory pulmonary fibrosis,Other primary cardiomyopathies,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Rheumatoid arthritis,Unspecified essential hypertension,Neoplasm of uncertain behavior of larynx,Peripheral vascular disease, unspecified'}


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: 60 yo F with RA (only on plaquenil), HTN, pulm fibrosis, PVD,
OA, tobacco use presents to ED with 2-3 wk h/o malaise, dry
cough, and progressive SOB.  Denies any F/C/NS.  Nearly
intubated in the ED for hypoxic respiratory failure (O2 sats
80s, RR 40s), with significant wheeze.  However, with IV
steroids and continuous albuterol nebs, improved and
stablilized, though still tachypnic with wheeze.  CTA
demonstrated no PE, though large mass (taking up much of RUL,
some of RML that compresses the RUL and RML bronchi, with
?extension into the pretrachial/subcarinial space vs associated
lymphadenopathy, innumerable bilateral nodules and thick
interstitial markings.  In addition, hypodensities were
visualized in the liver.  Started on empiric levo/azithro in the
ED.

MEDICAL HISTORY: RA
pulmonary fibrosis
PVD
tobacco use (>20 years)
OA
HTN
prior Cardiomyopathy, with EF now 55% (was 30-40% [**2095**], etiology
unknown)
Recent p-mibi, with no perfusion defects, no [**Last Name (LF) **], [**First Name3 (LF) **] 58%
s/p appy
s/p cervical fusion [**2095**]
s/p lumbar fusion
OA

MEDICATION ON ADMISSION: lopressor
oxycontin
vioxx
plaquenil
fosamax
mvi

ALLERGIES: Penicillins

PHYSICAL EXAM: T 97.9 HR 127  BP 138/63 RR 25  98% NRB
Gen: Female, sitting up, tachypnic, w/ acc muscle use
HEENT/Neck: +JVD, +cervical LAD, EOMI, MM dry,
CV: irregular, tachy, no m/r/g
Pul: diffuse wheezes, poor a/m b/l
abd: soft, nt, nd.
Ext: no edema, from

FAMILY HISTORY: N.C.

SOCIAL HISTORY: Very relgious, former heavy smoker. 

### Response:
{'Acute respiratory failure,Bronchopneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of lung,Postinflammatory pulmonary fibrosis,Other primary cardiomyopathies,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Rheumatoid arthritis,Unspecified essential hypertension,Neoplasm of uncertain behavior of larynx,Peripheral vascular disease, unspecified'}
