CHIEF COMPLAINT: swelling in my legs

PRESENT ILLNESS: 45-yo-woman h/o DM2, Hep C cirrhosis, primary pulm HTN, h/o IVDU
presents w/ syncope 3 days ago.  She fell while walking from
bedroom to bathroom, witnessed by friend.  Pt does not recall
event, but was observed falling to the floor and then found to
have urinated.  She denies associated CP, dizziness, confusion,
alcohol use, tongue biting, convulsions.  Presented last night
after talking to PCP, [**Name10 (NameIs) 1023**] recommended evaluation.  She also c/o
persistent dyspnea despite lasix, which was recently started
during admission for massive R sided heart failure.  She reports
frequent nose bleed w/ cough, no hematemesis, hematochezia, or
melena.

MEDICAL HISTORY: 1. Asthma
2. Pulmonary HTN - cathed [**8-/2161**], mean PA pressure 63 mmHg.
Right- sided filling pressures severely elevated: RA mean 24
mmHg, RVEDP 24 mmHg). Left sided filling pressures mildly
elevated: PCW 20 mmHg.
3. Thrombocytopenia
4. DM2 - unknown duration, on Lispro and NPH at home.
5. RHF - cor pulmonale, ECHO [**8-16**] w/ EF 55%, global R
ventricular dilation and hypokinesis
6. Liver cirrhosis - HCV positive Ab, neg VL in [**8-/2161**], not a
transplant candidate due to cor pulmonale, no varices by EGD
[**11-16**]

MEDICATION ON ADMISSION: 1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) inhalation Inhalation [**Hospital1 **] (2 times a day).
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
Disp:*2700 ML(s)* Refills:*2*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 9 days.
Disp:*9 Tablet(s)* Refills:*0*
6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
Disp:*30 Tablet(s)* Refills:*2*
7. NPH insulin
Take 25 units with breakfast each morning

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.0  BP 120/60  HR 101  RR 20  O2sats 97% RA
Gen: Obese female, comfortable, NAD
HEENT: clear OP, mmm, PERRL, EOMI
Neck: supple, no LAD, no thyromegaly, JVD to the ear
Lungs: Poor inspiratory effort and difficult to hear [**3-17**]
obesity. Otherwise clear no crackles, wheezes
Heart: RRR + S1/S2 no m/r/g
Abd: obese, soft, NT, ND, +BS
Ext: 2+ pitting edema to knees B, 2+ DP's
Neuro: A&O times 3, pt appropriate, no signs of delerium, no
asterixis

FAMILY HISTORY: HTN
CAD
Breast CA

SOCIAL HISTORY: Smokes ciggaretes on occasion, last one 2 days ago. Denies any
etoh, IVDU. Lives alone with her cat.
Syncope and collapse,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Acquired hemolytic anemia, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Alcoholic cirrhosis of liver,Hemorrhage of gastrointestinal tract, unspecified,Unspecified viral hepatitis C with hepatic coma,Acquired coagulation factor deficiency,Other and unspecified alcohol dependence, unspecified,Orthostatic hypotension,Asthma, unspecified type, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Chronic pulmonary heart disease, unspecified
Syncope and collapse,CHF NOS,Urin tract infection NOS,Acq hemolytic anemia NOS,DMI wo cmp nt st uncntrl,Alcohol cirrhosis liver,Gastrointest hemorr NOS,Hpt C w hepatic coma NOS,Acq coagul factor defic,Alcoh dep NEC/NOS-unspec,Orthostatic hypotension,Asthma NOS,Enterococcus group d,Chr pulmon heart dis NOS
Admission Date:  [**2162-2-18**]              Discharge Date:   [**2162-3-4**]

Date of Birth:  [**2116-6-18**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5644**]
Chief Complaint:
swelling in my legs

Major Surgical or Invasive Procedure:
None.


History of Present Illness:
45-yo-woman h/o DM2, Hep C cirrhosis, primary pulm HTN, h/o IVDU
presents w/ syncope 3 days ago.  She fell while walking from
bedroom to bathroom, witnessed by friend.  Pt does not recall
event, but was observed falling to the floor and then found to
have urinated.  She denies associated CP, dizziness, confusion,
alcohol use, tongue biting, convulsions.  Presented last night
after talking to PCP, [**Name10 (NameIs) 1023**] recommended evaluation.  She also c/o
persistent dyspnea despite lasix, which was recently started
during admission for massive R sided heart failure.  She reports
frequent nose bleed w/ cough, no hematemesis, hematochezia, or
melena.

Past Medical History:
1. Asthma
2. Pulmonary HTN - cathed [**8-/2161**], mean PA pressure 63 mmHg.
Right- sided filling pressures severely elevated: RA mean 24
mmHg, RVEDP 24 mmHg). Left sided filling pressures mildly
elevated: PCW 20 mmHg.
3. Thrombocytopenia
4. DM2 - unknown duration, on Lispro and NPH at home.
5. RHF - cor pulmonale, ECHO [**8-16**] w/ EF 55%, global R
ventricular dilation and hypokinesis
6. Liver cirrhosis - HCV positive Ab, neg VL in [**8-/2161**], not a
transplant candidate due to cor pulmonale, no varices by EGD
[**11-16**]

Social History:
Smokes ciggaretes on occasion, last one 2 days ago. Denies any
etoh, IVDU. Lives alone with her cat.

Family History:
HTN
CAD
Breast CA

Physical Exam:
T 99.0  BP 120/60  HR 101  RR 20  O2sats 97% RA
Gen: Obese female, comfortable, NAD
HEENT: clear OP, mmm, PERRL, EOMI
Neck: supple, no LAD, no thyromegaly, JVD to the ear
Lungs: Poor inspiratory effort and difficult to hear [**3-17**]
obesity. Otherwise clear no crackles, wheezes
Heart: RRR + S1/S2 no m/r/g
Abd: obese, soft, NT, ND, +BS
Ext: 2+ pitting edema to knees B, 2+ DP's
Neuro: A&O times 3, pt appropriate, no signs of delerium, no
asterixis


Pertinent Results:
[**2162-2-17**] 08:28PM   WBC-4.7 RBC-2.56* HGB-9.2* HCT-30.8* MCV-121*
MCH-36.1* MCHC-30.0* RDW-17.9*
[**2162-2-17**] 08:28PM   PLT COUNT-61*
[**2162-2-17**] 08:28PM   NEUTS-56.6 LYMPHS-35.6 MONOS-6.5 EOS-1.1
BASOS-0.2
[**2162-2-17**] 08:28PM   GLUCOSE-100 UREA N-13 CREAT-1.3* SODIUM-132*
POTASSIUM-3.4 CHLORIDE-99 TOTAL CO2-21* ANION GAP-15
[**2162-2-17**] 08:28PM   ALT(SGPT)-69* AST(SGOT)-166* CK(CPK)-700* ALK
PHOS-110 TOT BILI-6.1*
[**2162-2-17**] 08:28PM   LIPASE-21
[**2162-2-17**] 08:28PM   PT-18.3* PTT-37.4* INR(PT)-2.1
[**2162-2-17**] 08:28PM   CK-MB-5 cTropnT-<0.01
[**2162-2-18**] 04:45AM   CK-MB-4 cTropnT-<0.01
[**2162-2-18**] 04:45AM   LD(LDH)-431* CK(CPK)-579*

CT Head: There is no intracranial hemorrhage, abnormal
extra-axial fluid collection, mass effect or midline shift. The
ventricles are normal, and the cisterns are patent. The
[**Doctor Last Name 352**]-white matter attenuation is normal. The visualized
paranasal sinuses and mastoid air cells are clear. No fracture
is detected.

CXR: The heart size is unchanged. The pulmonary vascularity is
within normal limits. There is no pleural effusion or
pneumothorax. The visualized osseous structures are
unremarkable.

Abd US: The liver is diffusely coarsened in echotexture
consistent with cirrhosis. There is a tiny amount of ascites.
Spleen is not enlarged at 8.6 cm. The gallbladder is
decompressed. There is no intra or extrahepatic biliary
dilatation, and the common bile duct measures 4 mm.
   Liver Doppler: There is reversal of flow within the portal
vein as well as the splenic vein. Normal flow and waveforms are
identified within the left and right hepatic arteries. The IVC
as well as the hepatic veins are dilated.


Brief Hospital Course:
1. Syncope: her presenting complaint of syncope was most likely
[**3-17**] orthostatic hypotension, as supported by measurement of
orthostasis on admission and improvement in the pt's dizziness
after hydration, as below.  There was no cardiac arrhythmia on
telemetry, and the pt ruled out for MI by EKG and normal cardiac
enzymes.  The pt had no further dizziness or syncope during her
admission.  At d/c, she is at her baseline functional status.

2. GI bleed: the pt's HCT was noted to trend down over the 1st 2
hospital days.  She had guaiac positive stool, which was
concerning for slow GI bleed [**3-17**] portal gatropathy.  GI was
consulted and recommended colonoscopy after stabilization of the
pt's hypotension, as the bowel prep may exacerbate dehydration
and hypotension.  The pt's HCT stabilized after its initial
drop, and there was no evidence of active bleeding during the
rest of her hospital stay.  At d/c, there is no evidence of
active bleeding and the pt is advised to f/u with her PCP to
arrange colonoscopy in the near future.

3. Hypotension: the pt was hypotensive on admission w/ positive
orthostasis, indicating likely intravascular volume depletion in
the setting of total body fluid overload [**3-17**] cor pulmonale.  Her
cor pulmonale requires diuresis for treatment, but this was
limited during her admission by hypotension.  On the 2nd
hospital day, the pt became hypotensive w/ SBP in the 80s and
required multiple small fluid boluses (250cc each) to increase
SBP to 100s.  Given her tenuous fluid status, the pt was
transferred to the MICU for close monitoring and fluid
management.  During her short MICU stay, her SBP remained stable
in the 100-120 range, and she was then called out to the
Medicine service for ongoing care.  SBP remained stable
throughout the rest of her hospital stay.  At d/c, SBP remains
stable in the 120s.

4. Cor pulmonale: she has right heart failure [**3-17**] pulm HTN, not
responsive to NO on previous cath.  She was overall fluid
overloaded during her admission, but initially was
intravascularly depleted as above.  CHF service was consulted
for recs, and recommended gentle diuresis for treatment of RHF,
as limited only by BP.  Gentle diuresis was accomplished in the
hospital w/ lasix 40mg PO daily.  She will continue lasix after
d/c, and f/u in [**Hospital 1902**] clinic.

5. UTI: pt developed delirium during her hospital stay, which
was investigated with head CT and blood/urine cx.  Head CT was
normal, but UCX grew pan-sensitive enterococcus.  Her UTI was
treated w/ levaquin for a 7 day course, resulting in prompt
resolution of her delirium.  At d/c, there is no evidence of
active infxn and the pt is asymptomatic.

6. Anemia: workup of the pt's low presenting HCT demonstrated
low haptoglobin and elevated LDH, supporting a dx of hemolytic
anemia.  She had no schistocytes on peripheral smear, but had
many target cells most likely [**3-17**] liver dz.  Heme service was
consulted, and recommended Hb electrophoresis and outpt f/u in
[**Hospital **] clinic.  At d/c, Hb electrophoresis is pending.  The pt's
HCT is stable.  She will f/u in [**Hospital **] clinic after d/c.

7. DM2: controlled w/ outpt doses of NPH and lispro insulin
during this admission.

8. Asthma: controlled w/ advair and albuterol during this
admission.

9. Code status during this admission was full code.

Medications on Admission:
1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) inhalation Inhalation [**Hospital1 **] (2 times a day).
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
Disp:*2700 ML(s)* Refills:*2*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 9 days.
Disp:*9 Tablet(s)* Refills:*0*
6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
Disp:*30 Tablet(s)* Refills:*2*
7. NPH insulin
Take 25 units with breakfast each morning


Discharge Medications:
1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) inhalation Inhalation [**Hospital1 **] (2 times a day).
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
Disp:*2700 ML(s)* Refills:*2*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 9 days.
Disp:*9 Tablet(s)* Refills:*0*
6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
Disp:*30 Tablet(s)* Refills:*2*
7. NPH insulin
Take 25 units with breakfast each morning


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
 1. Vasovagal syncope
 2. Dehydration
 3. Right heart failure
 4. UTI
 5. Cirrhosis
 6. Hemolytic anemia

Secondary:
 1. Asthma
 2. DMII


Discharge Condition:
Stable to go home; no dysnpea with walking, peripheral edema
stable, HCT stable.

Discharge Instructions:
You are being discharged after treatment for dehydration, heart
failure, and urinary tract infection.  Please take all
medications as prescribed.  Present to your doctor or the ED if
you have chest pain, dizziness, fever, bleeding, or other
concerning symptoms.

Weight yourself every day.  Call your doctor if you gain more
than 2 pounds in any 24 hour period.

Followup Instructions:
Follow-up with your PCP (Dr. [**First Name (STitle) **] [**Telephone/Fax (1) 250**]) in 2 weeks.

Follow-up with Dr. [**First Name (STitle) 2031**] in heart failure clinic on [**2162-3-25**] at
2PM.

Follow-up with Dr. [**Last Name (STitle) **] in Pulmonary clinic on [**2162-3-15**] at
7:45AM, [**Hospital Ward Name 23**] Clinical Center [**Location (un) **], Rehab Services

Follow-up in [**Hospital **] clinic ([**Telephone/Fax (1) 22**]) in [**3-18**] weeks.
{'Syncope and collapse,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Acquired hemolytic anemia, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Alcoholic cirrhosis of liver,Hemorrhage of gastrointestinal tract, unspecified,Unspecified viral hepatitis C with hepatic coma,Acquired coagulation factor deficiency,Other and unspecified alcohol dependence, unspecified,Orthostatic hypotension,Asthma, unspecified type, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Chronic pulmonary heart 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: swelling in my legs

PRESENT ILLNESS: 45-yo-woman h/o DM2, Hep C cirrhosis, primary pulm HTN, h/o IVDU
presents w/ syncope 3 days ago.  She fell while walking from
bedroom to bathroom, witnessed by friend.  Pt does not recall
event, but was observed falling to the floor and then found to
have urinated.  She denies associated CP, dizziness, confusion,
alcohol use, tongue biting, convulsions.  Presented last night
after talking to PCP, [**Name10 (NameIs) 1023**] recommended evaluation.  She also c/o
persistent dyspnea despite lasix, which was recently started
during admission for massive R sided heart failure.  She reports
frequent nose bleed w/ cough, no hematemesis, hematochezia, or
melena.

MEDICAL HISTORY: 1. Asthma
2. Pulmonary HTN - cathed [**8-/2161**], mean PA pressure 63 mmHg.
Right- sided filling pressures severely elevated: RA mean 24
mmHg, RVEDP 24 mmHg). Left sided filling pressures mildly
elevated: PCW 20 mmHg.
3. Thrombocytopenia
4. DM2 - unknown duration, on Lispro and NPH at home.
5. RHF - cor pulmonale, ECHO [**8-16**] w/ EF 55%, global R
ventricular dilation and hypokinesis
6. Liver cirrhosis - HCV positive Ab, neg VL in [**8-/2161**], not a
transplant candidate due to cor pulmonale, no varices by EGD
[**11-16**]

MEDICATION ON ADMISSION: 1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) inhalation Inhalation [**Hospital1 **] (2 times a day).
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
Disp:*2700 ML(s)* Refills:*2*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 9 days.
Disp:*9 Tablet(s)* Refills:*0*
6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
Disp:*30 Tablet(s)* Refills:*2*
7. NPH insulin
Take 25 units with breakfast each morning

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.0  BP 120/60  HR 101  RR 20  O2sats 97% RA
Gen: Obese female, comfortable, NAD
HEENT: clear OP, mmm, PERRL, EOMI
Neck: supple, no LAD, no thyromegaly, JVD to the ear
Lungs: Poor inspiratory effort and difficult to hear [**3-17**]
obesity. Otherwise clear no crackles, wheezes
Heart: RRR + S1/S2 no m/r/g
Abd: obese, soft, NT, ND, +BS
Ext: 2+ pitting edema to knees B, 2+ DP's
Neuro: A&O times 3, pt appropriate, no signs of delerium, no
asterixis

FAMILY HISTORY: HTN
CAD
Breast CA

SOCIAL HISTORY: Smokes ciggaretes on occasion, last one 2 days ago. Denies any
etoh, IVDU. Lives alone with her cat. 

### Response:
{'Syncope and collapse,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Acquired hemolytic anemia, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Alcoholic cirrhosis of liver,Hemorrhage of gastrointestinal tract, unspecified,Unspecified viral hepatitis C with hepatic coma,Acquired coagulation factor deficiency,Other and unspecified alcohol dependence, unspecified,Orthostatic hypotension,Asthma, unspecified type, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Chronic pulmonary heart disease, unspecified'}
