CHIEF COMPLAINT: transfer from Lakes [**Hospital 12018**] Medical Center for cath

PRESENT ILLNESS: 65 year old woman admitted on the 9th to Lakes [**Hospital 12018**] Hosp
with severe dyspnea on exertion, wheezing. She also notes
orthopnea and restlessness at night. She denies swelling in her
legs, chest pain, cough, palpitations, syncope. She does note 3
weeks of diarrhea and some URI symptoms. VS there were notable
for hypoxia of 91 % on RA. She was treated for COPD exacerbation
and found to have LV impairment on echo. She ruled out for MI
with serial troponins. Her stool was sent for cdiff and is
pending at time of transfer.
.
She was transferred to [**Hospital1 18**] for cath. Cath showed a nonischemic
cardiomyopathy with very elevated filling pressures, a PCW of
38. She was started on a nitro gtt in the cath lab and given
lasix 40 IV. After this her PCW pressure dropped to 15. On
arrival to ICU her PCW was 13 and she had diuresed 1200 cc since
given lasix in cath lab. She denied any complaints.

MEDICAL HISTORY: Iron definecy anemia
Kidney stones
Gallstones
h/o pneumonia
Cholecystectomy
s/p cataract surgery
Recent diarrhea x 3 weeks resolved yesterday
Anxiety
s/p C section.

MEDICATION ON ADMISSION: Home medications:
Protonix 40 mg daily
MVI
Prozac
.
Medications on transfer:
Aspirin 325mg daily
Prozac 10mg daily
Lasix 20mg IV daily
Aspirin 325mg daily
Lopressor 12.5mg daily
Protonix 40mg daily
KCL 20meq daily
Metamucil 1 packet
Altace 2.5mg daily
Solumdrol 60mg IV q 12 hours

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.1 BP 143/74 HR 99 RR 14 O2100%4L
Gen: Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Elevated JVP
CV: Tachy, nl S1, S2, +systolic murmur, no S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. R groin line in place
Skin: No stasis dermatitis, ulcers.
.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

FAMILY HISTORY: History of CAD on her father side, her father died at 64 years
old of CAD/MI. Her cousing died of heart related problems in
40's.

SOCIAL HISTORY: significant for 1.5 PPD tobacco, pt says she is planning on
quitting, no significant ETOH use, no drug use. Married, lives
with husband.
Other primary cardiomyopathies,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Tobacco use disorder,Iron deficiency anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Family history of ischemic heart disease,Acute upper respiratory infections of unspecified site,Other and unspecified noninfectious gastroenteritis and colitis
Prim cardiomyopathy NEC,Chr airway obstruct NEC,Hypertension NOS,Tobacco use disorder,Iron defic anemia NOS,DMII wo cmp nt st uncntr,Fam hx-ischem heart dis,Acute uri NOS,Noninf gastroenterit NEC
Admission Date:  [**2190-5-7**]              Discharge Date:   [**2190-5-10**]

Date of Birth:  [**2125-4-13**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
transfer from Lakes [**Hospital 12018**] Medical Center for cath

Major Surgical or Invasive Procedure:
Cardiac catheterization

History of Present Illness:
65 year old woman admitted on the 9th to Lakes [**Hospital 12018**] Hosp
with severe dyspnea on exertion, wheezing. She also notes
orthopnea and restlessness at night. She denies swelling in her
legs, chest pain, cough, palpitations, syncope. She does note 3
weeks of diarrhea and some URI symptoms. VS there were notable
for hypoxia of 91 % on RA. She was treated for COPD exacerbation
and found to have LV impairment on echo. She ruled out for MI
with serial troponins. Her stool was sent for cdiff and is
pending at time of transfer.
.
She was transferred to [**Hospital1 18**] for cath. Cath showed a nonischemic
cardiomyopathy with very elevated filling pressures, a PCW of
38. She was started on a nitro gtt in the cath lab and given
lasix 40 IV. After this her PCW pressure dropped to 15. On
arrival to ICU her PCW was 13 and she had diuresed 1200 cc since
given lasix in cath lab. She denied any complaints.


Past Medical History:
Iron definecy anemia
Kidney stones
Gallstones
h/o pneumonia
Cholecystectomy
s/p cataract surgery
Recent diarrhea x 3 weeks resolved yesterday
Anxiety
s/p C section.

Social History:
significant for 1.5 PPD tobacco, pt says she is planning on
quitting, no significant ETOH use, no drug use. Married, lives
with husband.

Family History:
History of CAD on her father side, her father died at 64 years
old of CAD/MI. Her cousing died of heart related problems in
40's.

Physical Exam:
VS: T 98.1 BP 143/74 HR 99 RR 14 O2100%4L
Gen: Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Elevated JVP
CV: Tachy, nl S1, S2, +systolic murmur, no S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. R groin line in place
Skin: No stasis dermatitis, ulcers.
.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
EKG demonstrated SR, rate 100, nl axis, nl int, LVH, TW
falttening in V5-6, LAE
.
2D-ECHOCARDIOGRAM performed on [**2190-5-7**] at Lakes Regional
demonstrated:
Mod MR, LVH, nondilated LV, generalized HK, EF 25-30%, RV
normal, mild pulmonic insuff, mild TR, Est RV pressure 55-60,
mod pulm htn, no effusion
.
TTE performed on [**5-8**] demonstrated:
The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thicknesses
are normal. The left
ventricular cavity size is normal. There is severe global left
ventricular hypokinesis (ejection fraction 20-30 percent). There
is no ventricular septal defect. 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
mildly thickened. There is no mitral valve prolapse. Mild to
moderate ([**12-29**]+) mitral regurgitation is seen. There is moderate
pulmonary artery systolic hypertension. There is no pericardial
effusion.
.
CARDIAC CATH performed on [**2190-5-7**] demonstrated: normal LMCA,
LAD, LCX, 60% mid RCA spasm
.
HEMODYNAMICS: PA sat 59% Ao 164/82 RA 11, PA 27/20(23) PCW 38 CO
3.62, CI 2.65
.
CXR [**5-8**]:
Single frontal radiograph of the chest labeled upright
demonstrates a Swan-Ganz catheter from an inferior approach with
distal tip overlying the descending left pulmonary artery. The
cardiomediastinal silhouette is within normal limits. Biapical
opacities demonstrated right greater than left, likely scarring.
There is indistinctness of the pulmonary vasculature which may
be secondary to mild interstitial pulmonary edema versus chronic
interstitial lung disease, correlation with prior examinations
is recommended. There is no evidence of pleural effusion or
pneumothorax. More focal opacity in the left mid lung zone which
may be secondary to focal atelectasis, infection, or focal
edema, or neoplasm, followup to resolution is recommended.
Visualized osseous structures are intact. There is a metallic
clip overlying the right upper quadrant, likely from prior
cholecystectomy.
.
OSH labs: WBC 17 (93%PMN, 1%bands, 4%L, 2%M), hct 30.2, plt 342
INR pending, K 3.9 creat 1.0, trop normal
TSH 0.37, FT4 0.95, TCHol 232, LDL 166, HDL 49, TG 86, INR 0.96,
PTT 20.7, PT 12.1


Brief Hospital Course:
65 yo F with no previous cardiac history with new non-ischemic
cardiomyopthy of unknown etiolgy with elevated right sided
filling pressures in the cath lab, now improved after nitro and
lasix.
.
1) Pump: Patient was found to have a significantly depressed EF
of 20-30% and elevated filling pressures in cath lab from her
nonischemic cardiomyopathy. DDX includes viral myocarditis,
celiac disease, lupus, hypo/hyperthyroidism. Thyroid tests
normal at OSH. She did have symptoms of URI and gastroenteritis
that could be associated with a viral syndrome causing viral
myocarditis. She also had iron def anemia which is seen with
celiac disease which can rarely cause a cardiomyopathy. TTG was
sent off for this reason and was pending on discharge. She was
placed on a nitro gtt and continued on ACEI for afterload
reduction.  She had a good response to lasix in the cath lab
with improvement in her PCWP.  She was then started on lasix
20mg PO daily.  She was also continued on low dose BB, later
switched to Toprol XL.
.
2) ? hypertension- no reported history of HTN, however patient
did have LVH on echo  at OSH (not seen on TTE here, however
evident on EKG).  Hypertension is a possible etiology of her
newly diagnosed cardiomyopathy.  She was continued on lisinopril
as above and her lopressor was titrated up for BP control.
.
3) CAD: Had clean coronaries on cath making ischemic etiology of
her CM very unlikely. She denied chest pain and did not have
ischemic changes on EKG. Given her cardiac risk factors of age,
smoking, ? HTN and hyperlipidemia she was continued on ASA 81 mg
and started on statin.
.
4) Rhythm: Followed on tele with no significant arrythmias
noted.
.
5) Hyperlipidemia: Started statin after LFTs had been checked.
.
6) Elevated FS: Likely were from solumedrol she was receiving at
OSH for presumed asthma flare. Unlikely that she had asthma
flare, more likely her SOB was from her cardiomyopathy and
elevated filling pressures.  Steroids were not continued on
arrival to [**Hospital1 18**] and her FS normalized.
.
7) Iron def anemia: Confirmed with iron studies, continued
FeSO4. Patient will need a workup for anemia (colonoscopy) as an
outpatient.
.
8) FEN: low salt diet
.
9) PPX: pneumoboots, PPI
.
10) Access: PIV
.
11) Code: full


Medications on Admission:
Home medications:
Protonix 40 mg daily
MVI
Prozac
.
Medications on transfer:
Aspirin 325mg daily
Prozac 10mg daily
Lasix 20mg IV daily
Aspirin 325mg daily
Lopressor 12.5mg daily
Protonix 40mg daily
KCL 20meq daily
Metamucil 1 packet
Altace 2.5mg daily
Solumdrol 60mg IV q 12 hours


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*2*
2. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
3. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Furosemide 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).
Disp:*30 Tablet(s)* Refills:*2*
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Fluoxetine 10 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. K-Dur 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab
Sust.Rel. Particle/Crystal PO once a day.
Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
1. Nonischemic cardiomyopathy, s/p cardiac cath with clean
coronaries
2. Hypertension, newly diagnosed
3. Diarrhea, watery
.
Secondary Diagnosis:
1. Iron deficiency anemia
2. Gallstones


Discharge Condition:
Afebrile. Hemodynamically stable. Ambulating. Tolerating PO.


Discharge Instructions:
You have been treated for a heart condition called
cardiomyopathy. A study to look at your heart vessels was
performed (cardiac catheterization). It did not show any
occluded vessels. We were unable to determine the cause of your
heart failure.
.
You have been started on several new medications (Aspirin,
Lisinopril, Metoprolol, Lasix, Atorvastatin, potassium) which
you should continue after discharge.
.
You have also been found to be iron deficient causing chronic
anemia (low blood levels). ***It is very important that you
follow up with your PCP for further workup.***  You will need to
have a procedure called a colonoscopy which is a routine
screening test for colon cancer.
.
Please call your primary doctor or return to the ED with fever,
chills, chest pain, shortness of breath, nausea/vomiting,
spontaneous bleeding or any other concerning symptoms.
.
Please take all your medications as directed.
.
Please keep you follow up appointments as below.


Followup Instructions:
Please follow up with your primary care doctor ([**Last Name (LF) **],[**First Name3 (LF) **] M.
[**Telephone/Fax (1) 66238**]) within 1-2 weeks, Dr.[**Name (NI) 73159**] office should call
you back tomorrow, otherwise please call to make an appointment.
***You need further workup for your iron-deficiency anemia,
weight loss and night sweats.***
.
Please also follow up with [**Last Name (LF) **],[**First Name3 (LF) **]-[**Doctor First Name 10588**] [**Telephone/Fax (1) 11254**]
within 2 weeks.



Completed by:[**2190-5-10**]
{'Other primary cardiomyopathies,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Tobacco use disorder,Iron deficiency anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Family history of ischemic heart disease,Acute upper respiratory infections of unspecified site,Other and unspecified noninfectious gastroenteritis and colitis'}


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 Lakes [**Hospital 12018**] Medical Center for cath

PRESENT ILLNESS: 65 year old woman admitted on the 9th to Lakes [**Hospital 12018**] Hosp
with severe dyspnea on exertion, wheezing. She also notes
orthopnea and restlessness at night. She denies swelling in her
legs, chest pain, cough, palpitations, syncope. She does note 3
weeks of diarrhea and some URI symptoms. VS there were notable
for hypoxia of 91 % on RA. She was treated for COPD exacerbation
and found to have LV impairment on echo. She ruled out for MI
with serial troponins. Her stool was sent for cdiff and is
pending at time of transfer.
.
She was transferred to [**Hospital1 18**] for cath. Cath showed a nonischemic
cardiomyopathy with very elevated filling pressures, a PCW of
38. She was started on a nitro gtt in the cath lab and given
lasix 40 IV. After this her PCW pressure dropped to 15. On
arrival to ICU her PCW was 13 and she had diuresed 1200 cc since
given lasix in cath lab. She denied any complaints.

MEDICAL HISTORY: Iron definecy anemia
Kidney stones
Gallstones
h/o pneumonia
Cholecystectomy
s/p cataract surgery
Recent diarrhea x 3 weeks resolved yesterday
Anxiety
s/p C section.

MEDICATION ON ADMISSION: Home medications:
Protonix 40 mg daily
MVI
Prozac
.
Medications on transfer:
Aspirin 325mg daily
Prozac 10mg daily
Lasix 20mg IV daily
Aspirin 325mg daily
Lopressor 12.5mg daily
Protonix 40mg daily
KCL 20meq daily
Metamucil 1 packet
Altace 2.5mg daily
Solumdrol 60mg IV q 12 hours

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.1 BP 143/74 HR 99 RR 14 O2100%4L
Gen: Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Elevated JVP
CV: Tachy, nl S1, S2, +systolic murmur, no S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. R groin line in place
Skin: No stasis dermatitis, ulcers.
.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

FAMILY HISTORY: History of CAD on her father side, her father died at 64 years
old of CAD/MI. Her cousing died of heart related problems in
40's.

SOCIAL HISTORY: significant for 1.5 PPD tobacco, pt says she is planning on
quitting, no significant ETOH use, no drug use. Married, lives
with husband. 

### Response:
{'Other primary cardiomyopathies,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Tobacco use disorder,Iron deficiency anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Family history of ischemic heart disease,Acute upper respiratory infections of unspecified site,Other and unspecified noninfectious gastroenteritis and colitis'}
