CHIEF COMPLAINT: SOB, "Sweating"

PRESENT ILLNESS: The patient woke up this morning severely dyspneic and
diaphoretic.  She called EMS, and on arrival, she was pale and
in distress due to her SOB.  SHe was taken to the ED, had a
decreased O2 sat in the 70s due to pulmonary edema, and was
intubated.  An EKG showed acute ST elevations in V2-V4, and she
was taken directly to the cath lab.  She was found to have
diffuse multivessel disease, with the most [**Last Name **] problem in her
LAD.  She had several stents placed throughout this artery.  She
had several episodes of hypotension in the cath lab and a
balloon pump was placed.  She was sent to the CCU with balloon
pump and PA catheter in place.

MEDICAL HISTORY: 1.DMII
2.Hypertension
3.Hyperlipidemia
4.Chronic LBP
5.h/o SVT
6.h/o herpes zoster
7.Diabetic neuropathy
8.h/o allergies

MEDICATION ON ADMISSION: Ambien 10 qhs prn
Atenolol 25 qd
Glyburide 10 [**Hospital1 **]
Lisinopril 40 qd
MVI
[**Doctor First Name **] 60 [**Hospital1 **] prn
ASA 81 qd
Atorvastatin 20 qd
Lasix 40 qd
Metformin 1 g [**Hospital1 **]
Neurontin 300 tid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T=94.9, HR=98, BP=97/63, RR=18(on vent), O2 sat=100% on
vent
Gen: Sedated, on vent
HEENT:No JVD, ventilated, ET tube in place
CV:RRR without MRG. Nl S1, S2, no S3
Pulm: CTA bilaterally anteriorly and bilaterally
Abd:Soft, NT/ND, +BS
Ext.: Mild pretibial edema bilat., Good pulses on L, Good p.t.
on R.  Cold bilat.
Neuro: Sedated, but appropriate when addressed.

FAMILY HISTORY: Unknown, non-contributory

SOCIAL HISTORY: Social worker for the elderly.
No EtOH or tobacco use
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acute respiratory failure,Paroxysmal supraventricular tachycardia,Coronary atherosclerosis of native coronary artery,Chronic pulmonary heart disease, unspecified,Anemia, unspecified,Unspecified essential hypertension
Subendo infarct, initial,CHF NOS,Acute respiratry failure,Parox atrial tachycardia,Crnry athrscl natve vssl,Chr pulmon heart dis NOS,Anemia NOS,Hypertension NOS
Admission Date:  [**2122-7-10**]              Discharge Date:   [**2122-7-15**]

Date of Birth:  [**2055-12-20**]             Sex:   F

Service: [**Hospital Unit Name 196**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2901**]
Chief Complaint:
SOB, "Sweating"

Major Surgical or Invasive Procedure:
Cardiac Catheterization with LAD angioplasty and stenting
Endotracheal Intubation


History of Present Illness:
The patient woke up this morning severely dyspneic and
diaphoretic.  She called EMS, and on arrival, she was pale and
in distress due to her SOB.  SHe was taken to the ED, had a
decreased O2 sat in the 70s due to pulmonary edema, and was
intubated.  An EKG showed acute ST elevations in V2-V4, and she
was taken directly to the cath lab.  She was found to have
diffuse multivessel disease, with the most [**Last Name **] problem in her
LAD.  She had several stents placed throughout this artery.  She
had several episodes of hypotension in the cath lab and a
balloon pump was placed.  She was sent to the CCU with balloon
pump and PA catheter in place.

Past Medical History:
1.DMII
2.Hypertension
3.Hyperlipidemia
4.Chronic LBP
5.h/o SVT
6.h/o herpes zoster
7.Diabetic neuropathy
8.h/o allergies

Social History:
Social worker for the elderly.
No EtOH or tobacco use

Family History:
Unknown, non-contributory

Physical Exam:
Vitals: T=94.9, HR=98, BP=97/63, RR=18(on vent), O2 sat=100% on
vent
Gen: Sedated, on vent
HEENT:No JVD, ventilated, ET tube in place
CV:RRR without MRG. Nl S1, S2, no S3
Pulm: CTA bilaterally anteriorly and bilaterally
Abd:Soft, NT/ND, +BS
Ext.: Mild pretibial edema bilat., Good pulses on L, Good p.t.
on R.  Cold bilat.
Neuro: Sedated, but appropriate when addressed.

Pertinent Results:
[**2122-7-10**] 08:24AM BLOOD WBC-15.1*# RBC-5.12 Hgb-15.7 Hct-45.4
MCV-89 MCH-30.7 MCHC-34.6 RDW-13.8 Plt Ct-334
[**2122-7-10**] 01:31PM BLOOD Hct-37.1 Plt Ct-301
[**2122-7-10**] 10:56PM BLOOD Hct-34.0* Plt Ct-280
[**2122-7-11**] 05:49AM BLOOD WBC-7.6 RBC-3.66*# Hgb-10.9*# Hct-32.6*
MCV-89 MCH-29.7 MCHC-33.4 RDW-14.0 Plt Ct-261
[**2122-7-11**] 02:53PM BLOOD WBC-10.4 RBC-4.23 Hgb-12.9 Hct-36.7
MCV-87 MCH-30.5 MCHC-35.1* RDW-14.1 Plt Ct-252
[**2122-7-11**] 11:26PM BLOOD Hct-32.6*
[**2122-7-12**] 06:27AM BLOOD WBC-9.4 RBC-3.56* Hgb-10.8* Hct-30.9*
MCV-87 MCH-30.4 MCHC-34.9 RDW-14.2 Plt Ct-217
[**2122-7-12**] 09:59AM BLOOD Hct-32.5*
[**2122-7-13**] 06:30AM BLOOD WBC-9.3 RBC-3.36* Hgb-10.1* Hct-30.2*
MCV-90 MCH-30.1 MCHC-33.5 RDW-14.0 Plt Ct-238
[**2122-7-14**] 06:35AM BLOOD WBC-6.1 RBC-3.15* Hgb-9.4* Hct-28.2*
MCV-90 MCH-29.8 MCHC-33.2 RDW-14.2 Plt Ct-242
[**2122-7-14**] 03:15PM BLOOD Hct-29.6*
[**2122-7-10**] 08:24AM BLOOD Neuts-69.8 Lymphs-25.3 Monos-3.0 Eos-1.4
Baso-0.5

[**2122-7-11**] 05:49AM BLOOD PT-12.6 PTT-33.8 INR(PT)-1.1
[**2122-7-13**] 06:30AM BLOOD PT-13.3 PTT-78.9* INR(PT)-1.2
[**2122-7-14**] 06:35AM BLOOD Plt Ct-242

[**2122-7-10**] 01:31PM BLOOD Glucose-192* UreaN-26* Creat-0.8 Na-141
K-3.8 Cl-105 HCO3-25 AnGap-15
[**2122-7-11**] 05:49AM BLOOD Glucose-122* UreaN-24* Creat-0.7 Na-142
K-3.8 Cl-108 HCO3-25 AnGap-13
[**2122-7-12**] 06:27AM BLOOD Glucose-150* UreaN-15 Creat-0.7 Na-141
K-3.8 Cl-108 HCO3-25 AnGap-12
[**2122-7-13**] 06:30AM BLOOD Glucose-139* UreaN-12 Creat-0.8 Na-137
K-3.6 Cl-104 HCO3-23 AnGap-14
[**2122-7-14**] 06:35AM BLOOD Glucose-98 UreaN-12 Creat-0.7 Na-140
K-4.0 Cl-108 HCO3-23 AnGap-13

[**2122-7-10**] 08:24AM BLOOD CK(CPK)-73
[**2122-7-10**] 10:56PM BLOOD CK(CPK)-682*
[**2122-7-11**] 05:49AM BLOOD CK(CPK)-599*
[**2122-7-11**] 11:26PM BLOOD CK(CPK)-354*
[**2122-7-10**] 10:56PM BLOOD CK-MB-54* MB Indx-7.9* cTropnT-1.59*
[**2122-7-11**] 05:49AM BLOOD CK-MB-34* MB Indx-5.7 cTropnT-1.01*
[**2122-7-11**] 11:26PM BLOOD CK-MB-7

[**2122-7-11**] 05:49AM BLOOD Calcium-8.6 Phos-3.5 Mg-2.0 Cholest-132
[**2122-7-14**] 06:35AM BLOOD Calcium-8.7 Phos-3.4 Mg-2.0
[**2122-7-11**] 05:49AM BLOOD Triglyc-215* HDL-45 CHOL/HD-2.9
LDLcalc-44

[**2122-7-10**] 11:13PM BLOOD Type-ART pO2-86 pCO2-35 pH-7.45
calHCO3-25 Base XS-0

EchO:
Conclusions:  EF=45-50%
1. The left atrium is normal in size. The left atrium is
elongated.
2.Left ventricular wall thicknesses are normal. The left
ventricular cavity
size is normal. There is mild regional left ventricular systolic
dysfunction.
Overall left ventricular systolic function is mildly depressed.
Resting
regional wall motion abnormalities include apical, mid and
apical anteroseptal
and apical anterior hypokinesis.
3.Right ventricular chamber size is normal. Right ventricular
systolic
function is normal.
4.The aortic root is mildly dilated.
5.The aortic valve leaflets (3) are mildly thickened. No aortic
regurgitation
is seen.
6.The mitral valve leaflets are mildly thickened. Mild (1+)
mitral
regurgitation is seen.
7.There is no pericardial effusion.

Cath:
FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Elevated right and left heart filling pressures.
3. Acute myocaridal infarction managed by primary PTCA and
stenting of
the proximal and mid LAD.
4. Successful stenting of the distal LAD.
5. Successful insertion of an intraaortic balloon pump.


Brief Hospital Course:
After cath, she came to the CCU on a balloon pump and intubated.
 She was alert and her vitals were all adequate.
1.CAD: Her LAD lesion was stented.  Further review of the cath
films showed diffuse disease in her RCA and OM-1.  She had no
more cardiac chest pain while here, and daily ECGs did not show
any new ischemia/infarction.  It was determined that she should
have a stress test in approx 1 month as an outpatient to
determine the need for further catheterization/stenting in the
future.  Her cardiac enzymes were followed until they began to
trend downward.  She was initially on ASA, plavix, and a statin.
 Her beta-blocker and ACE-I were held due to BP issues.  Once
she recovered from this, and her vitals were improving, she was
slowly started back on her ACE and B-blocker without issue.  She
was initially on heparin due to akinetic apex.  A repeat echo
several days post-cath showed improvement and her heparin was
stopped.  No additional anticoagulation will be needed.  On D/C,
she was feeling well.
2.Pump: She was initally on a balloon pump, but this was removed
in the morning after admission, as she was holding her own BP
without issue, and tolerated weaning trials.  She was initially
on dopamine as well.  She had received lasix in ED, and had a
large diuresis.  We believe she was hypovolemic at that point,
and her BP responded well to a 1L fluid bolus.  Echo was done
several days later as above, and showed an EF of 45-50%.  All
walls are mobile enough for her to not require chronic
anticoagulation.
3.Rhythm: She stayed in NSR for the admission.  She had one
episode of non-sustained VT, but it was asymptomatic.
4.Pulmonary: She was intubated on arrival.  She was quickly
weaned from the vent in the morning without trouble and
extubated.  Her initial pulm edema was improving on CXR.  It was
likely acute CHF due to her anterior MI.  Her O2 sats remained
adequate throughout.  She did have some blood tinged sputum, but
this was likely the result of ET tube trauma, and gradually
faded.
5.Anemia:  She had a decrease in hematocrit during the stay.
Retroperitoneal bleed was a question, so she had an abdominal CT
which was negative for this.  She continued to have a low Hct,
but it was stable.  It is likely due to combination of dilution
by fluids and bleeding from procedures.  If this persists as an
outpt, she can have her anemia worked up further.  It was
trending up on discharge.
6.DMII: She was initially maintained on sliding scale insulin.
When she began eating, her home oral meds were added back.  We
waited >48 hrs until restarting her metformin.  She had good
glycemic control on day of discharge.
7.FEN:She was given maintenance fluids initially, then began
eating and drinking on her own.  Her electrolytes were monitored
and repleted as needed.
8.PT was consulted and she walked with them several times,
including up and down stairs.  They recommended that she is safe
to go home alone, but that she may benefit from outpt cardiac
rehab if she does not recover quickly onher own.
9. She was discharged home with stable vitals and several family
members to help her at home.  She will follow-up with her PCP
and with Drs [**Last Name (STitle) 911**] and [**Name5 (PTitle) 171**] in 1 month to arrange for a
stress test.
10. Her Lasix was stopped, but her other home BP meds were kept
at their original doses.  She was also put on Plavix and
understands the need to keep taking this for 6 months no matter
what.

Medications on Admission:
Ambien 10 qhs prn
Atenolol 25 qd
Glyburide 10 [**Hospital1 **]
Lisinopril 40 qd
MVI
[**Doctor First Name **] 60 [**Hospital1 **] prn
ASA 81 qd
Atorvastatin 20 qd
Lasix 40 qd
Metformin 1 g [**Hospital1 **]
Neurontin 300 tid

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD (once a day).
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD
(once a day) for 6 months: Do NOT stop this medicine unless
instructed by a Cardiologist.
Disp:*90 Tablet(s)* Refills:*1*
3. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
5. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
6. Metformin HCl 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
7. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO QD (once a
day).
Disp:*60 Tablet(s)* Refills:*2*
8. Atenolol 25 mg Tablet Sig: One (1) Tablet PO QD (once a day).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
1. ST elevation myocardial infarct
2. 2 vessel coronary disease
3. Hypertension
4. Diabetes Mellitus
5. Respiratory Failure requiring intubation
6. Supraventricular Tachycardia
7. Hyperlipidemia
8. Diabetic Neuropathy


Discharge Condition:
Stable and improved

Discharge Instructions:
1. Please take all medications as prescribed below.  We have
stopped your Lasix.  You can continue your Ambien and [**Doctor First Name **] as
needed.
2. Follow up with your Primary care doctor in [**12-26**] weeks;
cardiology in 1 month.
3. Return to ED for Chest Pain, Shortness of breath,
palpitations, or other concerning symptoms.

Followup Instructions:
1. Please Contact Dr. [**Last Name (STitle) **] to set up a follow up appointment
2. Call Dr. [**Last Name (STitle) 171**]/[**Doctor Last Name 911**] in cardiology at ([**Telephone/Fax (1) 7236**] to
schedule follow up.  You will need to have a stress test in the
future.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acute respiratory failure,Paroxysmal supraventricular tachycardia,Coronary atherosclerosis of native coronary artery,Chronic pulmonary heart disease, unspecified,Anemia, unspecified,Unspecified essential hypertension'}


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: SOB, "Sweating"

PRESENT ILLNESS: The patient woke up this morning severely dyspneic and
diaphoretic.  She called EMS, and on arrival, she was pale and
in distress due to her SOB.  SHe was taken to the ED, had a
decreased O2 sat in the 70s due to pulmonary edema, and was
intubated.  An EKG showed acute ST elevations in V2-V4, and she
was taken directly to the cath lab.  She was found to have
diffuse multivessel disease, with the most [**Last Name **] problem in her
LAD.  She had several stents placed throughout this artery.  She
had several episodes of hypotension in the cath lab and a
balloon pump was placed.  She was sent to the CCU with balloon
pump and PA catheter in place.

MEDICAL HISTORY: 1.DMII
2.Hypertension
3.Hyperlipidemia
4.Chronic LBP
5.h/o SVT
6.h/o herpes zoster
7.Diabetic neuropathy
8.h/o allergies

MEDICATION ON ADMISSION: Ambien 10 qhs prn
Atenolol 25 qd
Glyburide 10 [**Hospital1 **]
Lisinopril 40 qd
MVI
[**Doctor First Name **] 60 [**Hospital1 **] prn
ASA 81 qd
Atorvastatin 20 qd
Lasix 40 qd
Metformin 1 g [**Hospital1 **]
Neurontin 300 tid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T=94.9, HR=98, BP=97/63, RR=18(on vent), O2 sat=100% on
vent
Gen: Sedated, on vent
HEENT:No JVD, ventilated, ET tube in place
CV:RRR without MRG. Nl S1, S2, no S3
Pulm: CTA bilaterally anteriorly and bilaterally
Abd:Soft, NT/ND, +BS
Ext.: Mild pretibial edema bilat., Good pulses on L, Good p.t.
on R.  Cold bilat.
Neuro: Sedated, but appropriate when addressed.

FAMILY HISTORY: Unknown, non-contributory

SOCIAL HISTORY: Social worker for the elderly.
No EtOH or tobacco use 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acute respiratory failure,Paroxysmal supraventricular tachycardia,Coronary atherosclerosis of native coronary artery,Chronic pulmonary heart disease, unspecified,Anemia, unspecified,Unspecified essential hypertension'}
