CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 52-year-old man with a
history of paroxysmal atrial fibrillation, cerebrovascular
accident leading to sense left hemiparesis,
methicillin-resistant Staphylococcus aureus pneumonia,
fractures who present progressive shortness of breath and
cough productive of rust-colored sputum.  This is a gentleman
whose complicated medical course dates back to [**2189**] when he
suffered a cerebrovascular accident secondary to atrial
fibrillation leading to left hemiparesis.  He currently lives
at [**Hospital3 2558**] and has had problems in the past year
including endocarditis and recurrent urinary tract

MEDICAL HISTORY: 1.  Paroxysmal atrial fibrillation, on amiodarone and
therapeutic on Coumadin.
2.  Cerebrovascular accident secondary to atrial fibrillation
leading to left hemiparesis.
3.  Hypertension.
4.  Non-insulin-dependent diabetes mellitus.
5.  Status post left hip hemi-repair, status post fall
leading to new fracture of his left femur and unrepaired
fracture of his right hip.
6.  Endocarditis.
7.  Methicillin-resistant Staphylococcus aureus pneumonia.
8.  Urinary tract infections.

MEDICATION ON ADMISSION: Lopressor 25 mg p.o. b.i.d.,
Zoloft 200 mg p.o. q.d. BuSpar 5 mg p.o. b.i.d.,
Zantac 150 mg p.o. b.i.d., Coumadin 1 p.o. q.d., valproic
acid 500 mg p.o. every noon and 75 mg p.o. q.a.m. and q.h.s.,
Oramorph 15 mg p.o. b.i.d., Roxicodone 5 mg p.o. q.4h. p.r.n.
for pain, amiodarone 200 mg p.o. q.d., Colace 100 mg p.o.
b.i.d., Dulcolax 10 mg p.o. q.d. p.r.n. for constipation,
Senokot, aspirin 325 mg p.o. q.d., multivitamin 1 p.o. q.d.,
zinc 220 mg p.o. q.d., vitamin C 500 mg p.o. q.d.,
Serax 10 mg p.o. q.h.s. p.r.n., Atrovent nebulizers q.4h.
p.r.n., and vancomycin 1 g intravenously q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives in [**Hospital3 2558**].  His mother and
brother live in [**Name (NI) 86**].  No alcohol or tobacco use.
Acute and subacute bacterial endocarditis,Bacteremia,Methicillin susceptible pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Atrial fibrillation,Infection with microorganisms resistant to penicillins,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Ac/subac bact endocard,Bacteremia,Meth sus pneum d/t Staph,Urin tract infection NOS,CHF NOS,Atrial fibrillation,Inf mcrg rstn pncllins,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2193-8-27**]       Discharge Date:

Date of Birth:   [**2142-2-10**]       Sex:  M


HISTORY OF PRESENT ILLNESS:  This is a 52-year-old man with a
history of paroxysmal atrial fibrillation, cerebrovascular
accident leading to sense left hemiparesis,
methicillin-resistant Staphylococcus aureus pneumonia,
fractures who present progressive shortness of breath and
cough productive of rust-colored sputum.  This is a gentleman
whose complicated medical course dates back to [**2189**] when he
suffered a cerebrovascular accident secondary to atrial
fibrillation leading to left hemiparesis.  He currently lives
at [**Hospital3 2558**] and has had problems in the past year
including endocarditis and recurrent urinary tract

In [**2193-7-21**], he was dropped in the process of being
lifted from his bed leading to fracture of his left femur and
was hospitalized here.  During that hospital course he bled
into his leg leading in a drop of his hematocrit to about 23
and a transfusion, which put him into congestive heart
failure, was diuresed, and then went into atrial
fibrillation.  He was cardioverted times two at that time and
started on amiodarone.  He also spiked fevers during that
admission secondary to pneumonia with consolidation of his
left lung.  This was methicillin-resistant Staphylococcus
aureus pneumonia and bacteremia, and there was also
vegetations on his echocardiogram during that admission.  He
was sent out on six weeks of vancomycin due to a history of
endocarditis and methicillin-resistant Staphylococcus aureus
positive blood cultures; however, on admission, he was
subtherapeutic taking only 1 g of vancomycin intravenously
q.d.  For the last few days prior to admission he had been
experiencing increased shortness of breath and cough
productive of rust-colored sputum.  He was seen at [**Hospital6 6613**] on the morning of admission and found to be
short of breath with oxygen saturation in the middle 80s.  He
was transferred to the Emergency Department where he received
2 g of intravenous ceftazidime, and his saturations were
increased to the 90s on 4 liters of oxygen.

REVIEW OF SYSTEMS:  Review of systems was negative for chest
pain, palpitations or nausea.  However, he did complain of
dysuria, hematuria, and urinary frequency.


PAST MEDICAL HISTORY:
1.  Paroxysmal atrial fibrillation, on amiodarone and
therapeutic on Coumadin.
2.  Cerebrovascular accident secondary to atrial fibrillation
leading to left hemiparesis.
3.  Hypertension.
4.  Non-insulin-dependent diabetes mellitus.
5.  Status post left hip hemi-repair, status post fall
leading to new fracture of his left femur and unrepaired
fracture of his right hip.
6.  Endocarditis.
7.  Methicillin-resistant Staphylococcus aureus pneumonia.
8.  Urinary tract infections.

MEDICATIONS ON ADMISSION:  Lopressor 25 mg p.o. b.i.d.,
Zoloft 200 mg p.o. q.d. BuSpar 5 mg p.o. b.i.d.,
Zantac 150 mg p.o. b.i.d., Coumadin 1 p.o. q.d., valproic
acid 500 mg p.o. every noon and 75 mg p.o. q.a.m. and q.h.s.,
Oramorph 15 mg p.o. b.i.d., Roxicodone 5 mg p.o. q.4h. p.r.n.
for pain, amiodarone 200 mg p.o. q.d., Colace 100 mg p.o.
b.i.d., Dulcolax 10 mg p.o. q.d. p.r.n. for constipation,
Senokot, aspirin 325 mg p.o. q.d., multivitamin 1 p.o. q.d.,
zinc 220 mg p.o. q.d., vitamin C 500 mg p.o. q.d.,
Serax 10 mg p.o. q.h.s. p.r.n., Atrovent nebulizers q.4h.
p.r.n., and vancomycin 1 g intravenously q.d.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  He lives in [**Hospital3 2558**].  His mother and
brother live in [**Name (NI) 86**].  No alcohol or tobacco use.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature of 95.4
axillary, temperature of 96.8 rectally, blood
pressure 181/83, with a pulse of 56, respiratory rate of 18,
satting 95% on 4 liters.  The patient looked older than his
stated age and uncomfortable.  He was normocephalic and
atraumatic.  His pupils were constricted by round and
reactive to light, and there was a 1.5-cm node in the right
anterior cervical chain.  He had jugular venous distention to
9 cm.  On cardiac examination, he was bradycardic to the 40s,
but with a regular rhythm, and a [**3-26**] holosystolic murmur
loudest at the apex.  On lung examination, he had diffuse
rales anteriorly.  On abdominal examination, he had right
lower quadrant tenderness without rebound.  He was not
distended and had positive bowel sounds.  The patient refused
guaiac examination.  On extremity examination, he had 2+
pulse on the right, 1+ on the left, and evidence of chronic
venous disease bilaterally.  On neurologic examination, he
had 0/5 strength in the left upper and lower extremities, but
5/5 strength in right upper and lower extremity.  His mental
status was alert and oriented times three.  He was able to
name the months backwards and remembered [**2-23**] objects after
five minutes.

LABORATORY DATA ON ADMISSION:  Significant laboratories
included a hematocrit of 29.8, white blood cell count of 4.8,
platelets of 106.  The differential for his white blood cell
count was 70 neutrophils, 0 bands.  His baseline hematocrit
was 34 from previous admissions.  He had a PT of 18.9, a PTT
of 35.6, and an INR of 2.4.  His electrolytes were remarkable
only for a potassium of 3.3 and a calcium of 7.7.  His
initial creatine kinase was 19 with a troponin I of 0.3.  On
urinalysis, he had greater than 50 red blood cells, greater
than 50 white blood cells, and many bacteria.

RADIOLOGY/IMAGING:   On chest x-ray there was evidence of
congestive heart failure with indistinct pulmonary
vasculature in a prehilar distribution.  There were small
bilateral pleural effusions and linear band-like opacity in
the left middle lung zone which was likely atelectasis.
There was a left PICC line appropriately placed.

On electrocardiogram he had downgoing T waves in leads V2 and
V6; of which only the T wave in V2 was new from previous
examination.

ASSESSMENT:  This was felt to be a man with congestive heart
failure and possibly also with some residual pneumonia given
his therapeutic vancomycin treatment.  The other problems of
concern at that time included a probable urinary tract
infection and bradycardia.

HOSPITAL COURSE:

1.  CARDIOVASCULAR:  He was ruled out for a myocardial
infarction by enzymes and repeat electrocardiogram.  He
received 20 mg of intravenous Lasix immediately and then the
next day with a goal of diuresis for resolution of his
congestive heart failure, and an echocardiogram was planned
to evaluate his systolic function and endocarditis.  His
hypertension was controlled by Lopressor with strict hold
parameters.  His amiodarone was continued at 200 mg for his
atrial fibrillation, as was his Coumadin for that indication.

2.  PULMONARY:  He was placed on oxygen at a sufficient level
to maintain saturations of greater than 93%.  He was ordered
for a chest x-ray.  He was started on vancomycin as well as
gentamicin for coverage of possible agents for his pneumonia.
A sputum culture was taken, and he received p.r.n. albuterol
nebulizers.

3.  GASTROINTESTINAL:  He was placed on an aggressive bowel
regimen and all stools were guaiaced.



4.  GENITOURINARY:  His urine was sent for culture, and he
had Foley catheter placed.  The gentamicin was added also to
treat his urinary tract infection.

5.  RENAL:  His creatinine was 0.5, which was baseline.

6.  HEMATOLOGY:  His hematocrit of 29 was just below his
baseline in the 30s.  He refused rectal examination, but all
stools were guaiaced.

7.  INFECTIOUS DISEASE:  He was started on vancomycin and
gentamicin intravenously and had cultures were sent of his
sputum, blood, and urine.

8.  FLUIDS/ELECTROLYTES/NUTRITION:  His electrolytes were
repleted and followed with daily laboratories.  He had a left
PICC line in place.

On the afternoon of [**8-28**], he was found in his room
obtunded and barely responsive to sternal rub with
bradycardia down to the 30s and 40s.  A blood gas showed that
he was acidotic with a CO2 of 56, an O2 of 123 on 100% FIO2.

He was transferred to the Cardiac Intensive Care Unit and
Electrophysiology was consulted.  Their impression was that
his decline in mental status was secondary to poor cardiac
output secondary to bradycardia, and a temporary wire was
placed to increase cardiac output.

He remained in the Coronary Care Unit until [**8-31**].
During his stay there, he had a Swann-Ganz catheter placed
into his internal jugular which demonstrated elevated
pulmonary capillary wedge pressure, and he was found to have
poor cardiac  output with high systemic vascular resistance
of 1200s.  He was started on captopril to decrease his
systemic vascular resistance, and this improved his cardiac
output dramatically with some improvement of his mental
status.  Blood cultures came back as positive only in [**1-24**]
bottles, and that was with coagulase-negative Staphylococcus
which was a presumed contaminant.  He was transferred to [**Hospital Ward Name 121**] 7
on [**8-31**] in stable condition with improving mental
status.

On [**9-1**], he was found to have good mental status but in
rapid atrial fibrillation to the 120s and 130s.  He was given
12.5 mg of p.o. Lopressor as well as 50 mg intravenous
Lopressor, and 10 mg of diltiazem which improved his heart
rate to the 100s.

Electrophysiology was reconsulted, and they recommended
resumption of his amiodarone which had been discontinued in
an effort to keep a more rapid heart rate.

On [**9-2**], he was back in sinus rhythm with a heart rate
in the 60s and 70s, and good mentation.

An ultrasound demonstrated no significant residual pleural
fluid in his right lung, and a 3-cm fluid in his left lung.
Given his dramatic medical improvement, it was deemed
unnecessary to have a diagnostic tap.

On [**8-28**], in the morning, he received an echocardiogram
which demonstrated increased mitral regurgitation of 2+ and
decreased systolic function of approximately 30%.

CONDITION AT DISCHARGE:  He was afebrile with stable vital
signs including a blood pressure in the 130s, and a pulse in
the 60s, satting 99% on room air.  He was in no apparent
distress with cardiac examination in regular rhythm, and
still with a [**2-26**] holosystolic murmur at the left sternal
border.  His examination was otherwise remarkable for a
stable hematoma in his right upper thigh.  His mental status
had returned to baseline as he was alert and oriented times
three with good cognitive function.

DISCHARGE STATUS:   He was to be discharged to [**Hospital3 2558**]
(his place of residence).

MEDICATIONS ON DISCHARGE:
1.  Vancomycin 1 g intravenously q.12h.
2.  Captopril 75 mg p.o. t.i.d.
3.  Aspirin 325 mg p.o. q.d.
4.  Colace 100 mg p.o. b.i.d.
5.  Zoloft 200 mg p.o. q.d.
6.  BuSpar 5 mg p.o. b.i.d.
7.  Zantac 150 mg p.o. b.i.d.
8.  Depakote 500 mg p.o. q.a.m. and q.h.s. and 750 mg p.o.
every noon.
9.  Percocet 5/325 q.6h. p.r.n. for pain.

DISCHARGE DIAGNOSES:
1.  Methicillin-resistant Staphylococcus aureus pneumonia.
2.  Congestive heart failure.
3.  Paroxysmal atrial fibrillation.
4.  Status post right cerebrovascular accident.
5.  Hypertension.
6.  Diet controlled non-insulin-dependent diabetes mellitus.
7.  Bilateral hip fractures, unrepaired.
8.  Endocarditis.
9.  Urinary tract infection.






DISCHARGE FOLLOWUP:  He was to follow up with his primary
care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5762**].




                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 9755**]

Dictated By:[**Last Name (NamePattern1) 35238**]
MEDQUIST36

D:  [**2193-9-3**]  10:25
T:  [**2193-9-3**]  11:10
JOB#:  [**Job Number 35239**]
{'Acute and subacute bacterial endocarditis,Bacteremia,Methicillin susceptible pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Atrial fibrillation,Infection with microorganisms resistant to penicillins,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: 

PRESENT ILLNESS: This is a 52-year-old man with a
history of paroxysmal atrial fibrillation, cerebrovascular
accident leading to sense left hemiparesis,
methicillin-resistant Staphylococcus aureus pneumonia,
fractures who present progressive shortness of breath and
cough productive of rust-colored sputum.  This is a gentleman
whose complicated medical course dates back to [**2189**] when he
suffered a cerebrovascular accident secondary to atrial
fibrillation leading to left hemiparesis.  He currently lives
at [**Hospital3 2558**] and has had problems in the past year
including endocarditis and recurrent urinary tract

MEDICAL HISTORY: 1.  Paroxysmal atrial fibrillation, on amiodarone and
therapeutic on Coumadin.
2.  Cerebrovascular accident secondary to atrial fibrillation
leading to left hemiparesis.
3.  Hypertension.
4.  Non-insulin-dependent diabetes mellitus.
5.  Status post left hip hemi-repair, status post fall
leading to new fracture of his left femur and unrepaired
fracture of his right hip.
6.  Endocarditis.
7.  Methicillin-resistant Staphylococcus aureus pneumonia.
8.  Urinary tract infections.

MEDICATION ON ADMISSION: Lopressor 25 mg p.o. b.i.d.,
Zoloft 200 mg p.o. q.d. BuSpar 5 mg p.o. b.i.d.,
Zantac 150 mg p.o. b.i.d., Coumadin 1 p.o. q.d., valproic
acid 500 mg p.o. every noon and 75 mg p.o. q.a.m. and q.h.s.,
Oramorph 15 mg p.o. b.i.d., Roxicodone 5 mg p.o. q.4h. p.r.n.
for pain, amiodarone 200 mg p.o. q.d., Colace 100 mg p.o.
b.i.d., Dulcolax 10 mg p.o. q.d. p.r.n. for constipation,
Senokot, aspirin 325 mg p.o. q.d., multivitamin 1 p.o. q.d.,
zinc 220 mg p.o. q.d., vitamin C 500 mg p.o. q.d.,
Serax 10 mg p.o. q.h.s. p.r.n., Atrovent nebulizers q.4h.
p.r.n., and vancomycin 1 g intravenously q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives in [**Hospital3 2558**].  His mother and
brother live in [**Name (NI) 86**].  No alcohol or tobacco use. 

### Response:
{'Acute and subacute bacterial endocarditis,Bacteremia,Methicillin susceptible pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Atrial fibrillation,Infection with microorganisms resistant to penicillins,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
