CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: HPI:  73-yo-woman w/ CAD, CHF, ESRD presents w/ dyspnea x 12
hours.  She was feeling well until 1 day prior to admission
during dinner, when she developed acute onset dyspnea assoc w/
substernal chest pain.  The pain was "achy," moderate severity,
non-radiating.  There were no assoc palpitations, cough, nausea,
vomiting, or diaphoresis.  ROS reveals no fever, weight loss,
increasing edema, orthopnea, PND, or dietary indiscretion.  She
has been taking all her meds as prescribed.  Her last HD session
was the day prior to presentation to the ED.
.
In the [**Hospital1 18**] ED, she was initially hypertensive w/ BP 210/110,
HR 80, O2 sat 100% on BiPAP. She was treated w/ nitro gtt,
hydralazine 5mg IV, and enalapril 1.25mg IV x 1, and BP improved
to 190/82. Chest pain resolved early during her ED stay.   She
was dialyzed urgently and admitted to the MICU where she had no
further CP or SOB.  She was called out to the floor after 1 day.

MEDICAL HISTORY: 1. 3-V CAD; s/p NSTEMI [**6-/2154**], Had Taxus stent placed [**2154-6-7**] in
mid-LCx.
2. CHF: Echo [**12-6**] with EF=20%, 1+ AR, [**1-4**]+MR
3. H/o malignant hypertension.
4. Status post intubation for flash pulmonary edema on [**2154-6-3**], complicated by laryngeal edema.
5. History of human immunodeficiency virus, CD4 count 302 on
[**2156-12-8**]; viral load less than <50 on [**12-8**], on [**Month/Year (2) 2775**] therapy.
6. End-stage renal disease on hemodialysis secondary to HIV
nephropathy.
7. DM II, diet controlled
8. Spinal tuberculosis.
9. Hypercholesterolemia.
10. Hepatitis C viral infection.
11. Gout - has been on prednisone tapers in the past for flares.
12. H/o anemia
13.s/p unknown back surgery, possibly for spinal TB

MEDICATION ON ADMISSION: * ASA 325 mg daily
* plavix 75 mg daily
* lisinopril 20mg daily
* Toprol xl 100 mg daily
* lipitor 80 mg daily
* zetia 10 mg daily
* lamivudine 100 mg daily
* nevirapine 200 mg [**Hospital1 **]
* zidovudine 100 mg tid
* renagel 1600 mg tid
* sensipar 30 mg daily

ALLERGIES: Allopurinol / Ethambutol / Colchicine / Efavirenz

PHYSICAL EXAM: PE:  T 98.8 rectal, BP 143/67, HR 77, RR 14, O2 sat 100% RA
 Gen:  chronically ill appearing elderly woman, lying at 45
degrees in bed, pleasant and conversational, breathing
comfortably.
 [**Month/Year (2) 4459**]:  anicteric, EOMI, PERRL, OP clear w/ [**Month/Year (2) 5674**], EJ fills to
the mandible at 45 degrees.
 CV:  reg s1/s2, + 2/6 systolic murmur at apex, no s3/s4/r
 Pulm:  CTA anteriorly, no crackles or wheezes.
 Abd:  obese, +BS, soft, NT, ND
 Ext:  warm, 2+ DP b/l, no edema
 Neuro:  a/o x 3, CN 2-12 intact (vision impaired), strength 4/5
throughout, sensation to fine touch intact throughout.

FAMILY HISTORY: She has a son with DM and CAD

SOCIAL HISTORY: Pt lives alone and gets around with a walker. She cooks for
herself. Her daughter comes over daily to help her take her
meds.  She denies tobacco, EtOH, IVDA, herbals/vitamins.  She
has 6 kids.
Human immunodeficiency virus [HIV] disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,End stage renal disease,Unspecified viral hepatitis C without hepatic coma,Pulmonary collapse,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Human immuno virus dis,Hyp kid NOS w cr kid V,CHF NOS,End stage renal disease,Hpt C w/o hepat coma NOS,Pulmonary collapse,Nephritis NOS,DMII wo cmp nt st uncntr,Gout NOS,Crnry athrscl natve vssl,Status-post ptca
Admission Date:  [**2157-2-15**]              Discharge Date:   [**2157-2-17**]

Date of Birth:  [**2083-8-18**]             Sex:   F

Service: MEDICINE

Allergies:
Allopurinol / Ethambutol / Colchicine / Efavirenz

Attending:[**First Name3 (LF) 9240**]
Chief Complaint:
dyspnea


Major Surgical or Invasive Procedure:
Hemodialysis


History of Present Illness:
HPI:  73-yo-woman w/ CAD, CHF, ESRD presents w/ dyspnea x 12
hours.  She was feeling well until 1 day prior to admission
during dinner, when she developed acute onset dyspnea assoc w/
substernal chest pain.  The pain was "achy," moderate severity,
non-radiating.  There were no assoc palpitations, cough, nausea,
vomiting, or diaphoresis.  ROS reveals no fever, weight loss,
increasing edema, orthopnea, PND, or dietary indiscretion.  She
has been taking all her meds as prescribed.  Her last HD session
was the day prior to presentation to the ED.
.
In the [**Hospital1 18**] ED, she was initially hypertensive w/ BP 210/110,
HR 80, O2 sat 100% on BiPAP. She was treated w/ nitro gtt,
hydralazine 5mg IV, and enalapril 1.25mg IV x 1, and BP improved
to 190/82. Chest pain resolved early during her ED stay.   She
was dialyzed urgently and admitted to the MICU where she had no
further CP or SOB.  She was called out to the floor after 1 day.

Past Medical History:
1. 3-V CAD; s/p NSTEMI [**6-/2154**], Had Taxus stent placed [**2154-6-7**] in
mid-LCx.
2. CHF: Echo [**12-6**] with EF=20%, 1+ AR, [**1-4**]+MR
3. H/o malignant hypertension.
4. Status post intubation for flash pulmonary edema on [**2154-6-3**], complicated by laryngeal edema.
5. History of human immunodeficiency virus, CD4 count 302 on
[**2156-12-8**]; viral load less than <50 on [**12-8**], on [**Month/Year (2) 2775**] therapy.
6. End-stage renal disease on hemodialysis secondary to HIV
nephropathy.
7. DM II, diet controlled
8. Spinal tuberculosis.
9. Hypercholesterolemia.
10. Hepatitis C viral infection.
11. Gout - has been on prednisone tapers in the past for flares.
12. H/o anemia
13.s/p unknown back surgery, possibly for spinal TB


Social History:
Pt lives alone and gets around with a walker. She cooks for
herself. Her daughter comes over daily to help her take her
meds.  She denies tobacco, EtOH, IVDA, herbals/vitamins.  She
has 6 kids.


Family History:
She has a son with DM and CAD

Physical Exam:
PE:  T 98.8 rectal, BP 143/67, HR 77, RR 14, O2 sat 100% RA
 Gen:  chronically ill appearing elderly woman, lying at 45
degrees in bed, pleasant and conversational, breathing
comfortably.
 [**Month/Year (2) 4459**]:  anicteric, EOMI, PERRL, OP clear w/ [**Month/Year (2) 5674**], EJ fills to
the mandible at 45 degrees.
 CV:  reg s1/s2, + 2/6 systolic murmur at apex, no s3/s4/r
 Pulm:  CTA anteriorly, no crackles or wheezes.
 Abd:  obese, +BS, soft, NT, ND
 Ext:  warm, 2+ DP b/l, no edema
 Neuro:  a/o x 3, CN 2-12 intact (vision impaired), strength 4/5
throughout, sensation to fine touch intact throughout.


Pertinent Results:
[**2157-2-15**] 11:08PM   CK(CPK)-80
[**2157-2-15**] 11:08PM   CK-MB-NotDone cTropnT-0.43*
[**2157-2-15**] 04:17PM   K+-5.5*
[**2157-2-15**] 04:00PM   GLUCOSE-235* UREA N-53* CREAT-6.3*#
SODIUM-139 POTASSIUM-5.4* CHLORIDE-96 TOTAL CO2-30 ANION GAP-18
[**2157-2-15**] 04:00PM   ALT(SGPT)-29 AST(SGOT)-39 LD(LDH)-259*
CK(CPK)-75 ALK PHOS-159* AMYLASE-272* TOT BILI-0.3
[**2157-2-15**] 04:00PM   LIPASE-129*
[**2157-2-15**] 04:00PM   CK-MB-NotDone proBNP-9881*
[**2157-2-15**] 04:00PM   CALCIUM-10.5* PHOSPHATE-6.7*# MAGNESIUM-2.5
[**2157-2-15**] 04:00PM   WBC-6.6 RBC-3.52*# HGB-13.9# HCT-43.4#
MCV-123* MCH-39.6* MCHC-32.1 RDW-17.6*
[**2157-2-15**] 04:00PM   NEUTS-70.2* LYMPHS-23.9 MONOS-3.5 EOS-1.8
BASOS-0.6
[**2157-2-15**] 04:00PM   PT-11.8 PTT-27.2 INR(PT)-1.0
[**2157-2-15**] 04:00PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-100
GLUCOSE-100 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-NEG

.
EKG:  NSR @ 93 bpm, LAD, LVH, pseudonormalization of T waves in
V1-V6 since prior tracing [**5-7**].
.
pCXR [**2157-2-15**]:
Since most recent comparison film, there appears to be increased
interstitial alveolar opacities likely representing [**Month/Day/Year 9140**]
pulmonary edema with unchanged appearance to cardiomegaly, and
linear calcifications within the ascending and descending
thoracic aorta.  No focal parenchymal consolidation, pleural
effusions, or pneumothorax is identified
.
pCXR [**2157-2-16**]:
A small atelectasis is seen in the left lower lobe retrocardiac
area.  There has been almost complete resolution of the
pulmonary edema. There is no pneumothorax or pleural effusion.
Mild cardiomegaly is unchanged. The aorta is unfolded with
extensive atheromatous plaques in the ascending, descending, and
the arch

Brief Hospital Course:
73-yo-woman w/ CAD, CHF, ESRD on HD, HIV, HCV, HTN, and anemia
presents w/ dyspnea, thought [**2-4**] pulmonary edema in setting of
hypertensive emergency.
.
# Dyspnea: The patient's shortness of breath was felt most
likely secondary to pulmonary edema as evidenced by initial exam
and CXR in setting of severe hypertension.   Pt with CHF and
renal failure, making her prone to this.  There is no evidence
of PNA, PE, or obstructive disease.  The precipitant is unknown,
but the patient does have a history of flash pulmonary edema.
She denies medication non-compliance or excessive sodium
consumption.  Her shortness of breath resolved after
hemodialysis and better BP control, and she maintained her O2
saturation on room air. Cardiac enzymes revealed flat CKs and
elevated troponins (in setting of ESRD)   which did not rise.
She continued hemodialysis and will continue to be followed by
the [**Hospital6 **] in [**Location (un) **].
.
# Chest pain: The patient is known to have 3vd, w/ stent in LCX.
  Her pain was in the setting of hypertensive emergency and
resolved with control of her blood pressure, including nitro
drip.  There were no specific EKG changes on presentation to
indicate active ischemia.  Her cardiac enzymes were notable for
an elevated troponin (in setting of ESRD), with flat CKs.  She
was monitored on telemetry withoug event.  Her chest pain did
not recur.  She was placed back on her home medications: ASA,
metoprolol, ACEI, lipitor, and zetia.  She should follow up with
her cardiologist.
.
# ESRD: Her renal failure is secondary to HIV nephropathy.  She
was urgently dialyzed on the day of admission and then placed
back on her usual dialysis schedule(M,W,F).  She was followed by
the renal service who recommended to switch lisinopril to
captopril [**Hospital1 **] (this was done).  She was continued on Renagel and
Sensipar.  The patient will continue to be followed by the
[**Hospital6 **] in [**Location (un) **], with dialysis M,W,F.
.
# Hypertensive Emergency: The patient's blood pressure was
initially controlled with volume removal by HD, IV enalapril, IV
hydralazine, and nitroglycerin drip.  Her BP normalized and she
was placed back on her home regimen and monitored.  Her
pressures remained appropriate.  As per renal, her ACEI was
changed to Captopril 50mg [**Hospital1 **].  She will continue on Toprol XL
and Captopril [**Hospital1 **] as an outpatient.  Her HD will resume at
[**Hospital6 **] tomorrow.
.
# Elevated amylase/lipase: This is chronic and likely a chemical
pancreatitis from her [**Hospital6 2775**] therapy.  There were no signs of
clinical pancreatitis.  The patient will follow with her ID
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 724**].
.
# HIV: The patient's viral load is suppressed with [**Last Name (STitle) 2775**].  She
was continued on lamivudine, nevirapine, and zidovudine.  She
has follow up scheduled with her Infectious disease specialist
this month.
.
# DM type 2: This is controlled with diet as an outpt.  Her
fingerstick blood glucose was check four times daily.  She was
covered with an insulin sliding scale.  She did not require much
insulin and will resume diet control as an outpatient.
.
# FEN: [**Doctor First Name **], low sodium, cardiac diet.  Her electrolytes were
repleted prn.
.
# Proph: She was given heparin SC, but developed a hematoma in
her abdomen from these injections.  Therefore her heparin
injections were stopped.  She was ambulatory on the floor.  She
was given a bowel regimen.
.
* FULL CODE

Medications on Admission:
* ASA 325 mg daily
* plavix 75 mg daily
* lisinopril 20mg daily
* Toprol xl 100 mg daily
* lipitor 80 mg daily
* zetia 10 mg daily
* lamivudine 100 mg daily
* nevirapine 200 mg [**Hospital1 **]
* zidovudine 100 mg tid
* renagel 1600 mg tid
* sensipar 30 mg daily

Discharge Medications:
1. Sevelamer 800 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Captopril 50 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
5. Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Lamivudine 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
10. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
11. Nevirapine 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
12. Zidovudine 100 mg Capsule Sig: One (1) Capsule PO three
times a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Primary:
1. Hypertensive emergency
2. Pulmonary edema
3. Congestive Heart failure
4. End Stage Renal Disease


Discharge Condition:
Stable, symptoms resolved.


Discharge Instructions:
You were admitted with shortness of breath and chest pain,
thought due to severe high blood pressure and fluid building up
in the lungs.  You were treated with hemodialysis and blood
pressure medications.
.
You should take all medications as prescribed.  Please note that
your lisinopril was changed to captopril, which is to be taken
twice a day.  All your other medications are unchanged.
.
Call your doctor or return to the hospital if you have shortness
of breath, chest pain, dizziness, or any other symptom that
concerns you.

Followup Instructions:
* Please follow up with your primary physician [**Last Name (NamePattern4) **] [**1-4**] weeks.
* Please continue Dialysis at [**Hospital6 **] in
[**Location (un) **] on M,W,F as before.
* Please keep your appointments with your infectious disease
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 724**], and your Cardiologist, Dr. [**Last Name (STitle) 8499**], as
below:

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2157-2-22**]
1:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10134**], MD Phone:[**Telephone/Fax (1) 7976**]
Date/Time:[**2157-4-5**] 9:00



Completed by:[**2157-2-18**]
{'Human immunodeficiency virus [HIV] disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,End stage renal disease,Unspecified viral hepatitis C without hepatic coma,Pulmonary collapse,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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: dyspnea

PRESENT ILLNESS: HPI:  73-yo-woman w/ CAD, CHF, ESRD presents w/ dyspnea x 12
hours.  She was feeling well until 1 day prior to admission
during dinner, when she developed acute onset dyspnea assoc w/
substernal chest pain.  The pain was "achy," moderate severity,
non-radiating.  There were no assoc palpitations, cough, nausea,
vomiting, or diaphoresis.  ROS reveals no fever, weight loss,
increasing edema, orthopnea, PND, or dietary indiscretion.  She
has been taking all her meds as prescribed.  Her last HD session
was the day prior to presentation to the ED.
.
In the [**Hospital1 18**] ED, she was initially hypertensive w/ BP 210/110,
HR 80, O2 sat 100% on BiPAP. She was treated w/ nitro gtt,
hydralazine 5mg IV, and enalapril 1.25mg IV x 1, and BP improved
to 190/82. Chest pain resolved early during her ED stay.   She
was dialyzed urgently and admitted to the MICU where she had no
further CP or SOB.  She was called out to the floor after 1 day.

MEDICAL HISTORY: 1. 3-V CAD; s/p NSTEMI [**6-/2154**], Had Taxus stent placed [**2154-6-7**] in
mid-LCx.
2. CHF: Echo [**12-6**] with EF=20%, 1+ AR, [**1-4**]+MR
3. H/o malignant hypertension.
4. Status post intubation for flash pulmonary edema on [**2154-6-3**], complicated by laryngeal edema.
5. History of human immunodeficiency virus, CD4 count 302 on
[**2156-12-8**]; viral load less than <50 on [**12-8**], on [**Month/Year (2) 2775**] therapy.
6. End-stage renal disease on hemodialysis secondary to HIV
nephropathy.
7. DM II, diet controlled
8. Spinal tuberculosis.
9. Hypercholesterolemia.
10. Hepatitis C viral infection.
11. Gout - has been on prednisone tapers in the past for flares.
12. H/o anemia
13.s/p unknown back surgery, possibly for spinal TB

MEDICATION ON ADMISSION: * ASA 325 mg daily
* plavix 75 mg daily
* lisinopril 20mg daily
* Toprol xl 100 mg daily
* lipitor 80 mg daily
* zetia 10 mg daily
* lamivudine 100 mg daily
* nevirapine 200 mg [**Hospital1 **]
* zidovudine 100 mg tid
* renagel 1600 mg tid
* sensipar 30 mg daily

ALLERGIES: Allopurinol / Ethambutol / Colchicine / Efavirenz

PHYSICAL EXAM: PE:  T 98.8 rectal, BP 143/67, HR 77, RR 14, O2 sat 100% RA
 Gen:  chronically ill appearing elderly woman, lying at 45
degrees in bed, pleasant and conversational, breathing
comfortably.
 [**Month/Year (2) 4459**]:  anicteric, EOMI, PERRL, OP clear w/ [**Month/Year (2) 5674**], EJ fills to
the mandible at 45 degrees.
 CV:  reg s1/s2, + 2/6 systolic murmur at apex, no s3/s4/r
 Pulm:  CTA anteriorly, no crackles or wheezes.
 Abd:  obese, +BS, soft, NT, ND
 Ext:  warm, 2+ DP b/l, no edema
 Neuro:  a/o x 3, CN 2-12 intact (vision impaired), strength 4/5
throughout, sensation to fine touch intact throughout.

FAMILY HISTORY: She has a son with DM and CAD

SOCIAL HISTORY: Pt lives alone and gets around with a walker. She cooks for
herself. Her daughter comes over daily to help her take her
meds.  She denies tobacco, EtOH, IVDA, herbals/vitamins.  She
has 6 kids. 

### Response:
{'Human immunodeficiency virus [HIV] disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,End stage renal disease,Unspecified viral hepatitis C without hepatic coma,Pulmonary collapse,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
