CHIEF COMPLAINT: Cc:[**CC Contact Info 108953**]

PRESENT ILLNESS: .
HPI:
83M with PMH significant for CAD s/p CABG in [**2169**], MVR in [**2178**],
CHF, and COPD, presents to the ED after experiencing R hip pain
following a fall. He states that he was bending over, and became
dizzy with blurred visual after standing up abruptly. He fell on
his side. He denies LOC or head trauma. Films taken at his rehab
([**Hospital3 **]) demonstrated R femoral neck fracture, and he
was sent to [**Hospital1 **] ED. Of note, CXR at rehab on [**2183-10-10**] suggested
evidence of RLL and LUL infiltrate, and was started on
Levofloxacin 500mg PO qD x 10 days.
.
In the ED, initial VS were BP 134/69, HR 71, RR 18, SaO2 95% 2L
NC. Hip films confirmed R femoral neck fracture. Initial labs
significant for INR 5.4, on coumadin. CT head showed no evidence
of hemorrhage. He was seen by orthopedic surgery, who
recommended admission to medicine service for medical
optimization prior to likely ORIF surgery [**10-16**]. Mr. [**Known lastname **]
also complained of mild flank pain. A UA was ordered once he
reached the floor.

MEDICAL HISTORY: .
PMH:
CAD: s/p CABG [**2169**]
s/p MVR [**2178**]
s/p PPM, placed [**2178**] at time of valve surgery, V-paced
CHF - EF 40% on [**2178**] TTE
Pulmonary HTN by [**2178**] cath
Tracheomalacia following prolonged intubation
Restrictive lung disease with PFTs c/w neuromuscular disease,
possibly [**3-6**] diaphragmatic damage from previous cardiac
surgeries
h/o Endocarditis
h/o colon CA [**92**] yrs ago, resected
BPH
h/o GIB

MEDICATION ON ADMISSION: Meds:
Lopressor 25mg PO bid
Prilosec 20mg PO qD
Coumadin 3mg 5d/wk, 2mg 2d/wk
Azmacort 2 puffs tid
levaquin ([**10-19**] last dose - ?pnemonia)
lasix 10mg PO qD
lisinopril 5mg PO qD
Albuterol neb [**Hospital1 **]
Atrovent neb [**Hospital1 **]
Combivent 2 puffs qid
wellbutrin XL 150mg PO qD
Dulcolax 10mg PR prn
Remeron 7.5mg PO qHS
.

ALLERGIES: Aspirin / Nsaids

PHYSICAL EXAM: .
PE: TL 97.1F BP: 135/60, HR: 79, RR: 30, SaO2: 90% 2L (prior to
neb treatment).
Gen: Ill appearing gentleman, lying in bed, NAD
HEENT: PERRL, sclerae anicteric, OP clear
Neck: Supple, no LAD, previous orifice from trach visible
CV: RRR, II/VI SEM LUSB, mech valve click, +S3
Chest: Crackles R base, no w/r
Abd: Soft, NT/ND, +BS
Extr: R leg externally rotated, 2+ DPs bilaterally
Neuro: A&Ox3

FAMILY HISTORY: FAMILY HISTORY: Father died of an MI at age 82, mother died
of cancer at age 69. He is a carrier of alpha I antitrypsin
gene.
.

SOCIAL HISTORY: SOCIAL HISTORY: The patient denies history of intravenous
drug use or ethanol use. He has greater than 33 pack year
history of tobacco use, discontinued [**2178**]. His wife recently
died. His daughter died emphysema secondary to alpha I
antitrypsin
deficiency. The patient retired five years ago as a
[**Hospital **]medical Engineer.
.
Pneumonia, organism unspecified,Closed fracture of unspecified part of neck of femur,Unspecified septicemia,Septic shock,Acute respiratory failure,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Severe sepsis,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Heart valve replaced by other means,Personal history of malignant neoplasm of gastrointestinal tract, unspecified,Unspecified fall,Other alteration of consciousness
Pneumonia, organism NOS,Fx neck of femur NOS-cl,Septicemia NOS,Septic shock,Acute respiratry failure,CHF NOS,Obs chr bronc w(ac) exac,Food/vomit pneumonitis,Acute kidney failure NOS,Severe sepsis,Aortocoronary bypass,Long-term use anticoagul,Heart valve replac NEC,Hx of GI malignancy NOS,Fall NOS,Other alter consciousnes
Admission Date:  [**2183-10-15**]              Discharge Date:   [**2183-10-18**]


Service: MEDICINE

Allergies:
Aspirin / Nsaids

Attending:[**First Name3 (LF) 297**]
Chief Complaint:
Cc:[**CC Contact Info 108953**]


Major Surgical or Invasive Procedure:
ORIF

History of Present Illness:
.
HPI:
83M with PMH significant for CAD s/p CABG in [**2169**], MVR in [**2178**],
CHF, and COPD, presents to the ED after experiencing R hip pain
following a fall. He states that he was bending over, and became
dizzy with blurred visual after standing up abruptly. He fell on
his side. He denies LOC or head trauma. Films taken at his rehab
([**Hospital3 **]) demonstrated R femoral neck fracture, and he
was sent to [**Hospital1 **] ED. Of note, CXR at rehab on [**2183-10-10**] suggested
evidence of RLL and LUL infiltrate, and was started on
Levofloxacin 500mg PO qD x 10 days.
.
In the ED, initial VS were BP 134/69, HR 71, RR 18, SaO2 95% 2L
NC. Hip films confirmed R femoral neck fracture. Initial labs
significant for INR 5.4, on coumadin. CT head showed no evidence
of hemorrhage. He was seen by orthopedic surgery, who
recommended admission to medicine service for medical
optimization prior to likely ORIF surgery [**10-16**]. Mr. [**Known lastname **]
also complained of mild flank pain. A UA was ordered once he
reached the floor.


Past Medical History:
.
PMH:
CAD: s/p CABG [**2169**]
s/p MVR [**2178**]
s/p PPM, placed [**2178**] at time of valve surgery, V-paced
CHF - EF 40% on [**2178**] TTE
Pulmonary HTN by [**2178**] cath
Tracheomalacia following prolonged intubation
Restrictive lung disease with PFTs c/w neuromuscular disease,
possibly [**3-6**] diaphragmatic damage from previous cardiac
surgeries
h/o Endocarditis
h/o colon CA [**92**] yrs ago, resected
BPH
h/o GIB


Social History:
SOCIAL HISTORY: The patient denies history of intravenous
drug use or ethanol use. He has greater than 33 pack year
history of tobacco use, discontinued [**2178**]. His wife recently
died. His daughter died emphysema secondary to alpha I
antitrypsin
deficiency. The patient retired five years ago as a
[**Hospital **]medical Engineer.
.


Family History:
FAMILY HISTORY: Father died of an MI at age 82, mother died
of cancer at age 69. He is a carrier of alpha I antitrypsin
gene.
.

Physical Exam:
.
PE: TL 97.1F BP: 135/60, HR: 79, RR: 30, SaO2: 90% 2L (prior to
neb treatment).
Gen: Ill appearing gentleman, lying in bed, NAD
HEENT: PERRL, sclerae anicteric, OP clear
Neck: Supple, no LAD, previous orifice from trach visible
CV: RRR, II/VI SEM LUSB, mech valve click, +S3
Chest: Crackles R base, no w/r
Abd: Soft, NT/ND, +BS
Extr: R leg externally rotated, 2+ DPs bilaterally
Neuro: A&Ox3


Pertinent Results:

ECG [**2183-10-15**]: V-paced at 84bpm
[**2183-10-18**]: Atrial fibrillation. Right axis deviation. Compared to
the previous tracing of [**2183-10-15**] there is deep T wave inversion
in leads II, III, aVF and V3-V6 consistent with active ischemic
process. Rule out infarction. Clinical correlation is suggested.


.
Imaging:
CXR [**2183-10-15**]:
Cardiomegaly, s/p CABG and MVR, dual-lead PPM. Elevation of
right hemidiaphragm with volume loss and interstitial opacities
c/w CHF. Also focal opactiy over R lung zone and fluid in
fissure, could be c/w PNA. Small effusions, no PTX.
.
Head CT [**2183-10-15**]:
FINDINGS: There is no evidence of intra- or extra-axial
hemorrhage. The ventricles, cisterns and sulci are mildly
prominent, consistent with age-related involutional changes.
Multiple patchy areas of hypodensity in the white matter
consistent with chronic small vessel ischemic disease, and
include hypodensity which is more prominent, but unchanged
within the left subinsular cortex. A bony protuberance about the
ossicle may represent an osteoma which is unchanged or merely a
congenital variant.
IMPRESSION:
1. No evidence of intracranial hemorrhage.
2. Evidence of age related involutional changes and white matter
disease, unchanged.
.
Hip films: There is a comminuted right femoral neck fracture.
Subtle angulation is present. No other fracture is identified.
IMPRESSION: Right femur fracture.
.
[**3-9**] PFTs:
FVC 1.98L (51% predicted)
FEV1 1.25L (51% predicted)
FEV1/FVC: 63% (100% predicted)
.
[**1-2**] TTE:
EF 40%. The left atrium is moderately dilated. The right atrium
is moderately dilated. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. Overall
left ventricular systolic function is moderately depressed
secondary to severe inferior and posterior hypokinesis and mild
hypokinesis of the rest of the left ventricle; the ejection
fraction is approximately 40 percent. There is moderate global
right ventricular free wall hypokinesis. The number of aortic
valve leaflets cannot be determined. The aortic valve leaflets
are moderately thickened. There is no significant aortic valve
stenosis. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. A mitral valve annuloplasty
ring is present. There is moderate thickening of the mitral
valve chordae. Moderate
(2+) mitral regurgitation is seen. The mitral regurgitation jet
is eccentric. [Due to acoustic shadowing, the severity of mitral
regurgitation may be significantly UNDERestimated.] The
tricuspid valve leaflets are mildly thickened. There is mild
pulmonary artery systolic hypertension. Significant pulmonic
regurgitation is seen. There is no pericardial effusion.
.
[**7-3**] Cath: (prior to MVR)
1. Coronary angiography in this right dominant system revealed
three
vessel CAD. The left main coronary artery had a 40% distal
stenosis. The LAD had an 80% mid-vessel stenosis, and there was
competitive flow from the LIMA in the distal LAD. The ramus
intermedius branch had a 40% proximal stenosis. The left
circumflex artery was totally occluded proximally. The RCA had a
diffusely diseased proximal segment and was totally occluded
after the first acute marginal branch.
2. Graft arteriography revealed a patent LIMA to the LAD. The
SVG to the rPDA was widely patent, and the rPDA distal to the
anastamosis had a 70% stenosis. The SVG to the obtuse marginal
branch was ectatic but without significant stenosis and the
marginal branch distal to the anastamosis supplied collaterals
to the right postero-lateral branch.
3. Resting hemodynamic measurements revealed severe pulmonary
hypertension witha PA systolic pressure of 92 mmHg. There was
increased right and left sided filling pressures with a mean RA
pressure of 16 mmHg, a mean PCWP of 28 mmHg and an LVEDP of 22
mmHg. The cardiac index was preserved at 2.3 L/min/m2.
4. Left ventriculography revealed global hypokinesis with
posterobasal wall akinesis and moderate-to-severe (3+) mitral
regurgitation. The calculated LVEF was 45%.
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Patent LIMA and SVGs.
3. Moderate-to-severe (3+) mitral regurgitation.
4. Mild systolic ventricular dysfunction.
5. Severe pulmonary hypertension
[**2183-10-15**] 06:58AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2183-10-15**] 06:05AM   CALCIUM-8.8 PHOSPHATE-2.6* MAGNESIUM-2.3
[**2183-10-15**] 06:05AM   WBC-5.4 RBC-3.18* HGB-10.2* HCT-30.2* MCV-95
MCH-32.2* MCHC-33.9 RDW-16.7*
[**2183-10-15**] 06:05AM   PT-43.8* PTT-37.1* INR(PT)-5.0*
[**2183-10-15**] 01:30AM   GLUCOSE-90 UREA N-28* CREAT-1.1 SODIUM-138
POTASSIUM-4.8 CHLORIDE-96 TOTAL CO2-35* ANION GAP-12
[**2183-10-15**] 01:30AM   CK(CPK)-39
[**2183-10-15**] 01:30AM   cTropnT-0.02*
[**2183-10-15**] 01:30AM   CALCIUM-8.9 PHOSPHATE-2.8 MAGNESIUM-2.2
[**2183-10-15**] 01:30AM   WBC-6.3# RBC-3.33* HGB-10.7* HCT-31.6* MCV-95
MCH-32.3* MCHC-34.1 RDW-16.5*
[**2183-10-15**] 01:30AM   PT-46.7* PTT-37.4* INR(PT)-5.4*

Brief Hospital Course:
Pt. was admitted for optimization of medical status prior to
operation for hip fx.  stable until early [**10-17**] around 12:oo am
when began desatting to the high 80s on 2L NC. Vital signs o/w
at the time: T 97.3 BPs 90s-100s/30s-60s, HR 60s-70s, rr in the
high 20s. Pt was also noted to be increasingly somnolent and
unresponsive. Pt placed on 100% FM with improvement of sats. He
had been given MS contin 45 mg at 11 am the day prior and was
therefore given narcan 0.2 mg X1 and narcan 0.4 mg X1 several
hours later. He was given lasix 10 mg IV X3 o/n. Mental status
improved somewhat with the early dose of narcan. CXR checked at
the onset of the pt's change in status demonstrated worsened
bibasilar pna.
ABG trend o/n was as follows:
12:20 am 7.33/68/70
4:00 am 7.23/90/65
6:00 am 7.27/79/60
At time of MICU eval ABG was checked and demonstrated
7.05/139/125. Given worsening respiratory status pt transferred
to the unit. Code status confirmed with family to be DNR/DNI.
HCP felt that [**Name (NI) 108954**] would be an in-line with the pt's wishes.
Pt. EKG showed new Afib with ST changes worrisome for ischemia
and trop leak without elevation of CK in context of rapidly
progressive ARF.  He was given trial of [**Name (NI) 108954**] overnight without
much improvement of MS.  In discussion with pt.'s family, it was
decided to choose comfort care interventions.  He was placed on
morphine drip and passed [**10-18**] with family around


Medications on Admission:
Meds:
Lopressor 25mg PO bid
Prilosec 20mg PO qD
Coumadin 3mg 5d/wk, 2mg 2d/wk
Azmacort 2 puffs tid
levaquin ([**10-19**] last dose - ?pnemonia)
lasix 10mg PO qD
lisinopril 5mg PO qD
Albuterol neb [**Hospital1 **]
Atrovent neb [**Hospital1 **]
Combivent 2 puffs qid
wellbutrin XL 150mg PO qD
Dulcolax 10mg PR prn
Remeron 7.5mg PO qHS
.


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
hypercarbic respiratory failure
CAD: s/p CABG [**2169**]
Atrial fibrillation
Acute Renal Failure
Hip fracture
CHF
PNA

Discharge Condition:
deceased

Discharge Instructions:
none

Followup Instructions:
none
{'Pneumonia, organism unspecified,Closed fracture of unspecified part of neck of femur,Unspecified septicemia,Septic shock,Acute respiratory failure,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Severe sepsis,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Heart valve replaced by other means,Personal history of malignant neoplasm of gastrointestinal tract, unspecified,Unspecified fall,Other alteration of consciousness'}


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: Cc:[**CC Contact Info 108953**]

PRESENT ILLNESS: .
HPI:
83M with PMH significant for CAD s/p CABG in [**2169**], MVR in [**2178**],
CHF, and COPD, presents to the ED after experiencing R hip pain
following a fall. He states that he was bending over, and became
dizzy with blurred visual after standing up abruptly. He fell on
his side. He denies LOC or head trauma. Films taken at his rehab
([**Hospital3 **]) demonstrated R femoral neck fracture, and he
was sent to [**Hospital1 **] ED. Of note, CXR at rehab on [**2183-10-10**] suggested
evidence of RLL and LUL infiltrate, and was started on
Levofloxacin 500mg PO qD x 10 days.
.
In the ED, initial VS were BP 134/69, HR 71, RR 18, SaO2 95% 2L
NC. Hip films confirmed R femoral neck fracture. Initial labs
significant for INR 5.4, on coumadin. CT head showed no evidence
of hemorrhage. He was seen by orthopedic surgery, who
recommended admission to medicine service for medical
optimization prior to likely ORIF surgery [**10-16**]. Mr. [**Known lastname **]
also complained of mild flank pain. A UA was ordered once he
reached the floor.

MEDICAL HISTORY: .
PMH:
CAD: s/p CABG [**2169**]
s/p MVR [**2178**]
s/p PPM, placed [**2178**] at time of valve surgery, V-paced
CHF - EF 40% on [**2178**] TTE
Pulmonary HTN by [**2178**] cath
Tracheomalacia following prolonged intubation
Restrictive lung disease with PFTs c/w neuromuscular disease,
possibly [**3-6**] diaphragmatic damage from previous cardiac
surgeries
h/o Endocarditis
h/o colon CA [**92**] yrs ago, resected
BPH
h/o GIB

MEDICATION ON ADMISSION: Meds:
Lopressor 25mg PO bid
Prilosec 20mg PO qD
Coumadin 3mg 5d/wk, 2mg 2d/wk
Azmacort 2 puffs tid
levaquin ([**10-19**] last dose - ?pnemonia)
lasix 10mg PO qD
lisinopril 5mg PO qD
Albuterol neb [**Hospital1 **]
Atrovent neb [**Hospital1 **]
Combivent 2 puffs qid
wellbutrin XL 150mg PO qD
Dulcolax 10mg PR prn
Remeron 7.5mg PO qHS
.

ALLERGIES: Aspirin / Nsaids

PHYSICAL EXAM: .
PE: TL 97.1F BP: 135/60, HR: 79, RR: 30, SaO2: 90% 2L (prior to
neb treatment).
Gen: Ill appearing gentleman, lying in bed, NAD
HEENT: PERRL, sclerae anicteric, OP clear
Neck: Supple, no LAD, previous orifice from trach visible
CV: RRR, II/VI SEM LUSB, mech valve click, +S3
Chest: Crackles R base, no w/r
Abd: Soft, NT/ND, +BS
Extr: R leg externally rotated, 2+ DPs bilaterally
Neuro: A&Ox3

FAMILY HISTORY: FAMILY HISTORY: Father died of an MI at age 82, mother died
of cancer at age 69. He is a carrier of alpha I antitrypsin
gene.
.

SOCIAL HISTORY: SOCIAL HISTORY: The patient denies history of intravenous
drug use or ethanol use. He has greater than 33 pack year
history of tobacco use, discontinued [**2178**]. His wife recently
died. His daughter died emphysema secondary to alpha I
antitrypsin
deficiency. The patient retired five years ago as a
[**Hospital **]medical Engineer.
. 

### Response:
{'Pneumonia, organism unspecified,Closed fracture of unspecified part of neck of femur,Unspecified septicemia,Septic shock,Acute respiratory failure,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Severe sepsis,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Heart valve replaced by other means,Personal history of malignant neoplasm of gastrointestinal tract, unspecified,Unspecified fall,Other alteration of consciousness'}
