CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname 19198**] is a [**Age over 90 **] yo female with h/o hypothyroidism who awoke
at midnight with sudden onset shortness of breath. Symptoms
persisted for one hour without improvement and EMS was called.
.
History was obtained from son [**Name (NI) 3065**] as patient was intubated
and sedated at time of arrival. Patient has no prior history of
stroke, TIA, deep venous thrombosis, pulmonary embolism,
bleeding at the time of surgery, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. She has not had any
recent fevers, chills or rigors, exertional buttock or calf
pain. All of the other review of systems were negative.
.
Cardiac review of systems is notable only for the presence of
dyspnea at rest. ROS is negative for any report of chest pain,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
In the ED, patient was intubated emergently and code STEMI was
called. She received versed 5 mg IV x 2, ativan 2 mg, ASA 600
mg, Plavix 600 mg, Integrillin bolus, Etomidate 20 mg IV, and
Succinylcholine 12 mg, and was started on a heparin gtt. A nitro
drip was initiated which resulted in hypotension. BP transiently
responded to 1.5 L of NS.

MEDICAL HISTORY: 1) Hypothyroidism
2) Osteoporosis
3) Glaucoma
4) Dyslipidemia
5) h/o gallstones
6) Zenker's diverticulum
7) UTI, currently being treated

MEDICATION ON ADMISSION: 1) Synthroid 75 mcg daily
2) Actonel 35 mg qweek
3) Salsalate 750 mg [**Hospital1 **]
4) Bactrim DS [**Hospital1 **] (day 4)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.2, BP 128/65, HR 81, RR 18 , O2 97% on CPAP 50% FiO2,
PS 15
Gen: elderly white female, intubated and sedated
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with elevated JVD
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Coarse rhonchi in all
lung fields.
Abd: soft, NTND, No HSM or tenderness. No abdominal bruits.
Ext: Bilateral lower extremity edema R>>L. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. She currently [**Name (NI) 546**]
with a 24 hour caregiver and with her granddaughter who [**Name2 (NI) 546**]
in the upstairs apartment.
Acute myocardial infarction of unspecified site, initial episode of care,Acute diastolic heart failure,Acute respiratory failure,Urinary tract infection, site not specified,Aortic valve disorders,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Osteoporosis, unspecified
AMI NOS, initial,Ac diastolic hrt failure,Acute respiratry failure,Urin tract infection NOS,Aortic valve disorder,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Osteoporosis NOS
Admission Date:  [**2111-10-15**]              Discharge Date:   [**2111-10-18**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2901**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Ms. [**Known lastname 19198**] is a [**Age over 90 **] yo female with h/o hypothyroidism who awoke
at midnight with sudden onset shortness of breath. Symptoms
persisted for one hour without improvement and EMS was called.
.
History was obtained from son [**Name (NI) 3065**] as patient was intubated
and sedated at time of arrival. Patient has no prior history of
stroke, TIA, deep venous thrombosis, pulmonary embolism,
bleeding at the time of surgery, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. She has not had any
recent fevers, chills or rigors, exertional buttock or calf
pain. All of the other review of systems were negative.
.
Cardiac review of systems is notable only for the presence of
dyspnea at rest. ROS is negative for any report of chest pain,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
In the ED, patient was intubated emergently and code STEMI was
called. She received versed 5 mg IV x 2, ativan 2 mg, ASA 600
mg, Plavix 600 mg, Integrillin bolus, Etomidate 20 mg IV, and
Succinylcholine 12 mg, and was started on a heparin gtt. A nitro
drip was initiated which resulted in hypotension. BP transiently
responded to 1.5 L of NS.


Past Medical History:
1) Hypothyroidism
2) Osteoporosis
3) Glaucoma
4) Dyslipidemia
5) h/o gallstones
6) Zenker's diverticulum
7) UTI, currently being treated

Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. She currently [**Name (NI) 546**]
with a 24 hour caregiver and with her granddaughter who [**Name2 (NI) 546**]
in the upstairs apartment.

Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
VS: T 97.2, BP 128/65, HR 81, RR 18 , O2 97% on CPAP 50% FiO2,
PS 15
Gen: elderly white female, intubated and sedated
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with elevated JVD
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Coarse rhonchi in all
lung fields.
Abd: soft, NTND, No HSM or tenderness. No abdominal bruits.
Ext: Bilateral lower extremity edema R>>L. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP



Pertinent Results:
[**2111-10-15**] ADMISSION LABS:
CBC:
WBC-8.7 RBC-4.69 Hgb-15.1 Hct-45.1 MCV-96 MCH-32.1* MCHC-33.4
RDW-15.5 Plt Ct-272
.
CHEM:
Glucose-237* UreaN-20 Creat-0.9 Na-129* K-5.6* Cl-93* HCO3-22
AnGap-20
Calcium-9.1 Phos-5.1* Mg-2.5 Cholest-203*
.
TSH-1.4
.
COAGS:
PT-11.4 PTT-25.4 INR(PT)-1.0
.
CE's
[**2111-10-15**] 02:00AM BLOOD cTropnT-0.03*
[**2111-10-15**] 09:15AM BLOOD CK-MB-NotDone cTropnT-0.10*
[**2111-10-16**] 04:30AM BLOOD CK-MB-NotDone cTropnT-0.07*
.
STUDIES:
[**10-15**] EKG:
Sinus tachycardia
Left axis deviation
IV conduction defect
Poor R wave progression - cannot rule out septal infarct
Left ventricular hypertrophy
Lateral ST-T changes may be due to hypertrophy and/or ischemia
.
CHEST (PORTABLE AP)  [**2111-10-15**] 5:07 AM
IMPRESSION: Too low ET tube as described should be pulled back
about 3 cm. Worsening of pulmonary edema.
.
[**2111-10-15**] ECHO:
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy with normal cavity size and
regional/global systolic function (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. The number of
aortic valve leaflets cannot be determined. The aortic valve
leaflets are severely thickened/deformed. There is critical
aortic valve stenosis (area <0.5 cm2). Mild (1+) aortic
regurgitation is seen. Mild (1+) mitral regurgitation is seen.
[Due to acoustic shadowing, the severity of mitral regurgitation
may be significantly UNDERestimated.] The pulmonary artery
systolic pressure could not be determined. There is a small
pericardial effusion. The effusion appears circumferential.

IMPRESSION: Severe aortic stenosis. Symmetric LVH with
global/regional biventricular systolic function. Mild mitral
regurgitation.
.
UNILAT LOWER EXT VEINS RIGHT  [**2111-10-15**] 6:12 AM
IMPRESSION: No evidence of DVT.

Brief Hospital Course:
Ms. [**Known lastname 19198**] is a [**Age over 90 **] year-old woman who presented to the ER with
complaints of acute onset shortness of breath. An EKG performed
at that time revealed ST elevations in V1 and V2, reciprocal ST
depressions in I and AvL, and a code STEMI was called. The
patient was emergently intubated in the ED for respiratory
distress from pulmonary edema secondary to her MI. After
discussion, it was felt that she was not a candidate for cardiac
catheterization, and she was admitted to the CCU for further
management.
.
In the CCU,  EKG changes resolved with medical management
including ASA, Plavix, Lipitor, and heparin gtt. The patient did
not tolerate nitro gtt [**2-13**] hypotension. She was initially put on
peripheral dopamine for hemodynamic support, maintaining
SBP's>90, until it was revealed the she was DNR/DNI. At that
time, an extensive family discussion ensued, and it was decided
to wean the patient off of pressors and extubate her.
.
An echocardiogram was performed which revealed critical Aortic
Stenosis. Again, it was felt that the patient's condition was
too tenuous for valvuloplasty or operative repair. At this
point, per discussion with the family, the patient's goals of
care were changed to comfort measures. She was transferred to
the floor and her comfort was maintained with a morphine drip
and prn ativan.
.
On [**10-18**] the patient was noted to exhibit [**Last Name (un) 6055**]-[**Doctor Last Name **]/agonal
respirations had ceased. Family was at the bedside. PE revelaed
fixed and dilated puils, no carotid pulse, no withdrawal to
pain, and absence of cardiac sounds. Time of death pronounced at
8:55PM. Family declined an autopsy.

Medications on Admission:
1) Synthroid 75 mcg daily
2) Actonel 35 mg qweek
3) Salsalate 750 mg [**Hospital1 **]
4) Bactrim DS [**Hospital1 **] (day 4)

Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
ST elevation myocardial infarction [**2-13**] Aortic stenosis


Discharge Condition:
expired


Discharge Instructions:
n/a

Followup Instructions:
n/a


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Acute diastolic heart failure,Acute respiratory failure,Urinary tract infection, site not specified,Aortic valve disorders,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Osteoporosis, unspecified'}


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: shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname 19198**] is a [**Age over 90 **] yo female with h/o hypothyroidism who awoke
at midnight with sudden onset shortness of breath. Symptoms
persisted for one hour without improvement and EMS was called.
.
History was obtained from son [**Name (NI) 3065**] as patient was intubated
and sedated at time of arrival. Patient has no prior history of
stroke, TIA, deep venous thrombosis, pulmonary embolism,
bleeding at the time of surgery, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. She has not had any
recent fevers, chills or rigors, exertional buttock or calf
pain. All of the other review of systems were negative.
.
Cardiac review of systems is notable only for the presence of
dyspnea at rest. ROS is negative for any report of chest pain,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
In the ED, patient was intubated emergently and code STEMI was
called. She received versed 5 mg IV x 2, ativan 2 mg, ASA 600
mg, Plavix 600 mg, Integrillin bolus, Etomidate 20 mg IV, and
Succinylcholine 12 mg, and was started on a heparin gtt. A nitro
drip was initiated which resulted in hypotension. BP transiently
responded to 1.5 L of NS.

MEDICAL HISTORY: 1) Hypothyroidism
2) Osteoporosis
3) Glaucoma
4) Dyslipidemia
5) h/o gallstones
6) Zenker's diverticulum
7) UTI, currently being treated

MEDICATION ON ADMISSION: 1) Synthroid 75 mcg daily
2) Actonel 35 mg qweek
3) Salsalate 750 mg [**Hospital1 **]
4) Bactrim DS [**Hospital1 **] (day 4)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.2, BP 128/65, HR 81, RR 18 , O2 97% on CPAP 50% FiO2,
PS 15
Gen: elderly white female, intubated and sedated
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with elevated JVD
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Coarse rhonchi in all
lung fields.
Abd: soft, NTND, No HSM or tenderness. No abdominal bruits.
Ext: Bilateral lower extremity edema R>>L. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. She currently [**Name (NI) 546**]
with a 24 hour caregiver and with her granddaughter who [**Name2 (NI) 546**]
in the upstairs apartment. 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Acute diastolic heart failure,Acute respiratory failure,Urinary tract infection, site not specified,Aortic valve disorders,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Osteoporosis, unspecified'}
