CHIEF COMPLAINT: CC: SOB

PRESENT ILLNESS: .
58 M with CAD s/p CABG, CHF EF 20%, s/p BiV/ICD, OSA, DM2, htn
presents with SOB. The pt developed a relatively sudden onset of
SOB while sleeping. The family called EMS(arrived 0400 on [**6-29**])
who found the pt acutely SOB, using accessory muscles, vitals
were p 100 bp 220/110 rr 24 83% RA. He was given [**Month/Year (2) **] 100 IV
and ntg SL x3. Of note, the pt denies any chest pain, no fevers,
chills or coughing.
  On arrival to OSH, remained SOB with sats in 80s on NRB and
was intubated nasotracheally since he was a difficult
intubation. bp was better controlled to 150/90, he was breifly
on nitro gtt which was stopped when he was becoming hypotensive.
The pt was then transferred to [**Hospital1 18**] for further management.
.
Allergies: demerol, hctz, ambien, aldactone, strawberries.
.
ECG: regular paced rhythm at 64, QT wnl, no over signs of
ischemia
.
CXR at [**Hospital1 18**]:
1.  Satisfactory endotracheal tube position.
2.  Mild cardiac decompensation with small bilateral pleural
effusions, but no
pulmonary edema.
.

MEDICAL HISTORY: PMHx:
1.  CAD, s/p recent CABG as above; TTE [**3-5**] showing dilated
LA/LAV, 1+ MR, EF=20-30%, with BiV pacer for ventricular
arrhythmias
2.  Prostatitis
3.  Melanoma s/p excisions
4.  DM x 2 years
5.  Recurrent PNA
6.  GERD
7.  gout
8.  Sleep apnea
9.  s/p hemorrhoidectomy
10.  bilateral Iliac artery anneurysm s/p repair
11.  Hypertensive cardiomyopathy
12.  Hypercholesterolemia
13.  Cervical radiculopathy

MEDICATION ON ADMISSION: Coreg 12.5 mg b.i.d.
Digoxin 0.125 mg q.o.d.,
[**Month/Day (1) 11573**] 40 mg qd
Lisinopril 20 mg qd
Zetia 10 mg qd
Lantus 70U [**Hospital1 **]
Lipitor 80 mg qd
Lexapro 20 mg qd,
Folic Acid qd
Amiodarone 200 mg qd
Protonix 40 mg qd
ASA 81 mg qd
[**Doctor First Name **] 180 mg qd
Klonopin 0.5 mg up to b.i.d.

ALLERGIES: Hydrochlorothiazide / Demerol / Ambien

PHYSICAL EXAM: p62 bp 144/72 18 96% on CPAP 50%
Gen: nasotracheally intubated, though awakem alert, in no resp
distress on PSV
HEENT: PERRL, OP clear
Lungs: crackes at bases, mostly clear
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs, no masses
Extr: trace edema, DP 2+ bilat

FAMILY HISTORY: Father with MI in 50s

SOCIAL HISTORY: Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption.
Acute respiratory failure,Unspecified hypertensive heart disease with heart failure,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Gout, unspecified,Aortocoronary bypass status,Personal history of malignant melanoma of skin,Esophageal reflux,Brachial neuritis or radiculitis NOS,Other chronic pulmonary heart diseases
Acute respiratry failure,Hyp ht dis NOS w ht fail,CHF NOS,Chronic kidney dis NOS,Obstructive sleep apnea,DMII wo cmp nt st uncntr,Old myocardial infarct,Status autm crd dfbrltr,Gout NOS,Aortocoronary bypass,Hx-malig skin melanoma,Esophageal reflux,Brachial neuritis NOS,Chr pulmon heart dis NEC
Admission Date:  [**2124-6-29**]              Discharge Date:   [**2124-7-1**]

Date of Birth:  [**2064-3-13**]             Sex:   M

Service: MEDICINE

Allergies:
Hydrochlorothiazide / Demerol / Ambien

Attending:[**First Name3 (LF) 1436**]
Chief Complaint:
CC: SOB

Major Surgical or Invasive Procedure:
Intubation

History of Present Illness:
.
58 M with CAD s/p CABG, CHF EF 20%, s/p BiV/ICD, OSA, DM2, htn
presents with SOB. The pt developed a relatively sudden onset of
SOB while sleeping. The family called EMS(arrived 0400 on [**6-29**])
who found the pt acutely SOB, using accessory muscles, vitals
were p 100 bp 220/110 rr 24 83% RA. He was given [**Month/Year (2) **] 100 IV
and ntg SL x3. Of note, the pt denies any chest pain, no fevers,
chills or coughing.
  On arrival to OSH, remained SOB with sats in 80s on NRB and
was intubated nasotracheally since he was a difficult
intubation. bp was better controlled to 150/90, he was breifly
on nitro gtt which was stopped when he was becoming hypotensive.
The pt was then transferred to [**Hospital1 18**] for further management.
.
Allergies: demerol, hctz, ambien, aldactone, strawberries.
.
ECG: regular paced rhythm at 64, QT wnl, no over signs of
ischemia
.
CXR at [**Hospital1 18**]:
1.  Satisfactory endotracheal tube position.
2.  Mild cardiac decompensation with small bilateral pleural
effusions, but no
pulmonary edema.
.

Past Medical History:
PMHx:
1.  CAD, s/p recent CABG as above; TTE [**3-5**] showing dilated
LA/LAV, 1+ MR, EF=20-30%, with BiV pacer for ventricular
arrhythmias
2.  Prostatitis
3.  Melanoma s/p excisions
4.  DM x 2 years
5.  Recurrent PNA
6.  GERD
7.  gout
8.  Sleep apnea
9.  s/p hemorrhoidectomy
10.  bilateral Iliac artery anneurysm s/p repair
11.  Hypertensive cardiomyopathy
12.  Hypercholesterolemia
13.  Cervical radiculopathy

Echo [**2123-4-13**]:
LV EF severely depressed, severely dilated, global HK
TR gradient 31, mild RV free wall HK
1+MR, Tr AR
.
Stress [**2123-6-9**]:
no anginal sx with uninterpretable ECG
.
Cath [**2123-4-12**]:
1. Three vessel coronary artery disease.
2. Patent LIMA to LAD.
3. Three patent vein grafts.
4. Marked elevation of right and left heart filling pressures
and
moderate pulmonary hypertension.


Social History:
Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption.

Family History:
Father with MI in 50s

Physical Exam:
p62 bp 144/72 18 96% on CPAP 50%
Gen: nasotracheally intubated, though awakem alert, in no resp
distress on PSV
HEENT: PERRL, OP clear
Lungs: crackes at bases, mostly clear
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs, no masses
Extr: trace edema, DP 2+ bilat


Pertinent Results:
[**2124-6-29**] WBC-9.7# RBC-5.47# Hgb-14.5# Hct-44.6# Plt Ct-189
[**2124-6-29**] PT-11.9 PTT-21.2* INR(PT)-1.0
[**2124-6-29**] Glucose-186* UreaN-30* Creat-2.1* Na-143 K-5.4* Cl-105
HCO3-25 AnGap-18
[**2124-6-29**] Type-[**Last Name (un) **] Rates-/18 PEEP-10 FiO2-50 pO2-70* pCO2-55*
pH-7.29* calTCO2-28 Base XS-0 Intubat-INTUBATED

Brief Hospital Course:
Mr. [**Known lastname **] is a 58yo M well known to Dr. [**Last Name (STitle) **], with CAD s/p
CABG, CHF EF 20%, s/p BiV/ICD, OSA, DM2, obesity and htn
presents with acute SOB requiring intubation s/s flash pulmonary
edema after missing his [**Last Name (STitle) **] dose x 2 days, with subsequent
extubation 2 hours later and 2 days of aggressive diuresis.
.
1 Resp Distress:
Given the history of CHF, acute decomensation of CHF with flash
pulmonary edema was the likely etiology. The patient can have
sudden onset respiratory decompensation s/s to both high salt
meals and/or anxiety and in this case missed his [**Last Name (STitle) **] dose for
2 days prior to onset of symptoms. Patient was extubated soon
after intubation and with diuresis, had an accelerated
resolution of his symptoms.
.
2. Cardiac
a. pump: on admission, patient was volume overloaded but is now
better maintained after diuresis. Patient should be continued on
coreg, lisinopril, aldactone, digoxin on pre-admission [**Last Name (STitle) 4319**] and
should not miss [**First Name (Titles) **] [**Last Name (Titles) 4319**].
.
b. coronaries: no evidence of active ischemia, though the
patient has a history of CAD s/p CABG. mild troponin leak to
0.06 at peak in setting of CHF likely represented demand
ischemia. There were no dynamic ECG changes.
.
c. Rhythm: Mr. [**Known lastname **] is s/p BiV/ICD, with stable rhythm.
Appears AS-VP on ECG. Continue Amiodorone at pre-admission
[**Known lastname 4319**].
.
3. Dm2: Was maintained on lantus 20 [**Hospital1 **] during admission as
sugars have been in the 150-200 range. His home dose is 70 [**Hospital1 **]
and he should return to this regimen upon discharge.
.
4. CRI: Mr. [**Known lastname **] baseline Creatinine was 1.2-1.5 in [**4-5**]. He
should have his creatinine followed by his PCP and should avoid
nephrotoxic medications.
.
5. Gout: Allopurinol and colchicine were held during this
admission will being diuresed to avoid nephrotoxic medications.
Can be restarted on discharge.
.


Medications on Admission:
Coreg 12.5 mg b.i.d.
Digoxin 0.125 mg q.o.d.,
[**Month/Day (1) 11573**] 40 mg qd
Lisinopril 20 mg qd
Zetia 10 mg qd
Lantus 70U [**Hospital1 **]
Lipitor 80 mg qd
Lexapro 20 mg qd,
Folic Acid qd
Amiodarone 200 mg qd
Protonix 40 mg qd
ASA 81 mg qd
[**Doctor First Name **] 180 mg qd
Klonopin 0.5 mg up to b.i.d.

Discharge Medications:
1. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO twice a day.

2. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY
(Every Other Day).
3. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Escitalopram 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
10. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
11. Fexofenadine 60 mg Tablet Sig: Three (3) Tablet PO QDAY ().

12. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
13. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
14. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
Congestive Heart Failure

Discharge Condition:
Stable vital signs, afebrile, ambulating.

Discharge Instructions:
Please note that none of your medications have been changed
during this admission.

Please return to the hospital if you become short of breath,
experience chest pain or severe headache. Please make sure to
take all of your medications, including your diuretic, [**Doctor First Name 11573**].

Please contact your primary care physician if your weight goes
up by 3 pounds, or if you notice your legs becoming swollen.

Please note that one of your lab values, the Creatinine, which
is a measure of your kidney function, was slightly elevated on
this admission. Please have your primary care physician recheck
this value within 1-2 weeks of discharge from the hospital.

Followup Instructions:
Please follow up with your cardiologist, Dr. [**Last Name (STitle) **], within 1
week of discharge.
Please follow up with your primary care physician [**Name Initial (PRE) 176**] [**1-3**]
weeks of discharge.
{'Acute respiratory failure,Unspecified hypertensive heart disease with heart failure,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Gout, unspecified,Aortocoronary bypass status,Personal history of malignant melanoma of skin,Esophageal reflux,Brachial neuritis or radiculitis NOS,Other chronic pulmonary heart diseases'}


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: SOB

PRESENT ILLNESS: .
58 M with CAD s/p CABG, CHF EF 20%, s/p BiV/ICD, OSA, DM2, htn
presents with SOB. The pt developed a relatively sudden onset of
SOB while sleeping. The family called EMS(arrived 0400 on [**6-29**])
who found the pt acutely SOB, using accessory muscles, vitals
were p 100 bp 220/110 rr 24 83% RA. He was given [**Month/Year (2) **] 100 IV
and ntg SL x3. Of note, the pt denies any chest pain, no fevers,
chills or coughing.
  On arrival to OSH, remained SOB with sats in 80s on NRB and
was intubated nasotracheally since he was a difficult
intubation. bp was better controlled to 150/90, he was breifly
on nitro gtt which was stopped when he was becoming hypotensive.
The pt was then transferred to [**Hospital1 18**] for further management.
.
Allergies: demerol, hctz, ambien, aldactone, strawberries.
.
ECG: regular paced rhythm at 64, QT wnl, no over signs of
ischemia
.
CXR at [**Hospital1 18**]:
1.  Satisfactory endotracheal tube position.
2.  Mild cardiac decompensation with small bilateral pleural
effusions, but no
pulmonary edema.
.

MEDICAL HISTORY: PMHx:
1.  CAD, s/p recent CABG as above; TTE [**3-5**] showing dilated
LA/LAV, 1+ MR, EF=20-30%, with BiV pacer for ventricular
arrhythmias
2.  Prostatitis
3.  Melanoma s/p excisions
4.  DM x 2 years
5.  Recurrent PNA
6.  GERD
7.  gout
8.  Sleep apnea
9.  s/p hemorrhoidectomy
10.  bilateral Iliac artery anneurysm s/p repair
11.  Hypertensive cardiomyopathy
12.  Hypercholesterolemia
13.  Cervical radiculopathy

MEDICATION ON ADMISSION: Coreg 12.5 mg b.i.d.
Digoxin 0.125 mg q.o.d.,
[**Month/Day (1) 11573**] 40 mg qd
Lisinopril 20 mg qd
Zetia 10 mg qd
Lantus 70U [**Hospital1 **]
Lipitor 80 mg qd
Lexapro 20 mg qd,
Folic Acid qd
Amiodarone 200 mg qd
Protonix 40 mg qd
ASA 81 mg qd
[**Doctor First Name **] 180 mg qd
Klonopin 0.5 mg up to b.i.d.

ALLERGIES: Hydrochlorothiazide / Demerol / Ambien

PHYSICAL EXAM: p62 bp 144/72 18 96% on CPAP 50%
Gen: nasotracheally intubated, though awakem alert, in no resp
distress on PSV
HEENT: PERRL, OP clear
Lungs: crackes at bases, mostly clear
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs, no masses
Extr: trace edema, DP 2+ bilat

FAMILY HISTORY: Father with MI in 50s

SOCIAL HISTORY: Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption. 

### Response:
{'Acute respiratory failure,Unspecified hypertensive heart disease with heart failure,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Gout, unspecified,Aortocoronary bypass status,Personal history of malignant melanoma of skin,Esophageal reflux,Brachial neuritis or radiculitis NOS,Other chronic pulmonary heart diseases'}
