CHIEF COMPLAINT: Pericardial effusion on Echo

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 46 yo woman with a h/o DCD renal transplant [**1-16**]
IgA nephropathy in [**11-18**], dyslipidemia and bipolar disorder who
presents from clinic due to a large pericardial effusion noticed
on routine echo. Echo was first ordered one month prior to
evaluate palpitations which have since resolved.

MEDICAL HISTORY: ESRD [**1-16**] IgA nephropathy s/p DCD renal transplant [**11-18**]
(Baseline Cr 1.4)
Dyslipidemia
Bipolar disorder
PTSD
Hypertension
s/p fibroid surgery -[**2085**]
history of AV fistulas x2
s/p Cesarean section

MEDICATION ON ADMISSION: Mycophenolate Mofetil 500mg PO BID
Sirolimus 2mg PO Qday
Amlodipine 5mg PO Qday
Metoprolol Succinate 100mg PO Daily
Calcium/Vitamin D 500
Risperdal 3mg PO Qday
Benztropine 1mg PO Qday
Trimethroprim-Sulfamethoxazole 400/80 PO Qday

ALLERGIES: Amoxicillin

PHYSICAL EXAM: VS: T 97.3F BP 134/63mmHg HR 60 bpm RR 18 98%@RA
Gen: Obese female in no acute distress
HEENT: CN II-XII. No thyromegaly. No JVD
CV: S1 + S2 obscured by a murmur vs. rub throughout the cardiac
cycle.
Pulm: B CTA
Abd: Soft, NTND. No HSM or tenderness. No hepatojugular reflux
appreciated.
Ext: 1+ edema in LE, 2+ DP. Pulsus~8-9mmHg

FAMILY HISTORY: Patient's daughter explains that the patient lost nearly her
whole family in a war in [**Country **] as a child and has no details
regarding family history of illnesses/cancers.

SOCIAL HISTORY: The patient is of Cambodian origin. She lives with her husband
and daughter in [**Name (NI) **], [**Name (NI) **]. She denies tobacco, alcohol or drug
use. Her only recent travel to upstate [**State 531**].
Unspecified disease of pericardium,Peripheral vascular complications, not elsewhere classified,Kidney replaced by transplant,Syncope and collapse,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Bipolar disorder, unspecified,Posttraumatic stress disorder,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Pericardial disease NOS,Surg comp-peri vasc syst,Kidney transplant status,Syncope and collapse,Hypertension NOS,Hyperlipidemia NEC/NOS,Iatrogenc hypotnsion NEC,Cardiac dysrhythmias NEC,Bipolar disorder NOS,Posttraumatic stress dis,Abn react-cardiac cath
Admission Date:  [**2112-9-22**]              Discharge Date:   [**2112-9-26**]

Date of Birth:  [**2066-1-17**]             Sex:   F

Service: MEDICINE

Allergies:
Amoxicillin

Attending:[**First Name3 (LF) 2698**]
Chief Complaint:
Pericardial effusion on Echo

Major Surgical or Invasive Procedure:
Pericardiocentesis with serosanguinous fluid

History of Present Illness:
Mrs. [**Known lastname **] is a 46 yo woman with a h/o DCD renal transplant [**1-16**]
IgA nephropathy in [**11-18**], dyslipidemia and bipolar disorder who
presents from clinic due to a large pericardial effusion noticed
on routine echo. Echo was first ordered one month prior to
evaluate palpitations which have since resolved.

The patient reports dyspnea on exertion over the past month that
has actually improved with exercise. She denies chest pain,
weight loss, fevers, night sweats. She is at her baseline level
of energy/fatigue. Her leg edema has improved over the past
month.

Per the patient's daughter, the patient has a history of a
positive PPD with 9 months of INH therapy pre-transplant with a
Dr. [**First Name (STitle) 116**] in [**Location (un) **], Ma. The patient has also recently travelled to
upstate [**State 531**], although she denies any outside time. She
reports no joint pain or rashes. She has also been present in a
[**Age over 90 **]-year-old home that is being renovated.

ROS: Otherwise negative for lightheadedness, changes in urine or
stool, sick contacts or other exposures.


Past Medical History:
ESRD [**1-16**] IgA nephropathy s/p DCD renal transplant [**11-18**]
(Baseline Cr 1.4)
Dyslipidemia
Bipolar disorder
PTSD
Hypertension
s/p fibroid surgery -[**2085**]
history of AV fistulas x2
s/p Cesarean section

Social History:
The patient is of Cambodian origin. She lives with her husband
and daughter in [**Name (NI) **], [**Name (NI) **]. She denies tobacco, alcohol or drug
use. Her only recent travel to upstate [**State 531**].

Family History:
Patient's daughter explains that the patient lost nearly her
whole family in a war in [**Country **] as a child and has no details
regarding family history of illnesses/cancers.

Physical Exam:
VS: T 97.3F BP 134/63mmHg HR 60 bpm RR 18 98%@RA
Gen: Obese female in no acute distress
HEENT: CN II-XII. No thyromegaly. No JVD
CV: S1 + S2 obscured by a murmur vs. rub throughout the cardiac
cycle.
Pulm: B CTA
Abd: Soft, NTND. No HSM or tenderness. No hepatojugular reflux
appreciated.
Ext: 1+ edema in LE, 2+ DP. Pulsus~8-9mmHg


Pertinent Results:
[**2112-9-22**] ADMISSION EKG: rate 60, NSR, normal axis, with biphasic
T-waves in V2, no other ST changes

[**2112-9-22**] CXR PA and Lateral: marked enlargement of the cardiac
silhouette in the absence of significant congestion or pneumonic
infiltrate. The finding is compatible with chronic pericardial
effusion.

[**2112-9-22**] 2D-ECHOCARDIOGRAM / Pre-cath prior to drainage
demonstrated the following: The left atrium is normal in size.
No atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF 60%). There is no ventricular
septal defect. Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
regurgitation. The mitral valve leaflets are structurally
normal. There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is seen. There is mild pulmonary artery systolic
hypertension. There is a moderate to large sized pericardial
effusion. The effusion appears circumferential. There are no
echocardiographic signs of tamponade. No right atrial or right
ventricular diastolic collapse is seen.

[**2112-9-23**] 2D-ECHOCARDIOGRAM in cath lab after drainage of 400cc
fluid: left ventricular cavity is unusually small. Left
ventricular systolic function is hyperdynamic (EF>75%). There is
a moderate to large sized pericardial effusion. The effusion
appears circumferential. The effusion is echo dense, consistent
with blood, inflammation or other cellular elements.Compared
with the findings of the prior study (images reviewed) of [**2112-9-22**], the size of the pericardial effusion is similar.
No echocardiographic evidence of cardiac tamponade is present.

[**6-/2109**] STRESS MIBI: Normal myocardial perfusion study at the
level of stress achieved, ejection fraction is 69%

Discharge Labs:
[**2112-9-26**] 05:25AM BLOOD WBC-4.7 RBC-3.99* Hgb-10.3* Hct-31.5*
MCV-79* MCH-25.7* MCHC-32.6 RDW-12.9 Plt Ct-172
[**2112-9-26**] 05:25AM BLOOD Glucose-108* UreaN-23* Creat-1.6* Na-140
K-4.0 Cl-108 HCO3-24 AnGap-12
[**2112-9-22**] 05:45PM BLOOD C3-143 C4-37
[**2112-9-22**] 05:45PM BLOOD TSH-5.0*
[**2112-9-24**] 05:26AM BLOOD Anti-Tg-PND
[**2112-9-23**] 11:47AM BLOOD dsDNA-PND
[**2112-9-25**] 06:12AM BLOOD Triglyc-60 HDL-64 CHOL/HD-2.3 LDLcalc-72
[**2112-9-23**] 01:15PM OTHER BODY FLUID WBC-[**2103**]* RBC-[**Numeric Identifier 46304**]*
Polys-56* Bands-4* Lymphs-38* Monos-2*
[**2112-9-23**] 01:15PM OTHER BODY FLUID TotProt-5.6 Glucose-107
LD(LDH)-187 Amylase-108 Albumin-3.7
[**2112-9-23**] 01:15PM OTHER BODY FLUID ADENOSINE DEAMINASE, FLUID-PND

Brief Hospital Course:
In summary, the patient is a 46-year-old cambodian speaking
female who presented to her nephrologist complaining of 1 month
of intermittent palpitation episodes and worsening shortness of
breath with exertion. On further workup she was found to have
a moderate to large size pericardial effusion noted on
echocardiogram without tamponade. She was admitted for an
elective pericardial drainage on [**2112-9-23**]. She was monitored in
the CCU s/p procedure and recovered smoothly without any serious
complications.

1) Pericardial Effusion: The etiology of the effusion remains
unclear.  The patient had CT, CXR, and pericardiocentesis with
fluid analysis which did not reveal the etiology of the disease.
The differential includes TB, malignancy or idiopathic. She was
briefly transferred to the CCU post procedure where she
experienced an episode of bradycardia and hypotension which
resolved and did not return.  In addition, she briefly developed
atrial tachycardia which was controlled on metoprolol. The
patient was comfortable without signs or symptoms of effusion or
tamponade on discharge.  Her [**Doctor First Name **], dsdna and fluid cultures were
pending on discharge.  A CT showed continued effusion confirmed
as stable on follow up echocardiogram. She will continue
amlodipine and metoprolol and have a follow up echocardiogram in
1 week, followed by an appointment with Dr. [**Last Name (STitle) **] in 2 weeks.

2. Renal Transplant: The patient is status post renal transplant
for IgA Nephropathy in [**2108**].  She was continued on Mycophenolate
Mofetil and Sirolimus while admitted, with Sirolimus levels
followed.  She was also continued on Vitamin D & calcium.  Her
creatinine remained at baseline while admitted.

3. Hypertension: The patient was continued on her home dose of
Amlodipine 5mg and Toprol 100mg.

4. Bipolar disorder: The patient was continued on her home dose
Benztropine & Risperidal.

Medications on Admission:
Mycophenolate Mofetil 500mg PO BID
Sirolimus 2mg PO Qday
Amlodipine 5mg PO Qday
Metoprolol Succinate 100mg PO Daily
Calcium/Vitamin D 500
Risperdal 3mg PO Qday
Benztropine 1mg PO Qday
Trimethroprim-Sulfamethoxazole 400/80 PO Qday

Discharge Medications:
1. Mycophenolate Mofetil 500 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
2. Sirolimus 1 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
3. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Risperidone 1 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
5. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Benztropine 1 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
7. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
8. CALCIUM 500+D 500 (1,250)-200 mg-unit Tablet Sig: One (1)
Tablet PO once a day.
9. Outpatient Lab Work
Please have a CH50 drawn with results sent to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **],
[**Telephone/Fax (1) 62**]
10. Outpatient Lab Work
Please schedule an outpatient echocardiogram in 1 week,
instructions attached.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagosis:
1) Pericardial effusion

Secondary Diagnoses:
1) Renal Transplant
2) Hypertension
3) Bipolar Disorder


Discharge Condition:
Vital signs stable on room air, no discomfort.


Discharge Instructions:
You have been admitted to the hospital because of a fluid
collection that was found around your heart.  While you were
here we extracted the fluid and found that it was a mix of blood
and fluid.  We are still unsure why you have an effusion but we
think you are safe to go home.

Please take all of your medicines as described.

Please schedule an echocardiogram in 1 week and make all doctors
[**Name5 (PTitle) 4314**].

If you should feel short of breath or have chest pain (or any
other concerning medical symptom), please call your doctor or
911 to return to the emergency room.

Followup Instructions:
Test for consideration post-discharge: Complement CH50

Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2112-9-29**] 9:40

Please make an appointment with Dr. [**Last Name (STitle) **] within 2 weeks.
[**Telephone/Fax (1) 46305**].

Please schedule an Echocardiogram in 1 week.  The order &
instructions are attached to these instructions.

Please Call [**Telephone/Fax (1) 62**] to make an appointment to follow up
with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in 2 weeks.
{'Unspecified disease of pericardium,Peripheral vascular complications, not elsewhere classified,Kidney replaced by transplant,Syncope and collapse,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Bipolar disorder, unspecified,Posttraumatic stress disorder,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: Pericardial effusion on Echo

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 46 yo woman with a h/o DCD renal transplant [**1-16**]
IgA nephropathy in [**11-18**], dyslipidemia and bipolar disorder who
presents from clinic due to a large pericardial effusion noticed
on routine echo. Echo was first ordered one month prior to
evaluate palpitations which have since resolved.

MEDICAL HISTORY: ESRD [**1-16**] IgA nephropathy s/p DCD renal transplant [**11-18**]
(Baseline Cr 1.4)
Dyslipidemia
Bipolar disorder
PTSD
Hypertension
s/p fibroid surgery -[**2085**]
history of AV fistulas x2
s/p Cesarean section

MEDICATION ON ADMISSION: Mycophenolate Mofetil 500mg PO BID
Sirolimus 2mg PO Qday
Amlodipine 5mg PO Qday
Metoprolol Succinate 100mg PO Daily
Calcium/Vitamin D 500
Risperdal 3mg PO Qday
Benztropine 1mg PO Qday
Trimethroprim-Sulfamethoxazole 400/80 PO Qday

ALLERGIES: Amoxicillin

PHYSICAL EXAM: VS: T 97.3F BP 134/63mmHg HR 60 bpm RR 18 98%@RA
Gen: Obese female in no acute distress
HEENT: CN II-XII. No thyromegaly. No JVD
CV: S1 + S2 obscured by a murmur vs. rub throughout the cardiac
cycle.
Pulm: B CTA
Abd: Soft, NTND. No HSM or tenderness. No hepatojugular reflux
appreciated.
Ext: 1+ edema in LE, 2+ DP. Pulsus~8-9mmHg

FAMILY HISTORY: Patient's daughter explains that the patient lost nearly her
whole family in a war in [**Country **] as a child and has no details
regarding family history of illnesses/cancers.

SOCIAL HISTORY: The patient is of Cambodian origin. She lives with her husband
and daughter in [**Name (NI) **], [**Name (NI) **]. She denies tobacco, alcohol or drug
use. Her only recent travel to upstate [**State 531**]. 

### Response:
{'Unspecified disease of pericardium,Peripheral vascular complications, not elsewhere classified,Kidney replaced by transplant,Syncope and collapse,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Bipolar disorder, unspecified,Posttraumatic stress disorder,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
