CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 73F h/o DM, PVD s/p bilateral BKA, ESRD and diastolic CHF with
multiple admissions for acute pulmonary edema (most recent
[**2164-1-8**]) presents with acute SOB at home today.  She reports
that at her last HD, Friday [**2164-1-20**] she didn't have
enough fluid taken off and she had progressive DOE throughout
the day warranting a call to EMS.  EMS arrived and gave her
Lasix and CPAP.  She was brought to the ED where her CXR
revealed pulmonary edema.  She remained on CPAP and was started
on a nitro gtt peripherally after failed attempts at femoral
line cannulation for CVL placement.
.
She denies CP, nausea, or diaphoresis. Noted to be in
respiratory distress on EMS arrival and placed on CPAP with sats
mid-90s.

MEDICAL HISTORY: # CKD V on hemodialysis; qMWF schedule at [**Location (un) **] [**Location (un) **]
# DM2 on insulin
# HTN
# Chronic diastolic CHF (LVEF >75%) with a history of
tachycardia-induced acute LVOT obstruction
# Hyperlipidemia
# PVD s/p bilateral BKAs (left in [**2156**]; right in [**2157**])
# Paroxysmal a-flutter s/p failed ablation with subsequent
atrial fibrillation; on warfarin
# Chronic nighttime hypoxemia on 3 L/min nc
# Secondary hyperparathyroidism
# No occlusive coronary disease on cardiac cath [**12/2162**]
# Left eye blindness
# Mild functional mitral stenosis
# GERD
# Tobacco abuse-- still smokes [**12-23**] PPD as of [**12-30**]
# h/o VRE UTI's
# H/o Tibial fracture

MEDICATION ON ADMISSION: Medications on Admission: *per [**2164-1-5**] d/c summary*
1. Valsartan 160 mg Tablet qd
2. Lisinopril 10 mg qd
3. Metoprolol Succinate 150 mg daily
4. Simvastatin 40 mg qd
5. Amiodarone 200 mg qd
6. Warfarin 2 mg Tablet(MO,WE,FR).
7. Warfarin 1 mg ([**Doctor First Name **],TU,TH,SA).
8. Pantoprazole 40 mg Tablet daily
9. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puffs q4h prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Her father died in his 90s of complications of DM2 and mother at
the age of 102 of a stroke. Patient had a sister who died in her
70s of cancer (unknown type and site) and 2 brothers that died
stroke and brain cancer. She has 7 children who are healthy. Her
family history is significant for coronary artery disease,
cancer, and diabetes.

SOCIAL HISTORY: The patient denies alcohol and IV drug use.  She states that she
smokes approximately 3 cigarettes daily and has history of ~30
pack-year.  She lives in a senior citizen center; her daughter
lives with her.
Congestive heart failure, unspecified,End stage renal disease,Urinary tract infection, site not specified,Atrial flutter,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Mitral valve disorders,Hypotension of hemodialysis,Other and unspecified hyperlipidemia,Secondary hyperparathyroidism, non-renal,Below knee amputation status,Renal dialysis status,Long-term (current) use of insulin
CHF NOS,End stage renal disease,Urin tract infection NOS,Atrial flutter,Hyp kid NOS w cr kid V,DMII wo cmp nt st uncntr,Esophageal reflux,Mitral valve disorder,Hemododialysis hypotensn,Hyperlipidemia NEC/NOS,Sec hyprprthyrd nonrenal,Status amput below knee,Renal dialysis status,Long-term use of insulin
Admission Date:  [**2164-1-22**]              Discharge Date:   [**2164-1-25**]

Date of Birth:  [**2090-1-9**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30201**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
73F h/o DM, PVD s/p bilateral BKA, ESRD and diastolic CHF with
multiple admissions for acute pulmonary edema (most recent
[**2164-1-8**]) presents with acute SOB at home today.  She reports
that at her last HD, Friday [**2164-1-20**] she didn't have
enough fluid taken off and she had progressive DOE throughout
the day warranting a call to EMS.  EMS arrived and gave her
Lasix and CPAP.  She was brought to the ED where her CXR
revealed pulmonary edema.  She remained on CPAP and was started
on a nitro gtt peripherally after failed attempts at femoral
line cannulation for CVL placement.
.
She denies CP, nausea, or diaphoresis. Noted to be in
respiratory distress on EMS arrival and placed on CPAP with sats
mid-90s.

Past Medical History:
# CKD V on hemodialysis; qMWF schedule at [**Location (un) **] [**Location (un) **]
# DM2 on insulin
# HTN
# Chronic diastolic CHF (LVEF >75%) with a history of
tachycardia-induced acute LVOT obstruction
# Hyperlipidemia
# PVD s/p bilateral BKAs (left in [**2156**]; right in [**2157**])
# Paroxysmal a-flutter s/p failed ablation with subsequent
atrial fibrillation; on warfarin
# Chronic nighttime hypoxemia on 3 L/min nc
# Secondary hyperparathyroidism
# No occlusive coronary disease on cardiac cath [**12/2162**]
# Left eye blindness
# Mild functional mitral stenosis
# GERD
# Tobacco abuse-- still smokes [**12-23**] PPD as of [**12-30**]
# h/o VRE UTI's
# H/o Tibial fracture

Social History:
The patient denies alcohol and IV drug use.  She states that she
smokes approximately 3 cigarettes daily and has history of ~30
pack-year.  She lives in a senior citizen center; her daughter
lives with her.


Family History:
Her father died in his 90s of complications of DM2 and mother at
the age of 102 of a stroke. Patient had a sister who died in her
70s of cancer (unknown type and site) and 2 brothers that died
stroke and brain cancer. She has 7 children who are healthy. Her
family history is significant for coronary artery disease,
cancer, and diabetes.

Brief Hospital Course:
# SOB: Acute on chronic, likely due to acute pulmonary edema
from volume overload and diastolic CHF in the setting of
hypertensive urgency and tachycardia with function mitral
stenosis.  BNP [**Numeric Identifier 109109**].  IN the MICU pt was weaned off of BiPAP
and nitro gtt, restarted on home BP meds.  On [**1-23**] had 1.7L taken
off at HD and was neg 4L before going to floor.  Pt with
adequate O2 sats on room air after HD on the floor and was
discharged with O2 sats around 99% on RA. She will continue on
inhalers for symptoms control at home. In order to control the
tachycardia that may have been playing a role in worsening her
diastolic CHF and symptoms she was switched to 80mg of verapamil
Q6H. To prevent hypotension her toprol was also decreased to 100
from 150mg. She was also set up to get HD an extra hour on the
weekend to prevent fluid overload on the weekends. In addition
she will take isosorbide mononitrate on Sundays to help with her
symptom control.

# Positive U/A: h/o Klebsiella UTI sensitive to CTX so was
started on CTX, received 2 doses, and then was discharged on
cefpodoxime PO. Her PCP will attempt to obtain another urine
sample to insure clearance after her 7 day course of abx.

# ESRD: Emergent HD on [**1-23**] with 1.7L fluid taken off improved
SOB. She was then continued on M/W/F HD and will have an extra
hour of HD on the weekend as above.

# PAF: Had brief episode of atrial flutter at HD with transient
hypotension to 80s, quickly returned to 120s and returned to
sinus after HD. Coumadin, beta-blocker, and amiodarone were
continued.

# DM2: Home insulin 4 NPH [**Hospital1 **] with Humalog sliding scale.

# Sub-therapeutic INR: She was restarted on coumadin at home
dosing and will be followed up by [**Hospital 191**] [**Hospital 2786**] clinic to
ensure she gets back to goal INR [**1-24**] for her afib. It was felt
that she was low enough risk to not need a heparin bridge. Given
that she will be taking antibiotics it was felt that she should
not have a bolus of coumadin and instead was continued on just
her normal dose of coumadin.

Medications on Admission:
Medications on Admission: *per [**2164-1-5**] d/c summary*
1. Valsartan 160 mg Tablet qd
2. Lisinopril 10 mg qd
3. Metoprolol Succinate 150 mg daily
4. Simvastatin 40 mg qd
5. Amiodarone 200 mg qd
6. Warfarin 2 mg Tablet(MO,WE,FR).
7. Warfarin 1 mg ([**Doctor First Name **],TU,TH,SA).
8. Pantoprazole 40 mg Tablet daily
9. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puffs q4h prn

10. Brimonidine 0.15 % Drops 1 Drop Ophthalmic [**Hospital1 **]
11. Dorzolamide-Timolol 2-0.5 % Drops Sig: (1) Drop [**Hospital1 **]
12. Folic Acid 1 mg qd
13. Latanoprost 0.005 % Drops(1) Drop Ophthalmic HS
14. Sevelamer Carbonate 800 mg PO TID
15. Calcium Acetate 667 mg PO TID
16. Aspirin 81 mg qd
17. Insulin NPH 4 U twice a day with a humalog sliding scale




Discharge Medications:
1. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
2. Verapamil 80 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
Disp:*30 Tablet(s)* Refills:*2*
3. Cefpodoxime 100 mg Tablet Sig: One (1) Tablet PO twice a day
for 6 days.
Disp:*12 Tablet(s)* Refills:*0*
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Warfarin 2 mg Tablet Sig: One (1) Tablet PO QMOWEFR (Monday
-Wednesday-Friday).
7. Warfarin 1 mg Tablet Sig: One (1) Tablet PO QSU,TU,TH,SA ().

8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation every four (4) hours as needed for shortness of
breath or wheezing.
10. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
(at bedtime).
12. Sevelamer Carbonate 800 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
13. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
14. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Four
(4) units Subcutaneous twice a day.
15. Humalog 100 unit/mL Solution Sig: as directed per sliding
scale  Subcutaneous four times a day.
16. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
17. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
18. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
19. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*90 caps* Refills:*2*
20. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
21. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO QSUNDAY ().
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
22. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
23. Valsartan 160 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] [**Location (un) 269**]

Discharge Diagnosis:
Pulmonary edema
ESRD
UTI

Discharge Condition:
The patient was afebrile, hemodynamically stable with HR in the
70s and without urinary symptoms prior to discharge.

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1.5L

You were admitted to the hospital with fluid in your lungs. This
was probably caused by a fast heart rate. We have given you
hemodialysis to take the fluid out of your lungs. We have also
changed some of your medications to keep your heart rate lower.
Also, while you were in the hospital you had a urinary tract
infection that we are treating with antibiotics. You should
continue taking these antibiotics until you run out.

Medication Changes:
START: Cefpodoxime 100mg by mouth twice daily for 6 more days
CHANGE: Verapamil to 80mg by mouth every 8 hours
CHANGE: Toprol XL to 100my by mouth daily

Please come back to the emergency room or call your doctor if
you have light-headedness, dizziness, palpitations, chest pain,
shortness of breath, swelling of your legs, weight gain, or any
other concerning symptoms.

Followup Instructions:
Please follow up with your primary care provider, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **]
([**Telephone/Fax (1) 1300**]. She will check your urine for infection and make
sure you are taking your new medications appropriately.

Please continue hemodialysis as scheduled by your nephrologists.


Completed by:[**2164-1-25**]
{'Congestive heart failure, unspecified,End stage renal disease,Urinary tract infection, site not specified,Atrial flutter,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Mitral valve disorders,Hypotension of hemodialysis,Other and unspecified hyperlipidemia,Secondary hyperparathyroidism, non-renal,Below knee amputation status,Renal dialysis status,Long-term (current) use of insulin'}


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: 73F h/o DM, PVD s/p bilateral BKA, ESRD and diastolic CHF with
multiple admissions for acute pulmonary edema (most recent
[**2164-1-8**]) presents with acute SOB at home today.  She reports
that at her last HD, Friday [**2164-1-20**] she didn't have
enough fluid taken off and she had progressive DOE throughout
the day warranting a call to EMS.  EMS arrived and gave her
Lasix and CPAP.  She was brought to the ED where her CXR
revealed pulmonary edema.  She remained on CPAP and was started
on a nitro gtt peripherally after failed attempts at femoral
line cannulation for CVL placement.
.
She denies CP, nausea, or diaphoresis. Noted to be in
respiratory distress on EMS arrival and placed on CPAP with sats
mid-90s.

MEDICAL HISTORY: # CKD V on hemodialysis; qMWF schedule at [**Location (un) **] [**Location (un) **]
# DM2 on insulin
# HTN
# Chronic diastolic CHF (LVEF >75%) with a history of
tachycardia-induced acute LVOT obstruction
# Hyperlipidemia
# PVD s/p bilateral BKAs (left in [**2156**]; right in [**2157**])
# Paroxysmal a-flutter s/p failed ablation with subsequent
atrial fibrillation; on warfarin
# Chronic nighttime hypoxemia on 3 L/min nc
# Secondary hyperparathyroidism
# No occlusive coronary disease on cardiac cath [**12/2162**]
# Left eye blindness
# Mild functional mitral stenosis
# GERD
# Tobacco abuse-- still smokes [**12-23**] PPD as of [**12-30**]
# h/o VRE UTI's
# H/o Tibial fracture

MEDICATION ON ADMISSION: Medications on Admission: *per [**2164-1-5**] d/c summary*
1. Valsartan 160 mg Tablet qd
2. Lisinopril 10 mg qd
3. Metoprolol Succinate 150 mg daily
4. Simvastatin 40 mg qd
5. Amiodarone 200 mg qd
6. Warfarin 2 mg Tablet(MO,WE,FR).
7. Warfarin 1 mg ([**Doctor First Name **],TU,TH,SA).
8. Pantoprazole 40 mg Tablet daily
9. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puffs q4h prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Her father died in his 90s of complications of DM2 and mother at
the age of 102 of a stroke. Patient had a sister who died in her
70s of cancer (unknown type and site) and 2 brothers that died
stroke and brain cancer. She has 7 children who are healthy. Her
family history is significant for coronary artery disease,
cancer, and diabetes.

SOCIAL HISTORY: The patient denies alcohol and IV drug use.  She states that she
smokes approximately 3 cigarettes daily and has history of ~30
pack-year.  She lives in a senior citizen center; her daughter
lives with her. 

### Response:
{'Congestive heart failure, unspecified,End stage renal disease,Urinary tract infection, site not specified,Atrial flutter,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Mitral valve disorders,Hypotension of hemodialysis,Other and unspecified hyperlipidemia,Secondary hyperparathyroidism, non-renal,Below knee amputation status,Renal dialysis status,Long-term (current) use of insulin'}
