CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 60 year old
white female with a history of bronchospasm, chronic
obstructive pulmonary disease, hypertension, and congestive
heart failure with a left ventricular ejection fraction of
60% to 70% in [**2167-8-30**], who presents with shortness of
breath with productive cough and increased lower extremity
edema.

MEDICAL HISTORY: 1.  Bronchospasm.  2.  Chronic
obstructive pulmonary disease with pulmonary function test on
[**2167-4-6**] showing FVC 1.51/2.66 giving  57% of predicted,
FEV1 0.74/1.94 given 38% of predicted, FEV1FVC 49/73 giving
60% predicted with no response to bronchodilators.  3.
Hypertension.  4.  Congestive heart failure, [**2167-9-3**] transesophageal echocardiogram revealing a left
ventricular ejection fraction of 60% to 70%, right and left
atrial dilation, right ventricular hypertrophy, global
hypokinesis, 1 to 2+ aortic regurgitation and 2+ tricuspid
regurgitation, no pericardial effusion at the time.  5.
Anxiety.  6.  Depression.  7.  Hiatal hernia.  8.
Glaucoma/cataracts.  9.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: Celexa 20 mg p.o.q.d., Remeron 30
mg p.o.q.d., Proventil meter dose inhaler, Zantac 150 mg
p.o.b.i.d., aspirin, Lasix 40 mg p.o.q.d. and Prednisone 16
mg taper which ended one day prior to admission.

ALLERGIES: Tiazac and E-Vista.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives at home alone.  She denies
any alcohol or illicit drug use, however, she still smokes
one pack per day with a 50 pack year history.
Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Acute respiratory failure,Hyposmolality and/or hyponatremia,Acute myocardial infarction of other anterior wall, initial episode of care,Tobacco use disorder,Unspecified essential hypertension,Delirium due to conditions classified elsewhere
Obs chr bronc w(ac) exac,CHF NOS,Acute respiratry failure,Hyposmolality,AMI anterior wall, init,Tobacco use disorder,Hypertension NOS,Delirium d/t other cond
Admission Date:  [**2167-9-18**]       Discharge Date:  [**2167-9-24**]

Date of Birth:   [**2106-12-16**]       Sex:  F

Service:  MICU

HISTORY OF PRESENT ILLNESS:  The patient is a 60 year old
white female with a history of bronchospasm, chronic
obstructive pulmonary disease, hypertension, and congestive
heart failure with a left ventricular ejection fraction of
60% to 70% in [**2167-8-30**], who presents with shortness of
breath with productive cough and increased lower extremity
edema.

The patient was recently admitted from [**9-1**]
with complaints of shortness of breath, bilateral lower
extremity edema and facial edema.  Chest x-ray showed mild
congestive heart failure at that time and she was treated
with Lasix, which is new for her.  She was started on Lasix
despite the fact that her transthoracic echocardiogram
revealed a left ventricular ejection fraction of 60% to 70%
and 1 to 2+ aortic regurgitation.  She was also given a
Prednisone taper for suspected chronic obstructive pulmonary
disease flare during that hospitalization, and this taper
ended on [**2167-9-17**].

Since discharge on [**2167-9-3**], the patient did well
for the first week, however, four days prior to admission,
she called her primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], with
complaints of increased bilateral lower extremities edema
because she had stopped her Lasix secondary to excessive
urination.  Dr. [**Last Name (STitle) **] told the patient to restart her Lasix.

One day prior to admission, the patient [**Doctor First Name **] to Dr. [**Last Name (STitle) 109316**]
office with increased bilateral lower edema, a mild
productive cough and shortness of breath.  She was started on
two liters of home oxygen on the day prior to admission.  The
patient then returned to her primary care physician on the
day of admission looking pale off of her oxygen.  Her oxygen
saturation was 60% in room air and 88% on two liters of
oxygen.

The patient was sent to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **],
where her blood pressure was 159/79, heart rate 83,
respiratory rate 18 and oxygen saturation 94% on four liters.
Arterial blood gases were done and revealed a pH of 7.29,
pCO2 84 and pO2 30.  Since the patient was somnolent, she was
started on BIPAP 5/5/35% FiO2.  Her oxygen saturation was 98%
with the BIPAP.  Chemistries showed a sodium of 117 and CPK
of 175 with an MB of 25 and troponin of less than 0.3.  The
patient was initially started on intravenous Solu-Medrol 80
mg three times a day and nebulizers.  She was electively
intubated for hypercarbic respiratory failure.

ALLERGIES:  Tiazac and E-Vista.

MEDICATIONS ON ADMISSION:  Celexa 20 mg p.o.q.d., Remeron 30
mg p.o.q.d., Proventil meter dose inhaler, Zantac 150 mg
p.o.b.i.d., aspirin, Lasix 40 mg p.o.q.d. and Prednisone 16
mg taper which ended one day prior to admission.

PAST MEDICAL HISTORY:  1.  Bronchospasm.  2.  Chronic
obstructive pulmonary disease with pulmonary function test on
[**2167-4-6**] showing FVC 1.51/2.66 giving  57% of predicted,
FEV1 0.74/1.94 given 38% of predicted, FEV1FVC 49/73 giving
60% predicted with no response to bronchodilators.  3.
Hypertension.  4.  Congestive heart failure, [**2167-9-3**] transesophageal echocardiogram revealing a left
ventricular ejection fraction of 60% to 70%, right and left
atrial dilation, right ventricular hypertrophy, global
hypokinesis, 1 to 2+ aortic regurgitation and 2+ tricuspid
regurgitation, no pericardial effusion at the time.  5.
Anxiety.  6.  Depression.  7.  Hiatal hernia.  8.
Glaucoma/cataracts.  9.  Gastroesophageal reflux disease.

SOCIAL HISTORY:  The patient lives at home alone.  She denies
any alcohol or illicit drug use, however, she still smokes
one pack per day with a 50 pack year history.

PHYSICAL EXAMINATION:  On physical examination on admission,
the patient had a temperature of 97.1, blood pressure 116/63,
pulse 72, respiratory rate 20 and oxygen saturation 98% on
BIPAP 5/5/35%.  General:  Very drowsy and barely arousable
female, not tachypneic or using respiratory muscles.  Head,
eyes, ears, nose and throat:  Pupils equal, round, and
reactive to light, oropharynx moist, BIPAP mask on, prominent
external jugular vein with mild jugular venous pressure.
Cardiovascular:  Regular rate and rhythm, normal S1 and S2,
hard to appreciate secondary to BIPAP.  Lungs:  Poor air
movement bilaterally with occasional bilateral wheezes,
coarse crackles in bases bilaterally one-third up.  Abdomen:
Soft, nontender, obese, positive bowel sounds.  Extremities:
Bilateral lower extremity edema, right greater than left.

LABORATORY DATA:  Admission white blood cell count was 9.8,
hemoglobin 14.8, hematocrit 44.3, platelet count 299,000,
differential with 84% neutrophils, 2% bands, 10% lymphocytes
and 4% monocytes, sodium 117, potassium 4.2, chloride 74,
bicarbonate 37, BUN 19, creatinine 0.6, glucose 106, anion
gap 18, ALT 32, AST 34, alkaline phosphatase 103, total
bilirubin 0.4, albumin 3.9, CK 174, CK/MB 25, index 14.4,
troponin less than 0.3 and TSH 0.61.

Electrocardiogram:  Normal sinus rhythm at 57 beats per
minute, normal axis and intervals, biphasic T waves in V2,
otherwise no other acute ST-T changes.  Chest x-ray:
Possible mild congestive heart failure with no signs of
pneumonia or effusion, breast tissue attenuation with mild
bilateral atelectasis, positive chronic obstructive pulmonary
disease.  Arterial blood gases:  pH 7.29, pCO2 84, pO2 30; pH
7.34, pCO2 68, pO2 73.

HOSPITAL COURSE:  1.  Respiratory:  (a)  Hypercarbic
respiratory failure.  The patient was initially continued on
pressure of [**2100-5-2**]%.  An arterial line was put in and she was
continued on intravenous Solu-Medrol 80 mg every eight hours.
She was also given albuterol/Atrovent nebulizers every one to
two hours.  Since she was on the Solu-Medrol, the patient was
put on a regular insulin sliding scale and intravenous
Protonix 40 mg daily.  Sputum cultures were sent for Gram
stain also.  The patient was sedated with Ativan and fentanyl
since she was intubated.

The patient was then switched over to SIMV with pressure
support of 550 times 10 for respiratory rate, 5 of pressure
support and 5 of PEEP with an FiO2 of 40%.  The patient was
then weaned off to just pressure support and eventually
extubated.  She did quite well and her intravenous
Solu-Medrol was weaned down to 40 mg daily and then switched
over to oral Prednisone 60 mg daily.  During the
hospitalization, the patient was continued on her respiratory
therapy, nebulizers and worked with the nurses in getting out
of bed.

(b)  Tracheobronchitis:  The patient did show signs of
tracheobronchitis with initial sputum production.  Sputum
Gram stain did show gram positive cocci so the patient was
put on intravenous Levaquin 500 mg daily.  Upon discharge,
she completed six out of a ten day course for her
tracheobronchitis.  The patient is to finish the last of her
course at rehabilitation.

2.  Cardiovascular:  The patient was cycled on her cardiac
enzymes.  The patient was initially put on heparin but that
was discontinued after her cycled CKs turned out to be
normal.  The patient was then just put on aspirin 325 mg
daily.  Since the patient was self-diuresing herself quite
well, she was not given any Lasix and ended up being minus
four liters over the course of the hospitalization.  She did
not become symptomatic for her congestive heart failure.

The patient had episodes of bradycardia early in the
hospitalization, so her Haldol was discontinued because her
electrocardiogram showed some prolonged QT that may be
secondary to the Haldol.  The patient also developed
tachycardia during the hospitalization.  She had one or two
episodes where she would have 12 to 16 beats of
supraventricular tachycardia.  Her electrolytes at the time
revealed a potassium a bit low at 3, but then that was
replenished.  Her cardiac enzymes were cycled a second time
and were found to be negative once again.

During times of her bradycardia and tachycardia, the patient
also showed some new electrocardiographic changes.  During
the bradycardia, the patient had developed some new biphasic
T waves in V2 and V3,  During the tachycardia, she developed
biphasic T waves in II and III.  Again, her cardiac enzymes
were normal, so nothing was done.  It is believed that her
hypoxia may be contributing to the slight ischemic changes on
electrocardiogram.

3.  Endocrine:  The patient had hyponatremia which may be
secondary to dehydration or her congestive heart failure.
She was initially given one liter of normal saline slowly so
that she is not depleting more than 0.5 mEq per hour.  Her
sodium was then corrected back to baseline.

4.  Gastrointestinal:  The patient did develop some positive
gastric occult tests while on the high dose of Solu-Medrol.
Her Protonix was increased from 40 mg daily to twice a day,
however, her hematocrit remained stable at around 39 to 40.
It was recommended that an esophagogastroduodenoscopy may be
done on an outpatient basis; we did not do one at this time
because of her stable hematocrit.

5.  Neurologic:  (a)  Change in mental status:  The patient's
change in mental status may be due to many factors.  It may
be due to steroid psychosis, hyponatremia, stroke, hypoxia,
nicotine withdrawal and/or alcohol withdrawal.  To address
these issues, we corrected her hyponatremia and hypoxia.  Her
steroids were tapered.  She was given a 21 mg patch of
nicotine each day and given Ativan as needed for any alcohol
withdrawal signs.  Also, she was sent for a CT scan of the
head, which showed no new bleeds or mass.

(b) Alcohol use:  The patient was checked for B12 and folate
levels, which were normal.  She was also given B12, folate
and thiamine.  Her primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], [**First Name3 (LF) **]
check into her drinking history.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  To rehabilitation.

DISCHARGE DIAGNOSES:
1.  Hypercarbic respiratory failure secondary to chronic
obstructive pulmonary disease.
2.  Tracheobronchitis.
3.  Congestive heart failure.
4.  Hyponatremia.
5.  Change in mental status.

DISCHARGE MEDICATIONS:
Celexa 20 mg p.o.q.d.
Remeron 30 mg p.o.q.d.
Prevacid 30 mg p.o.q.d.
Aspirin 325 mg p.o.q.d.
Proventil meter dose inhaler two puffs q.i.d.
Levaquin 500 mg p.o.q.d. times four days.
Lasix 40 mg p.o.q.d.
Prednisone 40 mg p.o.q.d.




                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3795**]

Dictated By:[**Last Name (NamePattern4) 93107**]
MEDQUIST36

D:  [**2167-9-24**]  13:13
T:  [**2167-9-24**]  13:28
JOB#:  [**Job Number **]


Admission Date:  [**2167-9-18**]       Discharge Date:  [**2167-9-24**]

Date of Birth:   [**2106-12-16**]       Sex:  F

Service:  MED ICU

HISTORY OF PRESENT ILLNESS:  This is a 60 year old white
female with a history of bronchospasm, chronic obstructive
pulmonary disease, hypertension, and congestive heart failure
(ejection fraction of 60 to 70% on [**2167-8-30**]) who
presents with shortness of breath with productive cough and
lower extremity edema.  The patient was recently admitted
from [**9-1**] until [**2167-9-3**], with complaints of shortness of
breath and bilateral lower extremity edema, and facial edema.
Chest x-ray showed mild congestive heart failure at that
time.  She was treated with Lasix which is new for her
congestive heart failure, even though the ejection fraction
was 60 to 70% by transthoracic echocardiogram.  She was also
given a Prednisone taper for suspected chronic obstructive
pulmonary disease flare which ended on [**2167-9-17**].

Since discharge on [**2167-9-3**], the patient did fine for the
first week, however, four days prior to admission, the
patient called her primary care provided, Dr. [**Last Name (STitle) **], with
increased bilateral lower extremity edema because she had
stopped her Lasix secondary to excessive urination.  The
patient was told to restart the Lasix.  One day prior to
admission, the patient came in to the primary care provider's
office with an increased lower extremity edema and mild
productive cough.  She also complained of shortness of breath
without fevers or chills.  She was started on two liters of
home O2 one day prior to admission and then returned to her
primary care provider on day of admission looking pale, off
her oxygen.  Her saturation was 60% on room air and 88% on
two liters of oxygen by nasal cannula.

She was sent to the [**Hospital1 69**]
Emergency Department where her blood pressure was 108/60 and
heart rate of 90.  Her respiratory rate at that time was 32
and she was saturating at 90% on ten liters and
non-rebreather.  An arterial blood gas revealed a pH of 7.29,
CO2 of 84 and pO2 of 30.  Since she was somnolent, she was
started on Bi-PAP 5/5/35% FIO2 with oxygen saturation at 98%.
Chemistries in the Emergency Department revealed a sodium of
117.  CPK was 175 with MB of 25.  The troponin was less than
0.3.

The patient was started on



dictation ended abruptly


                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3795**]

Dictated By:[**Last Name (NamePattern1) 4270**]
MEDQUIST36

D:  [**2167-9-24**]  12:52
T:  [**2167-9-24**]  13:24
JOB#:  [**Job Number 109315**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Acute respiratory failure,Hyposmolality and/or hyponatremia,Acute myocardial infarction of other anterior wall, initial episode of care,Tobacco use disorder,Unspecified essential hypertension,Delirium due to conditions classified elsewhere'}


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: 

PRESENT ILLNESS: The patient is a 60 year old
white female with a history of bronchospasm, chronic
obstructive pulmonary disease, hypertension, and congestive
heart failure with a left ventricular ejection fraction of
60% to 70% in [**2167-8-30**], who presents with shortness of
breath with productive cough and increased lower extremity
edema.

MEDICAL HISTORY: 1.  Bronchospasm.  2.  Chronic
obstructive pulmonary disease with pulmonary function test on
[**2167-4-6**] showing FVC 1.51/2.66 giving  57% of predicted,
FEV1 0.74/1.94 given 38% of predicted, FEV1FVC 49/73 giving
60% predicted with no response to bronchodilators.  3.
Hypertension.  4.  Congestive heart failure, [**2167-9-3**] transesophageal echocardiogram revealing a left
ventricular ejection fraction of 60% to 70%, right and left
atrial dilation, right ventricular hypertrophy, global
hypokinesis, 1 to 2+ aortic regurgitation and 2+ tricuspid
regurgitation, no pericardial effusion at the time.  5.
Anxiety.  6.  Depression.  7.  Hiatal hernia.  8.
Glaucoma/cataracts.  9.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: Celexa 20 mg p.o.q.d., Remeron 30
mg p.o.q.d., Proventil meter dose inhaler, Zantac 150 mg
p.o.b.i.d., aspirin, Lasix 40 mg p.o.q.d. and Prednisone 16
mg taper which ended one day prior to admission.

ALLERGIES: Tiazac and E-Vista.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives at home alone.  She denies
any alcohol or illicit drug use, however, she still smokes
one pack per day with a 50 pack year history. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Acute respiratory failure,Hyposmolality and/or hyponatremia,Acute myocardial infarction of other anterior wall, initial episode of care,Tobacco use disorder,Unspecified essential hypertension,Delirium due to conditions classified elsewhere'}
