CHIEF COMPLAINT: Chest pain and dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 68192**] is a 36F with h/o autoimmune scleritis who presents
with 3 week h/o SOB and chest tightness. Ms. [**Known lastname 68192**] states that
over the past three weeks she has been experiencing progressive
SOB. She saw a NP shortly after the onset of her symptoms, who
suspected reactive airway disease, and prescribed an albuterol
inhaler and prednisone taper (60mg x 2 days, followed by
decrease of 10mg every 2 days). She states that her symptoms
improved significantly on steroids, but after the taper had
completed, began to recur. Three days PTA she developed a
nonproductive cough. The night prior to admission, Ms. [**Known lastname 68192**]
experienced worsening SOB and chest tightness. She found it
difficult to lie flat in bed, and was more comfortable sitting
up. She became nauseated and vomited NBNB emesis x 2. She went
to the ED in [**Hospital1 392**], where she was found to be tachycardic to
120s and hypotensive to 90s. Her ECG demonstrated STE in [**Last Name (LF) 1105**], [**First Name3 (LF) **]
depression in AVL, TWI in [**First Name3 (LF) 1105**] and lateral leads, and q in [**First Name3 (LF) 1105**].
Initial CEs were CK 42, tropI<0.15. A CTA was done to r/o PE and
aortic dissection, which was reportedly negative, but which
demonstrated a moderate sized pericardial effusion. She was
given 2L NS, and sent to [**Hospital1 **] ED. In the ED, she was confirmed to
be hypotensive to 90s and tachycardic to 120s. Pulsus paradoxus
10mmHg. She received an additional 2L NS, and had a stat bedside
TTE done, which demonstrated small pericardial effusion (0.6cm
anterior, 1cm posterior), with significant, accentuated
respiratory variation in mitral/tricuspid valve inflows,
consistent with impaired ventricular filling. There may have
been possible mild right ventricular diastolic indentation but
views suboptimal. She was admitted for close observation in CCU.
Immediate drainage was not thought to be indicated due to small
size of effusion. Currently, she complains of pleuritic chest
pain that was not improved by ketorolac, as well as shortness of
breath.
.
ROS: Notable for fatigue and exercise intolerance since [**1-9**].
6-pound weight gain in past year. Fever in the past 24-hours.
She also has had a chronic erythematous rash on her back for
years which waxes and wanes -- she has been told by
dermatologists that it is foliculitis. She also has occasional
rash on her nose and face that was diagnosed as rosacea. She
does have an apparent diagnosis of autoimmune scleritis,
diagnosed 6 years ago at [**Hospital 13128**]. She was treated with
MTX for 9 months, at which time she experienced apparent
MTX-associated lung toxicity, and MTX was d/c'ed. Ms. [**Known lastname 68192**] [**Last Name (Titles) 13230**]s any recent chest trauma or surgery, with no history of
XRT or malignancy. She denies any recent cold intolerance,
menstrual irregularities, changes to skin or hair, constipation
or diarrhea, arthralgias or joint effusions. Her BUN/Cr on
admission were normal at 11/0.7.

MEDICAL HISTORY: Autoimmune scleritis, as above

MEDICATION ON ADMISSION: Recent prednisone taper
Recent administration of albuterol inhaler, which she has not
used.

ALLERGIES: Methotrexate

PHYSICAL EXAM: T: BP: 95/63 HR: 114 RR: 31 SaO2: 99% 3L NC Pulsus 10mmHg
Gen: Caucasian female lying in bed, mild respiratory distress,
speaking in short sentences
HEENT: PERRL, OP pink and moist, no conjunctival injection,
sclerae anicteric
CV: Tachycardic, regular rhythm, nl S1 and S2, no m/r/g. JVP
elevated to angle of jaw.
Chest: Mild bibasilar crackles, no wheeze
Abd: Soft, NT/ND, +BS
Extr: cool, no LE edema
neuro: A&O x 3. [**12-5**]+ DTRs throughout, no obvious delayed
relaxation.
Skin: faint erythematous rash of forehead and nose,
non-blanching. Non-blanching petechial rash of shoulders and
back.
.

FAMILY HISTORY: Thyroid disease on her mother's side

SOCIAL HISTORY: Nonsmoker, occ EtOH, no h/o IVDU. Works as a nurse primarily in
nursing homes. She and her husband have a 3 year-old daughter
Other specified diseases of pericardium,Dehydration,Other scleritis and episcleritis
Pericardial disease NEC,Dehydration,Scleritis NEC
Admission Date:  [**2119-5-19**]              Discharge Date:   [**2119-5-22**]

Date of Birth:  [**2083-1-2**]             Sex:   F

Service: MEDICINE

Allergies:
Methotrexate

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
Chest pain and dyspnea

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname 68192**] is a 36F with h/o autoimmune scleritis who presents
with 3 week h/o SOB and chest tightness. Ms. [**Known lastname 68192**] states that
over the past three weeks she has been experiencing progressive
SOB. She saw a NP shortly after the onset of her symptoms, who
suspected reactive airway disease, and prescribed an albuterol
inhaler and prednisone taper (60mg x 2 days, followed by
decrease of 10mg every 2 days). She states that her symptoms
improved significantly on steroids, but after the taper had
completed, began to recur. Three days PTA she developed a
nonproductive cough. The night prior to admission, Ms. [**Known lastname 68192**]
experienced worsening SOB and chest tightness. She found it
difficult to lie flat in bed, and was more comfortable sitting
up. She became nauseated and vomited NBNB emesis x 2. She went
to the ED in [**Hospital1 392**], where she was found to be tachycardic to
120s and hypotensive to 90s. Her ECG demonstrated STE in [**Last Name (LF) 1105**], [**First Name3 (LF) **]
depression in AVL, TWI in [**First Name3 (LF) 1105**] and lateral leads, and q in [**First Name3 (LF) 1105**].
Initial CEs were CK 42, tropI<0.15. A CTA was done to r/o PE and
aortic dissection, which was reportedly negative, but which
demonstrated a moderate sized pericardial effusion. She was
given 2L NS, and sent to [**Hospital1 **] ED. In the ED, she was confirmed to
be hypotensive to 90s and tachycardic to 120s. Pulsus paradoxus
10mmHg. She received an additional 2L NS, and had a stat bedside
TTE done, which demonstrated small pericardial effusion (0.6cm
anterior, 1cm posterior), with significant, accentuated
respiratory variation in mitral/tricuspid valve inflows,
consistent with impaired ventricular filling. There may have
been possible mild right ventricular diastolic indentation but
views suboptimal. She was admitted for close observation in CCU.
Immediate drainage was not thought to be indicated due to small
size of effusion. Currently, she complains of pleuritic chest
pain that was not improved by ketorolac, as well as shortness of
breath.
.
ROS: Notable for fatigue and exercise intolerance since [**1-9**].
6-pound weight gain in past year. Fever in the past 24-hours.
She also has had a chronic erythematous rash on her back for
years which waxes and wanes -- she has been told by
dermatologists that it is foliculitis. She also has occasional
rash on her nose and face that was diagnosed as rosacea. She
does have an apparent diagnosis of autoimmune scleritis,
diagnosed 6 years ago at [**Hospital 13128**]. She was treated with
MTX for 9 months, at which time she experienced apparent
MTX-associated lung toxicity, and MTX was d/c'ed. Ms. [**Known lastname 68192**] [**Last Name (Titles) 13230**]s any recent chest trauma or surgery, with no history of
XRT or malignancy. She denies any recent cold intolerance,
menstrual irregularities, changes to skin or hair, constipation
or diarrhea, arthralgias or joint effusions. Her BUN/Cr on
admission were normal at 11/0.7.


Past Medical History:
Autoimmune scleritis, as above

Social History:
Nonsmoker, occ EtOH, no h/o IVDU. Works as a nurse primarily in
nursing homes. She and her husband have a 3 year-old daughter

Family History:
Thyroid disease on her mother's side

Physical Exam:
T: BP: 95/63 HR: 114 RR: 31 SaO2: 99% 3L NC Pulsus 10mmHg
Gen: Caucasian female lying in bed, mild respiratory distress,
speaking in short sentences
HEENT: PERRL, OP pink and moist, no conjunctival injection,
sclerae anicteric
CV: Tachycardic, regular rhythm, nl S1 and S2, no m/r/g. JVP
elevated to angle of jaw.
Chest: Mild bibasilar crackles, no wheeze
Abd: Soft, NT/ND, +BS
Extr: cool, no LE edema
neuro: A&O x 3. [**12-5**]+ DTRs throughout, no obvious delayed
relaxation.
Skin: faint erythematous rash of forehead and nose,
non-blanching. Non-blanching petechial rash of shoulders and
back.
.


Pertinent Results:
ECG: Sinus tachycardia. Diffuse non-specific ST-T wave
abnormalities. There is slight ST segment elevations in leads
II, [**Month/Day (2) 1105**] and aVF. Active inferior ischemic process cannot be
excluded. Followup and clinical correlation are suggested. No
previous tracing available for comparison
.
[**5-19**] TTE:
Overall left ventricular systolic function is normal (LVEF>55%).
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
appears structurally normal with
trivial mitral regurgitation. There is a small pericardial
effusion. There is significant, accentuated respiratory
variation in mitral/tricuspid valve inflows, consistent with
impaired ventricular filling. There may be mild right
ventricular diastolic indentation but views suboptimal.
.
[**5-20**] TTE:
1. The left ventricular cavity size is normal. Overall left
ventricular
systolic function is normal (LVEF>55%).
2. There is a small pericardial effusion. There are probably no

echocardiographic signs of tamponade.
3. Compared with the prior study (images reviewed) of [**2119-5-19**],
there is
probably no significant change.
.
[**5-22**] TTE:
Overall left ventricular systolic function is normal (LVEF>55%).
The remaining left ventricular segments contract normally. 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 mildly thickened. Trivial mitral regurgitation is
seen. There is a trvial/small pericardial effusion. There are no
echocardiographic signs of tamponade.
Compared with the prior study (images reviewed) of [**2119-5-20**], no
change.
.
[**2119-5-19**] WBC-17.5*  Hct-32.0* MCV-85 Plt Ct-305
Neuts-91.2* Bands-0 Lymphs-6.2* Monos-2.5 Eos-0 Baso-0.1
[**2119-5-22**] WBC-6.2  Hct-27.6* MCV-85  Plt Ct-317
.
[**2119-5-21**]  PT-12.5 PTT-27.0 INR(PT)-1.1
[**2119-5-19**]  ESR-77* CRP 148.5
[**2119-5-20**] [**Doctor First Name **]-NEGATIVE  RheuFac-18*  TSH-0.90
.
[**2119-5-19**]  Glucose-149* UreaN-11 Creat-0.7 Na-138 K-4.2 Cl-104
HCO3-22
Calcium-8.3* Phos-4.8* Mg-2.1
[**2119-5-22**]  Glucose-99 UreaN-12 Creat-0.8 Na-141 K-4.0 Cl-103
HCO3-29
.
[**2119-5-19**]  ALT-95* AST-78* LD(LDH)-552* AlkPhos-172* Amylase-19
TotBili-1.1 Lipase 20
[**2119-5-21**]  ALT-47* AST-19 AlkPhos-157*
[**2119-5-19**] CK(CPK)-45, 36. TropT <0.01, <0.01
.
Iron-14 calTIBC-259* Hapto-293* Ferritn-366* TRF-199
.
[**2119-5-19**] 01:00PM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE HAV
Ab-NEGATIVE
[**2119-5-19**] 01:00PM BLOOD HCV Ab-NEGATIVE
[**Location (un) **] PCR pending at time of discharge


Brief Hospital Course:
1) Pericarditis/Pericardial Effusion: Intitial bedside TTE in ED
suggesting some evidence of minimal RV compromise; however,
effusion was only 0.6cm anterior and 1.0cm posterior, so thought
that risks of pericardiocentesis outweighed likely benefit. She
remained tachycardic to 130s and hypotensive to 90s/50s, and was
monitored very closely in CCU, given IVF overnight. The morning
after admission, pulsus noted to be 15cm, from 10cm the evening
before. Repeat TTE was done, which did not suggest worsening of
pericardial effusion. Images from OSH chest CTA reviewed, and
were negative for aortic dissection or pulmonary embolus. Her
symptoms were managed with indomethacin and colchicine, with IV
morphine for breakthrough symptoms and ativan for anxiety, which
worked effectively. Her regimen was tapered down to ibuprofen by
the time of discharge. Consideration was given to a
rheumatological cause of her effusion, ie [**1-5**] serositis from SLE
or RA. RF was mildly elevated at 18, and [**Doctor First Name **] was negative.
Rheumatology was consulted, who did not believe that her
effusion was rheumatologic in nature, as pt did not have any
other symptomatology consistent with SLE, RA or AS. They
recommended a L-S spine xray as an outpatient, given known HLA
B27 state. TSH was found to be normal, at 0.90. [**Location (un) **] PCR
was also sent, which was pending at time of discharge. She also
had a PPD placed prior to d/c to r/o TB as etiology of
pericardial effusion, as pt is a nurse who works in nursing
home. She was to have her sister or PCP read the PPD on [**5-23**].
.
2) Elevated LFTs: Ms. [**Known lastname 68192**] had mild transaminitis and
elevated alk phos and LDH at time of admission. EBV and
Hepatitis serologies were sent, which were negative. Her LFTs
all decreased steadily throughout her stay. The etiology of the
elevation is unclear, but could reflect possible congestion from
mild volume overloaded state resulting from aggressive volume
resuscitation on first presentation.

Medications on Admission:
Recent prednisone taper
Recent administration of albuterol inhaler, which she has not
used.


Discharge Medications:
1. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO three times a
day for 4 weeks: Please take with food. .
Disp:*84 Tablet(s)* Refills:*0*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain for 2 weeks: do not drive or
operate heavy machinery while taking this medication. .
Disp:*20 Tablet(s)* Refills:*0*
3. Prilosec OTC 20 mg Tablet, Delayed Release (E.C.) Sig: [**12-5**]
Tablet, Delayed Release (E.C.)s PO once a day as needed for
stomach pain for 4 weeks.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
pericarditispericardial effusion

Discharge Condition:
stable

Discharge Instructions:
If you develop worsening chest pain, shortness of breath, or
palpitations, please call your PCP or return to the ED.
Please take the ibuprofren as needed for the next few weeks as
the pericarditis is healing. Please take this with food and if
you develop stomach discomfort, you can fill the prescription
for Prilosec OTC.

Followup Instructions:
Please call your PCP and arrange [**Name Initial (PRE) **] follow up appointment in the
next few weeks. The rheumatology doctors also suggested that you
get plain films of your lumbar and sacral spine at some point in
the future to rule out ankylosing spondylitis (an autoimmune
condition).
Also, please have your PPD read by your sister or another health
care professional on [**5-23**].
{'Other specified diseases of pericardium,Dehydration,Other scleritis and episcleritis'}


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: Chest pain and dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 68192**] is a 36F with h/o autoimmune scleritis who presents
with 3 week h/o SOB and chest tightness. Ms. [**Known lastname 68192**] states that
over the past three weeks she has been experiencing progressive
SOB. She saw a NP shortly after the onset of her symptoms, who
suspected reactive airway disease, and prescribed an albuterol
inhaler and prednisone taper (60mg x 2 days, followed by
decrease of 10mg every 2 days). She states that her symptoms
improved significantly on steroids, but after the taper had
completed, began to recur. Three days PTA she developed a
nonproductive cough. The night prior to admission, Ms. [**Known lastname 68192**]
experienced worsening SOB and chest tightness. She found it
difficult to lie flat in bed, and was more comfortable sitting
up. She became nauseated and vomited NBNB emesis x 2. She went
to the ED in [**Hospital1 392**], where she was found to be tachycardic to
120s and hypotensive to 90s. Her ECG demonstrated STE in [**Last Name (LF) 1105**], [**First Name3 (LF) **]
depression in AVL, TWI in [**First Name3 (LF) 1105**] and lateral leads, and q in [**First Name3 (LF) 1105**].
Initial CEs were CK 42, tropI<0.15. A CTA was done to r/o PE and
aortic dissection, which was reportedly negative, but which
demonstrated a moderate sized pericardial effusion. She was
given 2L NS, and sent to [**Hospital1 **] ED. In the ED, she was confirmed to
be hypotensive to 90s and tachycardic to 120s. Pulsus paradoxus
10mmHg. She received an additional 2L NS, and had a stat bedside
TTE done, which demonstrated small pericardial effusion (0.6cm
anterior, 1cm posterior), with significant, accentuated
respiratory variation in mitral/tricuspid valve inflows,
consistent with impaired ventricular filling. There may have
been possible mild right ventricular diastolic indentation but
views suboptimal. She was admitted for close observation in CCU.
Immediate drainage was not thought to be indicated due to small
size of effusion. Currently, she complains of pleuritic chest
pain that was not improved by ketorolac, as well as shortness of
breath.
.
ROS: Notable for fatigue and exercise intolerance since [**1-9**].
6-pound weight gain in past year. Fever in the past 24-hours.
She also has had a chronic erythematous rash on her back for
years which waxes and wanes -- she has been told by
dermatologists that it is foliculitis. She also has occasional
rash on her nose and face that was diagnosed as rosacea. She
does have an apparent diagnosis of autoimmune scleritis,
diagnosed 6 years ago at [**Hospital 13128**]. She was treated with
MTX for 9 months, at which time she experienced apparent
MTX-associated lung toxicity, and MTX was d/c'ed. Ms. [**Known lastname 68192**] [**Last Name (Titles) 13230**]s any recent chest trauma or surgery, with no history of
XRT or malignancy. She denies any recent cold intolerance,
menstrual irregularities, changes to skin or hair, constipation
or diarrhea, arthralgias or joint effusions. Her BUN/Cr on
admission were normal at 11/0.7.

MEDICAL HISTORY: Autoimmune scleritis, as above

MEDICATION ON ADMISSION: Recent prednisone taper
Recent administration of albuterol inhaler, which she has not
used.

ALLERGIES: Methotrexate

PHYSICAL EXAM: T: BP: 95/63 HR: 114 RR: 31 SaO2: 99% 3L NC Pulsus 10mmHg
Gen: Caucasian female lying in bed, mild respiratory distress,
speaking in short sentences
HEENT: PERRL, OP pink and moist, no conjunctival injection,
sclerae anicteric
CV: Tachycardic, regular rhythm, nl S1 and S2, no m/r/g. JVP
elevated to angle of jaw.
Chest: Mild bibasilar crackles, no wheeze
Abd: Soft, NT/ND, +BS
Extr: cool, no LE edema
neuro: A&O x 3. [**12-5**]+ DTRs throughout, no obvious delayed
relaxation.
Skin: faint erythematous rash of forehead and nose,
non-blanching. Non-blanching petechial rash of shoulders and
back.
.

FAMILY HISTORY: Thyroid disease on her mother's side

SOCIAL HISTORY: Nonsmoker, occ EtOH, no h/o IVDU. Works as a nurse primarily in
nursing homes. She and her husband have a 3 year-old daughter 

### Response:
{'Other specified diseases of pericardium,Dehydration,Other scleritis and episcleritis'}
