CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75 year-old
male with an extensive history of coronary artery disease
status post coronary artery bypass graft times two,
congestive heart failure, history of V fibrillation arrest in
[**2185**], status post an ICD who was transferred from [**Hospital3 38285**] after presenting complaining of being shocked
multiple times by his ICD.  The patient has multiple medical
problems, but was in his usual state of health on home O2
until earlier in [**Month (only) **] when he had an episode of shortness
of breath followed by fatigue and fever.  At that time he was
admitted to [**Location (un) **] [**Location (un) 1459**] where he spent one week for
pneumonia and atrial fibrillation.  Subsequently he was found
to have an atrial thrombus so he was not cardioverted.  In
subsequent weeks the patient had increased O2 requirement,
increased nebulizer use and lower extremity edema as well as
fatigue and was found to have decompensated congestive heart
failure.  Lasix was increased and Zaroxolyn started on
[**1-16**].  The patient slowly improved with loss of about
20 pounds and Zaroxolyn was discontinued.  Over the past
several nights the patient has had increased shortness of
breath with increased abdominal girth, increased weight,
increased lower extremity edema, plus paroxysmal nocturnal
dyspnea.  He experienced multiple ICD shocks culminating in
six or seven shocks the night prior to admission.  The
patient began to feel more increased shortness of breath on
the morning of admission and called 911 and was taken to
[**Hospital3 **].  There the patient's ICD was
interrogated and showed multiple episodes of ventricular
tachycardia, one episode of V fibrillation with 18 shocks
since [**1-19**].  He was started on a Lidocaine drip and
transferred to [**Hospital1 69**] where the
Lidocaine drip was discontinued.  The patient was started on
Amiodarone and admitted to the Coronary Care Unit.

MEDICAL HISTORY: 1.  Coronary artery disease.  History of myocardial
infarction in [**2171**].  Coronary artery bypass graft.  V
fibrillation arrest in [**2185**] and an ICD placed.
2.  Lung cancer status post lobectomy with radiation therapy
to the chest.
3.  Chronic obstructive pulmonary disease on home O2 since
[**2172**].
4.  Paroxysmal atrial fibrillation first in [**2182**] with
pneumonia.
5.  History of pneumonia times two.
6.  Bladder cancer diagnosed in [**2177**] with spread to nodes.
7.  Hypertension.
8.  History of smoking.
9.  Thrombocytopenia secondary to chemotherapy.
10.  Anemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives with his wife.  Thirty plus pack
year history of tobacco.  No drugs.  No alcohol.
Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Old myocardial infarction,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Anemia, unspecified
CHF NOS,Parox ventric tachycard,Chr airway obstruct NEC,Mitral valve disorder,Old myocardial infarct,Aortocoronary bypass,Chr ischemic hrt dis NEC,Anemia NOS
Admission Date:  [**2187-2-3**]       Discharge Date: [**2187-2-6**]

Date of Birth:   [**2111-9-19**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 75 year-old
male with an extensive history of coronary artery disease
status post coronary artery bypass graft times two,
congestive heart failure, history of V fibrillation arrest in
[**2185**], status post an ICD who was transferred from [**Hospital3 38285**] after presenting complaining of being shocked
multiple times by his ICD.  The patient has multiple medical
problems, but was in his usual state of health on home O2
until earlier in [**Month (only) **] when he had an episode of shortness
of breath followed by fatigue and fever.  At that time he was
admitted to [**Location (un) **] [**Location (un) 1459**] where he spent one week for
pneumonia and atrial fibrillation.  Subsequently he was found
to have an atrial thrombus so he was not cardioverted.  In
subsequent weeks the patient had increased O2 requirement,
increased nebulizer use and lower extremity edema as well as
fatigue and was found to have decompensated congestive heart
failure.  Lasix was increased and Zaroxolyn started on
[**1-16**].  The patient slowly improved with loss of about
20 pounds and Zaroxolyn was discontinued.  Over the past
several nights the patient has had increased shortness of
breath with increased abdominal girth, increased weight,
increased lower extremity edema, plus paroxysmal nocturnal
dyspnea.  He experienced multiple ICD shocks culminating in
six or seven shocks the night prior to admission.  The
patient began to feel more increased shortness of breath on
the morning of admission and called 911 and was taken to
[**Hospital3 **].  There the patient's ICD was
interrogated and showed multiple episodes of ventricular
tachycardia, one episode of V fibrillation with 18 shocks
since [**1-19**].  He was started on a Lidocaine drip and
transferred to [**Hospital1 69**] where the
Lidocaine drip was discontinued.  The patient was started on
Amiodarone and admitted to the Coronary Care Unit.

PAST MEDICAL HISTORY:
1.  Coronary artery disease.  History of myocardial
infarction in [**2171**].  Coronary artery bypass graft.  V
fibrillation arrest in [**2185**] and an ICD placed.
2.  Lung cancer status post lobectomy with radiation therapy
to the chest.
3.  Chronic obstructive pulmonary disease on home O2 since
[**2172**].
4.  Paroxysmal atrial fibrillation first in [**2182**] with
pneumonia.
5.  History of pneumonia times two.
6.  Bladder cancer diagnosed in [**2177**] with spread to nodes.
7.  Hypertension.
8.  History of smoking.
9.  Thrombocytopenia secondary to chemotherapy.
10.  Anemia.

ALLERGIES:  No known drug allergies.

MEDICATIONS AT HOME:
1.  Lisinopril 5 a day.
2.  Digoxin .25 once a day.
3.  Coreg 6.25 twice a day.
4.  Warfarin 3 mg four out of seven days and 1.5 mg three out
of seven days.
5.  Lasix 80 a day.
6.  K-Ciel 20 a day.
7.  Amiodarone 200 a day.
8.  Procrit 40,000 units q week.
9.  Iron.
10.  Albuterol and Atrovent nebulizers b.i.d.
11.  Sublingual nitroglycerin prn.

SOCIAL HISTORY:  He lives with his wife.  Thirty plus pack
year history of tobacco.  No drugs.  No alcohol.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs temperature
98.6.  Blood pressure 155/58.  Pulse 59.  Respiratory rate
15.  Satting 89% on 2 liters to 93% on 3 liters.  General,
obese, elderly male sitting upright, mildly tachypneic, in no
acute distress, speaking in four to five word sentences.
HEENT positive exophthalmos bilaterally.  Anicteric sclera.
Pale conjunctiva.  Pupils are equal, round and reactive to
light.  Dry mucous membranes.  Neck supple.  JVD to the angle
of the jaw.  Cardiovascular positive LV heave, regular rate
and rhythm.  Normal S1 and S2.  Positive S4.  3 out of 6
holosystolic murmur left sternal border going to the axilla.
Lungs decreased breath sounds on the left, 2/3 up on the
right crackles.  No wheezes or rhonchi.  Poor air movement
throughout.  Abdomen obese, soft, nontender, nondistended.
There is a 5 by 5 firm nontender suprapubic mass.
Extremities no clubbing, cyanosis, 1+ pitting edema
bilaterally.  Rectal normal tone.  Guaiac negative.

LABORATORY STUDIES:  Electrocardiogram V paced with fusion
beats, white blood cell count 8.9, hematocrit 31.3, platelets
134, sodium 136, potassium 3.5, BUN 22, creatinine 1.2, CK
32, troponin .04.  Chest x-ray cardiomegaly with a left
pleural effusion, questionable left lower lobe opacity versus
atelectasis.

HOSPITAL COURSE:  1.  Cardiovascular:  A:  Rhythm, patient
with recurrent ventricular tachycardia and one episode of V
fibrillation with recurrent ICD firings.  The patient was
seen by EP to change the lower pace rate increasing it to 80
as well as programming the ATP therapy for ventricular
tachycardia.  The patient was loaded on Amiodarone.  Digoxin
was held.  Warfarin was held for possible EP study.  The
patient was diuresed aggressively with intravenous Lasix and
Zaroxolyn.  It was felt that the patient's ventricular
rhythms were likely secondary to decompensated heart failure
rather then active ischemia.  After the adjustment in the ICD
and the Amiodarone load, the patient had no further events on
telemetry.  There was consideration of placing a [**Hospital1 **] V pacer.
This decision was deferred during this hospital stay as the
patient had no further events on telemetry and there was a
question of patient's long term prognosis from his bladder
cancer.  The patient had an appointment set up to see Dr.
[**Last Name (STitle) **] in clinic in two to three weeks.

B:  Ischemia, the patient was treated with aspirin and
statin, enzymes were cycled and he ruled out for an
myocardial infarction.  An ace inhibitor and beta blocker
were slowly titrated up.

C:  Pump, the patient was in decompensated heart failure,
diuresed aggressively with Lasix.  Echocardiogram was
performed revealing an EF of 20 to 25% with 3+ mitral
regurgitation, which was increased from his prior study.
Wall motion abnormalities including inferior and
inferolateral and apical akinesis as well as septal
hypokinesis.  His LA was moderately dilated and his left
ventricular was moderately dilated.  The patient was started
on Coreg slowly titrated up as well as Captopril.  Digoxin
continued to be held at the time of this dictation.

2.  Pulmonary:  The patient with a history of chronic
obstructive pulmonary disease as well as lung cancer and the
decompensated congestive heart failure makes his hypoxia
multifactorial in origin.  The patient improved with diuresis
as well as with nebulizer treatments.  At the time of this
dictation the patient was nearing baseline, however, was
still deconditioned and requiring more O2 then in the weeks
prior to the patient's recent illnesses according to his
wife.  [**Name (NI) **] continued on Serevent and Flovent, Atrovent and
Albuterol nebulizers as well as Mucomyst nebulizers.

3.  Hematology:  The patient with a fluctuating hematocrit at
the lowest point down to 26.7 with no clear evidence of
bleeding.  The patient was guaiac negative.  He was continued
on his Epogen as well as iron, folate and B-12 were checked,
which were normal.  He was transfused 1 unit of packed red
blood cells with a goal of keeping his hematocrit greater
then 28.  The patient's Coumadin was held on admission with
the possibility of [**Hospital1 **] V pacer.  At the time of this dictation
the decision regarding his further anticoagulation is pending
on discussion with his oncologist and therefore understanding
whether or not the [**Hospital1 **] V pacer is in his future.

4.  Oncology:  Patient with bladder cancer followed at [**Hospital3 7778**] by Dr. [**Last Name (STitle) 31394**].  At the time of this dictation
attempts were being made to contact Dr. [**Last Name (STitle) 31394**] regarding
the patient's overall prognosis as this will determine his
need for placement of a [**Hospital1 **] V pacer.

5.  Renal:  The patient's creatinine bumped from 1.2 on
admission to 1.5.  This was felt likely to be secondary to
diuresis.  At this point the diuresis was slowed.

6.  Psychiatric:  Patient with multiple problems with
sundowning as he had in the past.  His wife stayed in the
room, which helped some.  He was treated with Zyprexa at
bedtime.

The remainder of this discharge summary including the
remainder of the hospital course as well as discharge
medications and follow up will be dictated at a later date in
an addendum to the summary.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Name8 (MD) 13747**]
MEDQUIST36

D:  [**2187-2-6**]  12:16
T:  [**2187-2-6**]  12:27
JOB#:  [**Job Number 41205**]


Name:  [**Known lastname 7423**], [**Known firstname **] E                   Unit No:  [**Numeric Identifier 7424**]

Admission Date:  [**2187-2-3**]     Discharge Date:  [**2187-2-10**]

Date of Birth:   [**2111-9-19**]     Sex:  M

Service:

ADDENDUM:

The patient remained in house because of decompensated
congestive heart failure.  The congestive heart failure
service was consulted and recommended him changing to
intravenous diuretics from which he diuresed effectively.  He
was down to his dry weight, which was thought to be
approximately 210 to 215 pounds.  At that point it was
thought because of his contraction alkalosis he should be
changed from Metolazone to Diamox.  This seemed to work
effectively.  His ace inhibitor was also titrated up to
assist in diuresis.  Of note, the patient was slightly
somnolent during hospitalization.  His Zyprexa was weaned and
then discontinued which resulted in improvement of his mental
status.  He was restarted on his Coumadin for paroxysmal
atrial fibrillation.  His creatinine was 1.4 upon discharge.
His baseline was 1.0.  It had been stable at 1.4.  It was
thought this was secondary to the diuresis and would likely
resolve with equilibration.  His contraction alkalosis
improved prior to discharge with his last bicarbonate being
36.  He was starting standing potassium repletion and was
discharged home with home physical therapy as well as VNA
nursing with close follow-up of his magnesium, potassium and
INR.

MEDICATIONS ON DISCHARGE:
1.  Lisinopril 7.5 mg p.o. once daily.
2.  Acetazolamide 250 mg p.o. q12hours.
3.  Lasix 60 mg p.o. twice a day.
4.  Warfarin 1.5 mg p.o. once daily.  This is to be
alternated with 3 mg p.o. once daily.
5.  Amiodarone 400 mg p.o. once daily.
6.  Albuterol and Atrovent inhalers.
7.  Carvedilol 6.25 mg p.o. twice a day.
8.  Epogen 400 units subcutaneously q.week.
9.  Flovent two puffs twice a day.
10. Aspirin 81 mg p.o. once daily.
11. Colace.
12. Iron 325 mg p.o. once daily.
13. Multivitamin.
14. Serevent inhaler.
15. Atorvastatin 10 mg p.o. once daily.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 297**], M.D.  [**MD Number(1) 298**]

Dictated By:[**Last Name (NamePattern4) 2694**]

MEDQUIST36

D:  [**2187-2-10**]  12:43
T:  [**2187-2-10**]  13:59
JOB#:  [**Job Number 7425**]

cc:[**Numeric Identifier 7426**]
     [**Known firstname **] [**Known lastname **]
     [**Female First Name (un) 7427**]
     [**Location (un) 7428**], [**Numeric Identifier 7429**]
{'Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Old myocardial infarction,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Anemia, unspecified'}


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 75 year-old
male with an extensive history of coronary artery disease
status post coronary artery bypass graft times two,
congestive heart failure, history of V fibrillation arrest in
[**2185**], status post an ICD who was transferred from [**Hospital3 38285**] after presenting complaining of being shocked
multiple times by his ICD.  The patient has multiple medical
problems, but was in his usual state of health on home O2
until earlier in [**Month (only) **] when he had an episode of shortness
of breath followed by fatigue and fever.  At that time he was
admitted to [**Location (un) **] [**Location (un) 1459**] where he spent one week for
pneumonia and atrial fibrillation.  Subsequently he was found
to have an atrial thrombus so he was not cardioverted.  In
subsequent weeks the patient had increased O2 requirement,
increased nebulizer use and lower extremity edema as well as
fatigue and was found to have decompensated congestive heart
failure.  Lasix was increased and Zaroxolyn started on
[**1-16**].  The patient slowly improved with loss of about
20 pounds and Zaroxolyn was discontinued.  Over the past
several nights the patient has had increased shortness of
breath with increased abdominal girth, increased weight,
increased lower extremity edema, plus paroxysmal nocturnal
dyspnea.  He experienced multiple ICD shocks culminating in
six or seven shocks the night prior to admission.  The
patient began to feel more increased shortness of breath on
the morning of admission and called 911 and was taken to
[**Hospital3 **].  There the patient's ICD was
interrogated and showed multiple episodes of ventricular
tachycardia, one episode of V fibrillation with 18 shocks
since [**1-19**].  He was started on a Lidocaine drip and
transferred to [**Hospital1 69**] where the
Lidocaine drip was discontinued.  The patient was started on
Amiodarone and admitted to the Coronary Care Unit.

MEDICAL HISTORY: 1.  Coronary artery disease.  History of myocardial
infarction in [**2171**].  Coronary artery bypass graft.  V
fibrillation arrest in [**2185**] and an ICD placed.
2.  Lung cancer status post lobectomy with radiation therapy
to the chest.
3.  Chronic obstructive pulmonary disease on home O2 since
[**2172**].
4.  Paroxysmal atrial fibrillation first in [**2182**] with
pneumonia.
5.  History of pneumonia times two.
6.  Bladder cancer diagnosed in [**2177**] with spread to nodes.
7.  Hypertension.
8.  History of smoking.
9.  Thrombocytopenia secondary to chemotherapy.
10.  Anemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives with his wife.  Thirty plus pack
year history of tobacco.  No drugs.  No alcohol. 

### Response:
{'Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Old myocardial infarction,Aortocoronary bypass status,Other specified forms of chronic ischemic heart disease,Anemia, unspecified'}
