CHIEF COMPLAINT: Respiratory distress.

PRESENT ILLNESS: This is a 75 year old woman with
a history of chronic obstructive pulmonary disease,
hypertension, supraventricular tachycardia and nonsustained
ventricular tachycardia who was admitted to an outside
hospital on [**2118-12-9**] with respiratory distress.
Reportedly, the patient had been short of breath at home for
several days with productive cough, yellow sputum, and low-
grade temperature.  The patient did not report any chest
pain.  She did, however, report nausea and diarrhea just
prior to admission, as well as worsening shortness of breath
at home the night prior to admission.  Emergency Medical
Services found her to be "cyanotic and mottled," and
intubated her in the field.  In the outside hospital
Emergency Room, the patient was repleted for presumed chronic
obstructive pulmonary disease flare and received Solu-Medrol,
Albuterol and Atrovent nebulizers and Mucomyst nebulizers as
well as Levofloxacin.  Cardiac enzymes were cycled and the
patient ruled in for an myocardial infarction.  Her troponin
was 4.14.  Initially, the patient received Lasix, but
attributed hypotension upon receiving intravenous fluids was
noted to have increased dyspnea.  She was treated with Lasix
and Natrecor which 3 liters diuresis but reported chest pain
and was transferred to [**Hospital6 256**]
for cardiac catheterization.

MEDICAL HISTORY: 1. Hypertension.  2.  Chronic obstructive pulmonary disease
   with 2 liters of oxygen requirement at home.  3.  History
   of supraventricular tachycardia-history of nonsustained
   ventricular tachycardia, on Amiodarone.  4.
   Gastroesophageal reflux disease.  5.  Gastritis.  6.
   Hypercholesterolemia.  7.  Anxiety and depression.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies, but the patient does not
relate well to codeine, Protonix and SSRIs.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives at home with her husband.  She has
a 60 pack year history of tobacco use.  She denies alcohol
and intravenous drug use.
Subendocardial infarction, initial episode of care,Acute respiratory failure,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Anxiety state, unspecified
Subendo infarct, initial,Acute respiratry failure,CHF NOS,Obs chr bronc w(ac) exac,Crnry athrscl natve vssl,Hypertension NOS,Esophageal reflux,Anxiety state NOS
Admission Date: [**2118-12-13**]        Discharge Date: [**2118-12-27**]

Date of Birth:                    Sex:

Service:  MICU


CHIEF COMPLAINT:  Respiratory distress.

HISTORY OF PRESENT ILLNESS:  This is a 75 year old woman with
a history of chronic obstructive pulmonary disease,
hypertension, supraventricular tachycardia and nonsustained
ventricular tachycardia who was admitted to an outside
hospital on [**2118-12-9**] with respiratory distress.
Reportedly, the patient had been short of breath at home for
several days with productive cough, yellow sputum, and low-
grade temperature.  The patient did not report any chest
pain.  She did, however, report nausea and diarrhea just
prior to admission, as well as worsening shortness of breath
at home the night prior to admission.  Emergency Medical
Services found her to be "cyanotic and mottled," and
intubated her in the field.  In the outside hospital
Emergency Room, the patient was repleted for presumed chronic
obstructive pulmonary disease flare and received Solu-Medrol,
Albuterol and Atrovent nebulizers and Mucomyst nebulizers as
well as Levofloxacin.  Cardiac enzymes were cycled and the
patient ruled in for an myocardial infarction.  Her troponin
was 4.14.  Initially, the patient received Lasix, but
attributed hypotension upon receiving intravenous fluids was
noted to have increased dyspnea.  She was treated with Lasix
and Natrecor which 3 liters diuresis but reported chest pain
and was transferred to [**Hospital6 256**]
for cardiac catheterization.

At the [**Hospital6 256**], the patient had
coronary angiography which demonstrated 70 percent lesions in
the left anterior descending coronary artery and a 95 percent
focal mid lesion in the left circumflex coronary artery as
well as 70 percent lesion in the right coronary artery.  The
patient received stenting of the mid left circumflex coronary
artery with 2.0 times 13 mm pixel bare-metal stent.  After
the cardiac catheterization, the patient was extubated but
because of respiratory distress, she could not tolerate BiPAP
and was reintubated on [**2118-12-14**].  Echocardiogram on
[**2118-12-14**], showed overall left ventricular systolic
function severely depressed with anterior, apical, septal,
inferior and lateral severe hypokinesis/akinesis.  Ejection
fraction was less than 20 percent.

PAST MEDICAL HISTORY:
1. Hypertension.  2.  Chronic obstructive pulmonary disease
   with 2 liters of oxygen requirement at home.  3.  History
   of supraventricular tachycardia-history of nonsustained
   ventricular tachycardia, on Amiodarone.  4.
   Gastroesophageal reflux disease.  5.  Gastritis.  6.
   Hypercholesterolemia.  7.  Anxiety and depression.


MEDICATIONS AT HOME:  Serevent, Verapamil, Ativan,
Prednisone, Aspirin, Elavil, Combivent, Flovent, Zantac,
Nitropatch, Lasix.

ALLERGIES:  No known drug allergies, but the patient does not
relate well to codeine, Protonix and SSRIs.

SOCIAL HISTORY:  She lives at home with her husband.  She has
a 60 pack year history of tobacco use.  She denies alcohol
and intravenous drug use.

PHYSICAL EXAMINATION:  Physical examination upon admission to
the Coronary Care Unit after the cardiac catheterization,
revealed vital signs temperature 97.9, heart rate 108, blood
pressure 128/63, respiratory rate 14, oxygen saturation 94
percent.  In general in no acute distress, alert and oriented
times three.  Head, eyes, ears, nose and throat, pupils
equal, round and reactive to light, extraocular movements
intact, mucous membranes moist.  Cardiovascular, regular rate
and rhythm, S1 and S2, no murmur, rubs or thrills.  Lungs
with diffuse mild wheezes bilaterally.  Abdomen, soft,
nontender, nondistended with normoactive bowel sounds.
Extremities without edema.  Neurologic, alert and oriented
times three and mentating fairly well.  Follows commands.

LABORATORY DATA:  White blood cell count 14.4, hematocrit
37.1, platelets 256, BUN 30, creatinine 0.5.  Chest x-ray,
reveals cardiomegaly and severe emphysema.

HOSPITAL COURSE:  As mentioned above, the patient was
transferred to [**Hospital6 256**] from an
outside hospital and immediately received coronary
catheterization and stenting.  She was subsequently
transferred to the Coronary Care Unit and then to the
Medicine Intensive Care Unit Service.  There, her
hospitalization course was as follows, by system.

Respiratory - The patient was extubated after the coronary
catheterization but did not tolerate BiPAP well and was
reintubated on [**12-15**].  As she was failing spontaneous
breathing trials, a tracheostomy was placed.  She started
doing better on her spontaneous breathing trials on [**12-23**].  The plan was to gradually increase her time off the
ventilator, as tolerated.  On the day of discharge, the
patient had two spontaneous breathing trials for over three
hours.  The patient was maintained on Albuterol and Atrovent
nebulizers, as well as Prednisone for her chronic obstructive
pulmonary disease.  It was noted on [**12-18**], the patient
was noted to have left lower lobe pneumonia.  The Vancomycin
was added to her regimen of Levofloxacin.  The patient was to
finish a course of 14 days of Levofloxacin and 7 days of
Vancomycin.

Coronary artery disease - As mentioned, the patient underwent
cardiac catheterization and stenting.  She had no
complications and she was maintained on aspirin, Plavix and
beta blockers throughout her hospital course.  Her
echocardiogram showed an ejection fraction of 20 percent.
The patient was maintained euvolemic during this
hospitalization and even to 3500 cc ins and outs goal.  The
patient remained in normal sinus rhythm during this
hospitalization and the Lopressor was titrated to keep her
heart rate stable.

Hypertension - The patient was maintained on Metoprolol and
Captopril without complications.

Fluids, electrolytes and nutrition - The patient had a
percutaneous endoscopic gastrostomy placed on [**12-22**],
and tube feedings were started on [**2118-12-22**].  The
patient tolerated the tube feeds well without problems or
limitations.

Endocrine - Since the patient was on steroids for her chronic
obstructive pulmonary disease, initial sliding scale was used
during this hospitalization.

Prophylaxis - Heparin subcutaneously, proton pump inhibitor,
aspiration precautions.

Code status - Full.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To rehabilitation facility.

DISCHARGE MEDICATIONS:
1. Plavix 75 mg p.o. q.d.
2. Ranitidine 150 mg p.o. b.i.d.
3. Prednisone 30 mg p.o. q.d.
4. Nystatin oral suspension 5 ml p.o. q.i.d. prn/
5. Metoprolol 37.5 mg p.o. b.i.d.
6. Lorazepam 0.5 to 2 mg p.o. q. 4-6 hours prn.
7. Heparin 5000 units subcutaneously q. 8 hours.
8. Captopril 75 mg p.o. t.i.d.
9. Lipitor 10 mg p.o. q.h.s.
10.      Enteric coated aspirin 325 mg p.o. q.d.
11.      Albuterol nebulizers 1 nebulizer inhaled q. 4 hours
   prn.
12.      Albuterol 1 to 2 puffs inhaled q. 6 hours prn.
13.      Tylenol 325 to 650 mg p.o. q. 4-6 hours prn.
14.      Insulin sliding scale.
15.      Ipratropium Bromide nebulizer, one nebulizer inhaled
   q. 6 hours.
16.      Ipratropium Bromide metered dose inhaler 2 puffs
   inhaled q.i.d.


DISCHARGE INSTRUCTIONS:  Follow up - The patient was advised
to follow up with her primary care physician in one to two
weeks.
Diet - Tube feeding, Probalance full strength.
Post discharge services - Home oxygen, physical therapy and
respiratory therapy.


                        [**First Name8 (NamePattern2) **] [**Name8 (MD) **], [**MD Number(1) 6327**]

Dictated By:[**Last Name (NamePattern1) 26045**]
MEDQUIST36
D:  [**2119-6-28**] 18:42:42
T:  [**2119-6-28**] 19:40:54
Job#:  [**Job Number 28330**]
{'Subendocardial infarction, initial episode of care,Acute respiratory failure,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Anxiety state, 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: Respiratory distress.

PRESENT ILLNESS: This is a 75 year old woman with
a history of chronic obstructive pulmonary disease,
hypertension, supraventricular tachycardia and nonsustained
ventricular tachycardia who was admitted to an outside
hospital on [**2118-12-9**] with respiratory distress.
Reportedly, the patient had been short of breath at home for
several days with productive cough, yellow sputum, and low-
grade temperature.  The patient did not report any chest
pain.  She did, however, report nausea and diarrhea just
prior to admission, as well as worsening shortness of breath
at home the night prior to admission.  Emergency Medical
Services found her to be "cyanotic and mottled," and
intubated her in the field.  In the outside hospital
Emergency Room, the patient was repleted for presumed chronic
obstructive pulmonary disease flare and received Solu-Medrol,
Albuterol and Atrovent nebulizers and Mucomyst nebulizers as
well as Levofloxacin.  Cardiac enzymes were cycled and the
patient ruled in for an myocardial infarction.  Her troponin
was 4.14.  Initially, the patient received Lasix, but
attributed hypotension upon receiving intravenous fluids was
noted to have increased dyspnea.  She was treated with Lasix
and Natrecor which 3 liters diuresis but reported chest pain
and was transferred to [**Hospital6 256**]
for cardiac catheterization.

MEDICAL HISTORY: 1. Hypertension.  2.  Chronic obstructive pulmonary disease
   with 2 liters of oxygen requirement at home.  3.  History
   of supraventricular tachycardia-history of nonsustained
   ventricular tachycardia, on Amiodarone.  4.
   Gastroesophageal reflux disease.  5.  Gastritis.  6.
   Hypercholesterolemia.  7.  Anxiety and depression.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies, but the patient does not
relate well to codeine, Protonix and SSRIs.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives at home with her husband.  She has
a 60 pack year history of tobacco use.  She denies alcohol
and intravenous drug use. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute respiratory failure,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Anxiety state, unspecified'}
