CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 64 year old
African American female with HIV, last CD4 count 240 and
viral load of undetectable in [**2111-4-19**], and a history of
Factor VIII deficiency, chronic obstructive pulmonary
disease, asthma, hypertension, diabetes mellitus, who
presents to [**Hospital1 69**] for
shortness of breath.

MEDICAL HISTORY: 1.  HIV diagnosed in [**2104**], last CD4 approximately 230 in
    [**2111-4-19**], with a viral load undetectable.
2.  Hypertension.
3.  Diabetes mellitus times twenty-five years.
4.  Chronic obstructive pulmonary disease.
5.  Chronic bronchitis.
6.  Asthma since childhood, no history of intubation
    required.
7.  Factor VIII deficiency, status post steroids followed by
    hematology/oncology periodically.
8.  History of alcohol abuse in the past.
9.  Spinal stenosis, L4-L5.
10. History of renal failure secondary to volume depletion.

MEDICATION ON ADMISSION: 1.  AZT 200 mg p.o. b.i.d.
2.  3TC 150 mg p.o. b.i.d.
3.  Nevirapine 200 mg p.o. b.i.d.
4.  Glyburide 5 mg p.o. b.i.d.
5.  Megace 400 mg p.o. q.d.
6.  Timoptic 0.5% O.U. b.i.d.
7.  Multivitamins one tablet p.o. q.d.
8.  Bactrim one DS tablet p.o. q.d.
9.  Mycelex troches p.r.n.
10. Albuterol two puffs inhaled q6hours p.r.n.
11. Atrovent two puffs b.i.d.
12. Accubid two puffs b.i.d.
13. Prilosec 20 mg p.o. q.d.
14. Lopressor 50 mg p.o. b.i.d.
15. Reglan 10 mg p.o. t.i.d.
16. Epogen 5000 units subcutaneous Monday, Wednesday and
    Friday.

ALLERGIES: Motrin causes bleeding.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Chronic obstructive asthma, unspecified,Acute kidney failure, unspecified,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Asymptomatic human immunodeficiency virus [HIV] infection status
AMI anterior wall, init,Crnry athrscl natve vssl,Chronic obst asthma NOS,Acute kidney failure NOS,Mitral valve disorder,DMII wo cmp nt st uncntr,Hypertension NOS,Asymp hiv infectn status
Admission Date:  [**2111-6-9**]       Discharge Date:  [**2111-6-18**]

Date of Birth:   [**2046-6-27**]       Sex:  F

Service:  [**Doctor Last Name 1181**]

HISTORY OF PRESENT ILLNESS:  The patient is a 64 year old
African American female with HIV, last CD4 count 240 and
viral load of undetectable in [**2111-4-19**], and a history of
Factor VIII deficiency, chronic obstructive pulmonary
disease, asthma, hypertension, diabetes mellitus, who
presents to [**Hospital1 69**] for
shortness of breath.

The patient was in her usual state of health until the
evening prior to presentation on [**2111-6-9**], when she began
having chief complaint of shortness of breath. This shortness
of breath subsequently progressed and became very acute on
the morning of presentation approximately 6:00 a.m.  She took
her usual MDIs but had no relief.  She called the EMTs who
subsequently brought the patient to the Emergency Department
of [**Hospital1 69**].

Upon arrival, the patient was noted to be tachypneic and
wheezing.  On review of systems, the patient's granddaughter
had an upper respiratory infection.  The patient denied any
fever, chills, nausea, vomiting, chest pain or headache.  She
denied any rhinorrhea but did have mild pharyngitis, sinus
congestion.  She still smokes one half pack to one pack per
day.  She has a chronic nonproductive cough which is
unchanged.  The patient also reported that she had been
relatively noncompliant with all her medications.

While in the Emergency Department, the patient was given
nebulizers times two with no improvement.  She was given a
trial of Heliox with a little improvement.  Chest x-ray
revealed bilateral infiltrates.  She was given intravenous
Solu-Medrol and intravenous Levofloxacin and Bactrim.

PAST MEDICAL HISTORY:
1.  HIV diagnosed in [**2104**], last CD4 approximately 230 in
    [**2111-4-19**], with a viral load undetectable.
2.  Hypertension.
3.  Diabetes mellitus times twenty-five years.
4.  Chronic obstructive pulmonary disease.
5.  Chronic bronchitis.
6.  Asthma since childhood, no history of intubation
    required.
7.  Factor VIII deficiency, status post steroids followed by
    hematology/oncology periodically.
8.  History of alcohol abuse in the past.
9.  Spinal stenosis, L4-L5.
10. History of renal failure secondary to volume depletion.

MEDICATIONS ON ADMISSION:
1.  AZT 200 mg p.o. b.i.d.
2.  3TC 150 mg p.o. b.i.d.
3.  Nevirapine 200 mg p.o. b.i.d.
4.  Glyburide 5 mg p.o. b.i.d.
5.  Megace 400 mg p.o. q.d.
6.  Timoptic 0.5% O.U. b.i.d.
7.  Multivitamins one tablet p.o. q.d.
8.  Bactrim one DS tablet p.o. q.d.
9.  Mycelex troches p.r.n.
10. Albuterol two puffs inhaled q6hours p.r.n.
11. Atrovent two puffs b.i.d.
12. Accubid two puffs b.i.d.
13. Prilosec 20 mg p.o. q.d.
14. Lopressor 50 mg p.o. b.i.d.
15. Reglan 10 mg p.o. t.i.d.
16. Epogen 5000 units subcutaneous Monday, Wednesday and
    Friday.

ALLERGIES:  Motrin causes bleeding.

PHYSICAL EXAMINATION:  Upon presentation, temperature is
95.9, pulse 133, blood pressure 180/71, respiratory rate 32,
saturating 95% in room air.  In general, the patient was an
ill appearing black female sitting upright, tachypneic and
short of breath with short sentences.  Head, eyes, ears, nose
and throat examination is normocephalic and atraumatic.
Extraocular movements are intact.  The pupils are equal,
round, and reactive to light and accommodation.  The
oropharynx was clear.  No lymphadenopathy was appreciated.
The neck was supple.  Chest examination - expiratory wheezes
noted, decreased breath sounds throughout, no stridor, no
crackles.  Cardiovascular examination - tachycardia, II/VI
systolic murmur heard best at the right upper sternal border.
Abdominal examination is soft, normoactive bowel sounds,
nontender, nondistended, no guarding, no rebound.
Extremities no cyanosis, clubbing or edema.  Neurologically,
the patient is [**Year (4 digits) 3584**] and oriented, responds to commands,
speaks in short sentences.  Deep tendon reflexes are 2+
throughout.  Cranial nerves II through XII are intact.
Sensation intact.

LABORATORY DATA:  Upon presentation, white count was 10.1,
hematocrit 24.9, platelet count 343,000, 42% neutrophils, 52%
bands, 4% monocytes, 0.7% eosinophils.  Sodium 136, potassium
5.0, chloride 106, bicarbonate 15, blood urea nitrogen 53,
creatinine 3.6, glucose 325.  CK enzymes 130.  Arterial blood
gases on 100% nonrebreather was pH 7.21, pCO2 46, paO2 296.

Electrocardiogram revealed sinus tachycardia at 140, left
ventricular hypertrophy, T wave inversion and ST depression
in lead V5 through V6.  T wave inversions noted in lead III.
Chest x-ray revealed the heart size normal, diffuse bilateral
interstitial process with septal lines, pulmonary edema
versus interstitial pneumonitis.

HOSPITAL COURSE:  This is a 64 year old female with HIV,
diabetes mellitus, asthma and chronic obstructive pulmonary
disease presenting with acute shortness of breath.

1.  Cardiac - The patient was admitted originally to the
Medicine Service and placed on telemetry for rule out
myocardial infarction protocol.  The patient subsequently
ruled in for myocardial infarction with shortness of breath.
Her troponins were positive at 9.0.  CK enzymes were 130 and
upward trending.  At that time, cardiology consultation was
called and evaluated the patient.  Echocardiogram was
obtained which revealed ejection fraction of less than 40%
with wall motion abnormality consistent with ischemia.

That evening after cardiology consultation, the patient
subsequently became hypotensive and CK enzymes subsequently
increased to 1600 with positive MB index and positive
troponin greater than 50.  The patient was found with agonal
respirations.  The patient was emergently intubated and was
brought to the Medical Intensive Care Unit and subsequently
brought to the Cardiac Catheterization Suite where a cardiac
catheterization was performed.

A tight mid left circumflex lesion was seen.  Percutaneous
transluminal coronary angioplasty was performed and a stent
was placed.  The patient subsequently did well post cardiac
catheterization.  The patient was continued on Aspirin and
started on Plavix.  The patient's Lopressor was subsequently
titrated up.  Given the fact that the patient had acute renal
failure post cardiac catheterization and unable to tolerate
ace inhibitor, the patient was started on Hydralazine and
Isordil in order to decrease morbidity and mortality.

Congestive heart failure - The patient during hospital course
had an episode of flash pulmonary edema, congestive heart
failure from a blood transfusion.  Upon initial admission,
cardiac echocardiogram revealed ejection fraction of less
than 40% and wall motion abnormalities consistent with
ischemia.  During hospital course, the patient was
subsequently diuresed well.  Repeat echocardiogram revealed
ejection fraction of 40% with 3+ mitral regurgitation and
akinesis of the basal inferior and lateral walls with mild
regional left ventricular systolic dysfunction.  The patient
was subsequently diuresed further and I&Os were followed.

2.  Neurology - The patient upon admission was relatively
[**Name2 (NI) 3584**] and oriented times three, however, during hospital
course status post cardiac catheterization and intubation and
acute renal failure, the patient's mental status subsequently
waxed and waned and the patient was subsequently confused
most of the time.  Neurology service was consulted and the
patient's mental status was thought secondary to toxic
metabolic encephalopathy and related to her uremia and other
medical conditions.  The patient's mental status was
subsequently improved with resolution of her uremia.

3.  Pulmonary - The patient was originally admitted to the
Medicine service, however, when the patient became
hypotensive and was emergently intubated, the patient was
subsequently transferred to the Medical Intensive Care Unit.
Status post cardiac catheterization, the patient was
subsequently Dopamine pressors for blood pressure support for
a brief period of time.  The patient was subsequently rapidly
extubated and subsequently did well after extubation.  The
patient was able to be weaned down from face mask to nasal
cannula as well as maintaining her oxygen saturation
relatively well.  The patient has a history of chronic
obstructive pulmonary disease and asthma and was continued on
nebulizer treatment and continued her MDIs with good effect.

4.  Infectious disease - The patient has a history of HIV
positivity since [**2104**], on highly active antiretroviral
therapy with her last CD4 count of 230 and a viral load which
was undetectable.  Upon admission to [**Hospital1 190**], the patient was subsequently continued on her
highly active antiretroviral therapy.  However, when the
patient's acute renal failure subsequently began, the
patient's medication therapy was renally adjusted.

5.  Renal - The patient had an episode of acute renal
failure, status post cardiac catheterization.  The patient's
renal failure was thought secondary to possibly contrast
nephropathy, cardiac catheterization versus emboli from
cardiac catheterization to the renal glomerulus.  The
patient's creatinine subsequently began increasing and
subsequently plateaued at 6.1 to 6.2 and remained stable at
that time level.  However, approximately a week into the
[**Hospital 228**] hospital course, the patient subsequently began
making some urine and responded well with Lasix and the
patient was subsequently diuresed with Lasix and renal
function was observed very carefully.  The patient's renal
function at the time of this dictation remains stable at 6.1
and was expected to subsequently trend downward.  However, if
renal function does not improve, the patient will
subsequently require temporary dialysis.

6.  Diabetes mellitus - The patient had a history of diabetes
mellitus and was continued on fingerstick glucoses and
sliding scale insulin with good effect.

7.  Hematology - The patient had a history of acquired Factor
VIII deficiency.  During her last hospitalization, the
patient required multiple transfusions of Factor VIII.
However, during this hospital course, hematology/oncology
service was consulted in regards to the patient's care.  As
per hematology/oncology, the patient's Factor VIII deficiency
seemed to have resolved and did not require any transfusions
during this hospital course.  However, the patient required
transfusion of packed red blood cells secondary to her
anemia.  However, during transfusion, the patient had
subsequently flash pulmonary edema requiring Lasix therapy
and intubation.  As per hematology/oncology, transfusion of
packed red blood cells will be held off until absolutely
necessary due to the fact that the patient has a
predisposition for congestive heart failure.

8.  Fluids, electrolytes and nutrition - During her stay in
the Medical Intensive Care Unit, the patient was intubated
and did not have good nutrition and subsequently after the
patient was successfully extubated, the patient was able to
tolerate sips and moderate p.o.  Nutrition consultation was
consulted in regards to help with the patient's nutritional
status and the patient was encouraged to take p.o. liquids
and solids.

9.  Lines, access - The patient has a poor peripheral access.
During her stay in the Medial Intensive Care Unit, the
patient had a right internal jugular triple lumen as a
central line for venous access.  On [**2111-6-17**], the triple
lumen central line was changed over a wire.

10. The patient is full code, full care.

DISCHARGE DIAGNOSES:
1.  Myocardial infarction, status post percutaneous
    transluminal coronary angioplasty with stent placement to
    the mid left circumflex.
2.  Acute renal failure.
3.  HIV.
4.  Hypertension.
5.  Diabetes mellitus.
6.  Chronic obstructive pulmonary disease.
7.  Congestive heart failure.

An addendum to this discharge summary will be performed at a
later date for the patient's multiple medical problems.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2667**], M.D.  [**MD Number(1) 2668**]

Dictated By:[**Last Name (NamePattern1) 5588**]
MEDQUIST36

D:  [**2111-6-17**]  17:15
T:  [**2111-6-17**]  19:27
JOB#:  [**Job Number 102138**]


Admission Date:  [**2111-6-9**]       Discharge Date:

Date of Birth:   [**2046-6-27**]       Sex:  F

Service:

NOTE:  Admitted before with discharge summary up until
[**2111-6-18**].  This is a continuation of this discharge summary.

HOSPITAL COURSE:

1.  NEUROLOGIC:  The patient's neurological status after the
31st had improved fully.  She is [**Month/Day/Year 3584**] and oriented x3 with
slight changes in her memory, but this issue was resolved by
[**Month (only) **].

2.  CARDIAC:  The patient was watched on cardiac medications.
Blood pressure was monitored.  She did have an episode on
[**2111-6-20**] at night of acute shortness of breath, diaphoresis and
she looked very sick, very tachypneic.  Her saturations were
89% on room air, 94% on 6 liters.  Blood pressure 120/80,
heart rate 70.  Electrocardiogram showed a question of mild
J-point elevation in V2-V3 of 2 mm.  Lung exam revealed poor
air movement, wheezes, decreased breath sounds throughout.
Arterial blood gases:  pH 7.11, PCO2 71, PO2 62.  Aggressive
nebulizers were given.  Gas improved slowly throughout the
course of the night, 40 mg intravenous Lasix and then 120 mg
intravenous Lasix were given.  Chest x-ray showed congestive
heart failure, pulmonary edema and by 3:20 a.m. gas was 7.21,
60, 71 and then by 4:50 a.m. it was improved to 7.23, 56,
119.  The patient was also ruled out for myocardial
infarction.  Troponin was 8; it had been 50 in the past, so
this was actually followed and was found to be trending down
8 to 7 to 6 and her CKs ended up being negative.  The actual
cause of this acute decompensation was not fully known,
probably a combination between congestive heart failure and
chronic obstructive pulmonary disease flare since it improved
with nebulizers and Lasix, not clear which one, but we do not
think she had another cardiac event.

3.  PULMONARY:  For chronic obstructive pulmonary disease, we
continued her metered dose inhalers and after this one night,
she continued to do well.

4.  INFECTIOUS DISEASE:  She is on antiretrovirals for human
immunodeficiency virus, Bactrim prophylaxis.

5.  RENAL:  Creatinine continued to trend down.  It went from
5 to 4.6 and remained stable between 4.5 to 4.6 by discharge.

6.  ENDOCRINE:  We continued to check her fingersticks and
regular insulin.  She was on glyburide.  Her sugars were high
and we are continuing to watch and will ask nutrition for
help on a good nutrition supplement for a diabetic.

7.  HEME:  Acquired factor VIII deficiency, now stable.  No
issues.

DISCHARGE PLAN:  The changes we made to her medications, she
did well on a stable dose of Lasix 80 mg po qd.  It was an
adequate dose to keep her negative.  She was started on
captopril on [**2111-6-24**], 25 [**Hospital1 **] for renal protection because of
her renal failure and probable diabetic etiology for this
renal failure.  She also is on Procrit and Tums and she is
resisting rehabilitation, but we will try to convince her and
her family that this is the best option for her.  Physical
therapy saw her and agrees that she is not safe to go home by
herself.  She will be discharged to a short term
rehabilitation if her family will agree and if she will agree
pending bed availability.

DISCHARGE MEDICATIONS:
1.  Captopril 25 mg po bid
2.  Glyburide 5 mg po bid
3.  Atrovent/Albuterol metered dose inhaler 2 puffs qid
4.  Nystatin swish and swallow 4 to 6 cc po qid
5.  AZT zidovudine 100 mg po bid
6.  3TC lamivudine 50 mg po qd
7.  Flovent 110 mcg 2 puffs inhaled [**Hospital1 **]
8.  Colace 100 mg po bid
9.  Lipitor 80 mg po qd
10. Multivitamin 1 po qd
11. Megace 400 mg po qd
12. Timoptic 0.5
13. Optic 1 GGT both eyes [**Hospital1 **]
14. Bactrim double strength 1 po qd
15. Reglan 10 mg po tid with meals
16. Nevirapine 200 mg po bid
17. Prilosec 20 mg po qd
18. Enteric coated aspirin 325 mg po qd
19. Plavix 75 mg po qd until [**7-18**] to complete a 30 day course
20. Toprol XL 150 mg po qd
21. Lasix 80 mg po qd
22. Imdur 30 mg po qd
23. Tums 500 mg po bid with meals
24. Procrit 4000 units subcutaneous twice a week

DISCHARGE DIAGNOSES:
1.  Coronary artery disease
2.  Congestive heart failure
3.  Status post myocardial infarction
4.  Status post stent
5.  Chronic obstructive pulmonary disease
6.  Chronic renal failure
7.  Acute renal failure
8.  Hypertension
9.  Human immunodeficiency virus

DISCHARGE CONDITION:  Stable

FOLLOW UP:  Dr. [**Last Name (STitle) **]




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2667**], M.D.  [**MD Number(1) 2668**]

Dictated By:[**Name8 (MD) 6340**]
MEDQUIST36

D:  [**2111-6-24**]  09:57
T:  [**2111-6-24**]  11:28
JOB#:  [**Job Number 33849**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Chronic obstructive asthma, unspecified,Acute kidney failure, unspecified,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Asymptomatic human immunodeficiency virus [HIV] infection status'}


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 64 year old
African American female with HIV, last CD4 count 240 and
viral load of undetectable in [**2111-4-19**], and a history of
Factor VIII deficiency, chronic obstructive pulmonary
disease, asthma, hypertension, diabetes mellitus, who
presents to [**Hospital1 69**] for
shortness of breath.

MEDICAL HISTORY: 1.  HIV diagnosed in [**2104**], last CD4 approximately 230 in
    [**2111-4-19**], with a viral load undetectable.
2.  Hypertension.
3.  Diabetes mellitus times twenty-five years.
4.  Chronic obstructive pulmonary disease.
5.  Chronic bronchitis.
6.  Asthma since childhood, no history of intubation
    required.
7.  Factor VIII deficiency, status post steroids followed by
    hematology/oncology periodically.
8.  History of alcohol abuse in the past.
9.  Spinal stenosis, L4-L5.
10. History of renal failure secondary to volume depletion.

MEDICATION ON ADMISSION: 1.  AZT 200 mg p.o. b.i.d.
2.  3TC 150 mg p.o. b.i.d.
3.  Nevirapine 200 mg p.o. b.i.d.
4.  Glyburide 5 mg p.o. b.i.d.
5.  Megace 400 mg p.o. q.d.
6.  Timoptic 0.5% O.U. b.i.d.
7.  Multivitamins one tablet p.o. q.d.
8.  Bactrim one DS tablet p.o. q.d.
9.  Mycelex troches p.r.n.
10. Albuterol two puffs inhaled q6hours p.r.n.
11. Atrovent two puffs b.i.d.
12. Accubid two puffs b.i.d.
13. Prilosec 20 mg p.o. q.d.
14. Lopressor 50 mg p.o. b.i.d.
15. Reglan 10 mg p.o. t.i.d.
16. Epogen 5000 units subcutaneous Monday, Wednesday and
    Friday.

ALLERGIES: Motrin causes bleeding.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Chronic obstructive asthma, unspecified,Acute kidney failure, unspecified,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Asymptomatic human immunodeficiency virus [HIV] infection status'}
