CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45 year old
male with diabetes, hypertension, chronic renal
insufficiency, human immunodeficiency virus positive who
presented to [**Hospital3 3583**] on [**1-7**] for chest pain.
The patient had been transferred from [**Location 54282**] where he is an inmate.  The patient's
pain began while he was lying in bed and did not get better
over the next 24 hours.  The pain radiated to his left arm
and neck.  The patient denied associated shortness of breath,
diaphoresis, nausea or vomiting.  The patient denied
palpitations.  He also denied lightheadedness.  The patient
did report decreased exercise tolerance with shortness of
breath with less than one flight of stairs which had been
worse over the past few months.  He also reported increased
lower extremity edema over the past few months.  He denied
paroxysmal nocturnal dyspnea, he denied orthopnea.  At [**Hospital3 6265**] the patient ruled in for myocardial infarction with
creatinine kinase in the 500 and troponin of 6.  The patient
had flipped Ts laterally.  The patient received an Aspirin
and Plavix and was on a heparin drip at the time of transfer
to [**Hospital6 256**].

MEDICAL HISTORY: 1.  Type 2 diabetes; 2.  Hypertension;
3.  History of pancreatitis; 4.  History of Clostridium
difficile colitis; 5.  Chronic renal insufficiency, baseline
creatinine 1.8 to 2.2; 6.  Human immunodeficiency virus
positive, CD4 count in [**2198-9-24**] was 554; 7.  History
of line sepsis; 8.  Recent pneumonia complicated by
Clostridium difficile infection.  The patient had a negative
stress test in [**2197-9-24**].

MEDICATION ON ADMISSION: 1.  Lantus 15 q.a.m., regular sliding scale insulin.
2.  Lopressor 100 mg twice a day.
3.  Aspirin 325 mg p.o. once daily.
4.  Norvasc 10 mg p.o. once daily.
5.  Protonix 40 mg p.o. once daily.
6.  Flagyl 500 mg p.o. three times a day.
7.  Plavix 75 mg p.o. once daily.
8.  Statin 10 mg p.o. once daily.
9.  Ativan p.r.n.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is an inmate at the [**Location 54283**], history of cocaine use.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled
Subendo infarct, initial,CHF NOS,Surg compl-urinary tract,Acute kidney failure NOS,Gastrointest hemorr NOS,Hyp kid NOS w cr kid V,Mitral valve disorder,Crnry athrscl natve vssl,DMII renl nt st uncntrld
Admission Date:  [**2199-1-8**]       Discharge Date:  [**2199-1-14**]

Date of Birth:   [**2153-11-4**]       Sex:  M

Service:  [**Hospital Unit Name 196**]

HISTORY OF PRESENT ILLNESS:  The patient is a 45 year old
male with diabetes, hypertension, chronic renal
insufficiency, human immunodeficiency virus positive who
presented to [**Hospital3 3583**] on [**1-7**] for chest pain.
The patient had been transferred from [**Location 54282**] where he is an inmate.  The patient's
pain began while he was lying in bed and did not get better
over the next 24 hours.  The pain radiated to his left arm
and neck.  The patient denied associated shortness of breath,
diaphoresis, nausea or vomiting.  The patient denied
palpitations.  He also denied lightheadedness.  The patient
did report decreased exercise tolerance with shortness of
breath with less than one flight of stairs which had been
worse over the past few months.  He also reported increased
lower extremity edema over the past few months.  He denied
paroxysmal nocturnal dyspnea, he denied orthopnea.  At [**Hospital3 6265**] the patient ruled in for myocardial infarction with
creatinine kinase in the 500 and troponin of 6.  The patient
had flipped Ts laterally.  The patient received an Aspirin
and Plavix and was on a heparin drip at the time of transfer
to [**Hospital6 256**].

PAST MEDICAL HISTORY:  1.  Type 2 diabetes; 2.  Hypertension;
3.  History of pancreatitis; 4.  History of Clostridium
difficile colitis; 5.  Chronic renal insufficiency, baseline
creatinine 1.8 to 2.2; 6.  Human immunodeficiency virus
positive, CD4 count in [**2198-9-24**] was 554; 7.  History
of line sepsis; 8.  Recent pneumonia complicated by
Clostridium difficile infection.  The patient had a negative
stress test in [**2197-9-24**].

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Lantis 15 q. day, regular insulin sliding
scale, Atenolol 150 b.i.d., Norvasc 10 q. day, Protonix 40 q.
day, Flagyl 500 t.i.d.

SOCIAL HISTORY:  The patient is an inmate at the [**Location 54283**], history of cocaine use.

PHYSICAL EXAMINATION:  On admission the patient was afebrile,
blood pressure 127/79, pulse 97, respirations 24, sating 99%
on 5 liters of nasal cannula.  The patient was an
ill-appearing gentleman using his accessory muscles of
respiration.  Cardiovascular examination was regular rhythm,
tachycardiac, normal S1 and S2.  Respiratory examination
revealed decreased breathsounds at the left, part of the way
up, but was otherwise clear to auscultation bilaterally.  The
patient extremities 2 to 3+ pitting edema bilaterally,
dorsalis pedis were 2+ bilaterally.

LABORATORY DATA:  Laboratory values on admission were
significant for a white count of 7.6, hematocrit 32.4.
Chem-7 was significant for a creatinine of 1.9.  On admission
the creatinine kinase was 453, MB 90, troponin I 15.6.

HOSPITAL COURSE:  1.  Cardiac - The patient was transferred
from [**Hospital3 3583**] directly to the Cardiac Catheterization
Unit.  The patient underwent a cardiac catheterization which
revealed a right dominant system, two vessel disease, left
main 10%, proximal left anterior descending 60% occlusion,
mid left anterior descending 60% occlusion.  Obtuse marginal
2 with 100% occlusion which was stented times two.  The
patient's ventriculography revealed an ejection fraction of
46%, 2+ mitral regurgitation, pulmonary capillary wedge
pressure of 24 and left ventricular end diastolic pressure of
30.  It also revealed mild pulmonary hypertension, 35/11,
moderate diastolic dysfunction.  The patient's post procedure
experienced an increased work of breathing.  It was unclear
the etiology of this.  The patient received one dose of
Solu-Medrol and Benadryl for a question of an allergic
reaction, however, there was no good evidence that this had
been the case.  The patient improved shortly after that and
remained stable after his procedure.  The patient had
evidence of heart failure on examination.  An echocardiogram
was performed with an ejection fraction of 35 to 40%.  TR
gradient was 23 and revealed wall motion abnormalities
including inferior hypokinesis and inferior lateral akinesis
with anterolateral hypokinesis.  The patient was given Plavix
after his procedure and he was maintained on Integrilin
directly after the procedure.  The patient was also continued
on an Aspirin and beta blocker.  His Norvasc was also
restarted.  The patient was not started on an ACE inhibitor
given his renal function.  The patient was diuresed after his
catheterization with Lasix to improve his decompensated
congestive heart failure.  The patient will be maintained on
p.o. Lasix at the time of discharge.

2.  Respiratory - The patient with increased work of
breathing after catheterization and also decreased oxygen
saturations.  The patient's chest x-ray was consistent with
congestive heart failure.  The patient was afebrile with a
white count, no evidence of pneumonia.  The patient was
diuresed and his oxygen saturations improved significantly.

3.  Renal - Patient with baseline chronic renal insufficiency
with acute renal failure after his cardiac catheterization
with a creatinine rising to 3.8, consistent with a
dye-induced nephropathy.  Two days after the cardiac
catheterization the patient's creatinine began to improve and
at the time of discharge the patient's creatinine had
returned to his baseline values.

4.  Heme - The patient with anemia on admission.  The
patient's hematocrit dropped to 28 after the catheterization
and the patient was transfused 1 unit of packed red blood
cells.  The patient's hematocrit remained stable at this
level.  There was no evidence for bleeding.

5.  Gastrointestinal - Patient with a history of Clostridium
difficile, although the patient experienced some evidence of
loose stools during his admission.  He had no true issues
with his diarrhea.  He was given Flagyl 500 t.i.d. for
further treatment of his Clostridium difficile infection and
with plan to have a full 10 to 14 day course which would end
on [**1-16**].

6.  Diabetes - The patient was continued on his Lantis and a
Humalog insulin sliding scale.

7.  Human immunodeficiency virus - The patient was admitted
off [**Doctor Last Name **] therapy.  The patient should follow up with primary
care and infectious disease doctor for possible initiation of
[**Doctor Last Name **] therapy.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To [**Location 54284**].

DISCHARGE DIAGNOSIS:
1.  Myocardial infarction
2.  Coronary artery disease
3.  Congestive heart failure
4.  Acute renal failure
5.  Chronic renal insufficiency
6.  Diabetes
7.  Human immunodeficiency virus positive
8.  Clostridium difficile infection
9.  Hypertension

DISCHARGE MEDICATIONS:
1.  Amlodipine 5 q. day
2.  Aspirin 325 q. day
3.  Atorvastatin 10 q. day
4.  Carvedilol 25 b.i.d.
5.  Plavix 75 q. day for nine months
6.  Lasix 20 mg p.o. q. day
7.  Insulin, Lantis 15 units q. day with a Humalog insulin
sliding scale
8.  Magnesium oxide 400 b.i.d.
9.  Metronidazole 500 t.i.d. until [**2206-1-17**]. Pantoprazole 40 q. day

FOLLOW UP PLANS:  The patient was instructed to follow up
with his cardiologist within the next two to four weeks after
admission.  The patient should also follow up with his
primary care physician for blood draw within the next one to
two weeks for further monitoring of his renal function as
well as his electrolytes, in particular magnesium given the
addition of magnesium replacement.

The night prior to discharge, the patient had a GI bleed and was
transferred to the MICU.  The details of that stay will be
dictated at the conclusion of his hospitalization.

                            [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(2) 2139**]

Dictated By:[**Name8 (MD) 54285**]
MEDQUIST36

D:  [**2199-1-13**]  16:44
T:  [**2199-1-13**]  18:23
JOB#:  [**Job Number 54286**]


Admission Date:  [**2199-1-8**]       Discharge Date:  [**2199-1-23**]

Date of Birth:   [**2153-11-4**]       Sex:  M

Service:  C-MEDICINE

HISTORY OF PRESENT ILLNESS:  This is a 45 year old male with
diabetes mellitus, hypertension, history of pancreatitis,
Clostridium difficile, chronic renal insufficiency, HIV, last
CD4 count 554 in [**9-26**], who presented to [**Hospital3 3583**] on
[**2199-1-7**], with chest pain from the [**Location **] where he is an inmate.  At [**Hospital3 6265**], the patient ruled in for a myocardial infarction
with CKs in the 500s and troponin of 6.0 as well as flipped T
waves laterally.  The patient received Aspirin, Plavix and
Heparin drip.  The patient's pain began at rest and lasted
for 24 hours, radiated to his left arm and neck.  There were
no associated symptoms.  The patient has had decreased
exercise tolerance and shortness of breath with less than one
flight of stairs, which is worse over the past few months and
also increasing lower extremity edema over the past few
months.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus.
2.  Hypertension.
3.  Pancreatitis.
4.  Recent Clostridium difficile colitis.
5.  Chronic renal insufficiency.
6.  HIV positive, CD4 554 in [**9-26**].
7.  History of line sepsis.
8.  Recent pneumonia complicated by Clostridium difficile.
9.  Negative stress in 09/[**2197**].

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Lantus 15 q.a.m., regular sliding scale insulin.
2.  Lopressor 100 mg twice a day.
3.  Aspirin 325 mg p.o. once daily.
4.  Norvasc 10 mg p.o. once daily.
5.  Protonix 40 mg p.o. once daily.
6.  Flagyl 500 mg p.o. three times a day.
7.  Plavix 75 mg p.o. once daily.
8.  Statin 10 mg p.o. once daily.
9.  Ativan p.r.n.

SOCIAL HISTORY:  Inmate at [**Location 54287**].  Former Cocaine and intravenous drug use.

The patient's home medications are Lantus 15 q.a.m., regular
sliding scale insulin, Atenolol 150 mg twice a day, Norvasc
10 mg p.o. once daily, Protonix 40 mg once daily, Flagyl 500
mg three times a day.

PHYSICAL EXAMINATION:  On admission, the patient is afebrile,
blood pressure 127/79, pulse 97, respiratory rate 24, oxygen
saturation 99% on five liters.  In general, the patient is an
ill appearing male using accessory muscles for respiration.
Head, eyes, ears, nose and throat - The pupils are equal,
round, and reactive to light and accommodation.  Extraocular
movements are intact.  Cardiovascular is regular rate and
rhythm, normal S1 and S2.  Pulmonary - Decreased breath
sounds at the left one third up; otherwise clear to
auscultation bilaterally.  The abdomen is soft, nontender,
nondistended, bowel sounds positive.  Extremities - 2 to 3+
pitting edema bilaterally.  Dorsalis pedis 2+ bilaterally.

LABORATORY DATA:  Hematocrit 32.4 on admission.  CK 453,
troponin I of 15.6, CK MB 90, creatinine 1.9 which is at his
baseline chronic renal insufficiency.  Albumin 1.9.

HOSPITAL COURSE:
1.  Cardiac - The patient underwent catheterization on
[**2199-1-8**].  The patient had elevated filling pressures with a
mean [**Doctor Last Name **] of 225 mmHg and left ventricular ejection fraction
of 40% on left ventriculogram with global hypokinesis.  The
left main coronary artery was 10% and left anterior
descending was 60% proximal, 50% distal tubular, left
circumflex showed proximal 40% and mid 60% and occluded OM1,
patent OM2, which was crossed with Cypher stent, 0% in-stent
occlusion, proximal 30 to 40% disease left untreated, right
coronary artery mild disease.

Postcatheterization, the patient did well from a cardiac
standpoint.  He was continued on his Aspirin, Plavix, beta
blocker and statin.  The patient was felt to be in heart
failure postcatheterization given his elevated filling
pressures and he was diuresed.  The patient had no further
cardiac issues during the rest of his hospital admission.

2.  Gastrointestinal bleed - On [**2199-1-13**], the patient had
bright red blood per rectum and a stat hematocrit showed a
drop in his hematocrit from 32.0 to 24.0.  The patient's
systolic blood pressure was stable at 130.  The patient had
no associated symptoms.  Nasogastric lavage was attempted
twice, but the patient refused.  The patient was transfused
on unit and then taken for a tagged red blood cell scan.  The
tagged red blood cell scan showed a small bleed at the
hepatic flexure.  Gastroenterology was consulted.  The
patient was continued on q4hour hematocrit checks, given
platelets and the patient then had an upper scope on
[**2199-1-14**], which showed normal esophagus and normal stomach
and normal duodenum.  A colonoscopy showed on [**2199-1-16**], an
ulcerated heaped up tissue versus neoplasm versus
inflammatory mass with overlying clot.  The lesion had an
active pumping vessel visualized and this was injected with
8cc of Epinephrine.  This stopped, but then another visible
vessel spurted red blood was then seen.  The area was then
injected with another 8cc of Epinephrine.  No biopsy was done
at this time.  The patient at this time had been transferred
to the Medical Intensive Care Unit due to his active
gastrointestinal bleeding.  The patient prior to colonoscopy
had attempted to go to angiogram for embolization of the
bleeding site seen on the tagged red blood cell scan but they
were unable to embolize.  The patient's hematocrit then was
stable times 36 hours.  The patient's bleed initially had
been in the setting of being on Heparin as well as Aspirin
and Plavix postcatheterization.  All these were stopped while
the patient was in the Medical Intensive Care Unit.  His last
transfusion was on [**2199-1-16**], and his bowel movement after
that was brown.  The patient was transferred out to the floor
to the Medicine service where the patient was monitored
closely with q.day hematocrit checks.  Gastroenterology
continued to follow the patient and on [**2199-1-21**], rescoped the
patient for biopsy.  All that was seen was friability,
congestion and erythema in the proximal ascending colon in
the area of the previous bleed.  The cecum and the splenic
flexure and all of this was consistent with segmental
colitis.  A biopsy was taken of the area.  The patient had
continued on his Plavix during his stay on the floor but his
Aspirin had been held during this entire time.  The patient's
hematocrit dropped from 31.9 to 28.5 postcolonoscopy
overnight.  The patient had brown stools with occasional
flecks of blood.  The patient was transfused one unit on
[**2199-1-22**], to keep his hematocrit above 30.0 given his
coronary artery disease.

3.  Renal - The patient had chronic renal insufficiency
secondary to diabetes mellitus.  His creatinine became quite
elevated postcatheterization thought to be secondary to dye
load.  The patient did receive Mucomyst.  With continued
monitoring over the course of his admission, his creatinine
came down to his baseline of 1.4.

4.  Diabetes mellitus - The patient had elevated blood sugar
during admission.  He was continued on his Lantus as well as
regular sliding scale insulin without significant
complication.  On discharge, the patient's hematocrit was
stable postbiopsy and this will be followed up as an
outpatient.  He has had no chest pain and no shortness of
breath.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is to be discharged to the
[**Location 54284**] where he is an inmate.

MEDICATIONS ON DISCHARGE:
1.  Plavix 75 mg one p.o. once daily.
2.  Atorvastatin 10 mg one p.o. once daily.
3.  Protonix 40 mg one p.o. once daily.
4.  Glargine insulin 17 units subcutaneous once daily.
5.  Sliding scale insulin.
6.  Toprol XL 200 mg once daily.
7.  Lisinopril 10 mg p.o. once daily.

DISCHARGE FOLLOW-UP PLANS:  The patient is to follow-up with
gastroenterology service on [**2199-1-30**], for follow-up of the
patient's biopsy.  The patient should follow-up with the
infirmary doctor to follow his blood sugar, his renal
function and his hematocrit.




                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 2506**]

Dictated By:[**Last Name (NamePattern1) 8141**]
MEDQUIST36

D:  [**2199-1-22**]  17:52
T:  [**2199-1-22**]  18:21
JOB#:  [**Job Number 54288**]

cc:[**Location 54289**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled'}


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 45 year old
male with diabetes, hypertension, chronic renal
insufficiency, human immunodeficiency virus positive who
presented to [**Hospital3 3583**] on [**1-7**] for chest pain.
The patient had been transferred from [**Location 54282**] where he is an inmate.  The patient's
pain began while he was lying in bed and did not get better
over the next 24 hours.  The pain radiated to his left arm
and neck.  The patient denied associated shortness of breath,
diaphoresis, nausea or vomiting.  The patient denied
palpitations.  He also denied lightheadedness.  The patient
did report decreased exercise tolerance with shortness of
breath with less than one flight of stairs which had been
worse over the past few months.  He also reported increased
lower extremity edema over the past few months.  He denied
paroxysmal nocturnal dyspnea, he denied orthopnea.  At [**Hospital3 6265**] the patient ruled in for myocardial infarction with
creatinine kinase in the 500 and troponin of 6.  The patient
had flipped Ts laterally.  The patient received an Aspirin
and Plavix and was on a heparin drip at the time of transfer
to [**Hospital6 256**].

MEDICAL HISTORY: 1.  Type 2 diabetes; 2.  Hypertension;
3.  History of pancreatitis; 4.  History of Clostridium
difficile colitis; 5.  Chronic renal insufficiency, baseline
creatinine 1.8 to 2.2; 6.  Human immunodeficiency virus
positive, CD4 count in [**2198-9-24**] was 554; 7.  History
of line sepsis; 8.  Recent pneumonia complicated by
Clostridium difficile infection.  The patient had a negative
stress test in [**2197-9-24**].

MEDICATION ON ADMISSION: 1.  Lantus 15 q.a.m., regular sliding scale insulin.
2.  Lopressor 100 mg twice a day.
3.  Aspirin 325 mg p.o. once daily.
4.  Norvasc 10 mg p.o. once daily.
5.  Protonix 40 mg p.o. once daily.
6.  Flagyl 500 mg p.o. three times a day.
7.  Plavix 75 mg p.o. once daily.
8.  Statin 10 mg p.o. once daily.
9.  Ativan p.r.n.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is an inmate at the [**Location 54283**], history of cocaine use. 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled'}
