CHIEF COMPLAINT: Shortness of breath and weakness.

PRESENT ILLNESS: The patient is a 65-year-old
female with a history of esophageal cancer diagnosed in [**2151-5-21**], status post treatment with cisplatin,
5-fluorouracil, radiation therapy, as well as esophagectomy
in [**2151-10-21**] who presents markedly worsening shortness
of breath times two days.

MEDICAL HISTORY: 1.  History of esophageal cancer diagnosed in [**2151-5-21**];
treated with cisplatin, and 5-fluorouracil, and six weeks of
radiation therapy.  The patient is status post 3-hole
esophagectomy in [**2151-10-21**].
2.  Status post appendectomy.
3.  History of gastroesophageal reflux disease.
4.  Status post large left pleural effusion and thoracentesis
in [**2151-12-21**].

MEDICATION ON ADMISSION: Protonix 40 mg p.o. q.d. (which
was recently discontinued), Ativan 1 mg p.o. q.h.s.,
Reglan 10 mg p.o. five times per day, and Robitussin-AC.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history positive for coronary artery
disease in father.  Positive for hypertension in paternal
grandmother and mother.  She denies any history of cancer,
diabetes, or hypercholesterolemia.  Primary care physician is
[**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].  Oncologist is Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 3274**].

SOCIAL HISTORY: Positive smoking history with 1.5 packs per
day times 10 days.  Social alcohol use.  The patient lives in
[**Location 620**] and is a housewife.
Acute pericarditis, unspecified,Atrial fibrillation,Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Personal history of malignant neoplasm of esophagus
Acute pericarditis NOS,Atrial fibrillation,Mitral/aortic val insuff,Tricuspid valve disease,Hx-esophageal malignancy
Admission Date:  [**2152-3-9**]     Discharge Date:  [**2152-3-14**]

Date of Birth:   [**2086-6-4**]     Sex:  F

Service:  CCU

CHIEF COMPLAINT:  Shortness of breath and weakness.

HISTORY OF PRESENT ILLNESS:  The patient is a 65-year-old
female with a history of esophageal cancer diagnosed in [**2151-5-21**], status post treatment with cisplatin,
5-fluorouracil, radiation therapy, as well as esophagectomy
in [**2151-10-21**] who presents markedly worsening shortness
of breath times two days.

The patient says that she has experienced shortness of breath
since her surgery; however, on a recent trip to [**State 8842**] she
noted dyspnea on exertion even with minimal activity as well
as generalized weakness.

The patient returned to [**State 350**] and her shortness of
breath markedly worsened along with an associated productive
cough.  She visited her oncologist one day prior to admission
and was sent for an echocardiogram today with findings of a
large circumferential pericardial effusion.

The patient was noted to be tachycardic to approximately 140s
and in atrial fibrillation.  In addition, there was right
ventricular compression consistent with impaired filling
tamponade physiology.  The patient was taken for a right
heart catheterization with right atrial pressure of 12 mmHg,
a pericardial pressure of 14 mmHg, and a wedge of 19 mmHg.  A
pericardiocentesis removed approximately 500 cc of bloody
fluid, and subsequently right atrial pressure to be 8 mmHg,
pericardial pressure of 3 mmHg, and a wedge of 7 mmHg.
Cardiac index increased from 1.7 prior to pericardiocentesis
to 2.6, and the patient's heart rate decreased from 140s down
to 110.  In addition, the patient's shortness of breath
improved with tap, and she was sent to the Coronary Care Unit
for further monitoring with a pericardial drain in place.

PAST MEDICAL HISTORY:
1.  History of esophageal cancer diagnosed in [**2151-5-21**];
treated with cisplatin, and 5-fluorouracil, and six weeks of
radiation therapy.  The patient is status post 3-hole
esophagectomy in [**2151-10-21**].
2.  Status post appendectomy.
3.  History of gastroesophageal reflux disease.
4.  Status post large left pleural effusion and thoracentesis
in [**2151-12-21**].

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Protonix 40 mg p.o. q.d. (which
was recently discontinued), Ativan 1 mg p.o. q.h.s.,
Reglan 10 mg p.o. five times per day, and Robitussin-AC.

SOCIAL HISTORY:  Positive smoking history with 1.5 packs per
day times 10 days.  Social alcohol use.  The patient lives in
[**Location 620**] and is a housewife.

FAMILY HISTORY:  Family history positive for coronary artery
disease in father.  Positive for hypertension in paternal
grandmother and mother.  She denies any history of cancer,
diabetes, or hypercholesterolemia.  Primary care physician is
[**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].  Oncologist is Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 3274**].

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
revealed vital signs with a temperature of 99.5, heart rate
of 105, blood pressure of 126/74, respiratory rate of 20, and
oxygen saturation of 98% on 2 liters.  In general, the
patient was a middle-aged white female lying in bed, in no
apparent distress.  Head, eyes, ears, nose, and throat
examination revealed normocephalic and atraumatic.  Pupils
were equally round and reactive to light.  Extraocular
muscles were intact.  Sclerae were anicteric.  Mucous
membranes were dry.  Neck was soft and supple.  Positive
jugular venous distention; however, the patient was supine.
Heart had a regular rate, tachycardic to the 100s, positive
first heart sound and second heart sound.  No murmurs, rubs
or gallops.  Lungs revealed coarse breath sounds bilaterally
and anteriorly.  No wheezes or rhonchi.  Subxiphoid drain in
place which was clean, dry, and intact.  The abdomen was
soft, nontender, and nondistended.  Decreased bowel sounds.
Right groin had no hematoma or bruit.  Extremities revealed
no clubbing, cyanosis or edema, warm.  Dorsalis pedis pulses
were 2+ bilaterally.  Neurologically, awake, alert and
oriented times three.  Motor and sensory were grossly intact.

PERTINENT LABORATORY DATA ON PRESENTATION:  Laboratory data
revealed a white blood cell count of 11.7 (with
90% neutrophils, 4% lymphocytes, and 5% monocytes),
hematocrit of 34.3, platelets of 366.  Sodium of 137,
potassium of 4, chloride of 100, bicarbonate of 22, blood
urea nitrogen of 16, creatinine of 0.7, glucose of 141.  PT
of 12.3, PTT of 32.1, INR of 1.1.  Pericardial fluid revealed
a total protein of 5.3, a glucose of 102, an albumin of 2.9,
and LDH of 2143, and an amylase of 12.  The remainder of the
pericardial fluid analysis including Gram stain,
differential, culture, fungal culture, and acid-fast bacillus
culture were pending.

RADIOLOGY/IMAGING:   A CT of the chest showed a large
pericardial effusion significantly increased in size since
prior study, moderate bilateral pleural effusions (right
greater than left).  A right-sided effusion which was
partially loculated.  No interstitial lung disease, minimal
central lobar emphysema, status post esophagectomy with
likely radiation therapy changes.

Electrocardiogram #1 showed atrial fibrillation in the 140s
to 150s, normal axis.  No ST changes.  No Q waves.  T wave
flattening in V4 through V6, and possible electrical
alternans.

Electrocardiogram #2 status post tap, showed ST changes in
the 100s.  No ST changes.  No Q waves.  T waves upright in V5
and V6.

An echocardiogram showed an ejection fraction of 55%, right
ventricular and left ventricular chamber size and motion were
normal.  Aortic regurgitation of 1+, 1+ mitral regurgitation,
2+ tricuspid regurgitation.  Large circumferential
pericardial effusion with right ventricular compression;
consistent with impaired filling and tamponade physiology.

Right heart catheterization revealed hemodynamics consistent
with tamponade physiology (as described in the History of
Present Illness).

IMPRESSION:  A 65-year-old female with a history of
esophageal cancer diagnosed in [**2151-5-21**], status post
treatment with cisplatin, 5-fluorouracil, radiation therapy,
and esophagectomy who presented with a 10-day history of
worsening shortness of breath and noted to have a large
circumferential pericardial effusion with tamponade
physiology on echocardiogram, prompting a pericardiocentesis
with indwelling catheter placement.

HOSPITAL COURSE BY SYSTEM:

1.  CARDIOVASCULAR:   (a)  PERICARDIUM:  Drainage from the
pericardial catheter was minimal on hospital day two.
However, a repeat echocardiogram showed a moderate sized
pericardial effusion primarily located anteriorly as well as
a trivial pericardial effusion posteriorly which appeared to
be loculated.  At this time, there were no further
echocardiographic signs of tamponade.

Based on these findings, Cardiothoracic Surgery was
consulted, and the patient was taken to the operating room
for partial pericardectomy.  The patient tolerated the
procedure well and a left chest tube was subsequently placed.
Drainage from the chest tube remained somewhat brisk
initially; however, on the day prior to discharge,
Cardiothoracic Surgery felt that the chest tube could be
removed at this point.  Drainage prior to the removal of the
chest tube was notable for a serosanguineous fluid.

(b)  ISCHEMIA:  The patient with no known coronary artery
disease and was not found to have any ischemic-related events
while a patient at [**Hospital1 69**].

(c)  RHYTHM:  As above, the patient was admitted in sinus
tachycardia to the Coronary Care Unit; however, she was noted
to be in atrial fibrillation with rapid ventricular response
on hospital day two to the 140s, prompting the use of beta
blockers for rate control and subsequent trip to the
operating room to treat the underlying etiology of the atrial
fibrillation.  Status post partial pericardectomy, the
patient converted spontaneously to sinus rhythm and remained
in sinus rhythm for the remainder of her hospital course.
The patient remained rate controlled with beta blockers for
the remainder of her hospital course and was discharged on
Lopressor at 50 mg p.o. b.i.d.

(d)  PUMP:  The patient with an ejection fraction of 55% and
noted elevated wedge pressure prior to pericardiocentesis.
Status post pericardiocentesis, wedge pressure returned to
within normal limits.  The patient was noted to have slight
flash pulmonary edema when noted to have rapid atrial
fibrillation; however, her shortness of breath improved with
better rate control.

2.  PULMONARY:  The patient's upper respiratory infection
symptoms including a productive cough was thought to be
likely secondary to a viral infection.  The patient remained
afebrile with a mild leukocytosis.

A chest x-ray obtained on [**2152-3-12**] showed a new left
lower lobe infiltrate which was thought to be more likely
atelectasis rather than a pneumonia.  The decision to defer
antibiotics was made with close follow up as an outpatient.
The patient was treated symptomatically with Robitussin-AC.

3.  ONCOLOGY:  As above, the patient with a history of
esophageal cancer, treated with multiple modalities.  The
pericardial effusion was concerning for a malignant etiology.
Cytology from the pericardial fluid was subsequently found to
be negative for malignant cells.  The patient was to follow
up with her outpatient oncologist, Dr. [**Last Name (STitle) 3274**], for further
management.

4.  GASTROINTESTINAL:  As above, the patient is status post
esophagectomy with occasional nausea and vomiting treated
with Reglan as an outpatient for nausea as well as motility
purposes.  The patient was maintained on her outpatient dose,
and gastrointestinal symptoms were moderately well controlled
along with the use of Protonix.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE STATUS:  The patient was to be discharged to home
with no home services.

DISCHARGE DIAGNOSES:
1.  Pericardial tamponade; status post pericardiocentesis,
status post partial pericardectomy.
2.  History of esophageal cancer.
3.  New onset atrial fibrillation in the setting of
pericardial tamponade.
4.  Upper respiratory infection.

MEDICATIONS ON DISCHARGE:  (Discharge medications included)
1.  Reglan 10 mg p.o. five times per day.
2.  Lopressor 50 mg p.o. b.i.d.

DISCHARGE FOLLOWUP:   Follow-up appointments included with
Cardiothoracic Surgery and Oncology on [**2152-3-16**].





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

Dictated By:[**Name8 (MD) 2054**]

MEDQUIST36

D:  [**2152-3-31**]  00:01
T:  [**2152-4-1**]  08:31
JOB#:  [**Job Number 35340**]
{'Acute pericarditis, unspecified,Atrial fibrillation,Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Personal history of malignant neoplasm of esophagus'}


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: Shortness of breath and weakness.

PRESENT ILLNESS: The patient is a 65-year-old
female with a history of esophageal cancer diagnosed in [**2151-5-21**], status post treatment with cisplatin,
5-fluorouracil, radiation therapy, as well as esophagectomy
in [**2151-10-21**] who presents markedly worsening shortness
of breath times two days.

MEDICAL HISTORY: 1.  History of esophageal cancer diagnosed in [**2151-5-21**];
treated with cisplatin, and 5-fluorouracil, and six weeks of
radiation therapy.  The patient is status post 3-hole
esophagectomy in [**2151-10-21**].
2.  Status post appendectomy.
3.  History of gastroesophageal reflux disease.
4.  Status post large left pleural effusion and thoracentesis
in [**2151-12-21**].

MEDICATION ON ADMISSION: Protonix 40 mg p.o. q.d. (which
was recently discontinued), Ativan 1 mg p.o. q.h.s.,
Reglan 10 mg p.o. five times per day, and Robitussin-AC.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history positive for coronary artery
disease in father.  Positive for hypertension in paternal
grandmother and mother.  She denies any history of cancer,
diabetes, or hypercholesterolemia.  Primary care physician is
[**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].  Oncologist is Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 3274**].

SOCIAL HISTORY: Positive smoking history with 1.5 packs per
day times 10 days.  Social alcohol use.  The patient lives in
[**Location 620**] and is a housewife. 

### Response:
{'Acute pericarditis, unspecified,Atrial fibrillation,Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Personal history of malignant neoplasm of esophagus'}
