CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 72-year-old
female with a past medical history of coronary artery disease
with one vessel disease, hypercholesterolemia, hypertension,
remote tobacco, diabetes mellitus, hypothyroidism, and
chronic renal insufficiency, who was recently discharged from
[**Hospital1 69**] on [**2171-10-20**].  On that
admission, she presented with shortness of breath and
underwent a cardiac catheterization which revealed a 70 to
80% obtuse marginal I lesion which was angioplastied but not
stented.

MEDICAL HISTORY: 1.  Diabetes mellitus, Type 2, for five years.
2.  Chronic obstructive pulmonary disease with an FEV-1 of
1.43 and pulmonary hypertension on her last echocardiogram
3.  Coronary artery disease with one vessel disease, status
post obtuse marginal I percutaneous transluminal coronary
angioplasty in [**10-14**]
4.  Hypertension
5.  Obesity
6.  Congestive heart failure
7.  Chronic renal insufficiency
8.  Interstitial cystitis
9.  Hypercholesterolemia
10. Hypothyroidism
11. Anxiety disorder
12. Status post cholecystectomy

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to contrast dye, iodine,
penicillin and seafood.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Congestive heart failure, unspecified,Mitral valve disorders,Intermediate coronary syndrome,Anemia, unspecified,Other emphysema,Drug-induced delirium,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter
CHF NOS,Mitral valve disorder,Intermed coronary synd,Anemia NOS,Emphysema NEC,Drug-induced delirium,Adv eff benzodiaz tranq,DMII wo cmp nt st uncntr,Renal & ureteral dis NOS
Admission Date:  [**2171-10-30**]       Discharge Date:  [**2171-11-6**]

Date of Birth:   [**2099-3-17**]       Sex:  F

Service:

                        ADDENDUM

DISCHARGE MEDICATIONS:  There was a medication listed as
Trilafon at 2 mg p.o. q.d.  This should be changed to 2 mg
p.o. b.i.d.

HOSPITAL COURSE:  Additional Psychiatry recommendations were
made to obtain a head CT in the future if the patient's
mental status changes recur.





                         DR.[**First Name (STitle) **],[**First Name3 (LF) 870**] 12-464


Dictated By:[**Last Name (NamePattern1) 11732**]
MEDQUIST36

D:  [**2171-11-6**]  08:16
T:  [**2171-11-6**]  08:08
JOB#:  [**Job Number 36042**]


Admission Date:  [**2171-10-30**]       Discharge Date:  [**2171-11-6**]

Date of Birth:   [**2099-3-17**]       Sex:  F

Service:  CCU

HISTORY OF PRESENT ILLNESS:   The patient is a 72-year-old
female with a past medical history of coronary artery disease
with one vessel disease, hypercholesterolemia, hypertension,
remote tobacco, diabetes mellitus, hypothyroidism, and
chronic renal insufficiency, who was recently discharged from
[**Hospital1 69**] on [**2171-10-20**].  On that
admission, she presented with shortness of breath and
underwent a cardiac catheterization which revealed a 70 to
80% obtuse marginal I lesion which was angioplastied but not
stented.

The patient had a TTE, which revealed an ejection fraction of
greater than 55%, with no regional wall motion abnormality.
The patient did well until [**10-29**], when she presented to an
outside hospital complaining of chest heaviness at home for a
duration of 20 minutes.  She reportedly took one sublingual
nitroglycerin, and experienced pre-syncopal episode when she
stood.  She stated that the chest pain lasted throughout the
previous evening and was associated with nausea and shortness
of breath.  She denied diaphoresis.  The patient was admitted
to [**Hospital3 3834**] for rule out myocardial infarction.

On [**10-29**], she experienced a sudden worsening of her
respiratory status.  Her oxygen saturation was 81% on room
air.  A blood gas at that time revealed a pH of 7.19, PCO2
74, and PO2 of 92.  The patient was intubated at this time.
A Swan-Ganz catheter was placed, which revealed a pulmonary
capillary wedge pressure of 20.  The patient was diuresed
with Bumex, which reduced the wedge pressure to 15.  The
patient's CKs were negative, but her troponin reportedly went
from less than 0.04 to 1.08.  A TTE was obtained and, by
report, had a new inferior wall motion abnormality.  The
patient was transferred to [**Hospital1 188**] for further management of her congestive heart
failure.  Upon arrival, the patient was intubated, anxious,
but without any complaints.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus, Type 2, for five years.
2.  Chronic obstructive pulmonary disease with an FEV-1 of
1.43 and pulmonary hypertension on her last echocardiogram
3.  Coronary artery disease with one vessel disease, status
post obtuse marginal I percutaneous transluminal coronary
angioplasty in [**10-14**]
4.  Hypertension
5.  Obesity
6.  Congestive heart failure
7.  Chronic renal insufficiency
8.  Interstitial cystitis
9.  Hypercholesterolemia
10. Hypothyroidism
11. Anxiety disorder
12. Status post cholecystectomy

ALLERGIES:   The patient is allergic to contrast dye, iodine,
penicillin and seafood.

MEDICATIONS AT HOME:  Lopressor 25 mg by mouth twice a day,
Actos 30 mg by mouth once daily, Lipitor 10 mg by mouth daily
at bedtime, Alphagan eyedrops 0.2% to right eye twice a day,
Bumex 1 mg by mouth once daily, Imdur 30 mg by mouth once
daily, Colace 100 mg by mouth twice a day, Ativan 1 mg by
mouth twice a day as needed, percocet as needed, Norvasc 10
mg once daily, Cogentin 1 mg once daily, Trilafon 2 mg by
mouth once daily, Prozac 40 mg by mouth once daily, Synthroid
125 mcg by mouth once daily, Lopid 600 mg by mouth once
daily, Glucophage 850 mg by mouth once daily.

PHYSICAL EXAMINATION:   The patient had a blood pressure of
107/60, pulse 82, she was breathing at 27, oxygen saturation
95% on room air.  The ventilator was set on SIMV with an FIO2
of 50%, tidal volume of 750, and  PEEP of [**5-18**].  In general,
the patient was an alert, elderly female.  She was intubated
but in no acute distress.  On head, eyes, ears, nose and
throat examination, her pupils were equal, round and reactive
to light, her extraocular movements were  intact.  She was
intubated.  On neck examination, her neck was supple, without
any jugular venous distention.  On cardiovascular
examination, regular rate and rhythm, heart sounds were
distant and difficult to auscultate.  Respiratory examination
showed bibasilar rales.  Abdominal examination was soft, with
some mild right upper quadrant tenderness, positive bowel
sounds, no hepatosplenomegaly.  Extremity examination:  The
patient had no cyanosis, clubbing, and trace edema.  Her
extremities were warm, and her pedal pulses were not
palpable.

LABORATORY DATA:   On admission, revealed a white blood cell
count of 11.4, hematocrit 29.6, platelets 223. Sodium 142,
potassium 3, chloride 103, CO2 29, BUN 17, creatinine 1.2,
glucose 170.  She had a calcium of 8.2, a phosphate of 2.7, a
magnesium of 1.8.  CK was 53.  She had a pH of 7.46, PCO2 40,
PO2 70 on FIO2 of 50.  Electrocardiogram from [**10-29**] revealed
normal sinus rhythm at 72, with normal axis, normal
intervals, no ischemic changes.  Chest x-ray revealed
pulmonary edema.

HOSPITAL COURSE:   The patient arrived at the Coronary Care
Unit intubated but hemodynamically stable.  Despite negative
enzymes and a lack of ischemic electrocardiogram changes, we
were concerned about ischemia as a precipitant, since obtuse
marginal lesions can be electrically silent.  The patient was
monitored on 24 hour telemetry, and was continued on
Lopressor, aspirin and Lipitor.  She was started on
Captopril for afterload reduction.  The patient was initially
diuresed with lasix to reach a 24 hour fluid balance of .5 to
1 liter negative per day.

The patient had a transthoracic echocardiogram which revealed
the following:  The left atrium is enlarged.  The left
ventricular cavity size is normal. Global left ventricular
systolic function appears preserved due to suboptimal
technical quality.  A focal wall motion abnormality cannot be
fully excluded.  Right ventricular chamber size and free wall
motion are normal.  The aortic valve is not well seen.  No
aortic regurgitation is seen.  The mitral valve leaflets are
mildly thickened.  Mitral regurgitation is present but cannot
be quantified, likely at least moderate in severity.
Compared to the prior study of [**2171-10-16**], there is no definite
change.

The patient was taken to the cardiac catheterization
laboratory on [**10-31**].  The following was discovered:
1.  The left main was normal.  The left anterior descending
had a 70% stenosis in its D1 branch.  The left circumflex had
a 70% stenosis in its obtuse marginal II branch. The right
coronary artery had a 40% mid-vessel lesion.
2.  Successful percutaneous transluminal coronary angioplasty
of D1 and obtuse marginal II branches without dissection,
without residual stenosis and TIMI-III flow.

The final diagnoses at cardiac catheterization included two
vessel coronary artery branch disease and successful
percutaneous transluminal coronary angioplasty of D1 and
obtuse marginal II branches.

The patient tolerated the procedure well, without any
complications.  She was continued on her prior cardiac
regimen with the addition of Captopril, which was titrated
upwards as tolerated.  The decision was also made to maintain
her on Plavix for an extended time period given the
recurrence of her obtuse marginal disease.

From a pulmonary standpoint, the patient was slowly weaned
off the ventilator until she was successfully extubated on
[**11-2**].  Her oxygenation improved daily, with her most recent
oxygen requirement to date approximately 5 liters of oxygen
by nasal cannula, which is approaching her home oxygen
requirement of 2 liters.  Would continue to diurese her
gently with fluid goals of even to slightly negative.  She
was maintained on a standing dose of 40 mg of oral lasix,
with good effect.

During her hospital stay, the patient was very agitated and
anxious, requiring restraints to keep her from removing any
equipment.  We initially sedated her with Ativan, which she
takes at home.  We continued her on her home dose of
Trilafon.  Still, we had trouble calming the patient.

We consulted the Psychiatry service, who were concerned that
she might be undergoing benzodiazepine intoxication.  They
did not think that she was in any danger of acute withdrawal,
given that she only had increased dosages for a few days.
The Ativan was held, and the patient's agitation was treated
with supplemental Trilafon as needed.  The Psychiatry service
recommended resuming the patient's home dose of Ativan at 1
mg twice a day once the patient's mental status clears.

After the resolution of her acute medical problems, the
patient was seen by the Physical Therapy service, which felt
that she would benefit from an acute rehabilitation stay
prior to returning home.

CONDITION AT DISCHARGE:  The patient will be discharged to an
inpatient rehabilitation facility.

DISCHARGE DIAGNOSIS:
1.  Two vessel coronary artery disease status post successful
percutaneous transluminal coronary angioplasty
2.  Diabetes mellitus
3.  Hypertension
4.  Hypercholesterolemia
5.  Chronic obstructive pulmonary disease
6.  Chronic renal insufficiency
7.  Anxiety disorder

DISCHARGE MEDICATIONS:   Aspirin 325 mg by mouth once daily,
Protonix 40 mg by mouth once daily, Lipitor 10 mg by mouth
daily at bedtime, lasix 40 mg by mouth once daily, Imdur 30
mg by mouth once daily, Synthroid 125 mcg by mouth once
daily, atenolol 25 mg by mouth once daily, Zestril 10 mg by
mouth once daily, Combivent metered dose inhaler two puffs
four times a day, K-Dur 10 mEq by mouth once daily, Plavix 75
mg by mouth once daily, percocet one to two tablets by mouth
every four to six hours as needed, Colace 100 mg by mouth
twice a day, Cogentin 1 mg by mouth once daily, Trilafon 2 mg
by mouth once daily, Prozac 40 mg by mouth once daily,
Trilafon 2 mg by mouth/intravenously every six hours as
needed for agitation, Actos 30 mg by mouth once daily,
Glyburide 10 mg by mouth twice a day, Lopid 600 mg by mouth
once daily, Glucophage 850 mg by mouth once daily.

FOLLOW UP:  The patient will see her primary care provider,
[**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20585**], for an initial evaluation.  She will then
either be referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Hospital1 346**] or with a local cardiologist,
depending upon the family's preference.  Rehabilitation
potential is good.




                            [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 5219**]

Dictated By:[**Last Name (NamePattern1) 11732**]
MEDQUIST36

D:  [**2171-11-6**]  00:07
T:  [**2171-11-6**]  01:23
JOB#:  [**Job Number 36041**]


Admission Date:  [**2171-10-30**]       Discharge Date:  [**2171-11-6**]

Date of Birth:   [**2099-3-17**]       Sex:  F

Service:

ADDENDUM:  Given the severity of the patient's chronic lung
disease, we were concerned about chronic pulmonary emboli as
a possible cause.  The patient underwent a CT angiogram of
her chest, which revealed extensive emphysematous disease,
but no pulmonary emboli.

There has been a change in the patient's discharge status.
The patient and her family have decided that she should be
discharged to home with VNA and physical therapy assistance
at home.





                              DR.[**First Name (STitle) **],[**First Name3 (LF) 870**] 12-464


Dictated By:[**Last Name (NamePattern1) 11732**]
MEDQUIST36

D:  [**2171-11-6**]  14:44
T:  [**2171-11-6**]  14:50
JOB#:  [**Job Number 36043**]
{'Congestive heart failure, unspecified,Mitral valve disorders,Intermediate coronary syndrome,Anemia, unspecified,Other emphysema,Drug-induced delirium,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter'}


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 72-year-old
female with a past medical history of coronary artery disease
with one vessel disease, hypercholesterolemia, hypertension,
remote tobacco, diabetes mellitus, hypothyroidism, and
chronic renal insufficiency, who was recently discharged from
[**Hospital1 69**] on [**2171-10-20**].  On that
admission, she presented with shortness of breath and
underwent a cardiac catheterization which revealed a 70 to
80% obtuse marginal I lesion which was angioplastied but not
stented.

MEDICAL HISTORY: 1.  Diabetes mellitus, Type 2, for five years.
2.  Chronic obstructive pulmonary disease with an FEV-1 of
1.43 and pulmonary hypertension on her last echocardiogram
3.  Coronary artery disease with one vessel disease, status
post obtuse marginal I percutaneous transluminal coronary
angioplasty in [**10-14**]
4.  Hypertension
5.  Obesity
6.  Congestive heart failure
7.  Chronic renal insufficiency
8.  Interstitial cystitis
9.  Hypercholesterolemia
10. Hypothyroidism
11. Anxiety disorder
12. Status post cholecystectomy

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to contrast dye, iodine,
penicillin and seafood.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Congestive heart failure, unspecified,Mitral valve disorders,Intermediate coronary syndrome,Anemia, unspecified,Other emphysema,Drug-induced delirium,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter'}
