CHIEF COMPLAINT: Cough, weight loss, left LE edema/erythema/pain

PRESENT ILLNESS: 70 y/o male smoker with PVD, CAD S/P CABG ([**2125**]), CHF (EF
25-30%, sxs with minimal activity), h/o Head/Neck CA (hard
palate SCC 10 yrs ago s/p XRT/seeds), seveer PVD, who has had a
productive cough for approx 10 months, worse in the past week,
associated with a 20 lb wt. loss over several months, increasing
SOB with exertion, and left LE swelling/erythema over the past
2-3 weeks that is increasingly painful.
Denies chest pain or pressure. Denies anginal symptomes at home.
.
Reports history of incarceration/employment in TB [**Hospital1 **]. Denies
hemoptysis or night sweats.

MEDICAL HISTORY: Smoker 55yrs 2ppd
PVD
CAD S/P CABG [**2125**] - LIMA to LAD, SVG to OM, SVG to PDA.
CHF - EF 25-30% (in [**2125**]) - now essentially has Class III
failure
Hard palate SCC -dx. during intubation for CABG in [**2125**];
resected and XRT
ETOH abuse (currently drinks 2 drinks per day, last yesterday
S/P appendectomy
S/P Hernia repair

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99 HR 105 BP 102/52 RR 16  SAT 99% RA
Elderly man with mult. pigmented lesions of the face and chest,
NAD
CTA, mild expiratory wheezes
RRR, occ premature beat, mid-peaking crescendo-decrescendo
murmur, [**12-28**]
Abd soft, nt, nd, bs+
Thin, wasted extremities,
mult. stigmata of vascular insuficiency: dry, lichanified, skin,
warm, but non-palpable pulses, Lt. LLE painful to touch,
erythematous, open lesion b/t 4th and 5th toes, no purulence,
but serous drainage.

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives with Wife [**Location (un) 6409**]. ETOH use of two drinks per day.
Smokes 2 ppd for 55 years, Used to drive cab.
Malignant neoplasm of upper lobe, bronchus or lung,Acute and chronic respiratory failure,Secondary malignant neoplasm of pleura,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Atherosclerosis of native arteries of the extremities with gangrene,Cardiac arrest,Cachexia,Mitral valve disorders,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Cellulitis and abscess of foot, except toes,Anemia in neoplastic disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Personal history of other malignant neoplasm of skin
Mal neo upper lobe lung,Acute & chronc resp fail,Second malig neo pleura,CHF NOS,Food/vomit pneumonitis,Ath ext ntv art gngrene,Cardiac arrest,Cachexia,Mitral valve disorder,Chr airway obstruct NEC,Alcohol abuse-unspec,Cellulitis of foot,Anemia in neoplastic dis,DMII wo cmp nt st uncntr,Aortocoronary bypass,Hx-skin malignancy NEC
Admission Date:  [**2139-11-24**]              Discharge Date:   [**2139-12-6**]

Date of Birth:  [**2069-1-4**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Cough, weight loss, left LE edema/erythema/pain


Major Surgical or Invasive Procedure:
Thoracentesis of Left Pleural Space

History of Present Illness:
70 y/o male smoker with PVD, CAD S/P CABG ([**2125**]), CHF (EF
25-30%, sxs with minimal activity), h/o Head/Neck CA (hard
palate SCC 10 yrs ago s/p XRT/seeds), seveer PVD, who has had a
productive cough for approx 10 months, worse in the past week,
associated with a 20 lb wt. loss over several months, increasing
SOB with exertion, and left LE swelling/erythema over the past
2-3 weeks that is increasingly painful.
Denies chest pain or pressure. Denies anginal symptomes at home.
.
Reports history of incarceration/employment in TB [**Hospital1 **]. Denies
hemoptysis or night sweats.

Past Medical History:
Smoker 55yrs 2ppd
PVD
CAD S/P CABG [**2125**] - LIMA to LAD, SVG to OM, SVG to PDA.
CHF - EF 25-30% (in [**2125**]) - now essentially has Class III
failure
Hard palate SCC -dx. during intubation for CABG in [**2125**];
resected and XRT
ETOH abuse (currently drinks 2 drinks per day, last yesterday
S/P appendectomy
S/P Hernia repair

Social History:
Lives with Wife [**Location (un) 6409**]. ETOH use of two drinks per day.
Smokes 2 ppd for 55 years, Used to drive cab.


Family History:
Non contributory

Physical Exam:
T 99 HR 105 BP 102/52 RR 16  SAT 99% RA
Elderly man with mult. pigmented lesions of the face and chest,
NAD
CTA, mild expiratory wheezes
RRR, occ premature beat, mid-peaking crescendo-decrescendo
murmur, [**12-28**]
Abd soft, nt, nd, bs+
Thin, wasted extremities,
mult. stigmata of vascular insuficiency: dry, lichanified, skin,
warm, but non-palpable pulses, Lt. LLE painful to touch,
erythematous, open lesion b/t 4th and 5th toes, no purulence,
but serous drainage.


Pertinent Results:
ADMISSION LABS:
[**2139-11-24**] 04:00PM   WBC-6.2 RBC-3.41* HGB-9.3* HCT-28.8* MCV-84
MCH-27.2 MCHC-32.3 RDW-16.7*
[**2139-11-24**] 04:00PM   NEUTS-79.8* LYMPHS-15.3* MONOS-3.3 EOS-1.2
BASOS-0.4
[**2139-11-24**] 04:00PM   HYPOCHROM-3+ ANISOCYT-1+ POIKILOCY-1+
MICROCYT-1+
[**2139-11-24**] 04:00PM   PLT COUNT-468*
[**2139-11-24**] 04:00PM   PT-13.5* PTT-24.6 INR(PT)-1.2
[**2139-11-24**] 04:00PM   GLUCOSE-110* UREA N-18 CREAT-0.9 SODIUM-133
POTASSIUM-4.2 CHLORIDE-92* TOTAL CO2-33* ANION GAP-12
[**2139-11-24**] 04:00PM   CALCIUM-9.2 PHOSPHATE-3.6 MAGNESIUM-2.1
.
EKG:
Sinus rhythm. Ventricular premature beats. Left atrial
abnormality. Low limb lead QRS voltage is non-specific. Modest
non-specific low amplitude lateral T wave changes. Since the
previous tracing of [**2135-12-20**] limb lead QRS voltage is lower
making assessment for possible prior inferior wall myocardial
infarction more difficult, and lateral T wave amplitude is
lower.
.
CXR:
Large left effusion, obscuring the left mid and lower lung.
.
LEFT FOOT FILM:
No fracture of the left foot is identified. There are
degenerative changes at the tarsometatarsal joints. There is a
pes cavus. Clips are noted within the medial left ankle soft
tissues. Otherwise, soft tissues are unremarkable, and no ulcers
are visualized. There is no osseous destruction visualized to
confirm osteomyelitis.
.
CT CHEST:
There is a large layering left pleural effusion causing eversion
of the left hemidiaphragm and extending into the azygoesophageal
recess. There is atelectasis of the left lower lobe and lingula.
A 2.6 x 2 cm lobulated, pleural-based solid mass is seen in the
left upper lobe abutting the mediastinal pleura, however,
without any invasion of the mediastinal pleura or the lateral
chest wall.
A 4-mm noncalcified pulmonary nodule is seen in the right lower
lobe (image 2:36). The airways are patent up to the subsegmental
bronchi. There is an enlarged 11-mm subcarinal lymph node. There
is no hilar lymphadenopathy. There is no pericardial effusion.
The heart and great vessels are unremarkable.
.
ABI/PVR:
Findings consistent with significant aortobi-iliac level
arterial disease. In addition, there is most likely significant
tibial level arterial disease bilaterally.
.
ECHO:
The left atrium is mildly dilated. The left ventricular cavity
is moderately dilated. There is mild regional left ventricular
systolic dysfunction. [Intrinsic left ventricular systolic
function is likely more depressed given the severity of valvular
regurgitation.] Resting regional wall motion abnormalities
include basal to mid inferior and inferolateral
akinesis/hypokinesis. Right ventricular chamber size is normal.
The mitral valve leaflets are mildly thickened. There is
moderate/severe mitral valve
prolapse. There is partial mitral leaflet flail. Moderate to
severe (3+)
mitral regurgitation is seen. The mitral regurgitation jet is
eccentric. There is moderate pulmonary artery systolic
hypertension. There is no pericardial effusion.
.
CAROTID DOPPLER:
Findings as stated above which indicate 60-69% ICA stenoses
bilaterally


Brief Hospital Course:
  Shortly after admission, Mr. [**Known lastname **] developed respiratory
distress in the setting of aspiration and a large pleural
effusion, requiring intubation and transfer to ICU. While in the
ICU his pleural effusion was drained and found to have malignant
cells.  Recently the medical team had discovered a lung mass by
imaging studies and this was felt to be the likely primary.
After drainage of the effusion and placement of a pleuridex
catheter pt was able to be extubated.  Shortly after extubation
pt required re-intubation for hypercarbic respiratory failure.
At that time the patient was found to have a re-accumulation of
the pleural fluid as well as pulmonary edema.
  Pt was initially admitted for severe peripheral vascular
disease and resultant necrosis of the distal toes.  The legs
were mottled, with markedly diminished pulses, and amputation
was advised but refused by the patient.  Antibiotics were
administered in an attemt to cover likely infection given the
increasinglt gangrenous appearance of his feet.
  On [**2139-12-6**] while pt was intubated, sedation was lightened and
family was able talk to him about his wishes.  After a family
meeting with the ICU team, family requested extubation, fully
understanding that he would likely not survive long of of the
ventilator.  Pt was extubated and died shortly therafter.


Medications on Admission:
None

Prescribed Medications In Past:
(very poor compliance)
Zestril
Coreg 6.25 mg [**Hospital1 **]
Singulair
Combivent
Wellbutrin

Per patient, he is not taking any of these medications.

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
peripheral vascular disease
malignant pleural effusion

Discharge Condition:
na

Discharge Instructions:
na

Followup Instructions:
na


Completed by:[**2140-1-3**]
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute and chronic respiratory failure,Secondary malignant neoplasm of pleura,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Atherosclerosis of native arteries of the extremities with gangrene,Cardiac arrest,Cachexia,Mitral valve disorders,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Cellulitis and abscess of foot, except toes,Anemia in neoplastic disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Personal history of other malignant neoplasm of skin'}


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: Cough, weight loss, left LE edema/erythema/pain

PRESENT ILLNESS: 70 y/o male smoker with PVD, CAD S/P CABG ([**2125**]), CHF (EF
25-30%, sxs with minimal activity), h/o Head/Neck CA (hard
palate SCC 10 yrs ago s/p XRT/seeds), seveer PVD, who has had a
productive cough for approx 10 months, worse in the past week,
associated with a 20 lb wt. loss over several months, increasing
SOB with exertion, and left LE swelling/erythema over the past
2-3 weeks that is increasingly painful.
Denies chest pain or pressure. Denies anginal symptomes at home.
.
Reports history of incarceration/employment in TB [**Hospital1 **]. Denies
hemoptysis or night sweats.

MEDICAL HISTORY: Smoker 55yrs 2ppd
PVD
CAD S/P CABG [**2125**] - LIMA to LAD, SVG to OM, SVG to PDA.
CHF - EF 25-30% (in [**2125**]) - now essentially has Class III
failure
Hard palate SCC -dx. during intubation for CABG in [**2125**];
resected and XRT
ETOH abuse (currently drinks 2 drinks per day, last yesterday
S/P appendectomy
S/P Hernia repair

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99 HR 105 BP 102/52 RR 16  SAT 99% RA
Elderly man with mult. pigmented lesions of the face and chest,
NAD
CTA, mild expiratory wheezes
RRR, occ premature beat, mid-peaking crescendo-decrescendo
murmur, [**12-28**]
Abd soft, nt, nd, bs+
Thin, wasted extremities,
mult. stigmata of vascular insuficiency: dry, lichanified, skin,
warm, but non-palpable pulses, Lt. LLE painful to touch,
erythematous, open lesion b/t 4th and 5th toes, no purulence,
but serous drainage.

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives with Wife [**Location (un) 6409**]. ETOH use of two drinks per day.
Smokes 2 ppd for 55 years, Used to drive cab. 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute and chronic respiratory failure,Secondary malignant neoplasm of pleura,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Atherosclerosis of native arteries of the extremities with gangrene,Cardiac arrest,Cachexia,Mitral valve disorders,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Cellulitis and abscess of foot, except toes,Anemia in neoplastic disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Personal history of other malignant neoplasm of skin'}
