CHIEF COMPLAINT: Abdominal pain, shortness of breath.

PRESENT ILLNESS: Briefly, this is a 88 M with CAD s/p IMI and stenting, Afib,
admitted with progressive SOB. In ED, noted to be in AF with RVR
at rate of 130s. Was rate controlled on 15 mg IV dilt. Pt then
received 120 PO dilt. Given concern for PE, D-dimer sent and
returned at 516. CTA not performed given renal insufficiency,
and pt given 60 mg SQ lovenox for empiric treatment of PE . On
initial floor eval by primary team, noted to be tachypneic, with
basilar crackles, HR ~100. Given IV lasix. Then as pt was
straining to have BM, became bradycardic and hypotensive. Stools
guaiac negative. ABG 7.25/47/79 with lactate 6.1. On further
exam, was also noted to have lower abdominal pain.
.
Per daughter, pt functional at baseline. Lives alone, no
assistance with ADLs. Walks up to a mile to market without
exertional symptoms. Daughter takes [**Name2 (NI) **] weekly. Had been
regular up until this past Saturday when she noted it to be
irregular. Pt had otherwise been in USOH until this weekend when
had worsening SOB.

MEDICAL HISTORY: - Atrial fibrillation s/p cardioversion [**2190**]
- Hx upper GI bleed
- MI s/p stent [**2187**]
- HTN
- Hypercholesterolemia
- BPH

MEDICATION ON ADMISSION: ASA daily
Previously on amio, but stopped several months ago

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - 96.0, BP 94/79, HR 48, RR 28, O2 sat 96% 2L NC, wt 78 kg
Gen - somewhat uncomfortable, but NAD, speaking in full
sentences
HEENT - NCAT, PERRL, OP clr, MMM, no LAD
CV - [**Location 64063**] [**Last Name (LF) 64063**], [**First Name3 (LF) **], no mur
Lungs - dependent R-sided crackles (pt laying on R side)
Abdomen - NABS, distended, tender in lower abdomen with
voluntary guarding, no rebound tenderness, no CVA tenderness
Back - no back tenderness
Ext - 1+ bilat edema, WWP, distal pulses 2+
Neuro - A&Ox3
Skin - Pink, warm, no rashes

FAMILY HISTORY: Many family members with CAD.

SOCIAL HISTORY: Moved from [**Country 5881**] 50 years ago; he is widowed, lives alone and
is independent in all ADLs. He quit smoking 35 years ago, and
smoked 1ppd for "many years." Occasional alcohol use. Has 2
children. Daughter lives in [**Location 86**] and is active in his care. He
used to work at a raincoat factory.
Acute vascular insufficiency of intestine,Atrial fibrillation,Acute kidney failure, unspecified,Acidosis,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Ac vasc insuff intestine,Atrial fibrillation,Acute kidney failure NOS,Acidosis,Chronic kidney dis NOS,CHF NOS,Crnry athrscl natve vssl,Status-post ptca,Hy kid NOS w cr kid I-IV,Pure hypercholesterolem,BPH w/o urinary obs/LUTS
Admission Date:  [**2196-3-29**]              Discharge Date:   [**2196-4-2**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Abdominal pain, shortness of breath.


Major Surgical or Invasive Procedure:
None

History of Present Illness:

Briefly, this is a 88 M with CAD s/p IMI and stenting, Afib,
admitted with progressive SOB. In ED, noted to be in AF with RVR
at rate of 130s. Was rate controlled on 15 mg IV dilt. Pt then
received 120 PO dilt. Given concern for PE, D-dimer sent and
returned at 516. CTA not performed given renal insufficiency,
and pt given 60 mg SQ lovenox for empiric treatment of PE . On
initial floor eval by primary team, noted to be tachypneic, with
basilar crackles, HR ~100. Given IV lasix. Then as pt was
straining to have BM, became bradycardic and hypotensive. Stools
guaiac negative. ABG 7.25/47/79 with lactate 6.1. On further
exam, was also noted to have lower abdominal pain.
.
Per daughter, pt functional at baseline. Lives alone, no
assistance with ADLs. Walks up to a mile to market without
exertional symptoms. Daughter takes [**Name2 (NI) **] weekly. Had been
regular up until this past Saturday when she noted it to be
irregular. Pt had otherwise been in USOH until this weekend when
had worsening SOB.


Past Medical History:
- Atrial fibrillation s/p cardioversion [**2190**]
- Hx upper GI bleed
- MI s/p stent [**2187**]
- HTN
- Hypercholesterolemia
- BPH


Social History:
Moved from [**Country 5881**] 50 years ago; he is widowed, lives alone and
is independent in all ADLs. He quit smoking 35 years ago, and
smoked 1ppd for "many years." Occasional alcohol use. Has 2
children. Daughter lives in [**Location 86**] and is active in his care. He
used to work at a raincoat factory.


Family History:
Many family members with CAD.

Physical Exam:
VS - 96.0, BP 94/79, HR 48, RR 28, O2 sat 96% 2L NC, wt 78 kg
Gen - somewhat uncomfortable, but NAD, speaking in full
sentences
HEENT - NCAT, PERRL, OP clr, MMM, no LAD
CV - [**Location 64063**] [**Last Name (LF) 64063**], [**First Name3 (LF) **], no mur
Lungs - dependent R-sided crackles (pt laying on R side)
Abdomen - NABS, distended, tender in lower abdomen with
voluntary guarding, no rebound tenderness, no CVA tenderness
Back - no back tenderness
Ext - 1+ bilat edema, WWP, distal pulses 2+
Neuro - A&Ox3
Skin - Pink, warm, no rashes


Pertinent Results:
Radiographic studies:

HIDA scan on [**2196-3-31**]:
Serial images over the abdomen show normal uptake of tracer into
the hepatic parenchyma.  At 15 minutes, the gallbladder is
visualized with tracer. No activity is seen in the small bowel
to 90 minutes. The findings suggest sphincter of Oddi
contraction, possibly secondary to narcotic administration (as
tracer is not seen in the small bowel).
IMPRESSION: Evidence of sphincter of Oddi medication effect. No
evidence of cystic duct obstruction or cholecystitis.

Right upper quadrant ultrasound on [**2196-3-30**]:
IMPRESSION:
1.  No evidence of focal hepatic mass, ascites or biliary ductal
dilatation.
2.  Significant gallbladder wall edema concerning for acute
acalculous cholecystitis. If clinically indicated, a HIDA scan
could be considered for further confirmation.

Abdominal plain film on [**2196-3-30**]:
IMPRESSION:  No evidence of free air under the hemidiaphragms.
No evidence of obstruction.

CXR on [**2196-3-29**]:
CHEST, ONE VIEW:  Comparison with [**2191-12-17**], there is no
appreciable change.  There is persistent cardiomegaly, but no
pleural effusion, new consolidation, or pneumothorax.  There is
no pulmonary edema.
IMPRESSION:  Cardiomegaly without acute cardiopulmonary process.


[**2196-4-1**] 02:35AM BLOOD WBC-13.1* RBC-4.26* Hgb-12.9* Hct-39.7*
MCV-93 MCH-30.3 MCHC-32.5 RDW-14.8 Plt Ct-222
[**2196-3-31**] 04:02AM BLOOD ALT-38 AST-44* LD(LDH)-350* CK(CPK)-277*
AlkPhos-70 Amylase-55 TotBili-0.9
[**2196-4-1**] 02:35AM BLOOD Calcium-10.6* Phos-2.7 Mg-2.5
[**2196-3-30**] 09:52AM BLOOD Type-ART pO2-90 pCO2-25* pH-7.56*
calTCO2-23 Base XS-1

Brief Hospital Course:
88 year-old male with hypertension, coronary artery disease,
history of myocardial infarction, atrial fibrillation, who
presented initially with shortness of breath, found to be in
atrial fibrillation with rapid ventricular response and then
with abdominal pain and metabolic acidosis.
.
# Abdominal pain: Localized to right-upper quadrant.  Ultrasound
was concerning for acalculus cholecystitis but HIDA scan
negative for cystic duct obstruction or cholecystitis.
Therefore, abdominal pain is likely secondary to mesenteric
ishcemia (given initial lactate 6.1 on admission, history of
atrial fibrillation and not anticoagulated.) No evidence for
ascending cholangitis on imaging and LFTs near normal. CTA of
abdomen deferred due to [**3-4**] renal failure. GI, ERCP, and surgery
were consulted initially but family decided they do not want
surgery or any invasive measures. NO further intervention for
mesenteric ischemia.  Initially antibiotics were started but
these were discontinued once patinet was made comfort measures
only.  Morphine infusion was initiated.  Patient receiving
lorazepam and haloperidol as needed for comfort.  No longer
checking labs.
.
# delirium: Patient had new mental status changes likely
secondary to abdominal pathology.  Geriatrics was consulted for
management of delirium.  Delerium improved with better pain
control, haloperidol and lorazepam.  Can consider sublingual
olanzapine if needed.
.
# Atrial fibrillation: Likely secondary to abdominal
pathology/infection.  Started metoprolol initially for rate
control.
.
# Shortness of breath: Likely secondary to rapid AF with
resultant CHF. No infiltrate on CXR. Slight troponin elevation
with normal CKs, probably due to rapid heart rate and renal
failure. No AMI.
.
# Hypercalcemia: Chronically elevated PTH, patient started on
bisphosphonate initially.
.
# Coronary artery disease, s/p MI with stent: as above, low
suspicion for myocardial ischemmia as primary problem.  [**Name (NI) **]
maintained on aspirin and statin.
.
# Renal insufficiency: Known chronic renal insufficiency with
baseline cr 1.3-1.5. 1.7 on admit and now 2.2 x 2 days. Due to
volume depletion but also poor forward flow given CHF/atrial
fibrillation.  Treated with fluids and rate control with
metoprolol
.
# DM: Patient maintained on insulin sliding scale.
.
# Access: Peripheral IV
.
# FEN:  NPO, NG tube pulled out.
.
# Prophylaxis:  Initially on heparin subcutaneous which should
be discontinued.  Bowel regimen for comfot.
.
# Code: CMO
.
# Communication: With daughter, [**Name (NI) **]. c: [**Telephone/Fax (1) 98355**],
h: [**Telephone/Fax (1) 98356**]. Patient is Greek speaking mainly but does speak
a little bit of english.

Medications on Admission:
ASA daily
Previously on amio, but stopped several months ago


Discharge Disposition:
Expired

Discharge Diagnosis:
Mesenteric ischemia
Atrial fibrillation

Discharge Condition:
Expired

Discharge Instructions:
N/A

Followup Instructions:
N/A


Completed by:[**2196-4-3**]
{'Acute vascular insufficiency of intestine,Atrial fibrillation,Acute kidney failure, unspecified,Acidosis,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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: Abdominal pain, shortness of breath.

PRESENT ILLNESS: Briefly, this is a 88 M with CAD s/p IMI and stenting, Afib,
admitted with progressive SOB. In ED, noted to be in AF with RVR
at rate of 130s. Was rate controlled on 15 mg IV dilt. Pt then
received 120 PO dilt. Given concern for PE, D-dimer sent and
returned at 516. CTA not performed given renal insufficiency,
and pt given 60 mg SQ lovenox for empiric treatment of PE . On
initial floor eval by primary team, noted to be tachypneic, with
basilar crackles, HR ~100. Given IV lasix. Then as pt was
straining to have BM, became bradycardic and hypotensive. Stools
guaiac negative. ABG 7.25/47/79 with lactate 6.1. On further
exam, was also noted to have lower abdominal pain.
.
Per daughter, pt functional at baseline. Lives alone, no
assistance with ADLs. Walks up to a mile to market without
exertional symptoms. Daughter takes [**Name2 (NI) **] weekly. Had been
regular up until this past Saturday when she noted it to be
irregular. Pt had otherwise been in USOH until this weekend when
had worsening SOB.

MEDICAL HISTORY: - Atrial fibrillation s/p cardioversion [**2190**]
- Hx upper GI bleed
- MI s/p stent [**2187**]
- HTN
- Hypercholesterolemia
- BPH

MEDICATION ON ADMISSION: ASA daily
Previously on amio, but stopped several months ago

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - 96.0, BP 94/79, HR 48, RR 28, O2 sat 96% 2L NC, wt 78 kg
Gen - somewhat uncomfortable, but NAD, speaking in full
sentences
HEENT - NCAT, PERRL, OP clr, MMM, no LAD
CV - [**Location 64063**] [**Last Name (LF) 64063**], [**First Name3 (LF) **], no mur
Lungs - dependent R-sided crackles (pt laying on R side)
Abdomen - NABS, distended, tender in lower abdomen with
voluntary guarding, no rebound tenderness, no CVA tenderness
Back - no back tenderness
Ext - 1+ bilat edema, WWP, distal pulses 2+
Neuro - A&Ox3
Skin - Pink, warm, no rashes

FAMILY HISTORY: Many family members with CAD.

SOCIAL HISTORY: Moved from [**Country 5881**] 50 years ago; he is widowed, lives alone and
is independent in all ADLs. He quit smoking 35 years ago, and
smoked 1ppd for "many years." Occasional alcohol use. Has 2
children. Daughter lives in [**Location 86**] and is active in his care. He
used to work at a raincoat factory. 

### Response:
{'Acute vascular insufficiency of intestine,Atrial fibrillation,Acute kidney failure, unspecified,Acidosis,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
