CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 75 y/o M w/ atrial fibrillation, HTN, dyslipidemia, and DVT
(while on coumadin so now on lovenox) who persented with a 1 day
history of worsening SOB and cough productive of clear sputum.
He has recently been admitted twice within the last 2 months for
complaints of uncontrolled atrial fibrillation and SOB thought
to be secondary to a CHF flare with his most recent dicharge ~ 6
weeks ago.  He was in his USOH until this AM when he awoke
feeling fatigued.  He walked around and noticed increased
dyspnea with exertion.  He has had no orthopnea or PND and
denies any recent CP, palpatations, fevers, HA, visual changes,
diarrhea or chills. His chronic LE edema is stable per the
patient since his last admission.  Of note, the patient did not
take any of his medications today but has otherwise compliant.
He denies any sick contacts or recent travel.  He says that he
has been diet compliant but eats pastrami frequently.
.
While in the ED, he was noted to have a rapid ventricular rate
to the 130s for which he received 25mg of IV diltiazem followed
by 60mg of PO verapamil with good response.  His symptoms
disappeared but he was then noted to have rates in the 150s w/
new STE in I/aVL.  He received 10mg of IV metoprolol followed by
25mg PO and slowed into the 90s again.  Repeat EKG showed
reversion of his EKG changes to his baseline STD.  Cardiology
was consulted and felt this episode did not represent an acute
STEMI but suggested admission to [**Hospital Unit Name 196**].  While in the ED, he also
had a negative CTA and received a single dose of azithromycin.

MEDICAL HISTORY: 1. Hypetension
2. Atrial fibrillation
3. Dyslipidemia
4. h/o L popliteal vein DVT (while on coumadin)
5. Anxiety/Depession
6. Peptic ulcer disease
7. Diaphragmatic hernia
8. CKD
9. Prostate CA dx [**5-2**] T2a prostate cancer
10. R hernia repair [**2069**]
11. Tachycardia induced cardiomyopathy

MEDICATION ON ADMISSION: 1. Aspirin 325 mg daily
2. Enoxaparin 120 mg [**Hospital1 **]
3. Verapamil 240 mg daily
4. Atorvastatin 10 mg daily
5. Pantoprazole 40 mg daily
6. Paroxetine 10 mg daily
7. Olmesartan 20 mg daily
8. Toprol XL 300 mg daily
9. Ranitidine 150 mg daily
10. Furosemide 60 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS -  98.0, 157/93, 111, 20, 96%RA, 328lbs
Gen: Morbidly obese AAM sitting up in bed in NAD. Oriented x3.
Mood, affect appropriate.  Speaking in full sentences
HEENT: NCAT. Injected R medial sclera.
Neck: Supple, no JVD.  No appreciable JV elevation.  No carotid
bruits.
CV: Irregular rhythm.  Distant heart sounds.  No appreciable
M/R/G.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Bibasilar crackles
Abd: Obese but nontender. + BS.  Organ exam limited by habitus.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Patient is married and lives with wife.  [**Name (NI) **] is retired and walks
with a walker.  He peviously smoked but 30yrs ago (~ 15 pack
years). Denies EtOH or IVDU.
Diastolic heart failure, unspecified,Acute kidney failure, unspecified,Acidosis,Other primary cardiomyopathies,Cardiac arrest,Chronic kidney disease, unspecified,Morbid obesity,Malignant neoplasm of prostate,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
Diastolc hrt failure NOS,Acute kidney failure NOS,Acidosis,Prim cardiomyopathy NEC,Cardiac arrest,Chronic kidney dis NOS,Morbid obesity,Malign neopl prostate,Pure hypercholesterolem,Hy kid NOS w cr kid I-IV
Admission Date:  [**2114-11-18**]              Discharge Date:   [**2114-11-20**]

Date of Birth:  [**2039-9-24**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
None

History of Present Illness:
75 y/o M w/ atrial fibrillation, HTN, dyslipidemia, and DVT
(while on coumadin so now on lovenox) who persented with a 1 day
history of worsening SOB and cough productive of clear sputum.
He has recently been admitted twice within the last 2 months for
complaints of uncontrolled atrial fibrillation and SOB thought
to be secondary to a CHF flare with his most recent dicharge ~ 6
weeks ago.  He was in his USOH until this AM when he awoke
feeling fatigued.  He walked around and noticed increased
dyspnea with exertion.  He has had no orthopnea or PND and
denies any recent CP, palpatations, fevers, HA, visual changes,
diarrhea or chills. His chronic LE edema is stable per the
patient since his last admission.  Of note, the patient did not
take any of his medications today but has otherwise compliant.
He denies any sick contacts or recent travel.  He says that he
has been diet compliant but eats pastrami frequently.
.
While in the ED, he was noted to have a rapid ventricular rate
to the 130s for which he received 25mg of IV diltiazem followed
by 60mg of PO verapamil with good response.  His symptoms
disappeared but he was then noted to have rates in the 150s w/
new STE in I/aVL.  He received 10mg of IV metoprolol followed by
25mg PO and slowed into the 90s again.  Repeat EKG showed
reversion of his EKG changes to his baseline STD.  Cardiology
was consulted and felt this episode did not represent an acute
STEMI but suggested admission to [**Hospital Unit Name 196**].  While in the ED, he also
had a negative CTA and received a single dose of azithromycin.

Past Medical History:
1. Hypetension
2. Atrial fibrillation
3. Dyslipidemia
4. h/o L popliteal vein DVT (while on coumadin)
5. Anxiety/Depession
6. Peptic ulcer disease
7. Diaphragmatic hernia
8. CKD
9. Prostate CA dx [**5-2**] T2a prostate cancer
10. R hernia repair [**2069**]
11. Tachycardia induced cardiomyopathy

Social History:
Patient is married and lives with wife.  [**Name (NI) **] is retired and walks
with a walker.  He peviously smoked but 30yrs ago (~ 15 pack
years). Denies EtOH or IVDU.

Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
VS -  98.0, 157/93, 111, 20, 96%RA, 328lbs
Gen: Morbidly obese AAM sitting up in bed in NAD. Oriented x3.
Mood, affect appropriate.  Speaking in full sentences
HEENT: NCAT. Injected R medial sclera.
Neck: Supple, no JVD.  No appreciable JV elevation.  No carotid
bruits.
CV: Irregular rhythm.  Distant heart sounds.  No appreciable
M/R/G.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Bibasilar crackles
Abd: Obese but nontender. + BS.  Organ exam limited by habitus.

Ext: Bilateraly pitting edema to the hips.  Chronic venous
stasis changes.

Pertinent Results:
[**11-18**] CTA:
IMPRESSION:

1. No evidence of acute pulmonary embolism. Probable chronic PE
in the right lower lobe subsegmental bronchus, seen previously.

2. No evidence of pneumonia.

3. Cardiomegaly, mild interstitial edema, small bilateral
pleural effusions.

4. Stable bilateral hilar lymphadenopathy and
peribronchovascular density most notable on the right side.
Etiology unclear and PET CT can be performed to further
evaluate.

5. Stable 5-mm right upper lobe pulmonary nodule, again a repeat
evaluation in [**5-8**] months could document two-year stability.
.
[**11-18**] CXR:
IMPRESSION:

Cardiomegaly with pulmonary vascular congestion.
.
[**11-19**] Head CT:
HEAD CT WITHOUT CONTRAST: There is no comparison. There is no
acute intracranial hemorrhage, mass effect, or shift of normally
midline structures or [**Doctor Last Name 352**]-white differentiation or cerebral
edema. There are bilateral small vessel ischemic changes. No
gross acute territorial infarct is identified on this CT scan.
There is opacification of ethmoid sinuses. The skeletal
structure is unremarkable.

IMPRESSION: Chronic small vessel ischemia. No acute intracranial
hemorrhage or mass effect. Sinus disease.
.
[**11-19**] Port Abd:
PORTABLE ABDOMEN: Single portable abdominal view is somewhat
limited by motion. An endotracheal tube is seen terminating in
the mid trachea. No orogastric or nasogastric tube is seen; it
is presumably out of the field of view, i.e., in the patient's
pharynx. EKG leads are seen draping over the patient. There is
probable left-sided retrocardiac atelectasis and/or pleural
effusion.

IMPRESSION: No orogastric tube seen, likely representing coiling
in pharynx. Findings discussed with Dr. [**Last Name (STitle) **] by telephone
at 10 a.m., [**2114-11-19**].
.
[**11-19**] ECHO: EF > 60%
The left atrium is moderately dilated. There is mild symmetric
left ventricular hypertrophy with normal cavity size and
systolic function (LVEF>55%). Due to suboptimal technical
quality, a focal wall motion abnormality cannot be fully
excluded. The right ventricular cavity is moderately dilated
with moderate globa free wall hypokinesis. There is abnormal
septal motion/position consistent with right ventricular
pressure/volume overload. The aortic root is mildly dilated at
the sinus level. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Trace aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild (1+) mitral regurgitation is seen. Moderate [2+]
tricuspid regurgitation is seen. There is borderline pulmonary
artery systolic hypertension. There is a trivial/physiologic
pericardial effusion.

Compared with the prior study (images reviewed) of [**2114-10-5**],
the estimated pulmonary artery systolic pressure is now lower.
The other findings are similar.
.
Labs:
[**2114-11-18**] 08:45AM BLOOD WBC-3.6* RBC-4.01* Hgb-11.4* Hct-35.9*
MCV-90 MCH-28.4 MCHC-31.6 RDW-17.2* Plt Ct-274
[**2114-11-20**] 03:23AM BLOOD WBC-14.3* RBC-UNABLE TO  Hgb-9.0*
Hct-34.5* MCV-UNABLE TO  MCH-UNABLE TO  MCHC-27.4* RDW-UNABLE TO
 Plt Ct-148*
[**2114-11-18**] 08:45AM BLOOD Neuts-62.7 Lymphs-25.1 Monos-7.3 Eos-3.6
Baso-1.2
[**2114-11-18**] 08:45AM BLOOD Plt Ct-274
[**2114-11-18**] 09:30AM BLOOD PT-19.9* PTT-42.8* INR(PT)-1.9*
[**2114-11-20**] 03:23AM BLOOD PT-38.0* PTT-98.3* INR(PT)-4.1*
[**2114-11-19**] 05:42AM BLOOD Fibrino-357
[**2114-11-18**] 08:45AM BLOOD Glucose-122* UreaN-17 Creat-1.5* Na-143
K-3.6 Cl-105 HCO3-27 AnGap-15
[**2114-11-20**] 03:23AM BLOOD Glucose-156* UreaN-31* Creat-3.8* Na-142
K-5.6* Cl-98 HCO3-6* AnGap-44*
[**2114-11-19**] 05:42AM BLOOD ALT-42* AST-92* LD(LDH)-481* CK(CPK)-157
AlkPhos-99 TotBili-1.8*
[**2114-11-20**] 03:23AM BLOOD ALT-1545* AST-4828* CK(CPK)-524*
AlkPhos-136* Amylase-[**2038**]* TotBili-2.1*
[**2114-11-19**] 11:03AM BLOOD Lipase-65*
[**2114-11-20**] 03:23AM BLOOD Lipase-274*
[**2114-11-18**] 08:45AM BLOOD CK-MB-3 cTropnT-<0.01 proBNP-9271*
[**2114-11-19**] 11:03AM BLOOD CK-MB-10 MB Indx-3.7 cTropnT-0.12*
[**2114-11-19**] 05:43PM BLOOD CK-MB-14* MB Indx-3.8 cTropnT-0.22*
[**2114-11-20**] 03:23AM BLOOD CK-MB-16* MB Indx-3.1 cTropnT-0.16*
[**2114-11-20**] 03:23AM BLOOD Albumin-2.9* Calcium-8.8 Phos-9.2* Mg-2.5
[**2114-11-19**] 05:42AM BLOOD Cortsol-42.9*
[**2114-11-19**] 05:40AM BLOOD pO2-61* pCO2-76* pH-6.72* calTCO2-12*
Base XS--31 Intubat-INTUBATED Comment-GREEN TOP
[**2114-11-20**] 07:57AM BLOOD Type-ART Temp-35.6 Rates-26/10 Tidal
V-600 PEEP-12 FiO2-40 pO2-80* pCO2-18* pH-7.24* calTCO2-8* Base
XS--17 -ASSIST/CON Intubat-INTUBATED
[**2114-11-20**] 07:57AM BLOOD Glucose-116* Lactate-16.1* Na-136 K-4.9
Cl-103 calHCO3-8*
[**2114-11-20**] 07:57AM BLOOD freeCa-0.93*

Brief Hospital Course:
Mr. [**Known lastname 30207**] is a 75 M w/ pmh of afib, CRI, DVT on coumadin, HTN
who was admitted to the hospital for increasing shrotness of
breath in the setting of afib w/ RVR.  He was admitted for
rate-control and the plan was for him to be discharged home the
following day as he was feeling much better.  The morning of
[**11-20**], he was seen in stable clinical condition at approximately
5:24am. At 5:36am, he was found face down on the floor in his
room. Chest compressions were initiated and Code Blue was
called. Initial electrical rhythm was asystole. He received 2
rounds of epinephrine and Atropine, after which a wide complex
rhythm (consistent with baseline RBBB) was obtained at rate in
70s. He then received 3 more rounds of epinephrine, as well as 2
rounds of calcium and bicarbonate, and a liter of bolus IV NS.
Spontaneous circulation was restored at 5:50am.
.
Review of telemetry revealed atrial fibrillation with
progressive bradycardia and eventual asystole. ECHO w/o new WMA
and CE without significant elevation which does not support
cardiogenic cause. Likely a respiratory arrest, ? from
hypercarbia/hypoventilation after a fall. ? from massive PE
given h/o DVT and chronic PE seen on CTA on admission. Head CT
w/o bleed so heparin ggt re-started.  After the code, he never
regained consciousness and his pupils were eventally fixed and
dilated.  He continued to requre maximum dose of dopamine,
vasopressin and levophed with persistent hypotension. Also w/
shock liver and anuric renal failure and likely significant
brain damage was not awakening after sedation turned off.
Family was notified immediately after the code and were at his
side until the time of his death.  Because of his poor
prognosis, and with the knowledge that he never wanted to be
institutionalized and enjoyed being very independent, they made
the decision to make him DNR.  He passed away on [**Holiday **] night
secondary to cardiac arrest, likely from hyperkalemia.

Medications on Admission:
1. Aspirin 325 mg daily
2. Enoxaparin 120 mg [**Hospital1 **]
3. Verapamil 240 mg daily
4. Atorvastatin 10 mg daily
5. Pantoprazole 40 mg daily
6. Paroxetine 10 mg daily
7. Olmesartan 20 mg daily
8. Toprol XL 300 mg daily
9. Ranitidine 150 mg daily
10. Furosemide 60 mg daily

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
N/A

Discharge Condition:
Expired

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Diastolic heart failure, unspecified,Acute kidney failure, unspecified,Acidosis,Other primary cardiomyopathies,Cardiac arrest,Chronic kidney disease, unspecified,Morbid obesity,Malignant neoplasm of prostate,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}


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

PRESENT ILLNESS: 75 y/o M w/ atrial fibrillation, HTN, dyslipidemia, and DVT
(while on coumadin so now on lovenox) who persented with a 1 day
history of worsening SOB and cough productive of clear sputum.
He has recently been admitted twice within the last 2 months for
complaints of uncontrolled atrial fibrillation and SOB thought
to be secondary to a CHF flare with his most recent dicharge ~ 6
weeks ago.  He was in his USOH until this AM when he awoke
feeling fatigued.  He walked around and noticed increased
dyspnea with exertion.  He has had no orthopnea or PND and
denies any recent CP, palpatations, fevers, HA, visual changes,
diarrhea or chills. His chronic LE edema is stable per the
patient since his last admission.  Of note, the patient did not
take any of his medications today but has otherwise compliant.
He denies any sick contacts or recent travel.  He says that he
has been diet compliant but eats pastrami frequently.
.
While in the ED, he was noted to have a rapid ventricular rate
to the 130s for which he received 25mg of IV diltiazem followed
by 60mg of PO verapamil with good response.  His symptoms
disappeared but he was then noted to have rates in the 150s w/
new STE in I/aVL.  He received 10mg of IV metoprolol followed by
25mg PO and slowed into the 90s again.  Repeat EKG showed
reversion of his EKG changes to his baseline STD.  Cardiology
was consulted and felt this episode did not represent an acute
STEMI but suggested admission to [**Hospital Unit Name 196**].  While in the ED, he also
had a negative CTA and received a single dose of azithromycin.

MEDICAL HISTORY: 1. Hypetension
2. Atrial fibrillation
3. Dyslipidemia
4. h/o L popliteal vein DVT (while on coumadin)
5. Anxiety/Depession
6. Peptic ulcer disease
7. Diaphragmatic hernia
8. CKD
9. Prostate CA dx [**5-2**] T2a prostate cancer
10. R hernia repair [**2069**]
11. Tachycardia induced cardiomyopathy

MEDICATION ON ADMISSION: 1. Aspirin 325 mg daily
2. Enoxaparin 120 mg [**Hospital1 **]
3. Verapamil 240 mg daily
4. Atorvastatin 10 mg daily
5. Pantoprazole 40 mg daily
6. Paroxetine 10 mg daily
7. Olmesartan 20 mg daily
8. Toprol XL 300 mg daily
9. Ranitidine 150 mg daily
10. Furosemide 60 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS -  98.0, 157/93, 111, 20, 96%RA, 328lbs
Gen: Morbidly obese AAM sitting up in bed in NAD. Oriented x3.
Mood, affect appropriate.  Speaking in full sentences
HEENT: NCAT. Injected R medial sclera.
Neck: Supple, no JVD.  No appreciable JV elevation.  No carotid
bruits.
CV: Irregular rhythm.  Distant heart sounds.  No appreciable
M/R/G.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Bibasilar crackles
Abd: Obese but nontender. + BS.  Organ exam limited by habitus.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Patient is married and lives with wife.  [**Name (NI) **] is retired and walks
with a walker.  He peviously smoked but 30yrs ago (~ 15 pack
years). Denies EtOH or IVDU. 

### Response:
{'Diastolic heart failure, unspecified,Acute kidney failure, unspecified,Acidosis,Other primary cardiomyopathies,Cardiac arrest,Chronic kidney disease, unspecified,Morbid obesity,Malignant neoplasm of prostate,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}
