CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname 80763**] is a 63 year-old woman with h/o CAD s/p MI, COPD,
who was found by EMS at home at 2:15AM this morning with acute
onset of difficulty breathing. She was unable to speak due to
SOB. Her initial vitals were BP 240/140, HR 130, o2 Sat 70% on
RA. She was intubated by EMS and then taken to [**Hospital1 5109**]. Per her husband, she had been feeling well in the
previous days. She denied chest pain, fevers, chough, , had
similar episode in [**2132-2-19**]. No chest pain.
.
Upon arrival to [**Hospital1 2436**] ED, her vitals were 187/113, 150,
100.3, 100% on 400x16,100%, PEEP5. She was given Solumedrol
125IV, combivent nebs, lasix 60 IV, and zosyn, Levaquin. She was
noted to have blood tinged pulmonary secretions. She was
transferred to [**Hospital1 18**] as there were no ICU beds available at
[**Hospital1 2436**].
.
Upon arrival to MICU, unable to obtain further history as
patient was intubated and sedated.

MEDICAL HISTORY: 1. Congestive heart failure
2. Chronic obstructive pulmonary disease
3. Coronary Artery Disease, s/p MI 5 years ago
4. Renal failure requiring HD in [**Month (only) 404**] at [**Hospital1 1774**]
5. Diabetes Mellitus type 2
6. S/p nephrectomy, renal transplant in [**2100**]
7. Breast Cancer - T1, No, ER/PR negative, HEr negative, s/p
lumpectomy and XRT, declined chemotherapy
8. Right hand squamous cell carcinoma, s/p excision and xrt

MEDICATION ON ADMISSION: Azathioprine 100 mg daily
Glipizide 7.5 mg [**Hospital1 **]
Advair 250/50 [**Hospital1 **]
Coreg 3.125 mg [**Hospital1 **]
Simvastatin 20 mg qhs
Prednisone 10 mg daily
Aspirin 81
Lasix 40 mg [**Hospital1 **]

ALLERGIES: Bactrim / Vicodin / Sulfa (Sulfonamide Antibiotics) /
Penicillins / Erythromycin Base

PHYSICAL EXAM: Vitals: BP 137/75, HR 89, 100%, RR 16,
General: intubated, sedated, does not open eyes to name
HEENT: Sclera anicteric, ET and OGT in placed
Neck: unable to assess JVP
Lungs: faint expiratory wheezes
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: cool feet, 2+ pulses, no clubbing, cyanosis or edema

FAMILY HISTORY: Unknown

SOCIAL HISTORY: She smokes approximately [**1-30**] PPD for 40 years, currently
smoking. She denies alcohol use. She is married an dlives with
her husband.
Chronic systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Chronic kidney disease, Stage III (moderate),Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Personal history of malignant neoplasm of breast,Personal history of other malignant neoplasm of skin,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Old myocardial infarction,Unspecified deficiency anemia
Chr systolic hrt failure,Acute kidney failure NOS,Acute respiratry failure,Chr kidney dis stage III,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Hypoxemia,Hx of breast malignancy,Hx-skin malignancy NEC,Abn react-org transplant,Accident in place NEC,Hy kid NOS w cr kid I-IV,Old myocardial infarct,Deficiency anemia NOS
Admission Date:  [**2133-4-16**]              Discharge Date:   [**2133-4-18**]

Date of Birth:  [**2070-3-19**]             Sex:   F

Service: MEDICINE

Allergies:
Bactrim / Vicodin / Sulfa (Sulfonamide Antibiotics) /
Penicillins / Erythromycin Base

Attending:[**First Name3 (LF) 7881**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
s/p intubation and extubation, aterial line placement and
removal


History of Present Illness:
Ms. [**Known lastname 80763**] is a 63 year-old woman with h/o CAD s/p MI, COPD,
who was found by EMS at home at 2:15AM this morning with acute
onset of difficulty breathing. She was unable to speak due to
SOB. Her initial vitals were BP 240/140, HR 130, o2 Sat 70% on
RA. She was intubated by EMS and then taken to [**Hospital1 5109**]. Per her husband, she had been feeling well in the
previous days. She denied chest pain, fevers, chough, , had
similar episode in [**2132-2-19**]. No chest pain.
.
Upon arrival to [**Hospital1 2436**] ED, her vitals were 187/113, 150,
100.3, 100% on 400x16,100%, PEEP5. She was given Solumedrol
125IV, combivent nebs, lasix 60 IV, and zosyn, Levaquin. She was
noted to have blood tinged pulmonary secretions. She was
transferred to [**Hospital1 18**] as there were no ICU beds available at
[**Hospital1 2436**].
.
Upon arrival to MICU, unable to obtain further history as
patient was intubated and sedated.

Past Medical History:
1. Congestive heart failure
2. Chronic obstructive pulmonary disease
3. Coronary Artery Disease, s/p MI 5 years ago
4. Renal failure requiring HD in [**Month (only) 404**] at [**Hospital1 1774**]
5. Diabetes Mellitus type 2
6. S/p nephrectomy, renal transplant in [**2100**]
7. Breast Cancer - T1, No, ER/PR negative, HEr negative, s/p
lumpectomy and XRT, declined chemotherapy
8. Right hand squamous cell carcinoma, s/p excision and xrt

Social History:
She smokes approximately [**1-30**] PPD for 40 years, currently
smoking. She denies alcohol use. She is married an dlives with
her husband.

Family History:
Unknown

Physical Exam:
Vitals: BP 137/75, HR 89, 100%, RR 16,
General: intubated, sedated, does not open eyes to name
HEENT: Sclera anicteric, ET and OGT in placed
Neck: unable to assess JVP
Lungs: faint expiratory wheezes
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: cool feet, 2+ pulses, no clubbing, cyanosis or edema

Pertinent Results:
[**2133-4-16**] 08:50AM   WBC-9.8 RBC-2.71* HGB-10.3* HCT-30.5*
MCV-113* MCH-38.0* MCHC-33.7 RDW-18.7*
[**2133-4-16**] 08:50AM   CK-MB-NotDone cTropnT-0.26* proBNP-[**Numeric Identifier 79274**]*
[**2133-4-16**] 08:50AM   ALT(SGPT)-12 AST(SGOT)-28 LD(LDH)-257*
CK(CPK)-55 ALK PHOS-97 TOT BILI-0.8
[**2133-4-16**] 03:25PM   CK-MB-NotDone cTropnT-0.21*
[**2133-4-16**] 03:25PM   CK(CPK)-39

EKG. [**2133-4-16**]. NSR at 99 bpm, normal axis, normal PR, qrs, qtc
interval. TWI in I, R, L. J point elevation in V1-V4. Q waves in
II, III, F, V1-V5.
.
Echo.[**2133-4-16**].
The left atrium is mildly dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity is mildly
dilated. LV ejection fraction appears moderately-to-severely
depressed (30 percent) secomndary to severe hypokinesis/akinesis
of the interventricular septum, anterior wall, and apex. Tissue
Doppler imaging suggests an increased left ventricular filling
pressure (PCWP>18mmHg). Right ventricular chamber size and free
wall motion are normal. The aortic root is moderately dilated at
the sinus level. The ascending aorta is mildly dilated. The
aortic valve leaflets (3) are mildly thickened. There is a
minimally increased gradient consistent with minimal aortic
valve stenosis. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. There is
borderline pulmonary artery systolic hypertension. There is no
pericardial effusion.
IMPRESSION: extensive anterior, septal, apical myocardial
infarct.

Renal ultrasound [**2133-4-17**]:
IMPRESSION: extensive anterior, septal, apical myocardial
infarct
.
1. No hydronephrosis.
2. Delayed upstroke in the main renal artery, Doppler signal and
low-
resistive indices are concerning for renal artery stenosis.

Brief Hospital Course:
Pt is a 63 yo female with CAD s/p MI, COPD, s/p extubation for
flash pulmonary edema with resolved acute on chronic renal
failure. Transferred from unit to floor after extubation for
sCHF management.

# sCHF EF 30%- Patient had previous LAD large MI with wall
motion abnormality. BNP [**Numeric Identifier 16351**]. No ACEI since RAS in the only
renal artery. on BB, holding Lasix since there was acute renal
failure. Uptirtrating coreg. Imdur 60mg PO daily.

# Resolved respiratory failure // COPD- Patient presents with
acute onset of SOB with no clear prodrome symptoms per her
husband. Likely secondary to flash pulmonary edema given rapid
resolution of CXR and that symptoms occured in setting of HTN.
Given history of MI, concern for acute MI as well; patient
completed ROMI. Given lack of significant wbc or left shift or
fever, pneumonia unlikely. COPD does not seem to be etiology
given that it was acute in onset. Malignancy history raises the
possibility of PE, though currently no longer tachycardic and
hypoxia. Continue prednisone 10 mg, Advair continued, received
nebs while in house. Patient was satting 95% on RA at the time
of discharge. Smoking cessation was encouraged and patient said
that she would quit and patient was given a prescription for
nicotine patch.

# Resolved acute renal failure, Stage 3 chronic renal failure -
Only has one kidney. Patient is s/p renal transplant. Cr rose
from 1 to 1.4 over 8 hours without episode of hypotension, in
setting of lasix diuresis.

# RAS - By doppler study.  No intervention can be performed
until the patient quits smoking.

# s/p renal transplant - Patient was seen by transplant
nephrology. Continue prednisone 10 mg and azathioprine.

# Completed ROMI - troponin trending down, demand in setting
hypertensive emergency and chronic renal failure

# CAD s/p MI. H/o anteroseptal MI. Continue aspirin, statin,
coreg

# Diabetes. On glipizide at home. RISS  while in house.

FULL CODE

Patient to have home physical therapy. No need for home oxygen.

Medications on Admission:
Azathioprine 100 mg daily
Glipizide 7.5 mg [**Hospital1 **]
Advair 250/50 [**Hospital1 **]
Coreg 3.125 mg [**Hospital1 **]
Simvastatin 20 mg qhs
Prednisone 10 mg daily
Aspirin 81
Lasix 40 mg [**Hospital1 **]

Discharge Medications:
1. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
2. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Azathioprine 50 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Glipizide 5 mg Tablet Sig: 1.5 Tablets PO twice a day.
6. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
Disp:*30 Tablet Sustained Release(s)* Refills:*2*
9. Carvedilol 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
Disp:*120 Tablet(s)* Refills:*2*
10. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
Disp:*30 Patch 24 hr(s)* Refills:*2*
11. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
12. Outpatient Physical Therapy


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
flash pulmonary edema from hypertensive crisis
s/p extubation
sCHF chronic, EF 30%
COPD at baseline
Hypertension
resolved acute renal failure
chronic renal failure, stage 3, s/p renal transplant on chronic
immunosuppresion
completed ROMI

Secondary:
anemia
diabetes type 2, non-insulin dependent


Discharge Condition:
stable, satting 96% on RA


Discharge Instructions:
You were transferred from an outside hospital after being
intubated for flash pulmonary edema from hypertensive crisis.
You were diruesed and your lungs improved to the baseline and
you were extubated. You went into acute renal failure which
resolved when the lasix were held. Your hypertensive medications
were adjusted and medications for your congestive heart failure.

You should return to the ED if you develop acute shortness of
breath as this could be another episode of flash pulmonary edema
vs. COPD exacerbation.

Followup Instructions:
Please follow up with your PCP within two weeks. Ensure that
your renal function is at baseline since you are resuming your
lasix. Please follow up with your cardiologist within one month.

You will need outpatient physical therapy.

PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 4018**]

If you do not have a cardiologist, please call [**Telephone/Fax (1) 62**] to
book an appointment.



Completed by:[**2133-4-18**]
{'Chronic systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Chronic kidney disease, Stage III (moderate),Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Personal history of malignant neoplasm of breast,Personal history of other malignant neoplasm of skin,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Old myocardial infarction,Unspecified deficiency anemia'}


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: Ms. [**Known lastname 80763**] is a 63 year-old woman with h/o CAD s/p MI, COPD,
who was found by EMS at home at 2:15AM this morning with acute
onset of difficulty breathing. She was unable to speak due to
SOB. Her initial vitals were BP 240/140, HR 130, o2 Sat 70% on
RA. She was intubated by EMS and then taken to [**Hospital1 5109**]. Per her husband, she had been feeling well in the
previous days. She denied chest pain, fevers, chough, , had
similar episode in [**2132-2-19**]. No chest pain.
.
Upon arrival to [**Hospital1 2436**] ED, her vitals were 187/113, 150,
100.3, 100% on 400x16,100%, PEEP5. She was given Solumedrol
125IV, combivent nebs, lasix 60 IV, and zosyn, Levaquin. She was
noted to have blood tinged pulmonary secretions. She was
transferred to [**Hospital1 18**] as there were no ICU beds available at
[**Hospital1 2436**].
.
Upon arrival to MICU, unable to obtain further history as
patient was intubated and sedated.

MEDICAL HISTORY: 1. Congestive heart failure
2. Chronic obstructive pulmonary disease
3. Coronary Artery Disease, s/p MI 5 years ago
4. Renal failure requiring HD in [**Month (only) 404**] at [**Hospital1 1774**]
5. Diabetes Mellitus type 2
6. S/p nephrectomy, renal transplant in [**2100**]
7. Breast Cancer - T1, No, ER/PR negative, HEr negative, s/p
lumpectomy and XRT, declined chemotherapy
8. Right hand squamous cell carcinoma, s/p excision and xrt

MEDICATION ON ADMISSION: Azathioprine 100 mg daily
Glipizide 7.5 mg [**Hospital1 **]
Advair 250/50 [**Hospital1 **]
Coreg 3.125 mg [**Hospital1 **]
Simvastatin 20 mg qhs
Prednisone 10 mg daily
Aspirin 81
Lasix 40 mg [**Hospital1 **]

ALLERGIES: Bactrim / Vicodin / Sulfa (Sulfonamide Antibiotics) /
Penicillins / Erythromycin Base

PHYSICAL EXAM: Vitals: BP 137/75, HR 89, 100%, RR 16,
General: intubated, sedated, does not open eyes to name
HEENT: Sclera anicteric, ET and OGT in placed
Neck: unable to assess JVP
Lungs: faint expiratory wheezes
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: cool feet, 2+ pulses, no clubbing, cyanosis or edema

FAMILY HISTORY: Unknown

SOCIAL HISTORY: She smokes approximately [**1-30**] PPD for 40 years, currently
smoking. She denies alcohol use. She is married an dlives with
her husband. 

### Response:
{'Chronic systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Chronic kidney disease, Stage III (moderate),Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypoxemia,Personal history of malignant neoplasm of breast,Personal history of other malignant neoplasm of skin,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Old myocardial infarction,Unspecified deficiency anemia'}
