CHIEF COMPLAINT: Shortness of Breath

PRESENT ILLNESS: Patient is 72 year Spanish speaking male with PMHx of
Parkinson's Disease who presents to the ED for complaints of
shortness of breath. Per patient daughter he was at his baseline
health until night prior to admission when patient described
shortness of breath and sensation that his airways were blocked.
Patient was seen at [**Hospital1 112**] a few weeks ago for similar symptoms.
Per daughter etiology of shortness of breath was not identified
and thought breathing difficulty could be due to anxiety.
Patient denies any chest pain or diaphoresis and is symptoms do
not seem to coorelate with any medications. He has noticed no
change in his speech or any trouble with swallowing or eating
and drinking foods.
During this episode of shortness of breath at home patient
seemed anxious and paramedics were called. While they were
present,
he had brief unresponsiveness and was found to be in atrial
fibrillation. A nasal trumpet was placed with return of
responsiveness and of sinus rhythm. He was brought to [**Hospital1 18**]. On
arrival to ICU patient comfortable denies any shortness of
breath. He has a nasal trumpet in place. His O2Sat remains above
90% on room air but appears to drop when patient falls asleep.
Patient denies any swelling of his throat or airway, he just
feels congested in his nasal passages.
.
ROS: Patient denies any CP, HA, n/v, fevers, chills, cough,
abdominal pain. Patient is urinating normally and besides
constipation has normal bowel movements. His Parkinson's has
gotten worse over the last year but no acute worsening over the
past few months.

MEDICAL HISTORY: Parkinson's disease, diagnosed at age 66, followed by Dr.
[**Last Name (STitle) 4742**]
at [**Hospital1 2025**]
PCP is [**Last Name (NamePattern4) **]. [**Last Name (STitle) 4743**] at [**Hospital1 112**]

MEDICATION ON ADMISSION: sinemet 25/100mg tid (7am, 11am, 5pm)
sinemet 50/200mg qid (7am, 11am, 5pm, 10pm)
klonopin 0.25mg daily (7pm)
seroquel 0.25mg [**Hospital1 **] (11am, 10pm)
citalopram 20mg daily
ranitidine 150mg [**Hospital1 **]
mirapex 0.5/1/0.5/1mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.1 BP 127/74 HR 77 O2Sat 93%-94% on RA
Gen: NAD
Heent: PERRL, EOMI, OP clear no pharyngeal swelling, nasal
trumpet in place, MM dry.
Neck: supple, no LAD
Lungs: CTA B/L
Cardiac: RRR S1/S2 no murmurs
Abd: soft NTND NABS
Ext: FROM, no edema
Neuro: AAOx3, patient with resting tremors of UE and LE b/l,
normal reflexes, sensory grossly intact

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives with wife and sister-in-law, who have been limiting his
activities more recently, though he did go out of the house once
last week by himself. Able to do laundry, for example, b/c did
it last week but not allowed by his wife (per daughter). No
tobacco, EtOH, drug use.
Paralysis agitans,Other respiratory abnormalities,Anxiety state, unspecified
Paralysis agitans,Respiratory abnorm NEC,Anxiety state NOS
Admission Date:  [**2152-3-23**]              Discharge Date:   [**2152-3-25**]

Date of Birth:  [**2079-4-19**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 495**]
Chief Complaint:
Shortness of Breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Patient is 72 year Spanish speaking male with PMHx of
Parkinson's Disease who presents to the ED for complaints of
shortness of breath. Per patient daughter he was at his baseline
health until night prior to admission when patient described
shortness of breath and sensation that his airways were blocked.
Patient was seen at [**Hospital1 112**] a few weeks ago for similar symptoms.
Per daughter etiology of shortness of breath was not identified
and thought breathing difficulty could be due to anxiety.
Patient denies any chest pain or diaphoresis and is symptoms do
not seem to coorelate with any medications. He has noticed no
change in his speech or any trouble with swallowing or eating
and drinking foods.
During this episode of shortness of breath at home patient
seemed anxious and paramedics were called. While they were
present,
he had brief unresponsiveness and was found to be in atrial
fibrillation. A nasal trumpet was placed with return of
responsiveness and of sinus rhythm. He was brought to [**Hospital1 18**]. On
arrival to ICU patient comfortable denies any shortness of
breath. He has a nasal trumpet in place. His O2Sat remains above
90% on room air but appears to drop when patient falls asleep.
Patient denies any swelling of his throat or airway, he just
feels congested in his nasal passages.
.
ROS: Patient denies any CP, HA, n/v, fevers, chills, cough,
abdominal pain. Patient is urinating normally and besides
constipation has normal bowel movements. His Parkinson's has
gotten worse over the last year but no acute worsening over the
past few months.


Past Medical History:
Parkinson's disease, diagnosed at age 66, followed by Dr.
[**Last Name (STitle) 4742**]
at [**Hospital1 2025**]
PCP is [**Last Name (NamePattern4) **]. [**Last Name (STitle) 4743**] at [**Hospital1 112**]


Social History:
Lives with wife and sister-in-law, who have been limiting his
activities more recently, though he did go out of the house once
last week by himself. Able to do laundry, for example, b/c did
it last week but not allowed by his wife (per daughter). No
tobacco, EtOH, drug use.


Family History:
noncontributory

Physical Exam:
T 98.1 BP 127/74 HR 77 O2Sat 93%-94% on RA
Gen: NAD
Heent: PERRL, EOMI, OP clear no pharyngeal swelling, nasal
trumpet in place, MM dry.
Neck: supple, no LAD
Lungs: CTA B/L
Cardiac: RRR S1/S2 no murmurs
Abd: soft NTND NABS
Ext: FROM, no edema
Neuro: AAOx3, patient with resting tremors of UE and LE b/l,
normal reflexes, sensory grossly intact


Pertinent Results:
[**2152-3-23**] BLOOD WBC-12.1* RBC-4.53* Hgb-14.1 Hct-40.9 MCV-90
MCH-31.0 MCHC-34.4 RDW-13.7 Plt Ct-258
[**2152-3-23**] BLOOD Neuts-86.4* Bands-0 Lymphs-9.7* Monos-3.1 Eos-0.6
Baso-0.2
[**2152-3-23**] BLOOD PT-12.1 PTT-24.7 INR(PT)-1.0
[**2152-3-23**] BLOOD Glucose-130* UreaN-12 Creat-0.9 Na-136 K-4.0
Cl-97 HCO3-25 AnGap-18
[**2152-3-23**] BLOOD CK(CPK)-103
[**2152-3-23**]  BLOOD cTropnT-<0.01
[**2152-3-23**] BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG

[**2152-3-24**] BLOOD WBC-7.9 RBC-4.77 Hgb-14.6 Hct-42.4 MCV-89
MCH-30.7 MCHC-34.5 RDW-13.8 Plt Ct-274
[**2152-3-24**] BLOOD Glucose-92 UreaN-15 Creat-0.8 Na-138 K-4.3 Cl-101
HCO3-30 AnGap-11
[**2152-3-24**] BLOOD Calcium-9.1 Phos-4.1# Mg-2.4

Imaging:
CT neck ([**3-23**]): No soft tissue neck mass. Patent upper airway.
Calcified granuloma in the lung.
CT head ([**3-23**]): No acute intracranial hemorrhage. No mass
effect.
Neck soft tissues ([**3-23**]): There is no comparison. Upper airway
is visualized, with a nasal airway tube terminating above the
hyoid bone. There is no significant soft tissue swelling. There
is no abnormal soft tissue calcification.
CXR ([**3-23**]): Mild cardiomegaly. Left pleural effusion and
bibasilar atelectasis.


Brief Hospital Course:
Mr. [**Known lastname **] is a 72 y/o male with h/o Parkinson's disease who
presents from home with shortness of breath, now resolved.
.
## Shortness of Breath: The patient was admitted and had one
recurrent episode on his first night of admission which
unimproved by Parkinson's meds. We hypothesized that his
underlying Parkinson's disease may be contributing to these
episodes. The episode was relieved by a small dose of Ativan;
there appeared to be a large component of anxiety to the
episodes, but that is unlikely to be the sole cause, as he does
have objectively unusual breathing. He was evaluated by
Neurology during his admission who recommended continuing his
medical regimen for Parkinson's.
- The patient will follow up in Pulmonary Clinic with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **]. PFTs are planned as an outpatient.
- The patient reportedly had an episode of atrial fibrillation
per EMS; however, this did no recur while hospitalized.
- The patient was discharged with clonazepam to use as needed
during these episodes as this seemed to give relief.
- He will have an outpatient sleep study as well to evaluate for
sleep apnea.
.
## Parkinson's Diease. The patient was continued on his usual
medication regimen.
.
## Cardiac. Patient with reported atrial fibrillation per EMS
but none seen while in-house. It is doubtful that this was true
a fib; it is more likely he had MAT secondary to respiratory
distress.
- PCP could consider outpatient holter monitor if deemed
necessary.
.
## PPx: The patient was given a bowel regimen, tylenol as
needed, an H2 blocker, and heparin SC.
.
## FEN: He tolerated a regular diet.
.
## Comm: Daughter: [**First Name8 (NamePattern2) 1457**] [**Name (NI) **] [**Telephone/Fax (1) 4744**]
.
## Dispo: As the patient was stable hemodynamically without
further evidence of respiratory distress, he was discharged to
home from the MICU.

Medications on Admission:
sinemet 25/100mg tid (7am, 11am, 5pm)
sinemet 50/200mg qid (7am, 11am, 5pm, 10pm)
klonopin 0.25mg daily (7pm)
seroquel 0.25mg [**Hospital1 **] (11am, 10pm)
citalopram 20mg daily
ranitidine 150mg [**Hospital1 **]
mirapex 0.5/1/0.5/1mg


Discharge Medications:
1. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours as needed for anxiety or respiratory distress: Take
one tablet as needed for respiratory difficulty or anxiety. If
respiratory distress is not relieved, contact your doctor.
[**Last Name (Titles) **]:*90 Tablet(s)* Refills:*0*
2. Pramipexole 0.25 mg Tablet Sig: Two (2) Tablet PO bid @ 7am
and 5pm ().
3. Pramipexole 1 mg Tablet Sig: One (1) Tablet PO bid @ 11am and
10pm ().
4. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Citalopram 20 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
6. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Carbidopa-Levodopa 50-200 mg Tablet Sustained Release Sig:
One (1) Tablet PO QID (4 times a day).
8. Carbidopa-Levodopa 25-100 mg Tablet Sustained Release Sig:
One (1) Tablet PO TID (3 times a day).


Discharge Disposition:
Home

Discharge Diagnosis:
Dyspnea, resolved
Parkinson's disease


Discharge Condition:
Afebrile, normotensive, comfortable on room air


Discharge Instructions:
Please take your medications as prescribed. Please call your
doctor or return to the emergency room should you have any of
the following symptoms: fever > 101, chills, difficulty
breathing, passing out, dizziness, falls, abdominal pain, chest
pain, or any other concerns.
.
You have been evaluated for your shortness of breath. We think
that your shortness of breath and trouble breathing is related
to your Parkinson's disease. You Parkinson's can give you the
sensation of trouble breathing which can make you feel anxious.
We are prescribing a medicine which will help with the anxiety.

Followup Instructions:
You should follow up with your primary care doctor, Dr. [**Last Name (STitle) 4743**],
within one week. Please call his office at [**Telephone/Fax (1) 4745**] to
schedule this appointment.
.
You should also follow up with a lung specialist within [**1-4**]
weeks. Please call [**Telephone/Fax (1) 612**] to schedule an appointment with
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. You should have outpatient studies including a
sleep study and pulmonary function testing.



Completed by:[**2152-4-12**]
{'Paralysis agitans,Other respiratory abnormalities,Anxiety state, 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: Patient is 72 year Spanish speaking male with PMHx of
Parkinson's Disease who presents to the ED for complaints of
shortness of breath. Per patient daughter he was at his baseline
health until night prior to admission when patient described
shortness of breath and sensation that his airways were blocked.
Patient was seen at [**Hospital1 112**] a few weeks ago for similar symptoms.
Per daughter etiology of shortness of breath was not identified
and thought breathing difficulty could be due to anxiety.
Patient denies any chest pain or diaphoresis and is symptoms do
not seem to coorelate with any medications. He has noticed no
change in his speech or any trouble with swallowing or eating
and drinking foods.
During this episode of shortness of breath at home patient
seemed anxious and paramedics were called. While they were
present,
he had brief unresponsiveness and was found to be in atrial
fibrillation. A nasal trumpet was placed with return of
responsiveness and of sinus rhythm. He was brought to [**Hospital1 18**]. On
arrival to ICU patient comfortable denies any shortness of
breath. He has a nasal trumpet in place. His O2Sat remains above
90% on room air but appears to drop when patient falls asleep.
Patient denies any swelling of his throat or airway, he just
feels congested in his nasal passages.
.
ROS: Patient denies any CP, HA, n/v, fevers, chills, cough,
abdominal pain. Patient is urinating normally and besides
constipation has normal bowel movements. His Parkinson's has
gotten worse over the last year but no acute worsening over the
past few months.

MEDICAL HISTORY: Parkinson's disease, diagnosed at age 66, followed by Dr.
[**Last Name (STitle) 4742**]
at [**Hospital1 2025**]
PCP is [**Last Name (NamePattern4) **]. [**Last Name (STitle) 4743**] at [**Hospital1 112**]

MEDICATION ON ADMISSION: sinemet 25/100mg tid (7am, 11am, 5pm)
sinemet 50/200mg qid (7am, 11am, 5pm, 10pm)
klonopin 0.25mg daily (7pm)
seroquel 0.25mg [**Hospital1 **] (11am, 10pm)
citalopram 20mg daily
ranitidine 150mg [**Hospital1 **]
mirapex 0.5/1/0.5/1mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.1 BP 127/74 HR 77 O2Sat 93%-94% on RA
Gen: NAD
Heent: PERRL, EOMI, OP clear no pharyngeal swelling, nasal
trumpet in place, MM dry.
Neck: supple, no LAD
Lungs: CTA B/L
Cardiac: RRR S1/S2 no murmurs
Abd: soft NTND NABS
Ext: FROM, no edema
Neuro: AAOx3, patient with resting tremors of UE and LE b/l,
normal reflexes, sensory grossly intact

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives with wife and sister-in-law, who have been limiting his
activities more recently, though he did go out of the house once
last week by himself. Able to do laundry, for example, b/c did
it last week but not allowed by his wife (per daughter). No
tobacco, EtOH, drug use. 

### Response:
{'Paralysis agitans,Other respiratory abnormalities,Anxiety state, unspecified'}
