CHIEF COMPLAINT: Lightheadedness

PRESENT ILLNESS: Mr. [**Name14 (STitle) 84221**] is a 51 y/o M with a history of Ischemic CM (EF 30%,
[**12/2138**]), h/o MI (likely NSTEMI), chronic sCHF, DM, HPL, HTN, who
is transferred from OSH. Patient had presented to [**Hospital **]
Hospital this AM with complaints of dizziness and
lightheadedness, that he has been experiencing over the past
month that was unchanged. Initial VS were 98.8, 85, 86/54,
99%RA. In the OSH, patient was noted to be hypotensive and
received 2L NS. He was noted to have BUN/Cr 33/1.6 there, CKMB
2.3, Trop 0.07. He had an episode of witnessed syncope on the
gurney and was noted to be faint for several seconds. It is
unclear if this was associated with any arrythmia noted on
telemetry.
.
On tranfer, patient's vital signs are stable. Patient is
conversant and denies any denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion. Denies any other episodes of syncope (other
than at OSH ED), admits to mild ankle edema.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension

MEDICATION ON ADMISSION: Plavix 75mg po daily
Ranexa 1000mg po BID
Metolazone 2.5mg daily
Coreg 50mg po BID
Cozaar 50mg po BID (per patient)
Isosorbide Mononitrate 120mg po daily
Furosemide 80mg po BID
Novolog Mix 70/30: 80 units qAM, 50-60 units qPM
Novolog 100u/ml solution 50units with dinner
Aldactone 25mg po daily
ASA 325mg po daily
Cardura 4mg po daily
Crestor 40mg po daily
Digoxin 0.25mg po daily
Metformin 1000mg po BID
Indocin 25mg as directed: [**12-20**] pills/day PRN
Motrin 800mg po TID prn
Nitrostat PRN

ALLERGIES: Morphine

PHYSICAL EXAM: VS: 98.4  87  109/66 18 97/RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Occupation: Teacher
Tobacco: 1ppd x 20 years
ETOH: Rare
Other: History of heavy marijuana use
Acute kidney failure, unspecified,Chronic systolic heart failure,Hypovolemia,Syncope and collapse,Other specified forms of chronic ischemic heart disease,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Morbid obesity,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Acute kidney failure NOS,Chr systolic hrt failure,Hypovolemia,Syncope and collapse,Chr ischemic hrt dis NEC,Old myocardial infarct,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Morbid obesity,BPH w/o urinary obs/LUTS
Admission Date:  [**2139-1-21**]              Discharge Date:   [**2139-1-22**]

Date of Birth:  [**2087-10-17**]             Sex:   M

Service: MEDICINE

Allergies:
Morphine

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Lightheadedness

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mr. [**Name14 (STitle) 84221**] is a 51 y/o M with a history of Ischemic CM (EF 30%,
[**12/2138**]), h/o MI (likely NSTEMI), chronic sCHF, DM, HPL, HTN, who
is transferred from OSH. Patient had presented to [**Hospital **]
Hospital this AM with complaints of dizziness and
lightheadedness, that he has been experiencing over the past
month that was unchanged. Initial VS were 98.8, 85, 86/54,
99%RA. In the OSH, patient was noted to be hypotensive and
received 2L NS. He was noted to have BUN/Cr 33/1.6 there, CKMB
2.3, Trop 0.07. He had an episode of witnessed syncope on the
gurney and was noted to be faint for several seconds. It is
unclear if this was associated with any arrythmia noted on
telemetry.
.
On tranfer, patient's vital signs are stable. Patient is
conversant and denies any denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion. Denies any other episodes of syncope (other
than at OSH ED), admits to mild ankle edema.


Past Medical History:
1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension

2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS:
---> No history of Stent placement. Patient has had h/o MI in
[**2131**] and [**2134**].
---> h/o recent cardiac cath in [**11-26**]: Right dominant system
LM: NL, LAD: entire prox and mid portion of LAD is diffusely
diseased with maximum 80% obstruction in the mid LAD. LCx:
Diffuse, non obstructing diease. RCA: Proximal total occlusion
with L to R collaterals.
.
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
Past Medical History:
-Ischemic Cardiomyopathy - EF 15% [**2131**], 30% [**2138**] [**Hospital1 18**] Echo
-Coronary Artery Disease, History of MI [**2131**]/[**2134**]
-h/o sCHF
-Morbid Obesity
-History of PNA [**2131**] c/b multi system organ failure requiring
intubation [**2131**]
-Sleep Apnea, uses CPAP intermittently
-BPH
-Erectile Dysfunction
-Bilateral Achilles Tendonitis
- s/p tonsillectomy
- s/p right inguinal hernia repair
- s/p left inguinal hernia repair


Social History:
Occupation: Teacher
Tobacco: 1ppd x 20 years
ETOH: Rare
Other: History of heavy marijuana use


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
VS: 98.4  87  109/66 18 97/RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 10 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. Heart sounds distant given body
habitus, but uanble to auscultate m/r/g/s3/s4. No thrills,
lifts.
LUNGS: CTAB, no crackles, wheezes or rhonchi.
ABDOMEN: Obese. Soft, NTND. No HSM or tenderness. Unable to
palpate Abd aorta. No abdominial bruits.
EXTREMITIES: Tr LE edema. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ DP 1+ PT 1+
Left: Carotid 2+ DP 1+ PT 1+


Pertinent Results:
[**2139-1-22**]   Radiology CHEST (PRE-OP PA & LAT)
Heart size is normal. Mediastinal position, contour, and width
are
unremarkable. Lung volumes are low with elevated left
hemidiaphragm,
chronicity undetermined, but the lungs are essentially clear.
There is no
pleural effusion or pneumothorax.

[**2139-1-22**]   Radiology CAROTID SERIES COMPLETE     [**Last Name (LF) **],[**First Name3 (LF) **] V.
Results pending at discharge


[**2139-1-22**] 05:31AM BLOOD WBC-6.0 RBC-4.17* Hgb-11.6* Hct-33.3*
MCV-80* MCH-27.9 MCHC-35.0 RDW-14.8 Plt Ct-212
[**2139-1-21**] 08:39PM BLOOD PT-12.5 PTT-22.8 INR(PT)-1.1
[**2139-1-22**] 05:31AM BLOOD Glucose-201* UreaN-29* Creat-1.1 Na-135
K-3.7 Cl-92* HCO3-35* AnGap-12
[**2139-1-22**] 05:31AM BLOOD ALT-27 AST-20 LD(LDH)-148 CK(CPK)-138
AlkPhos-51 TotBili-0.4
[**2139-1-21**] 08:39PM BLOOD CK-MB-4 cTropnT-0.03*
[**2139-1-22**] 05:31AM BLOOD CK-MB-3 cTropnT-0.03*
[**2139-1-22**] 05:31AM BLOOD %HbA1c-11.0* eAG-269*

Brief Hospital Course:
51 y/o M with a history of Ischemic CM (EF 30%, [**12/2138**]), h/o MI
(likely NSTEMI), chronic sCHF, DM, HPL, HTN who is transferred
from OSH after lightheadedness and syncopal episode at OSH.

# Lightheadedness and Syncope: His symptoms were likely from
dehydration.  Patient describes orthostatic symptoms that
started shorly after increasing his diuretic regimen.  At OSH
ED, while patient was on the gurney, he had a brief episode of
syncope.  He was given 2L NS.  It is unclear whether patient was
monitored on telemetry during this time, as arrythmia given his
depressed EF is also possible.  At the [**Hospital1 18**], his lasix and
blood pressure medications were held, with resolution of his
symptoms.  He had no significant events on telemetry.  He was
discharged on [**12-20**] of his prior lasix dose, and without
metolizone.  His dry weight was 140 kg.
**** Follow weight and adjust Lasix as needed.

# Coronary Artery Disease awaiting CABG: His [**11-26**] Cath with
diffuse non-obstructive LCx disease, prox TO RCA, diffuse LAD
(max 80%) stenosis.  He is followed by Dr. [**Last Name (STitle) **] and is
scheduled to have CABG [**1-28**].  He was seen be cardiac surgery and
had his pre-op evaluation done in house.  He was evaluated by
anesthesia, had carotid ultrasound, labs and a chest x-ray.
**** Follow up results of carotid ultrasound

# Acute Renal Failure: Presented to OSH with Cr 1.6, that came
down to 1.1 here following resuscitation.  His baseline Cr is
reportedly 1.0

# DM II: Continued home 70/30 regimen.  His HbA1c came back at
11.
**** Patient needs up-titration of his insulin regimen.

Medications on Admission:
Plavix 75mg po daily
Ranexa 1000mg po BID
Metolazone 2.5mg daily
Coreg 50mg po BID
Cozaar 50mg po BID (per patient)
Isosorbide Mononitrate 120mg po daily
Furosemide 80mg po BID
Novolog Mix 70/30: 80 units qAM, 50-60 units qPM
Novolog 100u/ml solution 50units with dinner
Aldactone 25mg po daily
ASA 325mg po daily
Cardura 4mg po daily
Crestor 40mg po daily
Digoxin 0.25mg po daily
Metformin 1000mg po BID
Indocin 25mg as directed: [**12-20**] pills/day PRN
Motrin 800mg po TID prn
Nitrostat PRN


Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Please discontinue this medication on [**2139-2-4**].
2. Ranolazine 500 mg Tablet Sustained Release 12 hr Sig: Two (2)
Tablet Sustained Release 12 hr PO BID (2 times a day).
3. Carvedilol 25 mg Tablet Sig: Two (2) Tablet PO twice a day.
4. Cozaar 50 mg Tablet Sig: Two (2) Tablet PO twice a day.
5. Isosorbide Mononitrate 120 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Doxazosin 4 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

10. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a
day.
11. Aldactone 25 mg Tablet Sig: One (1) Tablet PO once a day.
12. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
13. Insulin
Novolog 70/30: 80 units in the morning, 50 units in the evening.
Use your previous sliding scale.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: syncope secondary to hypovolemia

Secondary: coronary artery disease
chronic systolic heart failure

Discharge Condition:
Good, hemodynamically stable.

Discharge Instructions:
You were admitted to the hospital because you were feeling
lightheaded.  Initially, we thought this might be your heart,
however it appears that this was due to the heart failure
regimen that you were on being over-aggressive.  We gave you
some fluids which improved your symptoms, and adjusted your
medications slightly in order to stop this from happening again.
 In particular, we believe that the furosemide (lasix) and
metolazone, which are medications that help remove fluid from
your body were at too high a dose.

In order to stop this from happening again, you should weigh
yourself every day in order to help manage your fluid status.
If your weight changes by more than 3lbs in either direction,
you should call your cardiologist Dr. [**Last Name (STitle) **] and ask for his
instructions in adjusting your medications.

While you were here, we also completed your pre-operative
testing for your coming heart bypass operation.  You are
scheduled to have your operation on [**2139-2-11**].  You should stop
taking your plavix (clopidogrel) on [**2139-2-4**] in preparation for
your surgery.

The following changes have been made to your medications:
Your metolazone has been STOPPED
Your lasix has been decreased from 80mg to 40mg twice daily.

All of your other medications are the same as they were prior to
your admission.

Followup Instructions:
Please schedule an appointment to see your cardiologist, Dr.
[**First Name8 (NamePattern2) 2092**] [**Last Name (NamePattern1) **] within 1 week's time.


Completed by:[**2139-1-22**]
{'Acute kidney failure, unspecified,Chronic systolic heart failure,Hypovolemia,Syncope and collapse,Other specified forms of chronic ischemic heart disease,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Morbid obesity,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: Lightheadedness

PRESENT ILLNESS: Mr. [**Name14 (STitle) 84221**] is a 51 y/o M with a history of Ischemic CM (EF 30%,
[**12/2138**]), h/o MI (likely NSTEMI), chronic sCHF, DM, HPL, HTN, who
is transferred from OSH. Patient had presented to [**Hospital **]
Hospital this AM with complaints of dizziness and
lightheadedness, that he has been experiencing over the past
month that was unchanged. Initial VS were 98.8, 85, 86/54,
99%RA. In the OSH, patient was noted to be hypotensive and
received 2L NS. He was noted to have BUN/Cr 33/1.6 there, CKMB
2.3, Trop 0.07. He had an episode of witnessed syncope on the
gurney and was noted to be faint for several seconds. It is
unclear if this was associated with any arrythmia noted on
telemetry.
.
On tranfer, patient's vital signs are stable. Patient is
conversant and denies any denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion. Denies any other episodes of syncope (other
than at OSH ED), admits to mild ankle edema.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension

MEDICATION ON ADMISSION: Plavix 75mg po daily
Ranexa 1000mg po BID
Metolazone 2.5mg daily
Coreg 50mg po BID
Cozaar 50mg po BID (per patient)
Isosorbide Mononitrate 120mg po daily
Furosemide 80mg po BID
Novolog Mix 70/30: 80 units qAM, 50-60 units qPM
Novolog 100u/ml solution 50units with dinner
Aldactone 25mg po daily
ASA 325mg po daily
Cardura 4mg po daily
Crestor 40mg po daily
Digoxin 0.25mg po daily
Metformin 1000mg po BID
Indocin 25mg as directed: [**12-20**] pills/day PRN
Motrin 800mg po TID prn
Nitrostat PRN

ALLERGIES: Morphine

PHYSICAL EXAM: VS: 98.4  87  109/66 18 97/RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Occupation: Teacher
Tobacco: 1ppd x 20 years
ETOH: Rare
Other: History of heavy marijuana use 

### Response:
{'Acute kidney failure, unspecified,Chronic systolic heart failure,Hypovolemia,Syncope and collapse,Other specified forms of chronic ischemic heart disease,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Morbid obesity,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
