CHIEF COMPLAINT: LE edema and SOA

PRESENT ILLNESS: Mr. [**Known lastname 2727**] is a 79 yo man who has had right LE swelling over the
last two days in addition to SOB.  He initially presented to
[**Hospital **] hospital where CTA showed multiple PE's and a thoracic
aorta mural thrombus.  He was give lovenox 90 mg and then sent
to [**Hospital1 18**] for further tx and evaluation.  Vascular surgery saw
the patient in the ED and did not want to do any surgery at this
point.  Pt was admitted to the [**Hospital Unit Name 153**] to monitor mental status and
to initiate anticoagulation therapy.

MEDICAL HISTORY: Prostate CA s/p radiation
Hypercholesterolemia
COPD
Daughter denied history of CHF, CAD, stroke, DM, CKD and GIB

MEDICATION ON ADMISSION: albuterol
lipitor

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Per Dr. [**First Name8 (NamePattern2) 402**] [**Last Name (NamePattern1) **]
VS on transfer from [**Location (un) **]: T 95.3, P 74, BP 112/60, RR 16,
93-99% 4L
General: NAD, appears comfortable in bed
Lungs: crackles at bases b/l, wheezing diffusely
Heart: muffled heart sounds
Abd: + BS, soft/obese, NTND
Extremities: R >> L LE swelling, right 3+ pitting edema;
diminished pulses on palpation but dopplerable.
Neuro: AA, Ox3, CN II - XII in tact

FAMILY HISTORY: 

SOCIAL HISTORY: Positive for alcohol and tobacco use: 6beers and 2 shots/day,
60pack year hx. Lives with his son.
Embolism and thrombosis of thoracic aorta,Other pulmonary embolism and infarction,Systolic heart failure, unspecified,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Personal history of malignant neoplasm of prostate,Chronic airway obstruction, not elsewhere classified,Pure hypercholesterolemia,Aortic valve disorders,Eosinophilia,Unspecified disorder of adrenal glands,Other and unspecified alcohol dependence, continuous
Thoracic aortic embolism,Pulm embol/infarct NEC,Systolic hrt failure NOS,Ac DVT/embl low ext NOS,Hx-prostatic malignancy,Chr airway obstruct NEC,Pure hypercholesterolem,Aortic valve disorder,Eosinophilia,Adrenal disorder NOS,Alcoh dep NEC/NOS-contin
Admission Date:  [**2181-7-13**]              Discharge Date:   [**2181-7-24**]

Date of Birth:  [**2102-3-8**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8104**]
Chief Complaint:
LE edema and SOA

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 2727**] is a 79 yo man who has had right LE swelling over the
last two days in addition to SOB.  He initially presented to
[**Hospital **] hospital where CTA showed multiple PE's and a thoracic
aorta mural thrombus.  He was give lovenox 90 mg and then sent
to [**Hospital1 18**] for further tx and evaluation.  Vascular surgery saw
the patient in the ED and did not want to do any surgery at this
point.  Pt was admitted to the [**Hospital Unit Name 153**] to monitor mental status and
to initiate anticoagulation therapy.

Past Medical History:
Prostate CA s/p radiation
Hypercholesterolemia
COPD
Daughter denied history of CHF, CAD, stroke, DM, CKD and GIB

Social History:
Positive for alcohol and tobacco use: 6beers and 2 shots/day,
60pack year hx. Lives with his son.

Physical Exam:
Per Dr. [**First Name8 (NamePattern2) 402**] [**Last Name (NamePattern1) **]
VS on transfer from [**Location (un) **]: T 95.3, P 74, BP 112/60, RR 16,
93-99% 4L
General: NAD, appears comfortable in bed
Lungs: crackles at bases b/l, wheezing diffusely
Heart: muffled heart sounds
Abd: + BS, soft/obese, NTND
Extremities: R >> L LE swelling, right 3+ pitting edema;
diminished pulses on palpation but dopplerable.
Neuro: AA, Ox3, CN II - XII in tact


Pertinent Results:
Labs ([**2181-7-13**]) 04:27

134  100  17          AGap=13
-------------< 97
4.7  26  0.9

Ca: 8.4 Mg: 2.2 P: 3.8
ALT: 16 AP: 68 Tbili: 1.4 Alb: 3.5
AST: 28 LDH: 358
PSA: 0.01
     14.2
7.7 >-----< 192
      44.0

N:69.2 L:17.2 M:6.6 E:6.6 Bas:0.4

OSH Imaging:
Duplex US: right LE DVT from the common femoral vein to the
popliteal vein.
.
CT Head: no ICH or mass effect, perventricular small vessel
ischemia 9left parietal lobe)
.
CTA Chest:
1. extensive mural thrombus through the thoracic aorta involving
the arch and descending aorta as well as abdominal aorta.
2. pulmonary emboli at the junction of the R upper and middle
lobe arteries. Other emboli in RML, RLL, and LLL arteries.
3. 2x1 cm left adrenal mass


Brief Hospital Course:
79 yo man remote hx prostate cancer, presenting to OSH with RLE
swelling and found to have multiple regions of thromboses
including DVT, PE, aortic mural thrombosis

1) Multiple thromboses, both arterial and venous:
a) RLE DVT
b) Extensive mural thrombus of aortic arch and descending
abdominal aorta
c) PE: junction right upper and right middle lob artery; also PE
of RML, RLL, LLL distal vessel

Vascular surgery was consulted on arrival to ED and felt pt did
not have clinical need for surgical intervention/thrombectomy at
this time.  He remained hemodynamically stable but was admitted
to ICU for close observation due to his significant clot burden.
 On admission pt was placed on heparin drip and started on
coumadin. Etiology of clots are unknown; denies hx of prior
clots or FH of hypercoagulable state. Patient has a distant
history of prostate cancer (previously seen by a radiation
oncologist) but PSA ([**2181-7-13**]) was found to be 0.1.  Given an
adrenal nodule of undetermined significance on OSH CT, an
adrenal protocol CT scan was done that showed adrenal
hyperplasia but no evidence of malignancy. Retroperitoneal and
periportal lymph nodes were found to be enlarged but not meeting
pathologic criteria. LDH, Cr, CBC, and Ca were normal. He will
need outpt age-appropriate cancer screening as well as f/u in
with hematology (Dr. [**Last Name (STitle) **] for evaluation of
hypercoagulablity. He has also been instructed to initiate care
with a new PCP.  [**Name10 (NameIs) **] was initiated on coumadin, and will have his
INR followed at rehab. After that he will need to have his INR
monitored by his new PCP, [**Name10 (NameIs) **] perhaps the [**Hospital3 **]
in [**Location (un) 620**].

2) COPD:  Pt was placed on 4L NC on admission, given nebs for
mild sx of dyspnea.  Sx likely related to PE; no evidence of
COPD flare. He also had small bilateral effusions with
associated compressive atelectasis, likely related to his
systolic heart failure. His O2 requirement decreased slightly
with gentle diuresis.

3) Alcohol abuse: Pt has a history of alcohol abuse and seemed
to be confabulating at times.  Pt was started on folate,
thiamine, and electrolytes were monitored.  Due to alcohol use
pt was thought to be at high risk for gastritis and was started
on PPI prophylaxis.  Pt was given valium for withdrawal
prophylaxis in ICU.  After discussion with patient's family, it
was felt that patient was at his baseline mental status.

4) Eosinophilia of unclear significance: developed in-house. As
the absolute eosinophil count was less than 1000 and he had no
signs or symptoms of allergic drug reaction or end-organ damage.
 He will need to have this monitored in the outpatient setting.

5) Systolic heart failure: the patient was found to have an EF
of 35% by TTE. Calls to his current and prior PCP produced no
evidence of having had prior echos. His heart failure is of
unknown chronicity or etiology. He denies a history of CAD,
although he has dyslipidemia. He was started on low-dose beta
blocker and ACEI which he tolerated, and he was diuresed gently
as above. He was made an appointment to follow up with an
outpatient cardiologist.

6) Aortic stenosis: He was found to have moderate to severe
aortic stenosis of TTE. This is of unknown chronicity but the
patient has been asymptomatic with no history of chest pain or
syncope. Lasix was dosed cautiously given this finding, and he
will follow up with an outpatient cardiologist.

Medications on Admission:
albuterol
lipitor

Discharge Medications:
1. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
2. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation every six (6) hours as
needed for SOB, wheezing.
3. Multivitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
4. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**1-10**] Sprays Nasal
QID (4 times a day) as needed.
8. Warfarin 2.5 mg Tablet Sig: Three (3) Tablet PO Once Daily at
4 PM.
9. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
10. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day:
***This has been on  hold for the last 2 days of
hospitalization****.
11. Outpatient Lab Work
Please check INR/PT on Thurs [**7-26**] and adjust coumadin as needed


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] Of [**Location (un) 620**]

Discharge Diagnosis:
1) Multiple thromboses, both arterial and venous:
a) RLE DVT
b) Extensive mural thrombus of aortic arch and descending
abdominal aorta
c) PE: junction right upper and right middle lob artery; also PE
of RML, RLL, LLL distal vessels
d) aortic stenosis
e) congestive heart failure
f) mild eosinophia


Discharge Condition:
Good


Discharge Instructions:
You were admitted with multiple pulmonary emboli, a deep vein
clot, and clots in your aorta.  You also have aortic stenosis
(tight valve) and congestive heart failure. You were started on
a medication that thins your blood.

Please return to the emergency room should you develop shortness
of breath, chest pain, lightheadness, or leg swelling. You
should also return to the emergency room should you develop dark
stools, blood in your stool, or abdominal pain.

Followup Instructions:
1) Cardiology: Friday [**8-10**] at 10:45am with Dr. [**First Name (STitle) **]
[**Name (STitle) 50213**]. [**Hospital1 18**] [**Location (un) 620**]: [**Street Address(2) 3001**], [**Location (un) 620**], [**Numeric Identifier 3002**]
Phone: [**Telephone/Fax (1) 79101**]

2) Hematology/Oncology: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Friday [**7-27**] at
11am.  Patient has to check in in admitting office at 10:45am.
[**Street Address(2) 3001**], [**Location (un) 620**], [**Numeric Identifier 3002**]
Phone: [**Telephone/Fax (1) 38619**]

3) You will need to establish care with a new primary care
doctor
{'Embolism and thrombosis of thoracic aorta,Other pulmonary embolism and infarction,Systolic heart failure, unspecified,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Personal history of malignant neoplasm of prostate,Chronic airway obstruction, not elsewhere classified,Pure hypercholesterolemia,Aortic valve disorders,Eosinophilia,Unspecified disorder of adrenal glands,Other and unspecified alcohol dependence, continuous'}


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: LE edema and SOA

PRESENT ILLNESS: Mr. [**Known lastname 2727**] is a 79 yo man who has had right LE swelling over the
last two days in addition to SOB.  He initially presented to
[**Hospital **] hospital where CTA showed multiple PE's and a thoracic
aorta mural thrombus.  He was give lovenox 90 mg and then sent
to [**Hospital1 18**] for further tx and evaluation.  Vascular surgery saw
the patient in the ED and did not want to do any surgery at this
point.  Pt was admitted to the [**Hospital Unit Name 153**] to monitor mental status and
to initiate anticoagulation therapy.

MEDICAL HISTORY: Prostate CA s/p radiation
Hypercholesterolemia
COPD
Daughter denied history of CHF, CAD, stroke, DM, CKD and GIB

MEDICATION ON ADMISSION: albuterol
lipitor

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Per Dr. [**First Name8 (NamePattern2) 402**] [**Last Name (NamePattern1) **]
VS on transfer from [**Location (un) **]: T 95.3, P 74, BP 112/60, RR 16,
93-99% 4L
General: NAD, appears comfortable in bed
Lungs: crackles at bases b/l, wheezing diffusely
Heart: muffled heart sounds
Abd: + BS, soft/obese, NTND
Extremities: R >> L LE swelling, right 3+ pitting edema;
diminished pulses on palpation but dopplerable.
Neuro: AA, Ox3, CN II - XII in tact

FAMILY HISTORY: 

SOCIAL HISTORY: Positive for alcohol and tobacco use: 6beers and 2 shots/day,
60pack year hx. Lives with his son. 

### Response:
{'Embolism and thrombosis of thoracic aorta,Other pulmonary embolism and infarction,Systolic heart failure, unspecified,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Personal history of malignant neoplasm of prostate,Chronic airway obstruction, not elsewhere classified,Pure hypercholesterolemia,Aortic valve disorders,Eosinophilia,Unspecified disorder of adrenal glands,Other and unspecified alcohol dependence, continuous'}
