CHIEF COMPLAINT: Shortness of breath.

PRESENT ILLNESS: This is a 66-year-old female
with a history of diabetes and hypertension with a resultant
end-stage renal disease who recently has had fatigue and
coughing spells making it hard for her to catch her breath,
with fevers and chills and dark sputum for one week.  Not
feeling well, she missed her dialysis appointment for
Wednesday, [**2-28**].  On [**3-2**] in the a.m. she had
acute shortness of breath without chest pain and Emergency
Medical Service was called.  She was intubated in the field
and taken to the Emergency Room.

MEDICAL HISTORY: 1.  Type 2 diabetes with retinopathy and nephropathy and
neuropathy.
2.  End-stage renal disease secondary to diabetes mellitus
and hypertension; dialyzed on Monday, Wednesday and Friday
for five years.
3.  Coronary artery disease, status post anterior myocardial
infarction in [**2158**]; last catheterization in [**2158**] showed 100%
right coronary artery with collaterals from distant
circumflex and right coronary artery, 80% left anterior
descending artery, and 64% ejection fraction, moderate
diastolic dysfunction with increased filling pressures.  An
echocardiogram in [**2166**] had an ejection fraction preserved
with mild left atrial enlargement and mild-to-moderate mitral
regurgitation.
4.  Cerebrovascular accident in [**2158**] with occasional
word-finding difficulties as only deficit.
5.  Peripheral vascular disease.
6.  Cholecystectomy and total abdominal hysterectomy.
7.  Loop graft for hemodialysis in [**2165-5-30**].
8.  Cervical spondylosis, status post multiple discectomies.
9.  Chronic diarrhea; the patient does not recall workup, on
Lomotil.

MEDICATION ON ADMISSION: Medications at home include
Calcitriol 0.25 mcg p.o. q.d., isosorbide/Isordil 10 mg p.o.
t.i.d., meclizine 12.5 mg p.o. b.i.d. p.r.n.,
metoprolol 50 mg p.o. b.i.d., Nephrocaps 1 tablet p.o. q.d.,
Zoloft 100 mg p.o. q.d., Lipitor 10 mg p.o. q.d.,
Cardizem 180 mg p.o. q.d., Celebrex 100 mg p.o. p.r.n.,
Renagel 4000 mg t.i.d., hydroxyzine 25 mg p.o. b.i.d. to
t.i.d. p.r.n., Lomotil 2.5 mg p.o. q.i.d. p.r.n., Ativan 1 mg
p.o. q.h.s., Epogen 3500 units at hemodialysis, quinine
sulfate 260 mg p.o. q.h.s.

ALLERGIES: ACE INHIBITOR causes cough.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient lives in her daughter's house
with her son-in-law.  She has been getting [**Hospital6 1587**] but not recently.  She denies ethanol and
tobacco.  She has been leaning on others to do things for her
recently.
Congestive heart failure, unspecified,Other pulmonary insufficiency, not elsewhere classified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Polyneuropathy in diabetes
CHF NOS,Other pulmonary insuff,DMII renl nt st uncntrld,Hyp kid NOS w cr kid V,Crnry athrscl natve vssl,Old myocardial infarct,Neuropathy in diabetes
Admission Date:  [**2170-3-2**]     Discharge Date:  [**2170-3-7**]

Date of Birth:   [**2103-11-27**]     Sex:  F

Service:  MEDICAL INTENSIVE CARE UNIT/[**Hospital1 **]

CHIEF COMPLAINT:  Shortness of breath.

HISTORY OF PRESENT ILLNESS:  This is a 66-year-old female
with a history of diabetes and hypertension with a resultant
end-stage renal disease who recently has had fatigue and
coughing spells making it hard for her to catch her breath,
with fevers and chills and dark sputum for one week.  Not
feeling well, she missed her dialysis appointment for
Wednesday, [**2-28**].  On [**3-2**] in the a.m. she had
acute shortness of breath without chest pain and Emergency
Medical Service was called.  She was intubated in the field
and taken to the Emergency Room.

There, she had hypertension to 215/120.  She was treated with
intravenous nitroglycerin, enalapril, MSO4, aspirin, and
admitted to the Medical Intensive Care Unit.  She was treated
with her Cardizem and Lopressor which was increased to 75 mg
b.i.d. and Isordil.  She was also given a dose of Lasix and
hydralazine.  Initial electrocardiogram changes with ST
elevations in V2 to V3 were attributed to her underlying
congestive heart failure by Cardiology.  Her creatine kinase
and troponin were negative.  She underwent ultrafiltration
later that day with removal of 4.2 kg.  Later on her first
day, she did have some chest pain responsive to morphine, but
her electrocardiogram had normalized.  An electrocardiogram
was done which showed her ejection fraction had fallen from
previously normal to 25%.  She had an episode of flash
pulmonary edema on [**3-2**] in the p.m.

On [**3-3**] she had another ultrafiltration for 3 kg with
plans to resume regular schedule thereafter.  She was
extubated after ultrafiltration after one failed attempt
earlier.  She also had several episodes of chest pain with ST
elevations in V2 to V3 on the electrocardiogram, treated with
nitroglycerin and Lopressor, and the pain resolved.  The team
then felt the chest pain was related to traumatic intubation
more than angina, as it is present only when she coughs.  The
cough precedes the chest pain, and the chest pain goes away
with the cough, and the pain is present substernally up to
her throat.  She has had a bit of colored sputum attributed
to traumatic intubation with mild hemoptysis.  She had
low-grade temperatures thought secondary to possible
aspiration and got one dose of zithromycin on [**3-4**].
Intravenous nitroglycerin was weaned off to her home Isordil.
With increased phosphate, Renal recommended checking PTH and
starting Amphojel 30 cc t.i.d. while in house which was done.

She was transferred to the floor on [**2170-3-4**].  At
that time she denied fevers, chills, night sweats.  Neck and
chest were sore, sharp, and achy but improving.  The pain had
been on and off for one week and was [**6-8**] in intensity but
only hurt with cough.  The patient did not remember what her
myocardial infarction pain was like.  Both shoulders were
chronically achy.  She did have shortness of breath while
coughing.  There was no nausea, vomiting, or diaphoresis.
When not coughing, the patient felt baseline breathing.  She
had brown diarrhea.  No melena or blood.  This is a chronic
condition for her.

PAST MEDICAL HISTORY:
1.  Type 2 diabetes with retinopathy and nephropathy and
neuropathy.
2.  End-stage renal disease secondary to diabetes mellitus
and hypertension; dialyzed on Monday, Wednesday and Friday
for five years.
3.  Coronary artery disease, status post anterior myocardial
infarction in [**2158**]; last catheterization in [**2158**] showed 100%
right coronary artery with collaterals from distant
circumflex and right coronary artery, 80% left anterior
descending artery, and 64% ejection fraction, moderate
diastolic dysfunction with increased filling pressures.  An
echocardiogram in [**2166**] had an ejection fraction preserved
with mild left atrial enlargement and mild-to-moderate mitral
regurgitation.
4.  Cerebrovascular accident in [**2158**] with occasional
word-finding difficulties as only deficit.
5.  Peripheral vascular disease.
6.  Cholecystectomy and total abdominal hysterectomy.
7.  Loop graft for hemodialysis in [**2165-5-30**].
8.  Cervical spondylosis, status post multiple discectomies.
9.  Chronic diarrhea; the patient does not recall workup, on
Lomotil.

MEDICATIONS ON ADMISSION:  Medications at home include
Calcitriol 0.25 mcg p.o. q.d., isosorbide/Isordil 10 mg p.o.
t.i.d., meclizine 12.5 mg p.o. b.i.d. p.r.n.,
metoprolol 50 mg p.o. b.i.d., Nephrocaps 1 tablet p.o. q.d.,
Zoloft 100 mg p.o. q.d., Lipitor 10 mg p.o. q.d.,
Cardizem 180 mg p.o. q.d., Celebrex 100 mg p.o. p.r.n.,
Renagel 4000 mg t.i.d., hydroxyzine 25 mg p.o. b.i.d. to
t.i.d. p.r.n., Lomotil 2.5 mg p.o. q.i.d. p.r.n., Ativan 1 mg
p.o. q.h.s., Epogen 3500 units at hemodialysis, quinine
sulfate 260 mg p.o. q.h.s.

ALLERGIES:  ACE INHIBITOR causes cough.

FAMILY HISTORY:   Family history was noncontributory.

SOCIAL HISTORY:  The patient lives in her daughter's house
with her son-in-law.  She has been getting [**Hospital6 1587**] but not recently.  She denies ethanol and
tobacco.  She has been leaning on others to do things for her
recently.

PHYSICAL EXAMINATION ON PRESENTATION:  Temperature of 98.8,
pulse 120, blood pressure 215/120, oxygen saturation 100%,
respiratory rate 24.  An elderly female, intubated, alert and
oriented.  Extraocular movements were intact.  Pupils were
equal, round, and reactive to light.  Cranial nerves II
through XII were intact except for her pupils.  The
oropharynx was clear.  Mucous membranes were moist.
Cardiovascular revealed she was tachycardic with a regular
rhythm, with an first heart sound and second heart sound and
third heart sound without murmurs or rubs.  Lungs had
bilateral rales.  No wheezing on rhonchi.  The abdomen
revealed normal active bowel sounds, soft, nontender, and
nondistended.  No masses.  Extremities revealed no cyanosis,
clubbing or edema, warm with good dorsalis pedis pulses.
Strength was 5/5 times four.  Sensation was slightly
decreased in the lower extremities with diabetic neuropathy,
dysesthesia when extubated today (on Sunday).  She was unsure
of the month, place was [**Hospital1 69**].
She had a slight tremor of tongue and jaw.

PERTINENT LABORATORY DATA ON PRESENTATION:  Admission
laboratories revealed white blood cell count of 18.8,
hematocrit of 40, platelets of 288.  Differential was
unrevealing.  Chem-7 was notable for blood urea nitrogen
of 73, creatinine 11.4, glucose 239.  Phosphate 6.2.  Anion
gap 21.  Coagulations were normal.  Creatine kinase of 43,
troponin of less than 0.3.  Arterial blood gas was
7.08/56/103/17/-14.  On next arterial blood gas pH had
improved to 7.27.   Blood cultures were no growth to date
times two.

RADIOLOGY/IMAGING:  Chest x-ray showed endotracheal tube and
nasogastric tube in place with heart size at the upper limits
of normal, diffuse bilateral opacities more focal in the
right perihilar regions, small effusions, right chronic
hemidiaphragm elevation.

Electrocardiogram showed normal sinus rhythm at 98 with a
normal axis, a Q wave in V2 to V3, with poor R wave
progression until V4 with ST elevations in V2 to V3 and ST
depressions in II and V5 to V6.

Echocardiogram showed 25% ejection fraction, moderate
symmetric left ventricular hypertrophy, global hypokinesis,
no valve disease.

Repeat chest x-ray revealed much decreased edema from the
first with a small right pleural effusion, left CPA not seen.

HOSPITAL COURSE:

1.  RENAL/FLUIDS/ELECTROLYTES/NUTRITION/VOLUME:  She had a
volume-related congestive heart failure episode managed by
further hemodialysis.  However, after [**3-6**] after
receiving a total of 8.4 kg removed at hemodialysis she had
blood pressures dropping to the systolic of 70s and received
two 250-cc boluses.  While she was in the hospital Amphojel
was added to control PO4.  A PTH was sent and was pending.
Calcitriol, and Renagel, Tums, Nephrocaps were continued.  A
new dry weight was being set at hemodialysis.

2.  CARDIOVASCULAR:  On transfer from the Medical Intensive
Care Unit she had a creatine kinase of 387 with a negative MB
and troponin which was attributed to immobility in the unit.
Cardiology team recommended catheterization or MIBI; however,
the latter was done because of her ejection fraction of 25%
by echocardiogram in the Medical Intensive Care Unit; normal
previously.  MIBI was negative with normal wall motion, fixed
or reversible ischemia with a 50% ejection fraction.  Her
chest pain was attributed to traumatic intubation and
improved steadily.  We tried to initiate [**Last Name (un) **], but after
repeated hemodialysis she was a little volume depleted with
low blood pressures, so this was held.  Diovan 81, her volume
status is worked out as a good option.  Aspirin, beta
blocker, Lipitor, and Isordil were continued.  The beta
blocker was increased to 75 b.i.d.

3.  PULMONARY/INFECTIOUS DISEASE:  Oxygen was weaned off.
Repeat chest x-ray showed slight elevation of her right
hemidiaphragm which is chronically blunted, CPA, and mild
right basilar atelectasis correlating with rales in her right
base.  No antibiotics were used despite low-grade
temperatures and a white blood cell count of 12.4.  The
patient continued to improve and felt at baseline.

4.  ENDOCRINE:  Fingersticks and regular insulin
sliding-scale were used.

5.  PROPHYLAXIS:  Prophylaxis was with subcutaneous heparin
and Zantac.

6.  PHYSICAL THERAPY:  She was seen by Physical Therapy who
recommended rehabilitation.

7.  PSYCHIATRY:  Zoloft was continued.

8.  GASTROINTESTINAL:  Lomotil was used as needed.  Chronic
diarrhea can be followed up as an outpatient.

CODE STATUS:  Full code.

DISCHARGE FOLLOWUP:  Follow up with her new primary care
physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] as well as with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 174**] of Nephrology through her dialysis.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE DIAGNOSES:
1.  Congestive heart failure secondary to volume overload
from a missed dialysis appointment.
2.  Possible minor aspiration event at intubation.
3.  Hypotension after loss of volume at hemodialysis.

MEDICATIONS ON DISCHARGE:
1.  Lipitor 10 mg p.o. q.h.s.
2.  Zantac 150 mg p.o. q.d.
3.  Aspirin 325 mg p.o. q.d.
4.  Tums 1000 mg p.o. t.i.d. with meals.
5.  Nephrocaps 1 tablet p.o. q.d.
6.  Lopressor 75 mg p.o. b.i.d.
7.  Zoloft 100 mg p.o. q.d.
8.  Isordil 10 mg p.o. t.i.d.

Cardizem was discontinued.  The patient may resume her home
Lomotil 2.5 q.i.d. p.r.n., and p.r.n. meclizine 12.5 t.i.d.,
and her Celebrex 100 p.r.n., and her Vistaril 25 t.i.d., and
her quinine sulfate 260 q.h.s., Renagel 4000 mg p.o. t.i.d.
with meals, Calcitriol 0.25 mcg p.o. q.d., try to initiate
Diovan 80 q.d. as blood pressure allows, Epogen 3500 units at
hemodialysis.




                          [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern1) 97867**], M.D.  [**MD Number(1) 97868**]

Dictated By:[**Last Name (NamePattern1) **]

MEDQUIST36

D:  [**2170-3-7**]  11:22
T:  [**2170-3-9**]  09:11
JOB#:  [**Job Number **]
{'Congestive heart failure, unspecified,Other pulmonary insufficiency, not elsewhere classified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Polyneuropathy in diabetes'}


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: This is a 66-year-old female
with a history of diabetes and hypertension with a resultant
end-stage renal disease who recently has had fatigue and
coughing spells making it hard for her to catch her breath,
with fevers and chills and dark sputum for one week.  Not
feeling well, she missed her dialysis appointment for
Wednesday, [**2-28**].  On [**3-2**] in the a.m. she had
acute shortness of breath without chest pain and Emergency
Medical Service was called.  She was intubated in the field
and taken to the Emergency Room.

MEDICAL HISTORY: 1.  Type 2 diabetes with retinopathy and nephropathy and
neuropathy.
2.  End-stage renal disease secondary to diabetes mellitus
and hypertension; dialyzed on Monday, Wednesday and Friday
for five years.
3.  Coronary artery disease, status post anterior myocardial
infarction in [**2158**]; last catheterization in [**2158**] showed 100%
right coronary artery with collaterals from distant
circumflex and right coronary artery, 80% left anterior
descending artery, and 64% ejection fraction, moderate
diastolic dysfunction with increased filling pressures.  An
echocardiogram in [**2166**] had an ejection fraction preserved
with mild left atrial enlargement and mild-to-moderate mitral
regurgitation.
4.  Cerebrovascular accident in [**2158**] with occasional
word-finding difficulties as only deficit.
5.  Peripheral vascular disease.
6.  Cholecystectomy and total abdominal hysterectomy.
7.  Loop graft for hemodialysis in [**2165-5-30**].
8.  Cervical spondylosis, status post multiple discectomies.
9.  Chronic diarrhea; the patient does not recall workup, on
Lomotil.

MEDICATION ON ADMISSION: Medications at home include
Calcitriol 0.25 mcg p.o. q.d., isosorbide/Isordil 10 mg p.o.
t.i.d., meclizine 12.5 mg p.o. b.i.d. p.r.n.,
metoprolol 50 mg p.o. b.i.d., Nephrocaps 1 tablet p.o. q.d.,
Zoloft 100 mg p.o. q.d., Lipitor 10 mg p.o. q.d.,
Cardizem 180 mg p.o. q.d., Celebrex 100 mg p.o. p.r.n.,
Renagel 4000 mg t.i.d., hydroxyzine 25 mg p.o. b.i.d. to
t.i.d. p.r.n., Lomotil 2.5 mg p.o. q.i.d. p.r.n., Ativan 1 mg
p.o. q.h.s., Epogen 3500 units at hemodialysis, quinine
sulfate 260 mg p.o. q.h.s.

ALLERGIES: ACE INHIBITOR causes cough.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient lives in her daughter's house
with her son-in-law.  She has been getting [**Hospital6 1587**] but not recently.  She denies ethanol and
tobacco.  She has been leaning on others to do things for her
recently. 

### Response:
{'Congestive heart failure, unspecified,Other pulmonary insufficiency, not elsewhere classified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Polyneuropathy in diabetes'}
