CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: Mr. [**Known lastname 109180**] is a [**Age over 90 **] y/o M with PMH of low-grade b-cell
non-hodgkins lymphoma most recently treated in [**2113-8-21**] with
rituxan, and CAD s/p CABG and pacer who was biba from home after
the sudden onset of SOB. Pt states he first noticed the
shortness of breath after he had been walking on his treadmill
for about 4 minutes. He said he had to stop and "didn't feel
right." He tried walking again after a short while and felt the
same. He says onset was relatively sudden, over the course of 45
minutes or so, characterized by tightness, cough, and SOB. No
CP. Pt states he noticed a similar feeling a few days earlier
but it went away. He has had a cough for approx. 1 week which
was also noticed by home home nurse, Pat. It is productive of
mucus "like saliva" but not green or yellow in color. He says he
has felt "congested" during the past week since he began
coughing. No palpitations, F/C/S, or abdominal pain. Says his BM
a little loose today but no other change in bowel movements. EMS
was called and found the patient to be wheezing with a room air
oxygen saturation 89%. He was also tachypneic in the 30s, but
began satting well on NRB. No h/o COPD or pulm disease.

MEDICAL HISTORY: - Non-hodgkins lymphoma: mesenteric, axillary/epitrochlear
recurrence (rituxin/leukeran/prednisone and radiation, rituxin
monotx for recurrence)
- HL
- HTN
- CAD (CABG x5v, pacer x13-15yrs)
- GERD
- Bilat total hip replacment c/b peripheral neuropathies
- anemia (pt states he has long history of anemia that is
"always near borderline")
- renal failure (baseline cr 1.6-1.8)

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] - 40 mg Tablet - 1 Tablet(s) by mouth
daily
FELODIPINE -  (Prescribed by Other Provider) - 10 mg Tablet
Extended Release 24 hr - Tablet(s) by mouth
METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 25 mg
Tablet Extended Release 24 hr - 1 Tablet(s) by mouth daily
OMEPRAZOLE -  (Prescribed by Other Provider) - 20mg
ASPIRIN 325mg po daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: coarse crackles in RLL but otherwise no crackles or
wheezes.  frequent coughing during lung exam
CV: systolic murmur [**3-26**] heard over entire precordium.  irregular
rate with frequent early beats.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN2-12 intact bilat, decreased hearing on right (pt wears
hearing aid bilat but was not wearing aid on right at time of
exam), strength 5/5 in UE and LE bilat

FAMILY HISTORY: - 2 sisters deceased
- Brother died 101
- Unknown cancer history

SOCIAL HISTORY: Married to his wife [**Name (NI) **], 2nd marriage.  Previously worked
in textiles. 2 sons, 1 daughter. [**Name (NI) 4084**] smokes, ocassional EtOH,
no other drug use.  Lives at home and walks with a cane.
Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Anemia in chronic kidney disease,Mitral valve disorders,Esophageal reflux,Hip joint replacement,Aortocoronary bypass status
Ac on chr diast hrt fail,Pneumonia, organism NOS,Oth lymp unsp xtrndl org,Acute kidney failure NOS,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Anemia in chr kidney dis,Mitral valve disorder,Esophageal reflux,Joint replaced hip,Aortocoronary bypass
Admission Date:  [**2113-11-15**]              Discharge Date:   [**2113-11-17**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 896**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mr. [**Known lastname 109180**] is a [**Age over 90 **] y/o M with PMH of low-grade b-cell
non-hodgkins lymphoma most recently treated in [**2113-8-21**] with
rituxan, and CAD s/p CABG and pacer who was biba from home after
the sudden onset of SOB. Pt states he first noticed the
shortness of breath after he had been walking on his treadmill
for about 4 minutes. He said he had to stop and "didn't feel
right." He tried walking again after a short while and felt the
same. He says onset was relatively sudden, over the course of 45
minutes or so, characterized by tightness, cough, and SOB. No
CP. Pt states he noticed a similar feeling a few days earlier
but it went away. He has had a cough for approx. 1 week which
was also noticed by home home nurse, Pat. It is productive of
mucus "like saliva" but not green or yellow in color. He says he
has felt "congested" during the past week since he began
coughing. No palpitations, F/C/S, or abdominal pain. Says his BM
a little loose today but no other change in bowel movements. EMS
was called and found the patient to be wheezing with a room air
oxygen saturation 89%. He was also tachypneic in the 30s, but
began satting well on NRB. No h/o COPD or pulm disease.

In the ED vitals were 94, 193/132, 25, 100% NRB. EKG was done in
ED which showed paced beats. CXR showed PNA in RLL. He was given
levofloxacin in the ED for CAP coverage (lives at home) and
nebs. He was ordered for cefepime but had not received it by the
time of transfer to the floor, so this was discontinued in favor
of CTX/azithro regimen starting in AM. Stool guaiac negative.

On transfer, ED vitals were VS: 98.0, 150/51, 60, 16, 100% 6L
NRB. On the floor the patient is comfortable and in no acute
distress, providing the above history. Pt expressed uncertainty
with being treated by physicians he does not know and would like
"the most experienced doctor" to perform any procedures that
must be done to him.


Past Medical History:
- Non-hodgkins lymphoma: mesenteric, axillary/epitrochlear
recurrence (rituxin/leukeran/prednisone and radiation, rituxin
monotx for recurrence)
- HL
- HTN
- CAD (CABG x5v, pacer x13-15yrs)
- GERD
- Bilat total hip replacment c/b peripheral neuropathies
- anemia (pt states he has long history of anemia that is
"always near borderline")
- renal failure (baseline cr 1.6-1.8)


Social History:
Married to his wife [**Name (NI) **], 2nd marriage.  Previously worked
in textiles. 2 sons, 1 daughter. [**Name (NI) 4084**] smokes, ocassional EtOH,
no other drug use.  Lives at home and walks with a cane.


Family History:
- 2 sisters deceased
- Brother died 101
- Unknown cancer history


Physical Exam:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: coarse crackles in RLL but otherwise no crackles or
wheezes.  frequent coughing during lung exam
CV: systolic murmur [**3-26**] heard over entire precordium.  irregular
rate with frequent early beats.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN2-12 intact bilat, decreased hearing on right (pt wears
hearing aid bilat but was not wearing aid on right at time of
exam), strength 5/5 in UE and LE bilat

Pertinent Results:
Labs on Admission:
[**2113-11-15**] 05:35PM   WBC-7.3 RBC-3.42* HGB-11.6* HCT-34.2*
MCV-100* MCH-33.9* MCHC-33.9 RDW-14.4
[**2113-11-15**] 05:35PM   NEUTS-60.6 LYMPHS-28.7 MONOS-5.3 EOS-4.7*
BASOS-0.7
[**2113-11-15**] 05:35PM   PLT COUNT-208
[**2113-11-15**] 05:35PM   GLUCOSE-118* UREA N-27* CREAT-1.6* SODIUM-137
POTASSIUM-4.5 CHLORIDE-98 TOTAL CO2-25 ANION GAP-19
[**2113-11-15**] 06:45PM   LACTATE-1.2

Imaging:
CXR: [**2113-11-15**]
Cardiomegaly, pulmonary edema, small bilateral pleural
effusions.
Post-diuresis chest radiograph recommended to exclude underlying
pneumonia in the lower lobes.

CXR: [**2113-11-16**]
Resolution of temporary severe CHF episode with pulmonary
congestion, remaining right lower lobe infiltrate which ought to
be followed.  No other new abnormalities.

Echo: [**2113-11-16**]
The left atrium is moderately dilated. No left atrial
mass/thrombus seen (best excluded by transesophageal
echocardiography). There is mild symmetric left ventricular
hypertrophy with normal cavity size and global systolic function
(LVEF>55%). Due to suboptimal technical quality, a focal wall
motion abnormality cannot be fully excluded. The ascending aorta
is mildly dilated. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Moderate (2+)
mitral regurgitation is seen. [Due to acoustic shadowing, the
severity of mitral regurgitation may be significantly
UNDERestimated.] There is mild pulmonary artery systolic
hypertension. There is no pericardial effusion.

IMPRESSION: Mild symmetric left ventricular hypertrophy with
preserved global biventricular systolic function. Moderate
mitral regurgitation. Pulmonary artery hypertension. Mild aortic
regurgitation.


Brief Hospital Course:
1. Pneumonia
2. Acute diastolic CHF
3. Non-hodgkins lymphoma
4. CABG s/p CABG
5. Hypertension
6. Mitral regurgitation
7. Pulmonary hypertension
8. GERD
9. Chronic kidney disease, stage III
10. Anemia, likely secondary to CKD

Admitted with acute onset of dyspnea likely multifactorial from
right lower lobe pneumonia and CHF. As per his pneumonia, he was
covered empirically with antibiotics for presumed CAP with
ceftriaxone and azithromycin. As per acute on chronic CHF
exacerbation, etiology was unclear and may have been
precipitated by underlying infection and catecholamine surge
during exertion. He was ruled out for acute ischemia with
cardiac enzymes x 2. Echo showed biventricular hypertrophy and
moderate mitral regurgitation. Patient's breathing responded
well to diuresis with decrease in oxygen requirement and
significant improvement in CXR. Given that he did not appear
total body overloaded and that his creatine increased with
initial diuresis, opted not discharge him on standing diuretics.
He will see his PCP soon after [**Name9 (PRE) 702**] for further evaluation.


Medications on Admission:
ATORVASTATIN [LIPITOR] - 40 mg Tablet - 1 Tablet(s) by mouth
daily
FELODIPINE -  (Prescribed by Other Provider) - 10 mg Tablet
Extended Release 24 hr - Tablet(s) by mouth
METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 25 mg
Tablet Extended Release 24 hr - 1 Tablet(s) by mouth daily
OMEPRAZOLE -  (Prescribed by Other Provider) - 20mg
ASPIRIN 325mg po daily


Discharge Medications:
1. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.

2. felodipine 10 mg Tablet Extended Release 24 hr Sig: One (1)
Tablet Extended Release 24 hr PO once a day.
3. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. azithromycin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
1. Pneumonia, unknown organism
2. Acute diastolic CHF
3. Non-hodgkins lymphoma
4. CABG s/p CABG
5. Hypertension
6. Mitral regurgitation
7. Pulmonary hypertension
8. GERD
9. Chronic kidney disease, stage III
10. Anemia, likely secondary to CKD

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).

Discharge Instructions:
You were admitted with shortness of breath, likely the result of
both pneumonia and congestive heart failure.

Please continue the prescribed antibiotic, completely the
medication as prescribed.

No other changes were made to your medications.

Followup Instructions:
Care connections
{'Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Anemia in chronic kidney disease,Mitral valve disorders,Esophageal reflux,Hip joint replacement,Aortocoronary bypass status'}


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: Dyspnea

PRESENT ILLNESS: Mr. [**Known lastname 109180**] is a [**Age over 90 **] y/o M with PMH of low-grade b-cell
non-hodgkins lymphoma most recently treated in [**2113-8-21**] with
rituxan, and CAD s/p CABG and pacer who was biba from home after
the sudden onset of SOB. Pt states he first noticed the
shortness of breath after he had been walking on his treadmill
for about 4 minutes. He said he had to stop and "didn't feel
right." He tried walking again after a short while and felt the
same. He says onset was relatively sudden, over the course of 45
minutes or so, characterized by tightness, cough, and SOB. No
CP. Pt states he noticed a similar feeling a few days earlier
but it went away. He has had a cough for approx. 1 week which
was also noticed by home home nurse, Pat. It is productive of
mucus "like saliva" but not green or yellow in color. He says he
has felt "congested" during the past week since he began
coughing. No palpitations, F/C/S, or abdominal pain. Says his BM
a little loose today but no other change in bowel movements. EMS
was called and found the patient to be wheezing with a room air
oxygen saturation 89%. He was also tachypneic in the 30s, but
began satting well on NRB. No h/o COPD or pulm disease.

MEDICAL HISTORY: - Non-hodgkins lymphoma: mesenteric, axillary/epitrochlear
recurrence (rituxin/leukeran/prednisone and radiation, rituxin
monotx for recurrence)
- HL
- HTN
- CAD (CABG x5v, pacer x13-15yrs)
- GERD
- Bilat total hip replacment c/b peripheral neuropathies
- anemia (pt states he has long history of anemia that is
"always near borderline")
- renal failure (baseline cr 1.6-1.8)

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] - 40 mg Tablet - 1 Tablet(s) by mouth
daily
FELODIPINE -  (Prescribed by Other Provider) - 10 mg Tablet
Extended Release 24 hr - Tablet(s) by mouth
METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 25 mg
Tablet Extended Release 24 hr - 1 Tablet(s) by mouth daily
OMEPRAZOLE -  (Prescribed by Other Provider) - 20mg
ASPIRIN 325mg po daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: coarse crackles in RLL but otherwise no crackles or
wheezes.  frequent coughing during lung exam
CV: systolic murmur [**3-26**] heard over entire precordium.  irregular
rate with frequent early beats.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN2-12 intact bilat, decreased hearing on right (pt wears
hearing aid bilat but was not wearing aid on right at time of
exam), strength 5/5 in UE and LE bilat

FAMILY HISTORY: - 2 sisters deceased
- Brother died 101
- Unknown cancer history

SOCIAL HISTORY: Married to his wife [**Name (NI) **], 2nd marriage.  Previously worked
in textiles. 2 sons, 1 daughter. [**Name (NI) 4084**] smokes, ocassional EtOH,
no other drug use.  Lives at home and walks with a cane. 

### Response:
{'Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Anemia in chronic kidney disease,Mitral valve disorders,Esophageal reflux,Hip joint replacement,Aortocoronary bypass status'}
