CHIEF COMPLAINT: Cough, shortness of breath

PRESENT ILLNESS: This is a 79-year-old woman with a pmhx. significant for
dementia, type DM2 (on insulin), PVD s/p bilateral amputation,
HTN, DLP, and CAD who is transferred from medical floor to ICU
for hypoxemic respiratory failure.  Ms. [**Known lastname 8738**] was initially
admitted to [**Hospital1 18**] for 3 days of cough, shortness of breath, and
increased work of breathing.  According to nightfloat admission
note (patient unable to give history), patient complained of
non-productive cough, shortness of breath (at rest), and sore
throat for the last few days.  She also has had chest
discomfort, worsened by both inspiration and cough,
non-radiating, as well as discomfort in her upper abdomen,
phantom leg-pain, and reflux.  She's unable to say how long the
chest pain lasted for when it came on.  She had one episode of
watery diarrhea.  She has not been on antibiotics recently and
had had no changes in medications.  Her grandson who she  is
around frequently was sick with a cold a few days ago.  Her son
also thinks that she is more tired than usual.  Her son has not
noticeed a fever.
.
In the ED, VS were: T 96.6, HR 85, BP 130/83, RR 16. She
triggered on arrival w/ O2 sat of 85% on RA, that improved to
high 90s on 2L nc. On exam pt found to have R sided crackles and
wheeze. In the ED BP ranged 160s-200s/70s-100s. Pt received
flagyl, levoquin, and combivent, IVF. ECG w/ sinus tachy 103
bpm, std in v3-v5.  Overnight on the floor, she had low O2 sats
that responded to oxygen.  On the morning of ICU transfer,
patient had HRs in the 140s with ST depressions V4-V6, 2 sets
0.02 from < 0.01.  Patient was going to go for CTA but IV was
infiltrated.  On transfer to the ICU vitals were HR: 100, BP:
139/109, RR 30, SP02: 99% on 100% facemask.

MEDICAL HISTORY: CAD s/p PCI to OM, w/ 3 vessel disease on cath in [**2140**]
Moderate to severe TR
Systolic and Diastolic CHF (EF 45-50%) per echo in [**2140**]
Pulm HTN
Left cataract surgery in [**2135-11-9**]
PVD s/p fem-peroneal, failed graft underwent left BKA
UTI with sepsis ([**2142**]), recurrent UTIs on suppressive
antibiotics
HTN
Hyperlipidemia
DM2
Positive PPD in [**2132**]
Anemia
CVA in [**2115**], s/p L carotid endarterectomy
Diabetic retinopathy, status post laser therapy x2

MEDICATION ON ADMISSION: ATORVASTATIN [[**First Name3 (LF) **]] 20 mg daily
CITALOPRAM 20 mg once a day
CLOPIDOGREL [PLAVIX] 75 mg Tablet daily
IMIPRAMINE HCL 25 mg QHS
INSULIN GLARGINE [LANTUS] 20 units qam
ISOSORBIDE MONONITRATE [IMDUR] 30 mg Tablet Sustained Release
once a day
LACTULOSE 15 CC po daily
METFORMIN 850 mg twice a day
METOPROLOL TARTRATE [LOPRESSOR] 150mg po daily
MIRTAZAPINE [REMERON] 30 mg at bedtime
NITROFURANTOIN (MACROCRYST25%) [MACROBID] 100 mg once a day
ROSIGLITAZONE [AVANDIA] 4 mg once a day
VALSARTAN [DIOVAN] 160 mg Tablet once a
day
ASPIRIN 325 mg once a day
CYANOCOBALAMIN 250 mcg once a day
MAGNESIUM OXIDE 400 mg once a day

ALLERGIES: Penicillins / Zestril

PHYSICAL EXAM: VS: 98.8 155/50 65 26 92/2L
GENERAL: Well-appearing man in NAD, speaking full sentences
HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear.
NECK: Supple, no thyromegaly, no JVD, no carotid bruits.
LUNGS: +Wheeze anteriorly, poor respiratory effort, resp
unlabored.
HEART: Tachy, no MRG, nl S1-S2.
ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding.
EXTREMITIES: Bl amputations
LYMPH: No cervical LAD.
NEURO: Awake, A&Ox2

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Patient lives w/ son. At baseline she is A&Ox2-3 (self/place,
difficulty w/ year). She uses a wheelchair. She needs assistance
w/ transferring to wheelchair and ADLs.  No history of cigarette
use. Denies ETOH/illicits.
Unspecified septicemia,Acute respiratory failure,Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Acute kidney failure, unspecified,Severe sepsis,Atherosclerosis of native arteries of the extremities, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diarrhea,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Long-term (current) use of insulin,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Percutaneous transluminal coronary angioplasty status,Examination of participant in clinical trial,Encounter for palliative care
Septicemia NOS,Acute respiratry failure,Subendo infarct, initial,Chr syst/diastl hrt fail,Acute kidney failure NOS,Severe sepsis,Athscl extrm ntv art NOS,Mental disor NEC oth dis,Hypertension NOS,Crnry athrscl natve vssl,Diarrhea,Chr pulmon heart dis NEC,Hyperlipidemia NEC/NOS,DMII ophth nt st uncntrl,Diabetic retinopathy NOS,Long-term use of insulin,Hx TIA/stroke w/o resid,Status-post ptca,Exam-clincal trial,Encountr palliative care
Admission Date:  [**2146-3-30**]              Discharge Date:   [**2146-4-1**]

Date of Birth:  [**2066-6-7**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Zestril

Attending:[**First Name3 (LF) 2712**]
Chief Complaint:
Cough, shortness of breath

Major Surgical or Invasive Procedure:
Intubation
Mechanical ventilation
Central line placement

History of Present Illness:
This is a 79-year-old woman with a pmhx. significant for
dementia, type DM2 (on insulin), PVD s/p bilateral amputation,
HTN, DLP, and CAD who is transferred from medical floor to ICU
for hypoxemic respiratory failure.  Ms. [**Known lastname 8738**] was initially
admitted to [**Hospital1 18**] for 3 days of cough, shortness of breath, and
increased work of breathing.  According to nightfloat admission
note (patient unable to give history), patient complained of
non-productive cough, shortness of breath (at rest), and sore
throat for the last few days.  She also has had chest
discomfort, worsened by both inspiration and cough,
non-radiating, as well as discomfort in her upper abdomen,
phantom leg-pain, and reflux.  She's unable to say how long the
chest pain lasted for when it came on.  She had one episode of
watery diarrhea.  She has not been on antibiotics recently and
had had no changes in medications.  Her grandson who she  is
around frequently was sick with a cold a few days ago.  Her son
also thinks that she is more tired than usual.  Her son has not
noticeed a fever.
.
In the ED, VS were: T 96.6, HR 85, BP 130/83, RR 16. She
triggered on arrival w/ O2 sat of 85% on RA, that improved to
high 90s on 2L nc. On exam pt found to have R sided crackles and
wheeze. In the ED BP ranged 160s-200s/70s-100s. Pt received
flagyl, levoquin, and combivent, IVF. ECG w/ sinus tachy 103
bpm, std in v3-v5.  Overnight on the floor, she had low O2 sats
that responded to oxygen.  On the morning of ICU transfer,
patient had HRs in the 140s with ST depressions V4-V6, 2 sets
0.02 from < 0.01.  Patient was going to go for CTA but IV was
infiltrated.  On transfer to the ICU vitals were HR: 100, BP:
139/109, RR 30, SP02: 99% on 100% facemask.

Past Medical History:
CAD s/p PCI to OM, w/ 3 vessel disease on cath in [**2140**]
Moderate to severe TR
Systolic and Diastolic CHF (EF 45-50%) per echo in [**2140**]
Pulm HTN
Left cataract surgery in [**2135-11-9**]
PVD s/p fem-peroneal, failed graft underwent left BKA
UTI with sepsis ([**2142**]), recurrent UTIs on suppressive
antibiotics
HTN
Hyperlipidemia
DM2
Positive PPD in [**2132**]
Anemia
CVA in [**2115**], s/p L carotid endarterectomy
Diabetic retinopathy, status post laser therapy x2

Social History:
Patient lives w/ son. At baseline she is A&Ox2-3 (self/place,
difficulty w/ year). She uses a wheelchair. She needs assistance
w/ transferring to wheelchair and ADLs.  No history of cigarette
use. Denies ETOH/illicits.

Family History:
Non-contributory.

Physical Exam:
VS: 98.8 155/50 65 26 92/2L
GENERAL: Well-appearing man in NAD, speaking full sentences
HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear.
NECK: Supple, no thyromegaly, no JVD, no carotid bruits.
LUNGS: +Wheeze anteriorly, poor respiratory effort, resp
unlabored.
HEART: Tachy, no MRG, nl S1-S2.
ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding.
EXTREMITIES: Bl amputations
LYMPH: No cervical LAD.
NEURO: Awake, A&Ox2

Pertinent Results:
Labs on Admission:
[**2146-3-30**] 09:54PM BLOOD WBC-9.7# RBC-3.69* Hgb-11.2* Hct-33.1*
MCV-90 MCH-30.4 MCHC-33.9 RDW-13.4 Plt Ct-244
[**2146-3-30**] 09:54PM BLOOD Neuts-81.4* Lymphs-11.2* Monos-4.3
Eos-2.6 Baso-0.4
[**2146-3-30**] 09:54PM BLOOD Glucose-174* UreaN-13 Creat-0.8 Na-132*
K-3.6 Cl-96 HCO3-26 AnGap-14
[**2146-3-30**] 09:54PM BLOOD cTropnT-<0.01
[**2146-3-30**] 09:54PM BLOOD Lactate-1.4
.
Studies:
[**2146-3-30**] CXR:
IMPRESSION: Markedly limited study. If clinically feasible,
consider PA and lateral views in the radiology suite for more
sensitive evaluation.
.
ECHO [**2146-4-1**]: The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is moderately depressed (LVEF= 35 %) secondary to
inferior posterior hypokinesis. The right ventricular cavity is
dilated with depressed free wall contractility. There are focal
calcifications in the aortic arch. The number of aortic valve
leaflets cannot be determined. The aortic valve leaflets are
moderately thickened. There is a minimally increased gradient
consistent with minimal aortic valve stenosis. The mitral valve
leaflets are mildly thickened. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. There is
moderate pulmonary artery systolic hypertension. There is no
pericardial effusion.
.
CXR [**2146-4-1**]:
FINDINGS: In comparison with the study of [**3-31**], there is little
change in the appearance of the monitoring and support devices.
Enlargement of the cardiac silhouette is again seen with
evidence of pulmonary edema, though the vascular congestion is
less than on the prior study. Again, the possibility of
superimposed pneumonia would be difficult to exclude in the
appropriate clinical setting.

Brief Hospital Course:
This is a 79-year-old woman with a pmhx. of DM II, COPD, HTN,
hyperlipidemia, PVD, and CHF who is admitted with fever and
respiratory distress.
.
# HYPOXEMIC RESPIRATORY FAILRUE:  Patient with an elevated a-a
gradient, respiratory distress, and fever, raising concern for
pneumonia.  Sputum with gram positive cocci.  Ms. [**Known lastname 8738**] was
treated broadly with antibiotics and anti-virals.  However, she
continued to decline clinically, with increased O2 requirement
and eventual need for intubation.  Her blood pressures decreased
as well, and although she was initially volume responsive,
pressors were eventually started to maintain adequate perfusion.
 On [**4-1**], as patient's clinical status continued to worsen,
family decided to withdraw care.  Patient was terminally
extubated and pressors were stopped.  With her family at the
bedside, Ms. [**Known lastname 8738**] passed away peacefully on [**4-1**] at 10:25pm.
Family declined an autopsy.
.
# CHEST PAIN:  Ms. [**Known lastname 8738**] had a bump in troponins upon arrival
in the MICU.  This was felt to be likely from demand ischemia in
the setting of severe respiratory distress however, acute
coronary syndrome could not be ruled out.  Patient was not a
candidate for catherization, and she was started on a heparin
drip.  She was continued on beta-[**Last Name (LF) 7005**], [**First Name3 (LF) **], and statin.

Medications on Admission:
ATORVASTATIN [[**First Name3 (LF) **]] 20 mg daily
CITALOPRAM 20 mg once a day
CLOPIDOGREL [PLAVIX] 75 mg Tablet daily
IMIPRAMINE HCL 25 mg QHS
INSULIN GLARGINE [LANTUS] 20 units qam
ISOSORBIDE MONONITRATE [IMDUR] 30 mg Tablet Sustained Release
once a day
LACTULOSE 15 CC po daily
METFORMIN 850 mg twice a day
METOPROLOL TARTRATE [LOPRESSOR] 150mg po daily
MIRTAZAPINE [REMERON] 30 mg at bedtime
NITROFURANTOIN (MACROCRYST25%) [MACROBID] 100 mg once a day
ROSIGLITAZONE [AVANDIA] 4 mg once a day
VALSARTAN [DIOVAN] 160 mg Tablet once a
day
ASPIRIN 325 mg once a day
CYANOCOBALAMIN 250 mcg once a day
MAGNESIUM OXIDE 400 mg once a day


Discharge Medications:
Patient expired.

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient expired.

Discharge Condition:
Patient expired.

Discharge Instructions:
Patient expired.

Followup Instructions:
Patient expired.
{'Unspecified septicemia,Acute respiratory failure,Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Acute kidney failure, unspecified,Severe sepsis,Atherosclerosis of native arteries of the extremities, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diarrhea,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Long-term (current) use of insulin,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Percutaneous transluminal coronary angioplasty status,Examination of participant in clinical trial,Encounter for palliative care'}


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: Cough, shortness of breath

PRESENT ILLNESS: This is a 79-year-old woman with a pmhx. significant for
dementia, type DM2 (on insulin), PVD s/p bilateral amputation,
HTN, DLP, and CAD who is transferred from medical floor to ICU
for hypoxemic respiratory failure.  Ms. [**Known lastname 8738**] was initially
admitted to [**Hospital1 18**] for 3 days of cough, shortness of breath, and
increased work of breathing.  According to nightfloat admission
note (patient unable to give history), patient complained of
non-productive cough, shortness of breath (at rest), and sore
throat for the last few days.  She also has had chest
discomfort, worsened by both inspiration and cough,
non-radiating, as well as discomfort in her upper abdomen,
phantom leg-pain, and reflux.  She's unable to say how long the
chest pain lasted for when it came on.  She had one episode of
watery diarrhea.  She has not been on antibiotics recently and
had had no changes in medications.  Her grandson who she  is
around frequently was sick with a cold a few days ago.  Her son
also thinks that she is more tired than usual.  Her son has not
noticeed a fever.
.
In the ED, VS were: T 96.6, HR 85, BP 130/83, RR 16. She
triggered on arrival w/ O2 sat of 85% on RA, that improved to
high 90s on 2L nc. On exam pt found to have R sided crackles and
wheeze. In the ED BP ranged 160s-200s/70s-100s. Pt received
flagyl, levoquin, and combivent, IVF. ECG w/ sinus tachy 103
bpm, std in v3-v5.  Overnight on the floor, she had low O2 sats
that responded to oxygen.  On the morning of ICU transfer,
patient had HRs in the 140s with ST depressions V4-V6, 2 sets
0.02 from < 0.01.  Patient was going to go for CTA but IV was
infiltrated.  On transfer to the ICU vitals were HR: 100, BP:
139/109, RR 30, SP02: 99% on 100% facemask.

MEDICAL HISTORY: CAD s/p PCI to OM, w/ 3 vessel disease on cath in [**2140**]
Moderate to severe TR
Systolic and Diastolic CHF (EF 45-50%) per echo in [**2140**]
Pulm HTN
Left cataract surgery in [**2135-11-9**]
PVD s/p fem-peroneal, failed graft underwent left BKA
UTI with sepsis ([**2142**]), recurrent UTIs on suppressive
antibiotics
HTN
Hyperlipidemia
DM2
Positive PPD in [**2132**]
Anemia
CVA in [**2115**], s/p L carotid endarterectomy
Diabetic retinopathy, status post laser therapy x2

MEDICATION ON ADMISSION: ATORVASTATIN [[**First Name3 (LF) **]] 20 mg daily
CITALOPRAM 20 mg once a day
CLOPIDOGREL [PLAVIX] 75 mg Tablet daily
IMIPRAMINE HCL 25 mg QHS
INSULIN GLARGINE [LANTUS] 20 units qam
ISOSORBIDE MONONITRATE [IMDUR] 30 mg Tablet Sustained Release
once a day
LACTULOSE 15 CC po daily
METFORMIN 850 mg twice a day
METOPROLOL TARTRATE [LOPRESSOR] 150mg po daily
MIRTAZAPINE [REMERON] 30 mg at bedtime
NITROFURANTOIN (MACROCRYST25%) [MACROBID] 100 mg once a day
ROSIGLITAZONE [AVANDIA] 4 mg once a day
VALSARTAN [DIOVAN] 160 mg Tablet once a
day
ASPIRIN 325 mg once a day
CYANOCOBALAMIN 250 mcg once a day
MAGNESIUM OXIDE 400 mg once a day

ALLERGIES: Penicillins / Zestril

PHYSICAL EXAM: VS: 98.8 155/50 65 26 92/2L
GENERAL: Well-appearing man in NAD, speaking full sentences
HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear.
NECK: Supple, no thyromegaly, no JVD, no carotid bruits.
LUNGS: +Wheeze anteriorly, poor respiratory effort, resp
unlabored.
HEART: Tachy, no MRG, nl S1-S2.
ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding.
EXTREMITIES: Bl amputations
LYMPH: No cervical LAD.
NEURO: Awake, A&Ox2

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Patient lives w/ son. At baseline she is A&Ox2-3 (self/place,
difficulty w/ year). She uses a wheelchair. She needs assistance
w/ transferring to wheelchair and ADLs.  No history of cigarette
use. Denies ETOH/illicits. 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Acute kidney failure, unspecified,Severe sepsis,Atherosclerosis of native arteries of the extremities, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diarrhea,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Long-term (current) use of insulin,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Percutaneous transluminal coronary angioplasty status,Examination of participant in clinical trial,Encounter for palliative care'}
