CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 65-year-old female
with a history of coronary artery disease, status post recent
admit for acute myocardial infarction complicated by
cardiogenic shock, acute renal failure and underwent
catheterization with a stent to the left circumflex artery.
Patient was discharged to rehabilitation over this month and
then to home last week.  She was doing well at her baseline
apparently.  Since then, on the day of admission, in the
morning, she had an acute episode of shortness of breath and
chest pressure.  The patient states that she apparently felt
normal last night with no recent fevers, chills.  Patient
does complain of a history of a dry cough without any sputum
productive.  Patient says she felt similarly during her
episode of acute myocardial infarction so she subsequently
called EMS.  On arrival, EMS noted that patient to be
tachypneic but had a stable oxygen saturation of 98% on a
questionable amount of supplemental 02.  The patient was,
however, still intubated in the field and brought to [**Hospital6 1760**] for further management.  The
patient was also given 100 mg of intravenous Lasix without
further improvement in her oxygenation and her shortness of
breath.

MEDICAL HISTORY: 1.  Coronary artery disease, status post myocardial
infarction in [**2111-6-19**], status post catheterization in
[**2111-5-19**] which showed 90% right coronary artery, 40% left
anterior descending and 100% mid left circumflex stenosis
which was stented and an ejection fraction of 40%.
2.  Chronic obstructive pulmonary disease with no documented
pulmonary function test on record.
3.  Acute renal failure during recent hospitalization.
4.  HIV.  Last recorded CD4 230 in [**2111-4-19**] with an
undetectable viral load.
5.  Factor VIII deficiency.
6.  Hypertension.
7.  Diabetes mellitus for 25 years.
8.  Congestive heart failure secondary to cardiogenic shock.
Ejection fraction of 40% and severe mitral regurgitation.

MEDICATION ON ADMISSION: AZT 200 mg po b.i.d., T3C 150 mg
po b.i.d., Nevirapine 200 mg b.i.d., Lasix 40 mg po q.d.,
Captopril 25 mg po b.i.d., glyburide 5 mg po b.i.d.,
albuterol and Atrovent MDI inhalers, Flovent 110 mcg 2 puffs
b.i.d., Colace 100 mg po b.i.d., Lipitor 80 mg po q.d.,
multivitamin 1 tablet po q.d., timoptic, Bactrim DS 1 tablet
po q.d., Reglan 10 mg po b.i.d., Prilosec 20 mg po q.d.,
aspirin 325 mg po q.d., Plavix 75 mg po q.d., Toprol XL 150
mg po q.d., Imdur 30 mg po q.d., Tums 500 mg po b.i.d.,
Procrit 4000 units subcutaneous biweekly.

ALLERGIES: To Motrin, the patient says that it causes
bleeding.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other pulmonary insufficiency, not elsewhere classified,Acidosis,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Old myocardial infarction
Other pulmonary insuff,Acidosis,CHF NOS,DMII wo cmp nt st uncntr,Asymp hiv infectn status,Chr airway obstruct NEC,Crnry athrscl natve vssl,Hypertension NOS,Old myocardial infarct
Admission Date:  [**2111-7-13**]     Discharge Date:  [**2111-7-17**]

Date of Birth:   [**2046-6-27**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  This is a 65-year-old female
with a history of coronary artery disease, status post recent
admit for acute myocardial infarction complicated by
cardiogenic shock, acute renal failure and underwent
catheterization with a stent to the left circumflex artery.
Patient was discharged to rehabilitation over this month and
then to home last week.  She was doing well at her baseline
apparently.  Since then, on the day of admission, in the
morning, she had an acute episode of shortness of breath and
chest pressure.  The patient states that she apparently felt
normal last night with no recent fevers, chills.  Patient
does complain of a history of a dry cough without any sputum
productive.  Patient says she felt similarly during her
episode of acute myocardial infarction so she subsequently
called EMS.  On arrival, EMS noted that patient to be
tachypneic but had a stable oxygen saturation of 98% on a
questionable amount of supplemental 02.  The patient was,
however, still intubated in the field and brought to [**Hospital6 1760**] for further management.  The
patient was also given 100 mg of intravenous Lasix without
further improvement in her oxygenation and her shortness of
breath.

In the Emergency Department, the patient had stable
hemodynamics and oxygenation.  Arterial blood gases showed pH
7.17, pCO2 of 42, pO2 of 535.  The patient was admitted to
the Medical Intensive Care Unit for further management of her
acidosis.

ALLERGIES:  To Motrin, the patient says that it causes
bleeding.

MEDICATIONS ON ADMISSION:  AZT 200 mg po b.i.d., T3C 150 mg
po b.i.d., Nevirapine 200 mg b.i.d., Lasix 40 mg po q.d.,
Captopril 25 mg po b.i.d., glyburide 5 mg po b.i.d.,
albuterol and Atrovent MDI inhalers, Flovent 110 mcg 2 puffs
b.i.d., Colace 100 mg po b.i.d., Lipitor 80 mg po q.d.,
multivitamin 1 tablet po q.d., timoptic, Bactrim DS 1 tablet
po q.d., Reglan 10 mg po b.i.d., Prilosec 20 mg po q.d.,
aspirin 325 mg po q.d., Plavix 75 mg po q.d., Toprol XL 150
mg po q.d., Imdur 30 mg po q.d., Tums 500 mg po b.i.d.,
Procrit 4000 units subcutaneous biweekly.

PAST MEDICAL HISTORY:
1.  Coronary artery disease, status post myocardial
infarction in [**2111-6-19**], status post catheterization in
[**2111-5-19**] which showed 90% right coronary artery, 40% left
anterior descending and 100% mid left circumflex stenosis
which was stented and an ejection fraction of 40%.
2.  Chronic obstructive pulmonary disease with no documented
pulmonary function test on record.
3.  Acute renal failure during recent hospitalization.
4.  HIV.  Last recorded CD4 230 in [**2111-4-19**] with an
undetectable viral load.
5.  Factor VIII deficiency.
6.  Hypertension.
7.  Diabetes mellitus for 25 years.
8.  Congestive heart failure secondary to cardiogenic shock.
Ejection fraction of 40% and severe mitral regurgitation.

PHYSICAL EXAM ON ADMISSION:  Patient had a pulse of 100.
Blood pressure 160/90.  Respiratory rate of 30.  02
saturation 99% on 100% FIO2.  In general, patient was
intubated but awake, comfortable appearing.  Head, eyes,
ears, nose and throat:  Pupils equal, round and reactive to
light.  Sclera were anicteric.  Neck:  Mildly increased
jugular venous distention, no lymphadenopathy.  Heart was
regular rate and rhythm, 2/6 systolic ejection murmur heard
at the left upper sternal border with radiation to the apex.
Lungs were clear to auscultation bilaterally, no rales or
wheezes were appreciated.  Abdomen was soft, nontender,
nondistended, normal active bowel sounds.  Extremities showed
no peripheral edema.  Electrocardiogram showed sinus
tachycardia, normal axis and intervals, unchanged from a
previous electrocardiogram.

After the patient's onset of myocardial infarction, chest
x-ray showed endotracheal tube in good position, mild
vascular redistribution likely with curly B lines, however,
there was no evidence of failure and no infiltrates on chest
x-ray.

LABORATORY VALUES:  Arterial blood gases:  pH 7.17, pCO2 42,
pO2 535.  PT 13.5, PTT 24.3, INR 1.2.  White blood cell count
7.0, 78% neutrophils, 0 bands, 60% lymphocytes, 4% monocytes.
Hematocrit 36.8, platelets 206,000.  Sodium 143, potassium
6.3, chloride 113, bicarbonate 14, BUN 68, creatinine 3.3,
blood sugar 183, CK of 7211, MB fraction of 17, troponin of
0.6.  Urinalysis showed large blood, 100 protein, 4 red blood
cells, 0 white blood cells.

HOSPITAL COURSE:  By system:

1.  Renal:  It was felt that the patient had an acidosis of
mild anion gap, as well as nongap variety.  The most likely
cause was renal in origin given the patient's increased BUN
and creatinine, as well as possibly impaired ability to
generate bicarbonate.  Given the fact that the patient was
also on antiretrovirals and had been shown to be a culprit at
times for this acidosis, they were held for part of the
[**Hospital 228**] hospital course until the lactate level which came
back and was normal.  Subsequently, patient's antiretrovirals
were re-continued.  The patient's acidosis continued to
improve while the patient was on the ventilator.  On day two
of admission, the patient self extubated and maintained good
02 saturations with nonrebreather as well as nasal cannula.
The patient's acute on chronic renal failure continued to
resolve with intravenous fluids.  Patient's BUN and
creatinine on discharge were 75 and 2.8 and the patient's pH
on discharge was 7.32.

2.  Pulmonary:  There was no defect in oxygenation.  The
patient was only intubated for help in management of the
acidosis.  The patient subsequently self-extubated on day two
of admission and had stable 02 saturations with minimal
supplemental oxygen.

3.  Cardiovascular:  Given the fact that the patient had a
similar presentation for her acute myocardial infarction and
was known to have a 90% right coronary artery lesion which
was not intervened on, the patient was initially started on
heparin and intravenous nitroglycerin and continued on her
aspirin beta-blocker ACE.  The patient's Lipitor was held
because of her elevated CK with a negative MB fraction.  The
patient was ruled out for myocardial infarction by enzymes
and the intravenous heparin and nitroglycerin were
subsequently discontinued.  The patient remained
hemodynamically stable throughout the hospital course and the
patient's Lipitor was held and subsequently the CKs were
trending down.  CK on discharge was 4,131, again, with a
negative MB fraction.  The patient was instructed to have
outpatient follow-up for further management of her lipids and
to see if another antihyperlipidemic medication could be
chosen.

4.  Infectious Disease:  Initially the patient's
antiretroviral medications were initially held, however,
after lactate levels came back negative, they were restarted.
Patient remained afebrile throughout the hospital course.
Patient's white blood cell count remained stable.  Patient
was continued on her antiretroviral medications, as well as
her prophylactic medications during her hospital course.

PATIENT'S CONDITION AT DISCHARGE:  Stable.

DISCHARGE STATUS:  To home with services.

DISCHARGE MEDICATIONS:
1.  Bactrim DS 1 tablet po q.d.
2.  Prilosec 20 mg po q.d.
3.  Enteric coated aspirin 325 mg po q.d.
4.  Flovent 110 mcg 2 puffs b.i.d.
5.  Tums 500 mg po b.i.d.
6.  Epogen 4000 units subcutaneous every Monday, Wednesday
and Friday.
7.  Multivitamin 1 tablet po q.d.
8.  Timoptic 0.25% eye drops, one drop to each eye b.i.d.
9.  Retrovir 200 mg po b.i.d.
10. Lamivudine 100 mg po q.d.
11. Viramune 200 mg po b.i.d.
12. Plavix 75 mg po q.d. until [**7-18**].
13. Glyburide 2.5 mg po b.i.d. before breakfast and before
dinner.
14. Lopressor 50 mg po b.i.d.
15. Hydralazine 25 mg po t.i.d.
16. Albuterol inhaler 2 puffs q.i.d.
17. Atrovent 2 puffs MDI q.i.d.

DISCHARGE DIAGNOSES:
1.  HIV positive.
2.  Hypertension.
3.  Chronic obstructive pulmonary disease.
4.  Diabetes type 2.
5.  Chronic bronchitis.
6.  Factor VIII deficiency.
7.  Spinal stenosis at L4-L5.
8.  Chronic renal failure.
9.  Coronary artery disease.
10. Congestive heart failure.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2667**], M.D.  [**MD Number(1) 2668**]

Dictated By:[**Name8 (MD) 9784**]

MEDQUIST36

D:  [**2112-1-29**]  10:14
T:  [**2112-1-29**]  10:14
JOB#:  [**Job Number 98280**]
{'Other pulmonary insufficiency, not elsewhere classified,Acidosis,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Old myocardial infarction'}


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: 

PRESENT ILLNESS: This is a 65-year-old female
with a history of coronary artery disease, status post recent
admit for acute myocardial infarction complicated by
cardiogenic shock, acute renal failure and underwent
catheterization with a stent to the left circumflex artery.
Patient was discharged to rehabilitation over this month and
then to home last week.  She was doing well at her baseline
apparently.  Since then, on the day of admission, in the
morning, she had an acute episode of shortness of breath and
chest pressure.  The patient states that she apparently felt
normal last night with no recent fevers, chills.  Patient
does complain of a history of a dry cough without any sputum
productive.  Patient says she felt similarly during her
episode of acute myocardial infarction so she subsequently
called EMS.  On arrival, EMS noted that patient to be
tachypneic but had a stable oxygen saturation of 98% on a
questionable amount of supplemental 02.  The patient was,
however, still intubated in the field and brought to [**Hospital6 1760**] for further management.  The
patient was also given 100 mg of intravenous Lasix without
further improvement in her oxygenation and her shortness of
breath.

MEDICAL HISTORY: 1.  Coronary artery disease, status post myocardial
infarction in [**2111-6-19**], status post catheterization in
[**2111-5-19**] which showed 90% right coronary artery, 40% left
anterior descending and 100% mid left circumflex stenosis
which was stented and an ejection fraction of 40%.
2.  Chronic obstructive pulmonary disease with no documented
pulmonary function test on record.
3.  Acute renal failure during recent hospitalization.
4.  HIV.  Last recorded CD4 230 in [**2111-4-19**] with an
undetectable viral load.
5.  Factor VIII deficiency.
6.  Hypertension.
7.  Diabetes mellitus for 25 years.
8.  Congestive heart failure secondary to cardiogenic shock.
Ejection fraction of 40% and severe mitral regurgitation.

MEDICATION ON ADMISSION: AZT 200 mg po b.i.d., T3C 150 mg
po b.i.d., Nevirapine 200 mg b.i.d., Lasix 40 mg po q.d.,
Captopril 25 mg po b.i.d., glyburide 5 mg po b.i.d.,
albuterol and Atrovent MDI inhalers, Flovent 110 mcg 2 puffs
b.i.d., Colace 100 mg po b.i.d., Lipitor 80 mg po q.d.,
multivitamin 1 tablet po q.d., timoptic, Bactrim DS 1 tablet
po q.d., Reglan 10 mg po b.i.d., Prilosec 20 mg po q.d.,
aspirin 325 mg po q.d., Plavix 75 mg po q.d., Toprol XL 150
mg po q.d., Imdur 30 mg po q.d., Tums 500 mg po b.i.d.,
Procrit 4000 units subcutaneous biweekly.

ALLERGIES: To Motrin, the patient says that it causes
bleeding.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other pulmonary insufficiency, not elsewhere classified,Acidosis,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Old myocardial infarction'}
