CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 53-year-old
female with a history coronary artery disease, congestive
heart failure, end-stage renal disease from type 1 diabetes,
status post cadaveric renal transplant in [**2178**], on
hemodialysis after the graft failed.  She was transferred
from the Medical Intensive Care Unit.

MEDICAL HISTORY: 1.  Three vessel coronary artery disease.
 2.  Hypertension.
 3.  Low thyroid.
 4.  History of myocardial infarction; negative Holter
monitoring in [**2188-11-17**].
 5.  Diabetes with triopathy.
 6.  End-stage renal disease.
 7.  Status post cadaveric renal transplant in [**2178**].
 8.  A progressive graft failure was noted, and a renal
biopsy was performed on [**2189-4-22**].
 9.  Status post tonsillectomy.
10.  Status post appendectomy.
11.  Cerebrovascular accident; on hemodialysis, in [**2186**].

MEDICATION ON ADMISSION: Medications on arrival included
levofloxacin 250 mg intravenously q.d., Zantac, Imuran,
Synthroid, diltiazem, Lopressor, nitroglycerin paste,
amiodarone, Zocor, and folate.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history revealed two sisters with
diabetes; otherwise noncontributory.

SOCIAL HISTORY: The patient lives with her husband.  [**Name (NI) **] use
of tobacco or alcohol.
Ventricular fibrillation,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Background diabetic retinopathy,Unspecified acquired hypothyroidism
Ventricular fibrillation,CHF NOS,Pneumonia, organism NOS,Ac kidny fail, tubr necr,DMI ophth nt st uncntrld,Compl kidney transplant,Hyp kid NOS w cr kid V,Diabetic retinopathy NOS,Hypothyroidism NOS
Admission Date:  [**2189-8-8**]     Discharge Date:  [**2189-8-14**]

Date of Birth:   [**2135-12-20**]     Sex:  F

Service:  C-MED Blue

ADMISSION DIAGNOSES:
1.  Coronary artery disease.
2.  Congestive heart failure.
3.  Diabetes mellitus.
4.  Hypertension.
5.  Status post ventricular tachycardia arrest.

HISTORY OF PRESENT ILLNESS:  The patient is a 53-year-old
female with a history coronary artery disease, congestive
heart failure, end-stage renal disease from type 1 diabetes,
status post cadaveric renal transplant in [**2178**], on
hemodialysis after the graft failed.  She was transferred
from the Medical Intensive Care Unit.

The patient was admitted to [**Hospital1 188**] on [**8-8**] following a hospitalization from [**8-3**] to
[**8-7**] at [**Hospital3 26615**] Hospital for a left lobe pneumonia
with treatment resulting in a history of supraventricular
tachycardia, ventricular tachycardia, and ventricular
fibrillation, history of a troponin of 14.

Ms. [**Known lastname **] presented [**Hospital3 26615**] on [**8-3**] with nausea,
vomiting, and flu-like symptoms.  She was found to have left
lower lobe pneumonia.  Per report, it was to rule out a right
upper lobe density versus mass and acute renal failure with a
creatinine of 4.8, as well as a fever of 101.9.

At [**Hospital3 26615**], the patient was treated with ceftriaxone and
levofloxacin, and she ruled out.  Per report, the patient had
an episode of nonsustained ventricular tachycardia on the
[**8-5**] which degenerated to sustained supraventricular
tachycardia and then ventricular tachycardia and ventricular
fibrillation.  She was defibrillated at 200 joules.  The
patient was not intubated.  She was conscious throughout this
episode, and she received cardiopulmonary resuscitation.

The patient was given amiodarone intravenously times 24 hours
and then switched to oral when she had a second episode of
supraventricular tachycardia.  The patient received diltiazem
20 mg intravenously and then a nitroglycerin drip as well.
Electrocardiogram at this time showed Q waves in the inferior
leads, and there was a question of new onset versus a prior
myocardial infarction.

A transthoracic echocardiogram at the outside hospital showed
a septal hypertrophy and an ejection fraction of 30% to 35%,
akinesis, and trace aortic regurgitation, and 1+ mitral
regurgitation.

The patient was flighted to [**Hospital1 188**] to the Medical Intensive Care Unit.  In the Medical
Intensive Care Unit, she was noted to be in stable condition
with no arrhythmias.  Her last hemodialysis was on [**8-8**].
Her diltiazem and ceftriaxone were discontinued.  The Renal
and Cardiology teams were consulted.

Throughout this period, the patient reported no chest pain
and no palpitations.  She has baseline exertional dyspnea,
one-pillow orthopnea.  No paroxysmal nocturnal dyspnea, and
no edema.

PAST MEDICAL HISTORY:
 1.  Three vessel coronary artery disease.
 2.  Hypertension.
 3.  Low thyroid.
 4.  History of myocardial infarction; negative Holter
monitoring in [**2188-11-17**].
 5.  Diabetes with triopathy.
 6.  End-stage renal disease.
 7.  Status post cadaveric renal transplant in [**2178**].
 8.  A progressive graft failure was noted, and a renal
biopsy was performed on [**2189-4-22**].
 9.  Status post tonsillectomy.
10.  Status post appendectomy.
11.  Cerebrovascular accident; on hemodialysis, in [**2186**].

MEDICATIONS ON ADMISSION:  Medications on arrival included
levofloxacin 250 mg intravenously q.d., Zantac, Imuran,
Synthroid, diltiazem, Lopressor, nitroglycerin paste,
amiodarone, Zocor, and folate.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient lives with her husband.  [**Name (NI) **] use
of tobacco or alcohol.

CODE STATUS:  Code status is full.

FAMILY HISTORY:  Family history revealed two sisters with
diabetes; otherwise noncontributory.

PHYSICAL EXAMINATION ON PRESENTATION:   On physical
examination vital signs revealed temperature was 96.8, blood
pressure was 136/52, respiratory rate was 18.  She was
saturating 96% on 3 liters.  Head, eyes, ears, nose, and
throat revealed alert and oriented times three.  The patient
was comfortable.  No evidence of jugular venous distention.
Cardiovascular examination revealed a regular rate and
rhythm.  Normal first heart sound and second heart sound.  No
murmurs, rubs or gallops.  Chest revealed rales noted in the
left greater than the right.  The abdomen revealed positive
bowel sounds, soft and nontender.  Evidence of the renal
graft in the right lower quadrant.  No tenderness.  No
bruits.  Extremities revealed evidence of 2+ edema in all
extremities.  A left upper extremity arteriovenous fistula
with a good thrill and good bruit.

PERTINENT LABORATORY DATA ON PRESENTATION:  Laboratories on
[**8-9**] revealed the patient's hematocrit was 32.8, blood
urea nitrogen was 65, with a creatinine of 3.8, glucose
was 322.  Creatine kinase was 55, troponin was 1.6.  AST
was 31, ALT was 64, alkaline phosphatase was 370, total
bilirubin was 1.3, calcium was 8.5, phosphorous was 3.6,
magnesium was 2.

RADIOLOGY/IMAGING:   A chest x-ray on [**8-8**] showed normal
heart size, no definite congestive heart failure.  A "more or
less rounded density" in the right upper lobe with bilateral
small pleural effusions and associated bilateral atelectasis
and consolidation in the left lower lobe.  Impression was
multilobar pneumonia with pleural effusions.

Per report, a transthoracic echocardiogram showed septal
hypertrophy, an ejection fraction of 30% to 35%,
anteroposterior akinesis, trace aortic regurgitation, 1+
mitral regurgitation, bilateral effusions.

A kidney biopsy from [**4-22**] showed no evidence of cellular
rejection, prominent hyaline change in arterials.

Electrocardiogram from [**8-9**] showed sinus rhythm, a regular
rate and rhythm, positive axis, evidence of Q wave in
inferior leads which were also seen on [**8-3**].  Nonspecific
ST changes in V1; question LAA, plus a incomplete left
bundle-branch block.

HOSPITAL COURSE:

1.  CARDIOVASCULAR:  The patient had known 3-vessel
nonrevascularized disease.  The patient did not want a
catheterization.

Given her history of arrhythmia, an implantable
cardioverter-defibrillator placement was considered
necessary.  An implantable cardioverter-defibrillator was
placed on [**8-12**].  A chest x-ray from [**2189-8-13**] showed
that an implantable cardioverter-defibrillator device had
been placed with dual-chamber bipolar leads.  There was
resolution of the congestive heart failure and marked
diminution in the bilateral effusions.  There was slight
bibasilar atelectasis, but no consolidations.

An echocardiogram was performed on [**8-10**].  The
echocardiogram showed mild symmetric left ventricular
hypertrophy, with focal systolic dysfunction; consistent with
coronary artery disease, mild aortic regurgitation, mild
mitral regurgitation, and pulmonary artery systolic
hypertension.

2.  PULMONARY:  The patient was maintained on levofloxacin
for her left-sided pneumonia.  The patient's x-ray from
[**8-13**] demonstrated resolution of the congestive heart
failure and pneumonia.

The patient was placed on hemodialysis in the hospital.  Her
blood urea nitrogen, and creatinine, and electrolytes
subsequently improved.  Her laboratories on [**8-13**] were
notable for a blood urea nitrogen of 46, a creatinine of 4.2,
and a sodium of 136, potassium was 4.3.  It was felt that the
patient would need outpatient hemodialysis treatments.  The
patient was placed on cyclosporin 50 mg p.o. b.i.d.

3.  INFECTIOUS DISEASE:  With an Infectious Disease
consultation, it was felt that she should have a course of
levofloxacin 250 mg every other day for two weeks for the
history of pneumonia.

4.  GASTROINTESTINAL:  Of note, the patient had an elevated
alkaline phosphatase level.  This was evaluated with a GGT
which was also elevated at 149.  We suggest these measures be
evaluated as an outpatient given the patient's lack of
abdominal findings and symptomatology.

5.  REHABILITATION:  The patient was seen by Physical Therapy
in house.  They felt it safe for her to be discharged to
home.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE STATUS:  Discharge status was to home with [**Hospital6 3429**] services.

DISCHARGE DIAGNOSES:
1.  End-stage renal disease.
2.  Diabetes.
3.  Coronary artery disease.
4.  Congestive heart failure.
5.  Pneumonia.
6.  Acute renal failure.
7.  Ventricular tachycardia.
8.  Ventricular fibrillation.


MEDICATIONS ON DISCHARGE:
 1.  Ferrous sulfate 325 mg p.o. b.i.d.
 2.  Isosorbide dinitrate 20 mg p.o. t.i.d.
 3.  Simvastatin 10 mg p.o. q.d.
 4.  Metoprolol 100 mg p.o. t.i.d.
 5.  Azathioprine 50 mg p.o. q.d.
 6.  Levothyroxine 112 mcg p.o. q.d.
 7.  Ranitidine 150 mg p.o. q.d.
 8.  Folic acid 1 mg p.o. q.d.
 9.  Tocopherol p.o. q.d.
10.  Amiodarone HCl 200 mg p.o. b.i.d.
11.  Aspirin 325 mg p.o. q.d.
12.  Levofloxacin 250 mg p.o. every other day (for 14 days).
13.  Cyclosporin 50 mg p.o. q.12h.

DISCHARGE INSTRUCTIONS:  As an outpatient, the patient was to
have dialysis at [**Hospital1 69**] the
following Monday and was to start at [**Location (un) 8641**] for dialysis.

DISCHARGE FOLLOWUP:   The patient was asked to follow up with
her primary care physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 68100**] (at telephone
number [**Telephone/Fax (1) 101930**]) and with her cardiologist.  She will
also need a follow-up appointment with the Transplant Center
with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] and in the Cardiology Service with
Dr. [**Last Name (STitle) 101931**].

FINAL DISCHARGE DIAGNOSES:
1.  Ventricular fibrillation arrest.
2.  Pneumonia.
3.  End-stage renal disease, dialysis.
4.  Status post implantable cardioverter-defibrillator
placement.





                          [**First Name11 (Name Pattern1) 420**] [**Last Name (NamePattern4) 421**], M.D.  [**MD Number(1) 422**]

Dictated By:[**Last Name (NamePattern1) 201**]

MEDQUIST36

D:  [**2189-9-8**]  15:27
T:  [**2189-9-12**]  07:57
JOB#:  [**Job Number **]

cc:[**Last Name (NamePattern4) 101932**]
{'Ventricular fibrillation,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Background diabetic retinopathy,Unspecified acquired hypothyroidism'}


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: The patient is a 53-year-old
female with a history coronary artery disease, congestive
heart failure, end-stage renal disease from type 1 diabetes,
status post cadaveric renal transplant in [**2178**], on
hemodialysis after the graft failed.  She was transferred
from the Medical Intensive Care Unit.

MEDICAL HISTORY: 1.  Three vessel coronary artery disease.
 2.  Hypertension.
 3.  Low thyroid.
 4.  History of myocardial infarction; negative Holter
monitoring in [**2188-11-17**].
 5.  Diabetes with triopathy.
 6.  End-stage renal disease.
 7.  Status post cadaveric renal transplant in [**2178**].
 8.  A progressive graft failure was noted, and a renal
biopsy was performed on [**2189-4-22**].
 9.  Status post tonsillectomy.
10.  Status post appendectomy.
11.  Cerebrovascular accident; on hemodialysis, in [**2186**].

MEDICATION ON ADMISSION: Medications on arrival included
levofloxacin 250 mg intravenously q.d., Zantac, Imuran,
Synthroid, diltiazem, Lopressor, nitroglycerin paste,
amiodarone, Zocor, and folate.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history revealed two sisters with
diabetes; otherwise noncontributory.

SOCIAL HISTORY: The patient lives with her husband.  [**Name (NI) **] use
of tobacco or alcohol. 

### Response:
{'Ventricular fibrillation,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Complications of transplanted kidney,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Background diabetic retinopathy,Unspecified acquired hypothyroidism'}
