CHIEF COMPLAINT: Lethargy, fall

PRESENT ILLNESS: This is an 80 year-old man/woman with the history below who
presents after a fall at homoe last night: per wife, he slid off
of bed onto bottom, mechanical fall, did not hit head, no LOC.
Had not been feeling well the day prior, "weak", slept all day.
Had a cough at night.  Denies fevers, chills, nausea, vomiting,
dysuria.  Came to the ED, found to be hypoxic (room air sat 92%)
and febrile to 102.9.  CXR negative, but given cough and fever,
pt. given  one gram of ctx. then 500 mg levofloxacin emperically
for pneumonia.  Cardiac enzymes were negative for the first set,
UA negative.  Hemodynamically stable.  Creatinine was very
slightly elevated above baseline, was given IV hydration (2
litres NS) and admitted.  Blood and urine cultures are pending.

MEDICAL HISTORY: Hx of presyncope
.
- Conduction system disease: right bundle branch block, left
anterior fascicular block, borderline PR interval
.
- [**Company 1543**] Virtuoso dual chambered ICD: [**Company 1543**] 6949 Fidelis
lead
which is the subject of a recently released FDA recall.  For
this
reason his numbers of detection in the VF zone were lengthened
([**2159-11-20**])and the alarms for his impedance measurements were
narrowed.  He remains programmed in DDD mode with a lower rate
of 70, and to treat rates greater than 188 beats per minute
.
- severe cardiomyopathy with LVEF of 35%, LVH,
moderate mitral regurgitation, status post cardiac arrest in
[**Month (only) 956**], chronic atrial fibrillation, status post ICD
placement,
multiple cardioversions with other conduction abnormalities, one
vessel coronary artery disease, bare metal stent placed
.
-initially diagnosed with rectal cancer T3 N0, stage IIA, in
03/[**2157**].  He received neoadjuvant 5-FU and radiation and then
underwent [**Month (only) **] surgery in 09/[**2157**].  On that surgery, he was found
to have no positive lymph nodes.  He received 4 cycles of 5-FU
and
leucovorin adjuvantly
.
BPH
Incidental R liver cyst
- stable since [**4-19**]
Diverticulosis
Basal cell CA of the nose
- removed [**2157-2-15**]
CVA [**2150**]
- resulting in dysesthesias R hand
- imaging consistent with lacunar hypodensity c/w lacunar
infarct, L cerebellar hypodensity c/w chronic infarct
Cervical spondylosis
Hypertension
varicose veins
Sleep apnea on CPAP

MEDICATION ON ADMISSION: aspirin 325 mg daily, Plavix 75 mg
daily, Lasix 20 mg daily, lisinopril 5 mg daily, Toprol-XL 25 mg
daily, Flomax 0.4 mg at bedtime, and warfarin 2 mg.

ALLERGIES: Penicillins / Erythromycin Base / Streptomycin / Citric Acid /
Atenolol

PHYSICAL EXAM: T Max (past 24 hours): 102.9 Temp: 98  BP:110/66   HR: 90  RR:
18
Oxygen Saturation  98 3L (on room air)
General Appearance: pale, comfortable, NAD
.
Ophthalmologic/Eyes: : PERLLA, EOMI, mild conjuctival injection,
anicteric
.
Otolaryngologic (ENT): no sinus tenderness, dry mucous
membranes, oropharynx without exudate or lesions, no
supraclavicular or cervical lymphadenopathy, no thyromegaly or
thyroid nodules
.
Cardiovascular: Irregular rate and rhythm, fixed split S2, no
murmurs, rubs, or gallops appreciated.  No carotid bruits.  JVD
flat (less than 6 cm)
.
Respiratory: CTA b/l with good air movement throughout - no
rales or wheezes
.
Gastrointestinal/abdomen: nd, +b/s, soft, nt, no masses or
hepatosplenomegaly
.
Genitourinary: foley draining dark colored (amber) urine
.
Musculoskeletal: no cyanosis, clubbing or edema
.
Integumentary: skin dry, no rashes, no jaundice
.
Neurological: Alert.  Oriented to self, time, place, situation.
CN II-XII intact.  Moving all four extremities.
.
Psychiatric:pleasant, appropriate affect.
.
Heme/Lymph: no cervical or supraclavicular lymphadenopathy

FAMILY HISTORY: Father died MI in 80s, Mother died PE in 80s, twin sister died
of colitis age 30s, no family h/o colon, breast, uterine, or
ovarian ca

SOCIAL HISTORY: lives in [**Location 745**] with wife [**Name (NI) **], one son, one daughter, 6
grandchildren, retired computer science professor, former heavy
cigar smoker, quit in [**2150**], [**2-17**] drinks per week
Viral pneumonia, unspecified,Acute on chronic systolic heart failure,Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Alkalosis,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified forms of chronic ischemic heart disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Automatic implantable cardiac defibrillator in situ,Chronic kidney disease, Stage III (moderate)
Viral pneumonia NOS,Ac on chr syst hrt fail,Subendo infarct, initial,Parox ventric tachycard,Acute kidney failure NOS,Alkalosis,Hx-rectal & anal malign,BPH w/o urinary obs/LUTS,Chr ischemic hrt dis NEC,Hy kid NOS w cr kid I-IV,Status autm crd dfbrltr,Chr kidney dis stage III
Admission Date:  [**2159-12-20**]              Discharge Date:   [**2159-12-26**]

Date of Birth:  [**2079-1-17**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Erythromycin Base / Streptomycin / Citric Acid /
Atenolol

Attending:[**First Name3 (LF) 1674**]
Chief Complaint:
Lethargy, fall

Major Surgical or Invasive Procedure:
none


History of Present Illness:
This is an 80 year-old man/woman with the history below who
presents after a fall at homoe last night: per wife, he slid off
of bed onto bottom, mechanical fall, did not hit head, no LOC.
Had not been feeling well the day prior, "weak", slept all day.
Had a cough at night.  Denies fevers, chills, nausea, vomiting,
dysuria.  Came to the ED, found to be hypoxic (room air sat 92%)
and febrile to 102.9.  CXR negative, but given cough and fever,
pt. given  one gram of ctx. then 500 mg levofloxacin emperically
for pneumonia.  Cardiac enzymes were negative for the first set,
UA negative.  Hemodynamically stable.  Creatinine was very
slightly elevated above baseline, was given IV hydration (2
litres NS) and admitted.  Blood and urine cultures are pending.


Past Medical History:
Hx of presyncope
.
- Conduction system disease: right bundle branch block, left
anterior fascicular block, borderline PR interval
.
- [**Company 1543**] Virtuoso dual chambered ICD: [**Company 1543**] 6949 Fidelis
lead
which is the subject of a recently released FDA recall.  For
this
reason his numbers of detection in the VF zone were lengthened
([**2159-11-20**])and the alarms for his impedance measurements were
narrowed.  He remains programmed in DDD mode with a lower rate
of 70, and to treat rates greater than 188 beats per minute
.
- severe cardiomyopathy with LVEF of 35%, LVH,
moderate mitral regurgitation, status post cardiac arrest in
[**Month (only) 956**], chronic atrial fibrillation, status post ICD
placement,
multiple cardioversions with other conduction abnormalities, one
vessel coronary artery disease, bare metal stent placed
.
-initially diagnosed with rectal cancer T3 N0, stage IIA, in
03/[**2157**].  He received neoadjuvant 5-FU and radiation and then
underwent [**Month (only) **] surgery in 09/[**2157**].  On that surgery, he was found
to have no positive lymph nodes.  He received 4 cycles of 5-FU
and
leucovorin adjuvantly
.
BPH
Incidental R liver cyst
- stable since [**4-19**]
Diverticulosis
Basal cell CA of the nose
- removed [**2157-2-15**]
CVA [**2150**]
- resulting in dysesthesias R hand
- imaging consistent with lacunar hypodensity c/w lacunar
infarct, L cerebellar hypodensity c/w chronic infarct
Cervical spondylosis
Hypertension
varicose veins
Sleep apnea on CPAP


Social History:
lives in [**Location 745**] with wife [**Name (NI) **], one son, one daughter, 6
grandchildren, retired computer science professor, former heavy
cigar smoker, quit in [**2150**], [**2-17**] drinks per week


Family History:
Father died MI in 80s, Mother died PE in 80s, twin sister died
of colitis age 30s, no family h/o colon, breast, uterine, or
ovarian ca

Physical Exam:
T Max (past 24 hours): 102.9 Temp: 98  BP:110/66   HR: 90  RR:
18
Oxygen Saturation  98 3L (on room air)
General Appearance: pale, comfortable, NAD
.
Ophthalmologic/Eyes: : PERLLA, EOMI, mild conjuctival injection,
anicteric
.
Otolaryngologic (ENT): no sinus tenderness, dry mucous
membranes, oropharynx without exudate or lesions, no
supraclavicular or cervical lymphadenopathy, no thyromegaly or
thyroid nodules
.
Cardiovascular: Irregular rate and rhythm, fixed split S2, no
murmurs, rubs, or gallops appreciated.  No carotid bruits.  JVD
flat (less than 6 cm)
.
Respiratory: CTA b/l with good air movement throughout - no
rales or wheezes
.
Gastrointestinal/abdomen: nd, +b/s, soft, nt, no masses or
hepatosplenomegaly
.
Genitourinary: foley draining dark colored (amber) urine
.
Musculoskeletal: no cyanosis, clubbing or edema
.
Integumentary: skin dry, no rashes, no jaundice
.
Neurological: Alert.  Oriented to self, time, place, situation.
CN II-XII intact.  Moving all four extremities.
.
Psychiatric:pleasant, appropriate affect.
.
Heme/Lymph: no cervical or supraclavicular lymphadenopathy


Pertinent Results:
[**2159-12-20**] 12:50AM URINE  RBC-0 WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0
[**2159-12-20**] 12:50AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-1 PH-5.0 LEUK-NEG
[**2159-12-20**] 12:50AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.012
[**2159-12-20**] 12:50AM   PT-19.8* PTT-31.3 INR(PT)-1.9*
[**2159-12-20**] 12:50AM   PLT COUNT-116*
[**2159-12-20**] 12:50AM   NEUTS-70.3* LYMPHS-19.7 MONOS-8.7 EOS-0.4
BASOS-0.9
[**2159-12-20**] 12:50AM   WBC-2.7* RBC-4.14* HGB-12.3* HCT-36.7* MCV-89
MCH-29.8 MCHC-33.6 RDW-15.3
[**2159-12-20**] 12:50AM   CK-MB-3
[**2159-12-20**] 12:50AM   cTropnT-0.02*
[**2159-12-20**] 12:50AM   CK(CPK)-288*
[**2159-12-20**] 12:50AM   estGFR-Using this
[**2159-12-20**] 12:50AM   UREA N-30* CREAT-1.8* SODIUM-132*
POTASSIUM-4.2 CHLORIDE-95* TOTAL CO2-22 ANION GAP-19
[**2159-12-20**] 01:22AM   LACTATE-3.1*
[**2159-12-20**] 04:01AM   LACTATE-1.1
[**2159-12-20**] 09:15AM   PT-19.8* PTT-34.9 INR(PT)-1.8*
[**2159-12-20**] 09:15AM   PLT SMR-LOW PLT COUNT-99*
[**2159-12-20**] 09:15AM   WBC-6.0# RBC-4.15* HGB-12.2* HCT-37.9* MCV-91
MCH-29.3 MCHC-32.1 RDW-14.7
[**2159-12-20**] 09:15AM   CALCIUM-8.1* PHOSPHATE-3.3 MAGNESIUM-1.9
[**2159-12-20**] 09:15AM   CK-MB-7 cTropnT-0.03*
[**2159-12-20**] 09:15AM   ALT(SGPT)-27 AST(SGOT)-48* LD(LDH)-356*
CK(CPK)-356* ALK PHOS-61 TOT BILI-2.4*
[**2159-12-20**] 09:15AM   GLUCOSE-157* UREA N-28* CREAT-1.6* SODIUM-135
POTASSIUM-3.5 CHLORIDE-99 TOTAL CO2-22 ANION GAP-18
[**2159-12-20**] 04:00PM   PT-23.0* PTT-32.2 INR(PT)-2.2*
[**2159-12-20**] 04:00PM   PLT COUNT-89*
[**2159-12-20**] 04:00PM   WBC-4.0 RBC-3.77* HGB-11.1* HCT-34.4* MCV-91
MCH-29.4 MCHC-32.2 RDW-14.6
[**2159-12-20**] 04:00PM   CALCIUM-8.0* PHOSPHATE-3.5 MAGNESIUM-3.5*
[**2159-12-20**] 04:00PM   CK-MB-12* MB INDX-3.4 cTropnT-0.19*
[**2159-12-20**] 04:00PM   ALT(SGPT)-28 AST(SGOT)-52* LD(LDH)-341*
CK(CPK)-357* ALK PHOS-49 TOT BILI-1.6*
[**2159-12-20**] 04:00PM   GLUCOSE-166* UREA N-28* CREAT-1.6*
SODIUM-132* POTASSIUM-4.1 CHLORIDE-99 TOTAL CO2-24 ANION GAP-13
[**2159-12-20**] 07:44PM URINE  MUCOUS-MOD
[**2159-12-20**] 07:44PM URINE  HYALINE-[**3-19**]*
[**2159-12-20**] 07:44PM URINE  RBC-[**6-24**]* WBC-[**3-19**] BACTERIA-FEW
YEAST-NONE EPI-0
[**2159-12-20**] 07:44PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-1 PH-5.0 LEUK-NEG
[**2159-12-20**] 07:44PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.020

Brief Hospital Course:
80 year-old man with a history of severe cardiomyopathy with
LVEF 30% with hx. cardiac arrest, DDD pacer, ICD, and stent to
Cx. artery, chronic afib on anticoagulation, presenting with one
day history of lethargy, cough, and s/p mechanical fall without
trauma, found to be febrile and hypoxic in the emergency
department, concerning for early pneumonia.
.
1) Fever and hypoxia - history most consistent with a viral
pneumonia.  No definiative lobar, bacterial process.  Continued
levofloxacin emperically with improvement.
.
2) Leukopenia and thrombocytopenia (relative): Resolved.
.
3) Malaise, somnolence, anorexia - all likely due to infection,
viral vs. bacterial pneumonia.  Monitor, encourage PO intake.
.
4) Chronic Systolic Heart Failure due to CAD with hx. cardiac
arrest and mult conduction system abnormalities s/p pacer and
ICD: Ruled out MI.  Cont. ASA, Plavix.
.
5) Chronic Kidney Disease, stage III: C r at baseline, slight
elevation, but NOT acute renal failure (not up by 25%).
.
6) Dehydration, mild.  Hold lasix as above for now, gentle IVF
until taking adequate PO.
.
7) Atrial Fibrillation - rate controlled.  Continue toprol,
warfarin.
.
8) Sleep apnea on CPAP - asked wife to bring machine from home -
she will today.
.


Medications on Admission:
aspirin 325 mg daily, Plavix 75 mg
daily, Lasix 20 mg daily, lisinopril 5 mg daily, Toprol-XL 25 mg
daily, Flomax 0.4 mg at bedtime, and warfarin 2 mg.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
CHF exacerbation
Atrial fibrillation
viral syndrome


Discharge Condition:
stable


Discharge Instructions:
Weigh yourself every morning.  If your weight ever increases by
more than 2 pounds in one day, please call your doctor.

Be sure to take Lasix 20 mg per day.

Be sure to complete all of your antibiotics.

Followup Instructions:
Please be sure to follow up with nurse [**Doctor Last Name **] of cardiology
-Provider: [**First Name8 (NamePattern2) 1903**] [**Last Name (NamePattern1) 1904**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 3512**]
Date/Time:[**2160-1-23**] 11:30
Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2160-1-23**]
3:00

Call the infectious disease clinic for an appointment within the
next month:
([**Telephone/Fax (1) 6732**]


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1677**]

Completed by:[**2160-1-16**]
{'Viral pneumonia, unspecified,Acute on chronic systolic heart failure,Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Alkalosis,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified forms of chronic ischemic heart disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Automatic implantable cardiac defibrillator in situ,Chronic kidney disease, Stage III (moderate)'}


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: Lethargy, fall

PRESENT ILLNESS: This is an 80 year-old man/woman with the history below who
presents after a fall at homoe last night: per wife, he slid off
of bed onto bottom, mechanical fall, did not hit head, no LOC.
Had not been feeling well the day prior, "weak", slept all day.
Had a cough at night.  Denies fevers, chills, nausea, vomiting,
dysuria.  Came to the ED, found to be hypoxic (room air sat 92%)
and febrile to 102.9.  CXR negative, but given cough and fever,
pt. given  one gram of ctx. then 500 mg levofloxacin emperically
for pneumonia.  Cardiac enzymes were negative for the first set,
UA negative.  Hemodynamically stable.  Creatinine was very
slightly elevated above baseline, was given IV hydration (2
litres NS) and admitted.  Blood and urine cultures are pending.

MEDICAL HISTORY: Hx of presyncope
.
- Conduction system disease: right bundle branch block, left
anterior fascicular block, borderline PR interval
.
- [**Company 1543**] Virtuoso dual chambered ICD: [**Company 1543**] 6949 Fidelis
lead
which is the subject of a recently released FDA recall.  For
this
reason his numbers of detection in the VF zone were lengthened
([**2159-11-20**])and the alarms for his impedance measurements were
narrowed.  He remains programmed in DDD mode with a lower rate
of 70, and to treat rates greater than 188 beats per minute
.
- severe cardiomyopathy with LVEF of 35%, LVH,
moderate mitral regurgitation, status post cardiac arrest in
[**Month (only) 956**], chronic atrial fibrillation, status post ICD
placement,
multiple cardioversions with other conduction abnormalities, one
vessel coronary artery disease, bare metal stent placed
.
-initially diagnosed with rectal cancer T3 N0, stage IIA, in
03/[**2157**].  He received neoadjuvant 5-FU and radiation and then
underwent [**Month (only) **] surgery in 09/[**2157**].  On that surgery, he was found
to have no positive lymph nodes.  He received 4 cycles of 5-FU
and
leucovorin adjuvantly
.
BPH
Incidental R liver cyst
- stable since [**4-19**]
Diverticulosis
Basal cell CA of the nose
- removed [**2157-2-15**]
CVA [**2150**]
- resulting in dysesthesias R hand
- imaging consistent with lacunar hypodensity c/w lacunar
infarct, L cerebellar hypodensity c/w chronic infarct
Cervical spondylosis
Hypertension
varicose veins
Sleep apnea on CPAP

MEDICATION ON ADMISSION: aspirin 325 mg daily, Plavix 75 mg
daily, Lasix 20 mg daily, lisinopril 5 mg daily, Toprol-XL 25 mg
daily, Flomax 0.4 mg at bedtime, and warfarin 2 mg.

ALLERGIES: Penicillins / Erythromycin Base / Streptomycin / Citric Acid /
Atenolol

PHYSICAL EXAM: T Max (past 24 hours): 102.9 Temp: 98  BP:110/66   HR: 90  RR:
18
Oxygen Saturation  98 3L (on room air)
General Appearance: pale, comfortable, NAD
.
Ophthalmologic/Eyes: : PERLLA, EOMI, mild conjuctival injection,
anicteric
.
Otolaryngologic (ENT): no sinus tenderness, dry mucous
membranes, oropharynx without exudate or lesions, no
supraclavicular or cervical lymphadenopathy, no thyromegaly or
thyroid nodules
.
Cardiovascular: Irregular rate and rhythm, fixed split S2, no
murmurs, rubs, or gallops appreciated.  No carotid bruits.  JVD
flat (less than 6 cm)
.
Respiratory: CTA b/l with good air movement throughout - no
rales or wheezes
.
Gastrointestinal/abdomen: nd, +b/s, soft, nt, no masses or
hepatosplenomegaly
.
Genitourinary: foley draining dark colored (amber) urine
.
Musculoskeletal: no cyanosis, clubbing or edema
.
Integumentary: skin dry, no rashes, no jaundice
.
Neurological: Alert.  Oriented to self, time, place, situation.
CN II-XII intact.  Moving all four extremities.
.
Psychiatric:pleasant, appropriate affect.
.
Heme/Lymph: no cervical or supraclavicular lymphadenopathy

FAMILY HISTORY: Father died MI in 80s, Mother died PE in 80s, twin sister died
of colitis age 30s, no family h/o colon, breast, uterine, or
ovarian ca

SOCIAL HISTORY: lives in [**Location 745**] with wife [**Name (NI) **], one son, one daughter, 6
grandchildren, retired computer science professor, former heavy
cigar smoker, quit in [**2150**], [**2-17**] drinks per week 

### Response:
{'Viral pneumonia, unspecified,Acute on chronic systolic heart failure,Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Alkalosis,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified forms of chronic ischemic heart disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Automatic implantable cardiac defibrillator in situ,Chronic kidney disease, Stage III (moderate)'}
