CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 84-year-old woman
with coronary artery disease, history of myocardial
infarction, and recent cardiac catheterization, who had been
experiencing increasing shortness of breath at rest.  Patient
woke up the morning of her admission with shortness of
breath.  Denied any chest pains, nausea, vomiting, or
diaphoresis.  Patient states lower extremity edema comes and
goes, and the shortness of breath has occasionally been
associated with cough.  She denies any fever or chills.  She
states that she avoids salts and she has been taking her
medications regularly.

MEDICAL HISTORY: 1. Cardiac catheterization status post inferior myocardial
infarction in [**2135-3-1**].  Cardiac catheterization showed
a 90% stenosis of the RCA, mild disease of the LAD, no
disease of the left circumflex.  Ejection fraction of 51% and
stenting of the right coronary artery.
2. Hypertension.
3. Hypercholesterolemia.
4. Chronic obstructive pulmonary disease.
5. Gastroesophageal reflux disease.
6. Right knee replacement.

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Sulfa.
2. Pravachol.
3. Bactrim.
4. Levaquin.
5. Plavix.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Has remote history of smoking.  Patient has
quit 15 years ago.  She lives alone, but has a daughter.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other complications due to other cardiac device, implant, and graft,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Unspecified essential hypertension
Subendo infarct, initial,CHF NOS,Comp-oth cardiac device,Urin tract infection NOS,Acute kidney failure NOS,Chr airway obstruct NEC,Crnry athrscl natve vssl,Anemia NOS,Hypertension NOS
Admission Date:  [**2135-7-7**]     Discharge Date:  [**2135-7-15**]


Service:




                          [**Doctor First Name 900**] [**Name8 (MD) 901**], M.D.  [**MD Number(1) 2144**]

Dictated By:[**Name8 (MD) 14262**]

MEDQUIST36

D:  [**2135-7-22**]  15:26
T:  [**2135-7-26**]  09:33
JOB#:  [**Job Number 49316**]


Admission Date:  [**2135-7-7**]     Discharge Date:  [**2135-7-15**]


Service:

HISTORY OF PRESENT ILLNESS:  This is an 84-year-old woman
with coronary artery disease, history of myocardial
infarction, and recent cardiac catheterization, who had been
experiencing increasing shortness of breath at rest.  Patient
woke up the morning of her admission with shortness of
breath.  Denied any chest pains, nausea, vomiting, or
diaphoresis.  Patient states lower extremity edema comes and
goes, and the shortness of breath has occasionally been
associated with cough.  She denies any fever or chills.  She
states that she avoids salts and she has been taking her
medications regularly.

Patient prior myocardial infarction in [**2135-3-1**]
presented as "indigestion-type symptoms without chest pain,
nausea, vomiting, or shortness of breath."  At that time, she
was taken to cardiac catheterization and had stented the RCA.
She was given Plavix on discharge, but patient discontinued
Plavix after developing a severe rash within one month's
time.

The patient went to outside hospital, [**Hospital1 **] for shortness of
breath and presented with a blood pressure of 167/87, sating
at 97% on 4 liters.  Her electrocardiogram at the outside
hospital showed normal sinus rhythm with a normal axis,
normal intervals, with flattening of the T waves with leads
III, and aVL, otherwise unremarkable, and CK of 67, and
troponin-I of 0.15.  At the outside hospital, she received
aspirin, sublingual nitroglycerin, ACE inhibitor, and started
on a Heparin drip with 100 mg of Lasix and a nitroglycerin
drip.

She was transferred to [**Hospital1 69**]
for cardiac catheterization.  Her cardiac catheterization was
delayed secondary to an elevated creatinine levels at 1.9.
On arrival to [**Hospital1 **], the patient states that
her shortness of breath had gotten better after
administration of Lasix from the outside hospital.

PAST MEDICAL HISTORY:
1. Cardiac catheterization status post inferior myocardial
infarction in [**2135-3-1**].  Cardiac catheterization showed
a 90% stenosis of the RCA, mild disease of the LAD, no
disease of the left circumflex.  Ejection fraction of 51% and
stenting of the right coronary artery.
2. Hypertension.
3. Hypercholesterolemia.
4. Chronic obstructive pulmonary disease.
5. Gastroesophageal reflux disease.
6. Right knee replacement.

ALLERGIES:
1. Sulfa.
2. Pravachol.
3. Bactrim.
4. Levaquin.
5. Plavix.

SOCIAL HISTORY:  Has remote history of smoking.  Patient has
quit 15 years ago.  She lives alone, but has a daughter.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION:  Pulse is 77, blood pressure 176/87,
respiratory rate 16, oxygen saturation 98% on 4 liters.
General examination:  In no acute distress.  Pleasant woman
lying comfortably in bed.  HEENT:  The patient has elevated
jugular venous distention to the angle of the jaw.  Lung
examination:  The patient has crackles on both bases of lung
fields.  Cardiovascular examination:  The patient exhibits
regular, rate, and rhythm, no murmurs, rubs, or gallops are
appreciated.  Abdominal examination:  Nontender and
nondistended with positive bowel sounds.  Extremities:  No
cyanosis evident.  The patient has +1 nonpitting edema of
both legs.

LABORATORIES FROM OUTSIDE HOSPITAL:  White count of 14.8,
hematocrit at 33.8, creatinine 1.9, CK of 67, troponin-I of
0.15, INR of 0.98.

CHEST X-RAY:  Right pleural effusion consistent with
congestive heart failure.

Last cardiac catheterization in [**2135-3-31**] showed an
ejection fraction of nearly 51%.

HOSPITAL COURSE:  Patient was taken to the cardiac floor and
enzymes were followed.  Patient ruled in for a myocardial
infarction for peak troponins of 0.77.  Patient was placed on
a nitroglycerin drip, Heparin drip, ACE inhibitor, statin,
aspirin, and a beta blocker.  Patient was also diuresed using
Lasix while on the floor.

Patient received an echocardiogram, which showed inferior
hypokinesis and anterior akinesis.  Echocardiogram also
showed a decreased ejection fraction of 30-35%.  Patient was
subsequently taken to cardiac catheterization, which
confirmed an ejection fraction of 35%.  Left main coronary
artery showed no disease, left anterior descending showed 50%
disease, a high diagonal ......... to LAD showed a 60-70%
stenosis, left circumflex showed no disease, right coronary
artery showed 80% irregular ulcerated in-stent restenosis.  A
new in-stent stent was placed with 0% residual narrowing.
Cardiac catheterization showed a right dominant system.  The
patient was subsequently placed on Integrilin drip, Ticlid.

Patient's blood pressure was monitored and blood pressure
medications were titrated up as her blood pressure was
uncontrolled.  Postprocedure, the patient's hematocrit
dropped from 33.8 to 29.4.  Subsequently, the patient
received 1 unit of packed red blood cells with 20 mg of IV
Lasix.

Subsequently, the patient complained of increasing shortness
of breath.  Patient's oxygen saturation dropped to the low
90s on 2 liters of oxygen.  Patient also became tachypneic
with a respiratory rate into the 40s.  Use of accessory
muscles was also noted.

Patient was transferred to the Coronary Care Unit.  Chest
x-ray was performed, which showed lung examination consistent
with congestive heart failure and pulmonary edema.  Patient
was started on a Natrecor diuresis on arrival to the CCU.
The patient's hematocrit was now stabilized to the mid 30s.
Patient was on Heparin drip for prophylaxis of thrombus
formation secondary to anterior akinesis visualized on
echocardiogram.

In CCU the patient was started on Augmentin for presumed
urinary tract infection secondary to leukocytosis of 17.
Patient's creatinine levels continued to be elevated at 1.9.
Patient was stabilized on the Cardiac Care Unit, and
transferred back to the cardiac floor, at which point her
oxygen saturations were in the mid 90s on room air.
Creatinine continued to be elevated into 2.2, at which point
patient's ACE inhibitor was discontinued and creatinine
levels were monitored.  Also while on the floor, the patient
was followed by the Advance Congestive Heart Failure Service.
The patient was continued on Natrecor and Lasix combination
for diuresis.

While on the floor, the patient was monitored.  The highest
elevation of her creatinine was 2.8.  She was continued on
gentle diuresis until her discharge.  Patient developed a
leukocytosis at 12.5.  Patient had completed her course of
Augmentin.  Urine cultures were sent and urinalysis suggested
a urinary tract infection.  The patient was getting
empirically treated with Augmentin for presumed urinary tract
infection.

Patient was discharged home with a hematocrit of 30.1 and
creatinine of 2.1.  She left with no shortness of breath and
no chest pain.

CONDITION ON DISCHARGE:  Good.  No chest pain, no shortness
of breath.

DISCHARGE STATUS:  Patient was discharged home with home VNA
services to draw blood work to maintain therapeutic INR.

DISCHARGE DIAGNOSES:
1. Non-ST-elevation myocardial infarction.
2. Congestive heart failure with an ejection fraction of 30%.
3. Urinary tract infection.
4. Anemia with a hematocrit into the low 30s.

DISCHARGE MEDICATIONS:
1. Nitroglycerin sublingual prn.
2. Ranitidine 150 mg po bid.
3. Aspirin 325 mg po q day.
4. Ticlopidine 250 mg po bid for 12 months.
5. Atorvastatin 20 mg po q day.
6. Atenolol 75 mg po q day.
7. Folic acid 1 mg po q day.
8. Imdur 30 mg po q day.
9. Augmentin 500-125 mg tablets po q day for three days
postdischarge.
10. Coumadin 3 mg po q day.

FOLLOWUP:  The patient was asked to followup with her
cardiologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10543**] and her primary care physician.
[**Name10 (NameIs) **] was encouraged to not stop her Ticlid under any
circumstances.  She was encouraged to see her primary care
physician regarding her creatinine levels, her INR, and
restarting ACE inhibitor as an outpatient.  She is also a
possible candidate for Epogen as she has a chronic anemia.
She was also encouraged to see her primary care physician
regarding [**Name Initial (PRE) **] granulocytosis secondary to Ticlid side-effects.



                          [**Doctor First Name 900**] [**Name8 (MD) 901**], M.D.  [**MD Number(1) 2144**]

Dictated By:[**Name8 (MD) 14262**]

MEDQUIST36

D:  [**2135-7-22**]  16:01
T:  [**2135-7-26**]  11:18
JOB#:  [**Job Number 49317**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other complications due to other cardiac device, implant, and graft,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Unspecified essential hypertension'}


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 an 84-year-old woman
with coronary artery disease, history of myocardial
infarction, and recent cardiac catheterization, who had been
experiencing increasing shortness of breath at rest.  Patient
woke up the morning of her admission with shortness of
breath.  Denied any chest pains, nausea, vomiting, or
diaphoresis.  Patient states lower extremity edema comes and
goes, and the shortness of breath has occasionally been
associated with cough.  She denies any fever or chills.  She
states that she avoids salts and she has been taking her
medications regularly.

MEDICAL HISTORY: 1. Cardiac catheterization status post inferior myocardial
infarction in [**2135-3-1**].  Cardiac catheterization showed
a 90% stenosis of the RCA, mild disease of the LAD, no
disease of the left circumflex.  Ejection fraction of 51% and
stenting of the right coronary artery.
2. Hypertension.
3. Hypercholesterolemia.
4. Chronic obstructive pulmonary disease.
5. Gastroesophageal reflux disease.
6. Right knee replacement.

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Sulfa.
2. Pravachol.
3. Bactrim.
4. Levaquin.
5. Plavix.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Has remote history of smoking.  Patient has
quit 15 years ago.  She lives alone, but has a daughter. 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other complications due to other cardiac device, implant, and graft,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Unspecified essential hypertension'}
