CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname 107322**] is an 89 year old Russian speaking female with a PMH
significant for atrial fibrillation, CRI, Type II DM and recent
pneumonia [**10-25**] who presents with respiratory distress starting
this [**Last Name (un) 44550**].  At her nursing home, the patient was noted to be
mildly short of breath yesterday with wheezes by report and was
started on 2 liters nasal cannula.  This morning she became
tachypneic with an 02 sat in the upper 80's on 2 liters NC and
improved to 95% on NRB.  She was brought to the [**Hospital1 18**] ED for
further management and given nebulizers in route.  Per report,
the patient complained of transient chest pain as well.

MEDICAL HISTORY: recent pneumonia (right sided with pleural effusion)
COPD? but no smoking hx!
type II DM
CRI (1.2-1.5 bl)
paroxysmal afib (no longer on anticoagulation)
hx thyroid nodule
hx pulmonary nodules
gout
angina

MEDICATION ON ADMISSION: coumadin d/c'ed [**2172-1-22**] (was on 0.5 mg QD), imdur, [**Month/Day/Year **],
allopurinol, toprol, remeron, MVI, senna/colace, norvasc,
prilosec, megace, metoprolol 100mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T = 99.2;  HR = 80; BP = 170/70
HEENT: dry MM
NECK: eleved JVD
CV: RRR
RESP: decreased BS at right base, bibasilar rales
ABD: NABS, soft, NT, ND
EXT: 1+ pedal edema, non-pitting LE

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Nursing Home resident, lives a [**Hospital3 2558**].
Contact is son [**Name (NI) 4186**] ([**Telephone/Fax (1) 107323**] and ([**Telephone/Fax (1) 107324**] (h)
Congestive heart failure, unspecified,Acute respiratory failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other and unspecified angina pectoris,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Other specified disorders resulting from impaired renal function,Coronary atherosclerosis of native coronary artery,Anemia, unspecified
CHF NOS,Acute respiratry failure,Atrial fibrillation,Chr airway obstruct NEC,Angina pectoris NEC/NOS,React-indwell urin cath,Urin tract infection NOS,Acute kidney failure NOS,DMII wo cmp nt st uncntr,Gout NOS,Impair ren funct dis NEC,Crnry athrscl natve vssl,Anemia NOS
Admission Date:  [**2172-2-28**]              Discharge Date:   [**2172-3-4**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2181**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Ms. [**Known lastname 107322**] is an 89 year old Russian speaking female with a PMH
significant for atrial fibrillation, CRI, Type II DM and recent
pneumonia [**10-25**] who presents with respiratory distress starting
this [**Last Name (un) 44550**].  At her nursing home, the patient was noted to be
mildly short of breath yesterday with wheezes by report and was
started on 2 liters nasal cannula.  This morning she became
tachypneic with an 02 sat in the upper 80's on 2 liters NC and
improved to 95% on NRB.  She was brought to the [**Hospital1 18**] ED for
further management and given nebulizers in route.  Per report,
the patient complained of transient chest pain as well.

In the ED, she got nebs, solumedrol, vanc/ceftriaxone/flagyl and
was placed on BiPAP.  A nitroglycerin drip and lasix was given
after her BNP came back at 40,000 and the chest x-ray showed an
large right effusion and findings consistent with CHF.  An EKG
was done which showed T wave inversions in the anteroseptal
leads. The patient was able to come off BiPAP after diuresis.
The patient gives a history of worsening SOB at night with
associated palpitations over the past few weeks.  She denies
fever, however, has had an occasional non-productive cough.  She
denied CP in ED but was confused per her son's assessment.

Past Medical History:
recent pneumonia (right sided with pleural effusion)
COPD? but no smoking hx!
type II DM
CRI (1.2-1.5 bl)
paroxysmal afib (no longer on anticoagulation)
hx thyroid nodule
hx pulmonary nodules
gout
angina


Social History:
Nursing Home resident, lives a [**Hospital3 2558**].
Contact is son [**Name (NI) 4186**] ([**Telephone/Fax (1) 107323**] and ([**Telephone/Fax (1) 107324**] (h)

Family History:
Non-contributory

Physical Exam:
VS: T = 99.2;  HR = 80; BP = 170/70
HEENT: dry MM
NECK: eleved JVD
CV: RRR
RESP: decreased BS at right base, bibasilar rales
ABD: NABS, soft, NT, ND
EXT: 1+ pedal edema, non-pitting LE


Pertinent Results:
Labs on Admission:

WBC-9.9 RBC-3.37* HGB-9.6* HCT-30.4* MCV-90 MCH-28.5 MCHC-31.7
RDW-19.7*
NEUTS-63.9 LYMPHS-30.9 MONOS-2.9 EOS-1.9 BASOS-0.4 PLT COUNT-299

GLUCOSE-115* UREA N-36* CREAT-1.5* SODIUM-143 POTASSIUM-5.7*
CHLORIDE-119* TOTAL CO2-13* ANION GAP-17 CALCIUM-9.2
PHOSPHATE-4.3 MAGNESIUM-2.1

proBNP-[**Numeric Identifier 107325**]*

CK(CPK)-28  CK-MB-NotDone  cTropnT-0.07*

PT-12.1 PTT-24.1 INR(PT)-0.9

ALT(SGPT)-18 AST(SGOT)-23 LD(LDH)-233 ALK PHOS-133* AMYLASE-127*
TOT BILI-0.3

URINE  RBC-[**1-25**]* WBC->50 BACTERIA-MOD YEAST-NONE EPI-3-5
BLOOD-SM NITRITE-POS PROTEIN-500 GLUCOSE-NEG KETONE-NEG
BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD

LACTATE-1.1

CHEST (PORTABLE AP)  [**2172-2-28**]
1) Moderate right pleural effusion; small left pleural effusion.
Bibasilar atelectasis.
2) Mild cardiac failure.

Echo [**2172-3-3**]:
1. The left atrium is mildly dilated. The interatrial septum is
aneurysmal.
2. The left ventricular cavity size is normal. There is moderate
global left ventricular hypokinesis. Overall left ventricular
systolic function is moderately depressed.
3. The aortic valve leaflets (3) are mildly thickened. Trace
aortic
regurgitation is seen.
4. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral
regurgitation is seen.
5. There is mild pulmonary artery systolic hypertension.

Brief Hospital Course:
89 year old Russian speaking female with a PMH significant for
atrial fibrillation, CRI, Type II DM and recent pneumonia [**10-25**]
who presents with respiratory distress.

In the ED she received nebs, Solu-Medrol,
vanc/ceftriaxone/Flagyl, nitroglycerin drip, Lasix, and was
placed on BiPAP. An EKG was done which showed T wave inversions
in the anteroseptal leads. The patient was able to come off
BiPAP after diuresis.

In the MICU the Nitro gtt was stopped and her Imdur and
Amlodipine were titrated up. She was diuresed 2.5 liters.
Ceftriaxone/Flagyl were d/c'ed, Vanco was continued for MRSA in
her urine. Her HCT dropped from 30 to 24 on [**2-29**] and she was
transfused one Unit of PRBC's. She was also noted to have an non
anion gap acidosis thought to be consistent with an RTA.

1) CHF exacerbation thought to be etiology of respiratory
distress. Her respiratory status was stable with prn diuresis (~
20 mg of po Lasix daily). She remained with O2 sats in the low
90%'s on RA. An echo revealed moderate global LV hypokinesis
with an EF of 30-35%. Her goal is even to 500 cc negative. On
day of discharge she appeared euvolemic. She was discharged on
10 mg of po Lasix. It was not increased further secondary to an
increase in her Cr from baseline (up to 1.7 on day of
discharge). She was started on Captopril which was converted to
5 mg of Lisinopril at discharge. Her Cr and K will be checked in
2 days and followed-up by Dr. [**First Name (STitle) 4223**] at [**Hospital3 2558**].

2) CAD. Pt was found to have new T wave inversions and mildly
elevated troponin (likely secondary to CRI) which remained flat.
She was ruled out for MI with 3 sets of cardiac enzymes. As [**Name6 (MD) **]
the RN at [**Hospital3 2558**] she has a h/o angina requiring PRN SL
NTG. She was continued on [**Last Name (LF) **], [**First Name3 (LF) **], and Metop 100 mg [**Hospital1 **].
Her BP was well controlled on Imdur and amlodipine as well.

3) CRI: (baseline Cr of 1.2-1.5). Cr slightly elevated above
baseline thought to be secondary to addition of ACEI and Lasix.
She had good UO.

4) ANEMIA: HCT drop from 30 (baseline) to 24 on [**2-29**]. Appropriate
increase with one unit of PRBC's. Guaiac negative. Anemia may be
secondary to CRI. B12, folate, Fe studies WNL. HCT remained
stable throughout her stay.

5) UTI. Pt with chronic Foley at nursing home. Urine culture
initially grew MRSA, however it was thought that her urine was
colonized given chronic Foley. She was given 4 days of Vanco
d/c'ed on [**3-2**] (initial UA with >50 WBC's). Repeat UA negative.
She was discharged with a Foley catheter.

6) TYPE II DM: Pt is diet controlled at nursing home. She was
continued on a RISS while hospitalized.

7) NON-ANION GAP MET ACIDOSIS - resolved. Urinary anion gap c/w
RTA. As per renal recs no further management.

8) FEN: She was given a soft solid diet with thin liquids, all
her meds were crushed.

9) CODE: Full, confirmed with son

10) COMM: son - [**Name (NI) **]; MD [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] - [**Location (un) 4223**] (pager
[**Telephone/Fax (1) 107326**]); PCP-[**Name Initial (NameIs) 9449**]

11) dispo: She returned to [**Hospital3 2558**]. She will need to have
her fluid status monitored and diuretics given PRN.

Medications on Admission:
coumadin d/c'ed [**2172-1-22**] (was on 0.5 mg QD), imdur, [**Month/Day/Year **],
allopurinol, toprol, remeron, MVI, senna/colace, norvasc,
prilosec, megace, metoprolol 100mg [**Hospital1 **]


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Allopurinol 300 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
6. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
8. Quinine Sulfate 260 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
9. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
10. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).

11. Megestrol Acetate 40 mg/mL Suspension Sig: Ten (10) ml PO
BID (2 times a day).
12. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
13. Lasix 20 mg Tablet Sig: [**11-24**] Tablet PO once a day: Dose may
be adjusted based on O2 sats, daily weights, and Creatinine. .


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Congestive Heart Failure


Discharge Condition:
Fair

Discharge Instructions:
Please call your primary care physician if you experience
worsening shortness of breath, chest pain, or have any other
concerns.

Please check daily weights, if you gain >2 lbs in one day you
will need to increase your diuretis. Please consult Dr.
[**First Name (STitle) 4223**].

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 9449**] if you leave [**Hospital3 2558**].
[**Telephone/Fax (1) 3530**]
{'Congestive heart failure, unspecified,Acute respiratory failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other and unspecified angina pectoris,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Other specified disorders resulting from impaired renal function,Coronary atherosclerosis of native coronary artery,Anemia, unspecified'}


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: Shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname 107322**] is an 89 year old Russian speaking female with a PMH
significant for atrial fibrillation, CRI, Type II DM and recent
pneumonia [**10-25**] who presents with respiratory distress starting
this [**Last Name (un) 44550**].  At her nursing home, the patient was noted to be
mildly short of breath yesterday with wheezes by report and was
started on 2 liters nasal cannula.  This morning she became
tachypneic with an 02 sat in the upper 80's on 2 liters NC and
improved to 95% on NRB.  She was brought to the [**Hospital1 18**] ED for
further management and given nebulizers in route.  Per report,
the patient complained of transient chest pain as well.

MEDICAL HISTORY: recent pneumonia (right sided with pleural effusion)
COPD? but no smoking hx!
type II DM
CRI (1.2-1.5 bl)
paroxysmal afib (no longer on anticoagulation)
hx thyroid nodule
hx pulmonary nodules
gout
angina

MEDICATION ON ADMISSION: coumadin d/c'ed [**2172-1-22**] (was on 0.5 mg QD), imdur, [**Month/Day/Year **],
allopurinol, toprol, remeron, MVI, senna/colace, norvasc,
prilosec, megace, metoprolol 100mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T = 99.2;  HR = 80; BP = 170/70
HEENT: dry MM
NECK: eleved JVD
CV: RRR
RESP: decreased BS at right base, bibasilar rales
ABD: NABS, soft, NT, ND
EXT: 1+ pedal edema, non-pitting LE

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Nursing Home resident, lives a [**Hospital3 2558**].
Contact is son [**Name (NI) 4186**] ([**Telephone/Fax (1) 107323**] and ([**Telephone/Fax (1) 107324**] (h) 

### Response:
{'Congestive heart failure, unspecified,Acute respiratory failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other and unspecified angina pectoris,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Other specified disorders resulting from impaired renal function,Coronary atherosclerosis of native coronary artery,Anemia, unspecified'}
