CHIEF COMPLAINT: Shortness of breath
Dizziness
Lethargy
Hypotension

PRESENT ILLNESS: 79 yo male with CHF (EF 35%), ESRD on HD presents with
complaints of dizziness and general malaise starting in the AM.
Denies fevers,chills, SOB, cough, rhinorrhea, dysuria, or
diarrhea. In ambulance to hospital,pt was hypotensive with SBP
in 80's. Taken to OSH and transferred here for further care.

MEDICAL HISTORY: Chronic Afib
CHF with EF 35-40%, RV dysfunction
s/p AoVR '[**84**] secondary to rheumatic heart disease
DMII, HbA1C 6.3 in [**1-21**]
H/O UGIB secondary to gastritis/AVM
ESRD on HD
CD s/p MI s/p CABG
Gout
[**Last Name (un) 309**] Body Dementia
H/0 hypotension

MEDICATION ON ADMISSION: Pantoprazole
Sevelamer
Digoxin
Donepezil
Allopurinol
[**Last Name (un) **]/Ipratrop
Epo
Coumadin

ALLERGIES: Haldol / Neurontin / Vancomycin

PHYSICAL EXAM: 100.6   84/56-->89/44  99-100  21  100% on 3L
CVP  22-30

FAMILY HISTORY: no cardiac disease

SOCIAL HISTORY: lives with wife
[**Name (NI) 3106**] veteran on disability x 18 years
Distant 5 yr history of tobacco use
occ ETOH use
Septicemia due to anaerobes,Sepsis,Septic shock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Atrial fibrillation,Heart valve replaced by other means,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Abnormal coagulation profile,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Anaerobic septicemia,Sepsis,Septic shock,Hyp kid NOS w cr kid V,CHF NOS,Atrial fibrillation,Heart valve replac NEC,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Abnrml coagultion prfile,Dementia w Lewy bodies,Dementia w/o behav dist,DMII wo cmp nt st uncntr
Admission Date:  [**2201-2-7**]              Discharge Date:   [**2201-2-19**]

Date of Birth:  [**2121-8-10**]             Sex:   M

Service: MEDICINE

Allergies:
Haldol / Neurontin / Vancomycin

Attending:[**First Name3 (LF) 5438**]
Chief Complaint:
Shortness of breath
Dizziness
Lethargy
Hypotension

Major Surgical or Invasive Procedure:
Left subclavian central line
Arterial line placement

History of Present Illness:
79 yo male with CHF (EF 35%), ESRD on HD presents with
complaints of dizziness and general malaise starting in the AM.
Denies fevers,chills, SOB, cough, rhinorrhea, dysuria, or
diarrhea. In ambulance to hospital,pt was hypotensive with SBP
in 80's. Taken to OSH and transferred here for further care.

Past Medical History:
Chronic Afib
CHF with EF 35-40%, RV dysfunction
s/p AoVR '[**84**] secondary to rheumatic heart disease
DMII, HbA1C 6.3 in [**1-21**]
H/O UGIB secondary to gastritis/AVM
ESRD on HD
CD s/p MI s/p CABG
Gout
[**Last Name (un) 309**] Body Dementia
H/0 hypotension

Social History:
lives with wife
[**Name (NI) 3106**] veteran on disability x 18 years
Distant 5 yr history of tobacco use
occ ETOH use

Family History:
no cardiac disease

Physical Exam:
100.6   84/56-->89/44  99-100  21  100% on 3L
CVP  22-30

Gen: lying in bed in no acute distress
HEENT: poor dentition, dry mm
Neck: supple, RIJ
CV: [**Last Name (un) 3526**], irreg +mech click
Chest: bibasilar crackles; right scl tunneled catheter
Abd: soft, distended, NT/BS
Ext: +L>r edema; left toe amputation, chronic venous stasis

Pertinent Results:
[**2201-2-7**] 11:58PM   GLUCOSE-138* UREA N-63* CREAT-5.3* SODIUM-133
POTASSIUM-4.2 CHLORIDE-93* TOTAL CO2-20* ANION GAP-24*
[**2201-2-7**] 11:58PM   WBC-10.8 RBC-6.06 HGB-12.6* HCT-41.4 MCV-68*
MCH-20.7* MCHC-30.4* RDW-17.8*
[**2201-2-7**] 11:58PM   NEUTS-91.9* BANDS-0 LYMPHS-4.9* MONOS-2.8
EOS-0.4 BASOS-0.1
[**2201-2-7**] 11:58PM   PLT SMR-NORMAL PLT COUNT-302
[**2201-2-7**] 02:39PM   LACTATE-1.5
[**2201-2-7**] 02:00PM   DIGOXIN-0.9
[**2201-2-7**] 02:00PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-NEG PH-6.5 LEUK-NEG

EKG: afib, normal axis, poor RWP, flat TW III avF
CXR: cardiomegaly with small right effusion

Brief Hospital Course:
Pt was admitted to MICU for further evaluation and treatment of
hypotension. Pt had a history of hypotension in the past in the
setting of ESRD, however, he had never been symptomatic. In the
setting of peristent hypotension, pt was initially started on
Levophed and Dopamine. Chest radiographs indicated CHF. In
addition to CHF, patient had significant amount of abdominal
ascites which appeared to be increasig in size. CVVH was started
for additional fluid removal from CHF. Pt was able to maintain
pressures, and pressors were discontinued early in the course.
Pt responded well to CVVH-->HD. Pt, however, continued to have
low grade fevers from a gram positive bacteremia, and increasing
INR most likely secondary to antibiotic use in setting of
sepsis, despite being taken off anticoagulants.

Throughout the course, pt had fluctuating blood pressures, going
down to SBP 50's during HD. Although pt continued to mentate
well initially, pressors were again started with gentle fluid
boluses to maintain pressures. At this point, a new set of blood
cultures came back positive for GNR etiology unknown, possibly
from infected fluid from abdominal ascites. The focus of care
was now on managing pressures in the setting of septic
physiology. Pressors were continued with gentle hydration.

It was thought at this time by the family, with the patient
persistently pressor dependent with now, altered mental status,
that the patient be made CMO. Pt expired on [**2201-2-19**] in the early
morning.


Medications on Admission:
Pantoprazole
Sevelamer
Digoxin
Donepezil
Allopurinol
[**Last Name (un) **]/Ipratrop
Epo
Coumadin

Discharge Medications:
none

Discharge Disposition:
Expired

Facility:
[**Hospital1 69**]

Discharge Diagnosis:
Pt expired

Discharge Condition:
expired

Discharge Instructions:
none

Followup Instructions:
none
{'Septicemia due to anaerobes,Sepsis,Septic shock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Atrial fibrillation,Heart valve replaced by other means,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Abnormal coagulation profile,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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
Dizziness
Lethargy
Hypotension

PRESENT ILLNESS: 79 yo male with CHF (EF 35%), ESRD on HD presents with
complaints of dizziness and general malaise starting in the AM.
Denies fevers,chills, SOB, cough, rhinorrhea, dysuria, or
diarrhea. In ambulance to hospital,pt was hypotensive with SBP
in 80's. Taken to OSH and transferred here for further care.

MEDICAL HISTORY: Chronic Afib
CHF with EF 35-40%, RV dysfunction
s/p AoVR '[**84**] secondary to rheumatic heart disease
DMII, HbA1C 6.3 in [**1-21**]
H/O UGIB secondary to gastritis/AVM
ESRD on HD
CD s/p MI s/p CABG
Gout
[**Last Name (un) 309**] Body Dementia
H/0 hypotension

MEDICATION ON ADMISSION: Pantoprazole
Sevelamer
Digoxin
Donepezil
Allopurinol
[**Last Name (un) **]/Ipratrop
Epo
Coumadin

ALLERGIES: Haldol / Neurontin / Vancomycin

PHYSICAL EXAM: 100.6   84/56-->89/44  99-100  21  100% on 3L
CVP  22-30

FAMILY HISTORY: no cardiac disease

SOCIAL HISTORY: lives with wife
[**Name (NI) 3106**] veteran on disability x 18 years
Distant 5 yr history of tobacco use
occ ETOH use 

### Response:
{'Septicemia due to anaerobes,Sepsis,Septic shock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Atrial fibrillation,Heart valve replaced by other means,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Abnormal coagulation profile,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
