CHIEF COMPLAINT: Melena

PRESENT ILLNESS: 89yM with CAD, systolic CHF EF 25-30%, moderate AS, on aspirin
and [**First Name3 (LF) **] presenting with severe anemia and melena. 3-4 days of
melena, [**3-21**] stools per day. Stool foul smelling, sticky, black.
No red blood. No abdominal pain, no nausea or vomiting. No EtOH
or NSAIDs, just ASA and [**Month/Day (3) **]. No additional ASA. No history of
GI bleeding and no EGD in th epast. Has NYHA class III CHF
symptoms at baseline, no angina at baseline. He gets short of
breath while walking in the part, does okay around the house. No
orthopnea, PND, or pedal edema. Weighed 177lbs on admission, 175
baseline. No other symptoms. No fevers/chills. In ED, had 2 PIV,
got 1L IVF, 40mg IV Protonix, and 1 unit pRBC's.

MEDICAL HISTORY: Diabetes
Dyslipidemia
CAD s/p PCA in [**1-/2182**]
Moderate Aortic Stenosis
Anemia
CKD (baseline creatinine 2.1)
Gout
CHF, EF 25-30%

MEDICATION ON ADMISSION: Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals 97,0F, BP 98/51, HR 77, RR 14, O2 sat 97%RA
General: NAD, A&O x 3
HEENT: MM slightly dry, JVP 8cm
Cardiac: RRR, [**2-23**] mid peaking systolic crescendo decrescendo
murmur at the USB with radiation to the precordium and the
carotids, good carotid pulsations
Lung: CTAB
Abdomen: Soft, NT, ND, no masses or organomegaly
Rectal: minimal melnea in rectal vault, no red blood, no rectal
masses
Neuro: A&O x3, grossly normal

FAMILY HISTORY: No know FH of cardiac disease, diabetes, no colon/proste/breast
cancer. Parents lived to 70s to 80s with no known medical
problems. Children in good health. Brother had heart disease.

SOCIAL HISTORY: Lives in [**Location 1268**] with wife. [**Name (NI) **] 2 daughters and a son.
[**Name (NI) **] was born in [**Country 4754**], moved to the US in [**2125**]. Worked in
construction as a labor foreman. Married x 54 years, with 3
children and 9 grandchildren.
-Tobacco history:  Denies
-ETOH:  Occasional
-Illicit drugs:  Denies
Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Hyperosmolality and/or hypernatremia,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Gout, unspecified,Other and unspecified hyperlipidemia,Long-term (current) use of aspirin,Percutaneous transluminal coronary angioplasty status
Gastrointest hemorr NOS,Acute kidney failure NOS,Chr systolic hrt failure,Delirium d/t other cond,Hyperosmolality,Ac posthemorrhag anemia,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Crnry athrscl natve vssl,Aortic valve disorder,Gout NOS,Hyperlipidemia NEC/NOS,Long-term use of aspirin,Status-post ptca
Admission Date:  [**2182-4-10**]              Discharge Date:   [**2182-4-17**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3043**]
Chief Complaint:
Melena

Major Surgical or Invasive Procedure:
None

History of Present Illness:
89yM with CAD, systolic CHF EF 25-30%, moderate AS, on aspirin
and [**First Name3 (LF) **] presenting with severe anemia and melena. 3-4 days of
melena, [**3-21**] stools per day. Stool foul smelling, sticky, black.
No red blood. No abdominal pain, no nausea or vomiting. No EtOH
or NSAIDs, just ASA and [**Month/Day (3) **]. No additional ASA. No history of
GI bleeding and no EGD in th epast. Has NYHA class III CHF
symptoms at baseline, no angina at baseline. He gets short of
breath while walking in the part, does okay around the house. No
orthopnea, PND, or pedal edema. Weighed 177lbs on admission, 175
baseline. No other symptoms. No fevers/chills. In ED, had 2 PIV,
got 1L IVF, 40mg IV Protonix, and 1 unit pRBC's.

Past Medical History:
Diabetes
Dyslipidemia
CAD s/p PCA in [**1-/2182**]
Moderate Aortic Stenosis
Anemia
CKD (baseline creatinine 2.1)
Gout
CHF, EF 25-30%

Social History:
Lives in [**Location 1268**] with wife. [**Name (NI) **] 2 daughters and a son.
[**Name (NI) **] was born in [**Country 4754**], moved to the US in [**2125**]. Worked in
construction as a labor foreman. Married x 54 years, with 3
children and 9 grandchildren.
-Tobacco history:  Denies
-ETOH:  Occasional
-Illicit drugs:  Denies


Family History:
No know FH of cardiac disease, diabetes, no colon/proste/breast
cancer. Parents lived to 70s to 80s with no known medical
problems. Children in good health. Brother had heart disease.

Physical Exam:
Vitals 97,0F, BP 98/51, HR 77, RR 14, O2 sat 97%RA
General: NAD, A&O x 3
HEENT: MM slightly dry, JVP 8cm
Cardiac: RRR, [**2-23**] mid peaking systolic crescendo decrescendo
murmur at the USB with radiation to the precordium and the
carotids, good carotid pulsations
Lung: CTAB
Abdomen: Soft, NT, ND, no masses or organomegaly
Rectal: minimal melnea in rectal vault, no red blood, no rectal
masses
Neuro: A&O x3, grossly normal

DISCHARGE EXAM:
98.2F, BP 102/64, 862, 96%RA
No JVD
RRR, 2/6 systolic murmur
Lungs clear to auscultation bilaterally
Abdomen benign
No peripheral edema
A&O x 3

Pertinent Results:
[**2182-4-9**] 11:30PM   PT-12.8 PTT-29.3 INR(PT)-1.1
[**2182-4-9**] 11:30PM   PLT COUNT-233
[**2182-4-9**] 11:30PM   NEUTS-68.5 LYMPHS-17.4* MONOS-6.1 EOS-7.3*
BASOS-0.6
[**2182-4-9**] 11:30PM   WBC-5.0 RBC-2.32*# HGB-7.5*# HCT-22.1*#
MCV-96 MCH-32.2* MCHC-33.7 RDW-13.6
[**2182-4-9**] 11:30PM   cTropnT-0.05*
[**2182-4-9**] 11:30PM   CK(CPK)-81
[**2182-4-9**] 11:30PM   GLUCOSE-195* UREA N-163* CREAT-2.9*
SODIUM-132* POTASSIUM-6.3* CHLORIDE-99 TOTAL CO2-25 ANION GAP-14
[**2182-4-10**] 04:32AM   PT-12.9 PTT-29.3 INR(PT)-1.1
[**2182-4-10**] 04:32AM   HCT-22.4*
[**2182-4-10**] 04:32AM   ALBUMIN-3.4* CALCIUM-8.3* PHOSPHATE-4.0
MAGNESIUM-2.8*
[**2182-4-10**] 04:32AM   ALT(SGPT)-79* AST(SGOT)-36 LD(LDH)-177 ALK
PHOS-57 TOT BILI-0.6
[**2182-4-10**] 04:32AM   GLUCOSE-55* UREA N-158* CREAT-2.7* SODIUM-136
POTASSIUM-5.3* CHLORIDE-104 TOTAL CO2-24 ANION GAP-13
[**2182-4-10**] 12:40PM   HCT-24.8*
[**2182-4-10**] 12:40PM   POTASSIUM-5.2*
[**2182-4-10**] 03:39PM   HCT-25.8*
[**2182-4-10**] 06:07PM   MAGNESIUM-2.4
[**2182-4-10**] 06:07PM   estGFR-Using this
[**2182-4-10**] 06:07PM   UREA N-134* CREAT-2.3* POTASSIUM-5.3*

Echo [**2182-4-10**]: The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal for the patient's body size. There is
moderate global left ventricular hypokinesis (LVEF = 35-40 %).
The aortic valve leaflets are severely thickened/deformed. There
is moderate to severe aortic valve stenosis (valve area
1.0-1.2cm2). Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. Moderate [2+] tricuspid regurgitation is seen. There
is moderate pulmonary artery systolic hypertension. There is no
pericardial effusion.

Compared with the prior study (images reviewed) of [**2182-3-16**],
the heart fate is higher and left ventricular systolic function
is slightly more vigorous. The left ventricular ejection
fraction may have been slightly underestimated in the prior
report. . Estimated valve area is slightly higher in the current
report.

Chest X-ray [**2182-4-10**]: IMPRESSION: No evidence for pulmonary
edema. Suspected tiny or small pleural effusion on the left.

Chest X-ray [**2182-4-16**]: IMPRESSION: Unchanged mild cardiomegaly
and small bilateral effusions.

Brief Hospital Course:
89yM with CAD and systolic CHF, moderate AS, on aspirin and
[**Year (4 digits) **], admitted with severe anemia and melena.

# GI Bleeding. Hct on admission 22; baseline 30-32. Thought
secondary to UGIB (gastritis, PUD). ASA/[**Year (4 digits) **] stopped on
admission. Seen by GI; given multiple cardiac problems, any
procedure would need to be done by [**Last Name (LF) **], [**First Name3 (LF) **] deferred. Hematocrit
stabilized off ASA/[**First Name3 (LF) **]; GI bleeding thought secondary to
[**Last Name (LF) **], [**First Name3 (LF) **] this should be permanently discontinued. Metoprolol,
lisinopril, and torsemide held in setting of GI bleeding.
Hematocrit after [**4-12**] was stable, ranging from 25-30%. Received
a total of 5 units pRBC's during admission (last on [**4-16**]);
hematocrit at discharge 28%. No bowel movement in 3 days at time
of discharge. Discharged on pantoprazole [**Hospital1 **].

# Acute on chronic renal failure. Creatinine 2.7 at time of
admission (baseline 2.0-2.2). Creatinine was as low as 1.7
during the admission. Bumped from 1.7 to 2.2 when lisinopril
initially restarted; this medication was discontinued again and
should be restarted as an outpatient. Torsemide to be restarted
on discharge.

# Coronary artery disease. [**Hospital1 **] discontinued. Aspirin
restarted three days prior to discharge with subsequent stable
hematocrit. Statin continued. Metoprolol restarted two days
prior to discharge, and lisinopril to be restarted as
outpatient.

# Chronic systolic heart failure. Well-compensated throughout
the admission. Change in x-ray demonstrated accumulation of mild
bilateral pulmonary effusions (diuresis was held during the
admission). I's/O's closely monitored, and he remained euvolemic
throughout the admission. Beta blocker restarted during
admission, torsemide to start as outpatient, and lisinopril to
be restarted within one week of discharge.

# Delirium. Noted to have reversed sleep/wake cycles during the
admission, with subsequent confusion. Improved with trazodone,
to be continued on discharge.

# Gout flare. On [**5-6**], patient had low-grade fever and
bilateral great toe pain. Given one dose of colchicine with
resolution of fever and pain.

# Hyperlipidemia. Continued statin.

# Hypernatremia. Did develop hypernatremia during
hospitalization. Resolved with increased PO fluid intake.

# Full Code, confirmed with patient.


Medications on Admission:
Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

Lisinopril 10mg daily
[**Date Range **] 75mg daily
Glipizide 10 mg Tablet Sig: One (1) Tablet PO once a day.
Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times
a day).
Torsemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO
DAILY (Daily).
Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO every [**4-23**]
hours as needed for pain.
Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO once a day
Zantac 75mg [**Hospital1 **]


Discharge Medications:
1. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Glipizide 10 mg Tablet Sig: One (1) Tablet PO once a day.
3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
4. Torsemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Trazodone 50 mg Tablet Sig: 0.25 Tablet PO HS (at bedtime).
Disp:*30 Tablet(s)* Refills:*2*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO every [**4-23**]
hours as needed for pain.
9. Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One
(1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
1) GI bleed
2) Coronary artery disease

Discharge Condition:
Mental Status: Clear and coherent
Level of Consciousness: Alert and interactive
Activity Status: Ambulatory - Independent, with cane/walker

Discharge Instructions:
You were admitted with bleeding in your GI tract. This was most
likely due to your medication, [**Hospital **], that you recently started
taking. Please do not take your [**Hospital **]. Your aspirin was
restarted, and you had no further bleeding; you should continue
to take this medication.

Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs. Please take all of your medications as prescribed
and keep all follow up appointments.

The following changes are made to your medication list:
- [**Name8 (MD) **]: DO NOT TAKE THIS MEDICATION, as it likely contributed
to your episode of bleeding from your GI tract
- Pantoprazole: this is an anti-acid medication that you are
prescribed to help prevent bleeding from your GI tract
- Lisinopril: This medication will likely be restarted by Dr.
[**Last Name (STitle) 131**]; please discuss this medication with him when you see him
on [**2182-4-24**]
- Trazodone: This is a medication for sleep.

Followup Instructions:
Appointment #1
MD: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 131**]
Specialty: Internal Medicine-Primary Care
Date/ Time: [**2182-4-24**] 10:30am
Location: [**Street Address(2) 3375**] [**Location (un) 858**], [**Location (un) **] MA
Phone number: [**Telephone/Fax (1) 133**]
Special instructions for patient:

Appointment #2
MD: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7965**]
Specialty: Cardiology
Date/ Time:
Location:
Phone number: [**Telephone/Fax (1) 62**]
Special instructions for patient: The office will call you with
an appointment. If you do not hear or have any questions please
call the office. Thanks.
{'Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Hyperosmolality and/or hypernatremia,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Gout, unspecified,Other and unspecified hyperlipidemia,Long-term (current) use of aspirin,Percutaneous transluminal coronary angioplasty status'}


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: Melena

PRESENT ILLNESS: 89yM with CAD, systolic CHF EF 25-30%, moderate AS, on aspirin
and [**First Name3 (LF) **] presenting with severe anemia and melena. 3-4 days of
melena, [**3-21**] stools per day. Stool foul smelling, sticky, black.
No red blood. No abdominal pain, no nausea or vomiting. No EtOH
or NSAIDs, just ASA and [**Month/Day (3) **]. No additional ASA. No history of
GI bleeding and no EGD in th epast. Has NYHA class III CHF
symptoms at baseline, no angina at baseline. He gets short of
breath while walking in the part, does okay around the house. No
orthopnea, PND, or pedal edema. Weighed 177lbs on admission, 175
baseline. No other symptoms. No fevers/chills. In ED, had 2 PIV,
got 1L IVF, 40mg IV Protonix, and 1 unit pRBC's.

MEDICAL HISTORY: Diabetes
Dyslipidemia
CAD s/p PCA in [**1-/2182**]
Moderate Aortic Stenosis
Anemia
CKD (baseline creatinine 2.1)
Gout
CHF, EF 25-30%

MEDICATION ON ADMISSION: Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals 97,0F, BP 98/51, HR 77, RR 14, O2 sat 97%RA
General: NAD, A&O x 3
HEENT: MM slightly dry, JVP 8cm
Cardiac: RRR, [**2-23**] mid peaking systolic crescendo decrescendo
murmur at the USB with radiation to the precordium and the
carotids, good carotid pulsations
Lung: CTAB
Abdomen: Soft, NT, ND, no masses or organomegaly
Rectal: minimal melnea in rectal vault, no red blood, no rectal
masses
Neuro: A&O x3, grossly normal

FAMILY HISTORY: No know FH of cardiac disease, diabetes, no colon/proste/breast
cancer. Parents lived to 70s to 80s with no known medical
problems. Children in good health. Brother had heart disease.

SOCIAL HISTORY: Lives in [**Location 1268**] with wife. [**Name (NI) **] 2 daughters and a son.
[**Name (NI) **] was born in [**Country 4754**], moved to the US in [**2125**]. Worked in
construction as a labor foreman. Married x 54 years, with 3
children and 9 grandchildren.
-Tobacco history:  Denies
-ETOH:  Occasional
-Illicit drugs:  Denies 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Chronic systolic heart failure,Delirium due to conditions classified elsewhere,Hyperosmolality and/or hypernatremia,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Gout, unspecified,Other and unspecified hyperlipidemia,Long-term (current) use of aspirin,Percutaneous transluminal coronary angioplasty status'}
