CHIEF COMPLAINT: Lightheadedness, worsening Dyspnea on exertion

PRESENT ILLNESS: Ms. [**Known lastname **] is a 46-year old woman with cirrhosis thought to be [**3-17**]
to Hep C (Ab+, VL-), ?hx of EtOH abuse, with recent admission
for LGIB, hx of CHF, pulm HTN, who presents w/ lightheadedness
and DOE x 2 days.

MEDICAL HISTORY: 1. Asthma
2. Pulmonary HTN - cathed [**8-/2161**], mean PA pressure 63 mmHg.
Right- sided filling pressures severely elevated: RA mean 24
mmHg, RVEDP 24 mmHg). Left sided filling pressures mildly
elevated: PCW 20
mmHg.
3. Thrombocytopenia
4. IDDM - unknown duration, on Lispro and NPH at home.
5. RHF - Echo in [**5-18**]. EF>55%, Global right ventricular
hypokinesis.
6. Liver cirrhosis - HCV positive Ab, neg VL in [**8-/2161**], not a
transplant candidate due to cor pulmonale.

MEDICATION ON ADMISSION: Albuterol
Advair
Insulin NPH 10U qam, 7U qpm
Lactulose
Pantoprazole 40 mg qd
Spironolactone 25 mg qd
Flagyl 250 [**Hospital1 **]
Lasix 20mg qd
Ca carbonate 500mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam:
VS P 105 BP 127/50 RR 20 Sao2
General: middle-aged woman sitting comfortably in bed, no signs
of resp distress
HEENT: icteric sclerae, MMM, no JVD, nl JVP
Chest: CTA bilaterally w/o wheezes or crackes
Cardiac: sinus tach, loud P2, splitting of S2 best heard at LUSB
no murmurs or rubs
Abd: soft, obese, diffusely tender, + bowel sounds, no HSM
Ext: 1+ pitting edema to knees, 2+ DPs, no cyanosis
Neuro: alert and oriented x 3, no asterxis, grossly normal

FAMILY HISTORY: HTN
CAD
Breast CA

SOCIAL HISTORY: Unclear whether she is currently drinking.
States she lives alone. Smoke 1 cigarette qd. Had heavy etOH in
past -denies any etoh recently. Snorted cocaine in past but
denies IVDU.
Hemorrhage of gastrointestinal tract, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Congestive heart failure, unspecified,Diverticulosis of colon (without mention of hemorrhage),Asthma, unspecified type, unspecified,Other chronic pulmonary heart diseases,Portal hypertension,Other esophagitis
Gastrointest hemorr NOS,Chr blood loss anemia,Cirrhosis of liver NOS,Hpt C w/o hepat coma NOS,CHF NOS,Dvrtclo colon w/o hmrhg,Asthma NOS,Chr pulmon heart dis NEC,Portal hypertension,Other esophagitis
Admission Date:  [**2162-5-26**]              Discharge Date:   [**2162-5-29**]

Date of Birth:  [**2116-6-18**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2181**]
Chief Complaint:
Lightheadedness, worsening Dyspnea on exertion

Major Surgical or Invasive Procedure:
Colonoscopy [**2162-5-28**]
Upper Endoscopy 4/015/05


History of Present Illness:
Ms. [**Known lastname **] is a 46-year old woman with cirrhosis thought to be [**3-17**]
to Hep C (Ab+, VL-), ?hx of EtOH abuse, with recent admission
for LGIB, hx of CHF, pulm HTN, who presents w/ lightheadedness
and DOE x 2 days.

Pt had recent admission [**Date range (1) 51556**] at [**Hospital1 18**]. Initially she was
admitted for worsening LE edema, SOB - sx attributed to her RHF
[**3-17**]  pulm HTN. At the time of discharge, pt noted to have BRBPR
and underwent a colonscopy which showed a rectal vessel w/
overlying clot thought to be source. Despite epi, cauterization,
pt continued to bleed and went for a 2nd coloscopy which showed
areas of ulceration. She was taken to colorectal surgery for
ligation of area (unclear whether [**Name (NI) 24997**]??????s lesion vs bleeding
rectal varix).
Her course was complicated by hepatic encephalopathy requiring
pt to be admitted to MICU for several days after found to be
unresponsive and improved w/ aggressive lactulose Rx. Since then
she was readmitted for worsening CHF and r/o??????d out for MI. At
the time Hct noted to be low and was transfused 2 U PRBCs. Hct
upon discharge on [**4-26**] was 30.9.

Today, pt presents after noting both lightheadedness and dyspnea
with exertion. At baseline, pt states that she has shortness of
breath but noticed [**Month/Year (2) 766**] that it had worsened. Since then she
also notes diffuse, sharp chest pain w/ activity, relieved by
rest. She denies worsening of LE edema, diaphoresis, dark
stools, BRBPR.

In the [**Name (NI) **], pt??????s vitals were T 97.9 P 98  BP 120/63 RR 24 O2SAT
100%RA. Labs were notable for Hct 21 Tn .02 CK 630. Physical
exam notable for guiac + maroon stool. NG lavage was negative.
EKG demonstrated NSR 96 borderline RAD no ST-T wave changes,
unchanged from previous EKG. CXR no acute cardiopulm. process.
She received an ASA 325mg, Lasix 40mg, 1U PRBC.  She was
transferred the MICU for further management.

Past Medical History:
1. Asthma
2. Pulmonary HTN - cathed [**8-/2161**], mean PA pressure 63 mmHg.
Right- sided filling pressures severely elevated: RA mean 24
mmHg, RVEDP 24 mmHg). Left sided filling pressures mildly
elevated: PCW 20
mmHg.
3. Thrombocytopenia
4. IDDM - unknown duration, on Lispro and NPH at home.
5. RHF - Echo in [**5-18**]. EF>55%, Global right ventricular
hypokinesis.
6. Liver cirrhosis - HCV positive Ab, neg VL in [**8-/2161**], not a
transplant candidate due to cor pulmonale.

Social History:
Unclear whether she is currently drinking.
States she lives alone. Smoke 1 cigarette qd. Had heavy etOH in
past -denies any etoh recently. Snorted cocaine in past but
denies IVDU.

Family History:
HTN
CAD
Breast CA

Physical Exam:
Physical Exam:
VS P 105 BP 127/50 RR 20 Sao2
General: middle-aged woman sitting comfortably in bed, no signs
of resp distress
HEENT: icteric sclerae, MMM, no JVD, nl JVP
Chest: CTA bilaterally w/o wheezes or crackes
Cardiac: sinus tach, loud P2, splitting of S2 best heard at LUSB
no murmurs or rubs
Abd: soft, obese, diffusely tender, + bowel sounds, no HSM
Ext: 1+ pitting edema to knees, 2+ DPs, no cyanosis
Neuro: alert and oriented x 3, no asterxis, grossly normal


Pertinent Results:
Admission Labs:

HCT-22.7*  PLT COUNT-71*

PT-16.9* PTT-35.1* INR(PT)-1.8

GLUCOSE-155* UREA N-19 CREAT-1.0 SODIUM-139 POTASSIUM-4.0
CHLORIDE-109* TOTAL CO2-21* ANION GAP-13

CK(CPK)-630*  CK-MB-4 cTropnT-0.02*

ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG
tricyclic-NEG

WBC-5.0 RBC-1.99*# HGB-6.7*# HCT-21.2*# MCV-106*# MCH-33.4*
MCHC-31.4 RDW-19.3*  HYPOCHROM-3+ ANISOCYT-2+ POIKILOCY-1+
MACROCYT-3+

RET AUT-6.9*

Studies:

Echo [**2162-5-28**]:
1. Left ventricular wall thickness, cavity size, and systolic
function abnormal (LVEF>55%). Regional left ventricular wall
motion is normal.
2. The right ventricular cavity is moderately dilated. There is
severe global right ventricular free wall hypokinesis. There is
abnormal septal
motion/position consistent with right ventricular
pressure/volume overload.
3. Moderate to severe [3+] tricuspid regurgitation is seen.
There is severe pulmonary artery systolic hypertension.
4. Compared with the findings of the prior report (tape
unavailable for
review) of [**2161-8-26**], the tricuspid regurgitation is worse, and
the pulmonary pressures may be less.

Colonoscopy [**2162-5-28**]:
Diverticulosis of the sigmoid colon.
Grade 1 internal hemorrhoids.
No evidence of recent or previous bleeding noted up to the
cecum.

EGD [**2162-5-28**]:
Erythema in the gastroesophageal junction compatible with
esophagitis.
Mosaic appearance in the fundus and stomach body compatible with
portal gastropathy. Hypertrophied duodenal folds.

CXR [**2162-5-26**]: Stable cardiomegaly. No acute cardiopulmonary
process observed

Brief Hospital Course:
46-year old woman with cirrhosis [**3-17**] to Hep C (Ab+, VL-),
hepatic encephalopathy, CHF (right heart failure secondary to
pulm HTN), h/o EtOH abuse, recent admission for LGIB p/w
lightheadedness and DOE x 2 days. She notes SOB at baseline
however dyspnea worsening over last 2 days.

In the ED, Hct was noted to be 21. Rectal exam revealed guiac +
maroon stool. NG lavage was negative. 2 [**Name (NI) 51557**] (pt refused
central line). She was admitted to the MICU. She has been
transfused 3 Units PRBC's.

1. GIB/anemia- Pt has hx of recent LGIB, negative NG lavage,
maroon stools which are guiuac pos. Pt received 3 units of PRBCs
bumping her crit from 21 to 30. She remained hemodynamically
stable during her stay. Her SOB was attributed to her severe
anemia. She had several small melanotic stools but there was no
BRBPR. She received Golytely prep for coloscopy and EGD.
Colonoscopy revealed diverticulosis of the sigmoid colon and
Grade 1 internal hemorrhoids, there was no evidence of recent or
previous bleeding noted up to the cecum.  EGD revealed erythema
in the gastroesophageal junction compatible with esophagitis,
Mosaic appearance in the fundus and stomach body compatible with
portal gastropathy and Hypertrophied duodenal folds. Her hct
remained >28. She was discharged on protonix [**Hospital1 **].

2. CV: Elevated troponins likely [**3-17**] to demand ischemia in
setting of anemia. Serial EKG unchanged from prior and without
ST-T wave changes suggestive ischemia/infarction.

3. Cirrhosis -  [**3-17**] to HepC although with neg VL, hx of EtOH
use? - Home diuretics were intially held since pt was
intravascularly dry [**3-17**] to GIB. Lasix and spironolactone
restarted on [**5-27**]. She continued on Lactulose and Flagyl.

4. RHF/cor pulmonale ?????? [**3-17**] to portopulmonary HTN. Pt
demonstrated no signs of worsening CHF. LE edema remained
stable, lungs were clear. Home diuretics restarted as mentioned
above. Echo revealed RV cavity moderately dilated, severe global
RV free wall hypokinesis. There is abnormal septal
motion/position consistent with RV pressure/volume overload.
Breathing at baseline by time of discharge.

5. Type 2 DM- BS well controlled on reduced regimen of NPH 3U q
AM and 2U q PM. Per patient, has been having very good blood
sugar control at home (~90's-100's) on her home regimen of 10U
NPH qAM and 7 U NPH qPM.  Therefore, she was told to resume her
outpt insulin regimen.

6. Asthma - She did well on her home dose of Advair and
albuterol prn.

Medications on Admission:
Albuterol
Advair
Insulin NPH 10U qam, 7U qpm
Lactulose
Pantoprazole 40 mg qd
Spironolactone 25 mg qd
Flagyl 250 [**Hospital1 **]
Lasix 20mg qd
Ca carbonate 500mg [**Hospital1 **]


Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
Two (2) puffs Inhalation [**Hospital1 **] (2 times a day).
2. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q4H (every 4 hours) as needed.
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO every twelve (12)
hours.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
5. Metronidazole 250 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Calcium Antacid 500 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO three times a day with meals.
9. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: One (1)
Subcutaneous twice a day: 10 units qAM
7 units qPM.
Disp:*qs * Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
GI bleed
Anemia secondary to blood loss


Discharge Condition:
Fair

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet

Please call your primary care physician or return to the
hospital if you experience bleeding, chest pain, shortness of
breath, or have any other concerns.

Followup Instructions:
You have the following appointments scheduled:

1. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], MD Where: LM [**Hospital Unit Name 7129**]
CENTER Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2162-6-11**] 2:00

2. Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 640**] [**Name8 (MD) 6121**], MD Where: [**Hospital6 29**]
[**Hospital3 249**] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2162-6-3**] 3:00



Completed by:[**2162-5-29**]
{'Hemorrhage of gastrointestinal tract, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Congestive heart failure, unspecified,Diverticulosis of colon (without mention of hemorrhage),Asthma, unspecified type, unspecified,Other chronic pulmonary heart diseases,Portal hypertension,Other esophagitis'}


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: Lightheadedness, worsening Dyspnea on exertion

PRESENT ILLNESS: Ms. [**Known lastname **] is a 46-year old woman with cirrhosis thought to be [**3-17**]
to Hep C (Ab+, VL-), ?hx of EtOH abuse, with recent admission
for LGIB, hx of CHF, pulm HTN, who presents w/ lightheadedness
and DOE x 2 days.

MEDICAL HISTORY: 1. Asthma
2. Pulmonary HTN - cathed [**8-/2161**], mean PA pressure 63 mmHg.
Right- sided filling pressures severely elevated: RA mean 24
mmHg, RVEDP 24 mmHg). Left sided filling pressures mildly
elevated: PCW 20
mmHg.
3. Thrombocytopenia
4. IDDM - unknown duration, on Lispro and NPH at home.
5. RHF - Echo in [**5-18**]. EF>55%, Global right ventricular
hypokinesis.
6. Liver cirrhosis - HCV positive Ab, neg VL in [**8-/2161**], not a
transplant candidate due to cor pulmonale.

MEDICATION ON ADMISSION: Albuterol
Advair
Insulin NPH 10U qam, 7U qpm
Lactulose
Pantoprazole 40 mg qd
Spironolactone 25 mg qd
Flagyl 250 [**Hospital1 **]
Lasix 20mg qd
Ca carbonate 500mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam:
VS P 105 BP 127/50 RR 20 Sao2
General: middle-aged woman sitting comfortably in bed, no signs
of resp distress
HEENT: icteric sclerae, MMM, no JVD, nl JVP
Chest: CTA bilaterally w/o wheezes or crackes
Cardiac: sinus tach, loud P2, splitting of S2 best heard at LUSB
no murmurs or rubs
Abd: soft, obese, diffusely tender, + bowel sounds, no HSM
Ext: 1+ pitting edema to knees, 2+ DPs, no cyanosis
Neuro: alert and oriented x 3, no asterxis, grossly normal

FAMILY HISTORY: HTN
CAD
Breast CA

SOCIAL HISTORY: Unclear whether she is currently drinking.
States she lives alone. Smoke 1 cigarette qd. Had heavy etOH in
past -denies any etoh recently. Snorted cocaine in past but
denies IVDU. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Congestive heart failure, unspecified,Diverticulosis of colon (without mention of hemorrhage),Asthma, unspecified type, unspecified,Other chronic pulmonary heart diseases,Portal hypertension,Other esophagitis'}
