CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 51-year-old gentleman
who was diagnosed 2 months ago with cardiomyopathy following a
viral illness with inferior apical akinesis and an ejection
fraction estimated at 15-20 percent at [**Hospital1 2025**].  He was sent home
with stable cardiac and renal function on a new heart failure
regiment.

MEDICAL HISTORY: Notable for a viral cardiomyopathy
diagnosed on [**2159-6-3**] with an ejection fraction of 15-20
percent.
Hyperlipidemia, controlled with Lipitor.
Borderline hypertension.
Obesity.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Unavailable, as he is adopted.

SOCIAL HISTORY: He quit smoking in [**2139**] and has an
approximate 10-pack-year history.  He occasionally used to
drink alcohol though he quit 2 months ago after his diagnosis
of viral cardiomyopathy.  He has never used any IV drugs.  He
is married and lives in [**Location 13040**] with his wife and his 2
children.  He also cares for 2 children who are biologically
his wife's.  He is an insurance consultant and generally
engages in travel every week though he has been on leave for
3 months now.  His work schedule is quite demanding and
stressful.
Acute kidney failure, unspecified,Congestive heart failure, unspecified,Other primary cardiomyopathies,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Obesity, unspecified,Other vasodilators causing adverse effects in therapeutic use
Acute kidney failure NOS,CHF NOS,Prim cardiomyopathy NEC,Thrombocytopenia NOS,Hyperlipidemia NEC/NOS,Hypertension NOS,Obesity NOS,Adv eff vasodilators NEC
Admission Date: [**2159-7-6**]        Discharge Date: [**2159-7-11**]

Date of Birth:  [**2108-5-25**]        Sex:  M

Service:  MED


The patient was a transfer from [**Hospital3 1196**] on
[**2159-7-6**].

HISTORY OF PRESENT ILLNESS:  This is a 51-year-old gentleman
who was diagnosed 2 months ago with cardiomyopathy following a
viral illness with inferior apical akinesis and an ejection
fraction estimated at 15-20 percent at [**Hospital1 2025**].  He was sent home
with stable cardiac and renal function on a new heart failure
regiment.

Two weeks prior to this admission, he began to feel unwell with
nasal congestion and fatigue.  Five days prior to admission, he
began to experience nausea, vomiting, and diarrhea without any
evidence of blood and he had a difficult time keeping any fluids
down.  He was able to keep his medications down at that time. Two
days prior to admission, he noted "feeling cloudy" and thought he
was more confused than before.  His son brought him to the
Emergency Room at [**Location (un) 745**]- [**University/College **] on the day of admission. He
had previously been started on a new regimen of medications for
his newly diagnosed viral cardiomyopathy and CHF including Coreg,
Coumadin, lasix and lisinopril, which was changed on [**2159-6-26**] to
valsartan.  When he presented to [**Hospital3 1196**], he
was found to have a BUN reported as 700 and a creatinine of 17.6.
His potassium at that time was 7.6.  He was thought to be in
acute renal failure and was given 1.5 liters of normal saline
with bicarbonate, as well as insulin, glucose, and Kayexalate for
the hyperkalemia.  He was then transferred to [**Hospital1 **] Hospital.  He reported no chest pain, no palpitations,
no abdominal pain, no melena, no numbness or tingling in his
feet, and no shortness of breath, as well as no lower extremity
edema.

PAST MEDICAL HISTORY:  Notable for a viral cardiomyopathy
diagnosed on [**2159-6-3**] with an ejection fraction of 15-20
percent.
Hyperlipidemia, controlled with Lipitor.
Borderline hypertension.
Obesity.

PAST SURGICAL HISTORY:  Notable for appendectomy at the age
of 8 and elective vasectomy.

ALLERGIES:  He has no known drug allergies.

MEDICATIONS:  At home he takes,
1. Nexium.
2. Lasix 40 mg q.d.
3. Lipitor 20 mg q.d.
4. Fragmin 10,000 units b.i.d. up until the 27th, as he was
   then transitioned to Coumadin, which he currently takes.
5. Coreg 6.25 mg b.i.d.
6. Aldactone 25 mg q.d.
7. Lisinopril 30 mg q.d. up until [**2159-6-26**] when due to cough
   he was changed to valsartan.
8. Imdur 30 mg q.d.


SOCIAL HISTORY:  He quit smoking in [**2139**] and has an
approximate 10-pack-year history.  He occasionally used to
drink alcohol though he quit 2 months ago after his diagnosis
of viral cardiomyopathy.  He has never used any IV drugs.  He
is married and lives in [**Location 13040**] with his wife and his 2
children.  He also cares for 2 children who are biologically
his wife's.  He is an insurance consultant and generally
engages in travel every week though he has been on leave for
3 months now.  His work schedule is quite demanding and
stressful.

FAMILY HISTORY:  Unavailable, as he is adopted.

PHYSICAL EXAMINATION:  On arrival to the ED, he was afebrile,
his blood pressure was 132/62, heart rate 73, breathing at a
rate of 12 respirations per minute, saturating 97 percent on
room air.  Generally, he is an obese, 51-year-old gentleman,
in no apparent distress who appears lethargic, but awake and
oriented x3.  HEENT exam:  His oropharynx was clear.  Mucous
membranes were moist.  No conjunctivae, exudates, or scleral
icterus.  Neck:  No lymphadenopathy.  No jugular venous
distention.  No carotid bruits.  Normal thyroid.
Cardiovascular:  Regular rate and rhythm.  Normal S1 and S2.
No murmurs, rubs, or gallops appreciated.  Lungs:  Clear to
auscultation bilaterally, breathing on room air, saturating
93-98 percent.  Abdominal exam:  Obese, soft, nontender, and
nondistended.  No hepatosplenomegaly.  Extremities:  Trace
pretibial edema.  No clubbing, no cyanosis.  Neurologic:
Upper extremity and lower extremity strength intact.
Sensation and vibratory sense intact.  Cranial nerves II
through XII intact.  Mild asterixis and clonus noted.  Awake
and oriented x3 though lethargic, and denying any pain.  GU:
Foley catheter in place draining small amount of clear yellow
urine.  Skin:  Intact with acne on back.

LABORATORY DATA:  On admission, CBC, white blood cell count
5.3, hemoglobin 12.9, hematocrit 37.3, MCV 86, platelets 83
and verified by smear.  Differential on white blood cell
count, 79 percent neutrophils, 17 percent lymphocytes, 3
percent monos, 0.8 percent eosinophils, 0.2 percent
basophils.  PTT 44.1, PT 25.0, INR 4.1.  On admission, D-
dimer 370.  Chem-10, sodium 140, potassium 3.8, chloride 105,
bicarbonate 14, BUN 266, creatinine 12.4, glucose 184,
calcium 7.8, magnesium 2.6, phosphorus 11.4.  CK 178 with C-
troponin of 0.02 and a CK-MB of 4.  LFTs, ALT 19, AST 15, LDH
177, alkaline phosphatase 78.  Total bilirubin of 0.7.
Urinalysis, straw, clear, specific gravity of 1.013 notable
for large blood, negative nitrites, protein, glucose,
ketones, bilirubin, urobilinogen, and leukocytes, pH of 6.5.
Red blood cells [**3-30**], white blood cells 0-2, few bacteria, no
yeast, 0-2 epithelial cells from a catheter.  No urine
eosinophils were present.  Urine electrolytes were urine
sodium 32, urine creatinine 158 with urine osm of 395 and
urine urea of 803.  This calculates to a FeNa of 1.79
percent.  EKG was in sinus rhythm with peak T waves
consistent with hyperkalemia and no other findings.  Renal
ultrasound revealed a right kidney 12.4 cm, left 12.2 cm with
no stones, no masses, and no hydronephrosis.  Blood cultures
were sent at this time.

HOSPITAL COURSE:
Renal Failure. After transfer from [**Hospital3 20445**], the patient received Kayexalate for hyperkalemia
and had 3 small stools.  K level was checked and had come
down to 4.5.  He also received Renagel and a bicarbonate drip
for his acidosis.  His pH was 7.26.  In the ED, his fluids
were changed to D5W for concern of volume overload given his
depressed EF and congestive heart failure.  He was
transferred to the MICU were he was found to be alert and
oriented x3 with severe shaking chills but no fever.  He was
placed on a tele monitor with vital signs in normal limits.
The patient received D5W with 3 ampules of bicarbonate at 200
an hour.  Shortly after his arrival, he also received 4 g of
calcium gluconate IV.  Foley catheter was draining a small
amount of clear yellow urine, and the patient was taking sips
of water.  Foley was discontinued on [**2159-7-7**], and the
patient was able to void in a urinal.  Fluids were decreased
to D5W with 2 ampules of bicarbonate at 100 cc an hour.

The patient's renal failure continued to improve dramatically
with a creatinine on the afternoon of [**2159-7-7**] of 6.6 and a
creatinine of 3.4 on [**2159-7-8**].  On [**2159-7-8**], the patient was
transferred to the floor and his renal failure still
continued to improve.  His BUN and creatinine on discharge on
[**2159-7-11**] were creatinine of 1.2 and BUN of 22.  The rapidity
of his improvement suggests a non-intrinsic renal process.
The etiology is likely a combination of his medication and
dehydration.  He had been on an ACE inhibitor, lisinopril,
until [**6-26**] and then had been switched to an angiotensin
receptor blocker, valsartan, and likely his vasoconstriction
of afferent glomerular arteries caused a decreased blood
volume to the kidney.  In addition, he was likely dehydrated
from his vomiting and diarrhea though clinically he did not
appear dry.  Obstruction was ruled out by his negative
ultrasound and an intrinsic renal process would not have
resolved so quickly.  His baseline creatinine from records
from the [**Hospital6 1129**], which were obtained,
is around 1.2-1.3.  Over his course, he was encouraged to
increase his free water intake as he was experiencing a
uremic diuresis and his sodium was increasing to a maximum of
149.  His effective loss was free water as his urine osm was
mostly BUN.

Cardiomyopathy. His viral cardiomyopathy is seemingly improving
with an echocardiogram done on [**2159-7-9**], which found mild left
ventricular cavity enlargement with mild-to-moderate global
hypokinesis consistent with a diffuse process.  His ejection
fraction was estimated at 35-40 percent, which is an
improvement from his 16-20 percent estimate at the
[**Hospital3 **] over 1 month ago.  Clinically, he
showed no signs of CHF during his hospital course except for
some trace pretibial edema, which he reports is stable.  We
continued his Coreg, Imdur, and Lipitor, but held his Lasix,
spironolactone, and angiotensin receptor blocker.

Borderline hypertension.  Towards the end of his hospital
stay, he was started on hydralazine 10 mg q.i.d. to control
his blood pressure, which had raised to 154/80 without his
angiotensin receptor blocker.  He responded well to this dose
and will be titrated as an outpatient.

Thrombocytopenia.  His platelet count continued to stay in
the mid 60s to 70s with a discharge platelet count of 63.
His prior platelet count from the [**Hospital6 1130**] records was in the 140s.  His picture was not
concerning for a hemolytic pattern.  His haptoglobin was 157
and D-dimer 370, and he did not show clinical signs of
hemolysis, TTP, or HUS.  His coagulation studies were also
trending down, as he discontinued his Coumadin.  We were,
however, concerned for heparin-induced thrombocytopenia
possibly related to his Fragmin dose, the last of which he
received on [**2159-6-21**].  This would fall within the 3-week
window of HIT type 2 autoimmune reaction.  We sent a heparin-
induced antibody laboratory test, which was found to be
negative.  He will recheck his platelets as an outpatient
next week and will follow up with Dr. [**First Name4 (NamePattern1) 333**] [**Last Name (NamePattern1) **].  An
abdominal ultrasound was also obtained to check for
splenomegaly to determine if his low platelet count was from
sequestration in the spleen.  The liver was normal in
echotexture without focal hepatic masses.  There was no
intrahepatic or extrahepatic biliary dilatation.  The
pancreas was not well visioned.  The portal vein was patent.
The gallbladder was normal with no stones or edema.  The
spleen was mildly enlarged measuring 13.3 cm with a general
cut off of 13 cm; however, this is an obese rather large
individual and this mild splenomegaly was not thought to be
clinically significant.

His bicarbonate re-normalized over the course of his stay as
did his potassium; and we repleted his magnesium, calcium,
and phosphorus as needed.  He was on prophylaxis treatments
of Protonix, Tylenol p.r.n., and Ambien p.r.n. for sleep.  He
was up and out of bed everyday and did not require DVT
prophylaxis.  He received no heparinoid products on the floor
and no heparin flushes as the concern for HIT was unanswered
for most of his hospital course.

DISCHARGE CONDITION:  Good.

DISCHARGE DIAGNOSES:  Acute renal failure, which has resolved
and low platelet count in the mid 60s but stable.


DISCHARGE MEDICATIONS:
1. Lasix 20 mg p.o. q.d. with instructions to please weigh
   himself everyday.  If he weighs above 295 pounds, he is to
   take 40 mg 2 tablets of Lasix and call Dr. [**Last Name (STitle) **].  If he
   weighs less than 290 pounds, he is to hold his Lasix and
   also call Dr. [**Last Name (STitle) **].
2. Pantoprazole sodium 40 mg tablet Delayed Release 1 tablet
   q.d.
3. Atorvastatin 20 mg p.o. q.d.
4. Carvedilol (Coreg) 6.25 mg p.o. b.i.d.
5. Isosorbide mononitrate 30 mg tablet Sustained Release
   (Imdur) p.o. q.d.
6. Hydralazine 10 mg p.o. q.6 h.


FOLLOWUP PLANS:  The patient was instructed to return to the
hospital if shortness of breath, chest pain, nausea,
vomiting, high fevers, confusion, mental status changes,
bleeding, leg swelling, or any other concerning symptoms
arise.  He was instructed to not use Motrin, aspirin, or any
other nonsteroidal anti-inflammatory medication.  He may use
Tylenol p.r.n.  He was instructed to weigh himself everyday
and follow instructions on his Lasix bottle for how to change
his dosage appropriate to his weight.  His recommended
followup will be with Dr. [**First Name4 (NamePattern1) 333**] [**Last Name (NamePattern1) **] in [**Company 191**] on [**2159-7-23**]
at 2:30.

Cardiology appointment with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in the [**Hospital Ward Name 23**]
Center for cardiac services on [**2159-8-6**] at 9:00 a.m.



                        [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 56522**] RES, M.D. [**MD Number(2) 56523**]

Dictated By:[**Doctor Last Name 56524**]
MEDQUIST36
D:  [**2159-7-12**] 09:53:12
T:  [**2159-7-12**] 13:28:48
Job#:  [**Job Number 56525**]
{'Acute kidney failure, unspecified,Congestive heart failure, unspecified,Other primary cardiomyopathies,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Obesity, unspecified,Other vasodilators causing adverse effects in therapeutic use'}


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 a 51-year-old gentleman
who was diagnosed 2 months ago with cardiomyopathy following a
viral illness with inferior apical akinesis and an ejection
fraction estimated at 15-20 percent at [**Hospital1 2025**].  He was sent home
with stable cardiac and renal function on a new heart failure
regiment.

MEDICAL HISTORY: Notable for a viral cardiomyopathy
diagnosed on [**2159-6-3**] with an ejection fraction of 15-20
percent.
Hyperlipidemia, controlled with Lipitor.
Borderline hypertension.
Obesity.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Unavailable, as he is adopted.

SOCIAL HISTORY: He quit smoking in [**2139**] and has an
approximate 10-pack-year history.  He occasionally used to
drink alcohol though he quit 2 months ago after his diagnosis
of viral cardiomyopathy.  He has never used any IV drugs.  He
is married and lives in [**Location 13040**] with his wife and his 2
children.  He also cares for 2 children who are biologically
his wife's.  He is an insurance consultant and generally
engages in travel every week though he has been on leave for
3 months now.  His work schedule is quite demanding and
stressful. 

### Response:
{'Acute kidney failure, unspecified,Congestive heart failure, unspecified,Other primary cardiomyopathies,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Obesity, unspecified,Other vasodilators causing adverse effects in therapeutic use'}
