CHIEF COMPLAINT: Dypnea on Exertion

PRESENT ILLNESS: Cardiologist: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**], MD

MEDICAL HISTORY: 1. Atrial Fibrillation - discovered approx 4 years ago,
cardioverted and has been maintained on sotolol; 2 weeks ago at
his visit with Dr. [**Last Name (STitle) 73**] he was noted to be in afib again.
2. Prostate Cancer s/p xray therapy with radiation prostatitis
3. Recent ECHO [**4-30**] with preserved EF; recent catheterization
without significant disease
4. Hypertension

MEDICATION ON ADMISSION: Sotolol 120mg [**Hospital1 **]
Lisinopril 5mg daily
Coumadin 2.5mg daily 5 days a week; 5mg daily thursday and
friday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS (at [**Hospital1 18**]): afebrile, BP 140/50, P 70's irregular, RR 20,
99% facemask
Gen: reclining in bed with facemask initially but then switched
over to 2L NC and maintained sats in high 90s, in NAD, speaking
in full sentences, not using any accessory muscles.
HEENT: MMM, OP clear
Neck: moderate JVD
CV: irregularly irregular, no murmurs appreciated
Lungs: crackles [**1-29**] of the way up lung fields R>L
Abd: distended, soft, NT, +BS
Ext: right foot cooler than left with more discoloration [**1-28**]
venous stasis changes, strong pulses bilaterally, good strength,
1+ edema to mid shin.
Neuro: aox3.

FAMILY HISTORY: CAD in father (died MI age 80).

SOCIAL HISTORY: Former smoker.
Occasional alcohol.
Denies IVDU.
Lives with wife, son and daughter in law in [**Name (NI) 86**] area.
Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Other specified disorders of rectum and anus,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Personal history of malignant neoplasm of prostate
CHF NOS,Atrial fibrillation,Crnry athrscl natve vssl,Hypertension NOS,Long-term use anticoagul,Rectal & anal dis NEC,Abn react-radiotherapy,Hx-prostatic malignancy
Admission Date:  [**2115-9-10**]              Discharge Date:   [**2115-9-13**]


Service: [**Hospital Unit Name 196**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4765**]
Chief Complaint:
Dypnea on Exertion

Major Surgical or Invasive Procedure:
1. cardioversion ([**9-11**])

History of Present Illness:
Cardiologist: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**], MD

This is an 83 year old male who was in his usual state of health
until this morning when he awoke with shortness of breath and
epigastric "pressure".  He called 911 and was brought to [**Hospital **]
Hospital where T:98.1 BP:210/110, HR:92, RR:40. 91% on
non-rebreather.  CK:86, MB:1.6 TN>0.02.  ECG with Afib at 99,
non-specific ST-T changes, and PVCs.   BNP of 1370.  He was
placed on CPAP, then IV nitroglycerin, morphine and 80 IV lasix
with some relief of symptoms.  The nitro drip was titrated off
but given persistent oxygen requirement he was transferred to
[**Hospital1 18**] for further evaluation.

ROS: Denies fevers, chills, worsening reflux, lightheadedness,
LOC, vision changes, palpitations, pleuritic pressure/pain,
lower extremity edema, now bowel or urinary changes (except the
proctitis), nocturia, chest pain.

POSITIVE: nausea (no vomiting) x 1 day, changed from HCTZ to
Lisinopril two weeks ago and sotolol increased to 120 [**Hospital1 **], 2
pillow orthopnea, worsening abdominal distention over the past
few weeks, lower extremity fatigue with
exercise over the past 3 days.

Past Medical History:
1. Atrial Fibrillation - discovered approx 4 years ago,
cardioverted and has been maintained on sotolol; 2 weeks ago at
his visit with Dr. [**Last Name (STitle) 73**] he was noted to be in afib again.
2. Prostate Cancer s/p xray therapy with radiation prostatitis
3. Recent ECHO [**4-30**] with preserved EF; recent catheterization
without significant disease
4. Hypertension


Social History:
Former smoker.
Occasional alcohol.
Denies IVDU.
Lives with wife, son and daughter in law in [**Name (NI) 86**] area.

Family History:
CAD in father (died MI age 80).

Physical Exam:
VITALS (at [**Hospital1 18**]): afebrile, BP 140/50, P 70's irregular, RR 20,
99% facemask
Gen: reclining in bed with facemask initially but then switched
over to 2L NC and maintained sats in high 90s, in NAD, speaking
in full sentences, not using any accessory muscles.
HEENT: MMM, OP clear
Neck: moderate JVD
CV: irregularly irregular, no murmurs appreciated
Lungs: crackles [**1-29**] of the way up lung fields R>L
Abd: distended, soft, NT, +BS
Ext: right foot cooler than left with more discoloration [**1-28**]
venous stasis changes, strong pulses bilaterally, good strength,
1+ edema to mid shin.
Neuro: aox3.

Pertinent Results:
CBC
[**2115-9-10**] 04:11PM   WBC-5.5 RBC-4.41* HGB-14.1 HCT-40.0 MCV-91
MCH-32.0 MCHC-35.3* RDW-14.1
[**2115-9-10**] 04:11PM   PLT COUNT-166

Chemistries
[**2115-9-10**] 04:11PM   GLUCOSE-97 UREA N-17 CREAT-0.7 SODIUM-141
POTASSIUM-3.9 CHLORIDE-103 TOTAL CO2-25 ANION GAP-17
[**2115-9-10**] 04:11PM   CALCIUM-9.5 PHOSPHATE-3.9 MAGNESIUM-2.0
[**2115-9-12**] 06:45AM BLOOD Glucose-99 UreaN-27* Creat-0.8 Na-140
K-3.7 Cl-100 HCO3-31* AnGap-13
[**2115-9-13**] 09:25AM BLOOD Glucose-136* UreaN-33* Creat-1.2 Na-140
K-4.0 Cl-101 HCO3-27 AnGap-16

Coags
[**2115-9-10**] 04:11PM   PT-19.4* PTT-28.8 INR(PT)-2.4
[**2115-9-11**] 03:49AM BLOOD PT-24.9* PTT-33.3 INR(PT)-3.9
[**2115-9-12**] 06:45AM BLOOD PT-20.2* PTT-30.1 INR(PT)-2.6
[**2115-9-13**] 09:25AM BLOOD PT-19.0* INR(PT)-2.3

Cardiac Enzymes
From OSH: CK 86 MB 1.6 TnT <0.02
[**2115-9-10**] 04:11PM   CK(CPK)-62
[**2115-9-10**] 04:11PM   CK-MB-NotDone cTropnT-0.04*
[**2115-9-11**] 03:49AM BLOOD CK-MB-NotDone cTropnT-0.02*

Lipid Panel
[**2115-9-10**] 04:11PM   TRIGLYCER-127 HDL CHOL-54 CHOL/HDL-3.8
LDL(CALC)-127

LFTs
[**2115-9-11**] 03:49AM BLOOD ALT-23 AST-23 LD(LDH)-207 CK(CPK)-42
AlkPhos-36* TotBili-0.7

TSH 2.1

Hemolysis Labs
[**2115-9-11**] 03:49AM BLOOD Fibrino-217
[**2115-9-11**] 03:49AM BLOOD Hapto-126

CXR ([**9-10**]):
pulmonary edema

ECHO ([**9-10**]):
Conclusions:
The left atrium is moderately dilated. There is mild symmetric
left
ventricular hypertrophy with normal cavity size and moderate
global
hypokinesis. The right ventricular cavity is mildly dilated with
mild global
free wall hypokinesis. The aortic root and ascending aorta are
mildly dilated.
The aortic valve leaflets are mildly thickened but not stenotic.
Mild (1+)
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened.
Trivial mitral regurgitation is seen. There is mild pulmonary
artery systolic
hypertension. There is no pericardial effusion.

Compared with the report of the prior study (tape unavailable
for review) of
[**2115-5-13**], left ventricular systolic function is now reduced -
35% - (global) and mild mitral regurgitation is present.


Brief Hospital Course:
83 year old man with a history of atrial fibrillation s/p
cardioversion and maintained on sotolol and coumadin (recently
therapeutic INR), presented to OSH in afib with respiratory
distress, HTN (210/110) and mild tachycardia (90-100s).  Sx
improved with diuresis.

1.  Cardiovascular
-- CAD: There was no evidence of significant CAD from a cardiac
catheterization in [**1-30**].  Serial EKGs did not show any
concerning ST-T wave changes.  Cardiac enzymes were negative x3.
 The patient's LDL was high at 127, so he was started on
atorvastatin 20mg daily.
-- Rate/rhythm: The patient presented in atrial fibrillation
with rates in the 70-90s.  He was initially diagnosed with afib
4 years ago, and at the time of initial diagnosis had similar
symptoms to the ones that brought him to the hospital this time
(shortness of breath and fatigue).  He is s/p cardioversion and
maintained on sotolol and coumadin.  He has been therapeutic on
his coumadin for at least the past one month, and ECHO shows no
thrombus in the LV.  Therefore, initially the plan was to DC
cardiovert him, but overnight on his first hospital day he
spontaneously converted to sinus rhythm.  Approximately 16 hours
later he returned to a fib with rates in the 60-70s, and
converted spontaneously again after that.  He was asymptomatic
as he was in and out of afib.  He was continued on sotolol and
coumadin per outpatient doses.  He was discharged in sinus
rhythm, with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts monitor which he was going to
telephone in twice a day until he followed up with Dr. [**Last Name (STitle) 73**]
in two weeks ([**9-27**] at 11:30am).
-- Pump: The patient's last EF at [**Hospital1 18**] in [**4-30**] was 60%; EF done
as OSH today was estimated to be 20%.  Repeated on admission to
[**Hospital1 18**] and revealed an EF of 35%. The cause of the decreasing EF
was unclear - tachycardia associated cardiomyopathy vs. viral
cardiomyopathy vs. stunning.  The patient presented in pulmonary
edema per exam and CXR, and was bolused with Lasix IV 40 twice a
day with good urine output, and was transitioned over to 40mg po
twice a day.  Spironolactone was also added to his regimen.  He
was negative approximately 4.5 liters during his stay.  He was
discharged home on 20mg lasix PO as well as spironolactone
12.5mg daily.  He was initially continued on Lisinopril 5mg
daily per outpatient regimen, and this was increased to 10mg
daily.  The patient tolerated these medication additions and
changes well, his blood pressure remained in the 110-130s
systolic.  He will follow up with his primary care physician
next week ([**9-19**] at 9:15am) to get his INR checked as well as to
assess how he is tolerating his medications.  He has a follow up
appointment in the [**Hospital 1902**] clinic on [**10-21**] at 9AM.
2.  Respiratory: The patient arrived from OSH on a 100% facemask
with sats in the high 90s.  That night he was transitioned to 4L
NC without difficulty and continued to maintain sats in the high
90s.  He was able to be weaned off of oxygen over the next
couple of days as his diuresis progressed.  This respiratory
distress was presumed to be due to his volume overload.  He was
discharged with sats in the mid 90s on room air.
3.  Renal: The patient came in with a creatinine of 0.7.  This
was stable as he was diuresed until the day of discharge when it
rose to 1.2.  Therefore his lasix was cut back on discharge to
20mg daily from 40mg twice a day, and he will follow up with his
primary physician next week to recheck his labs.  A U/A was sent
and was negative.
4.  GI: The patient was kept on a low salt cardiac diet.  He has
a h/o proctitis and went to ED last week for blood he noticed in
his stool and was found to be stable.  Here he had a stable HCT,
and reported a recent negative colonoscopy in past 3 months.  He
was continued on his hydrocortisone PR while admitted for the
proctitis.  He has a gastroenterologist and will follow up on
this issue as an outpatient.
5. GU: Initially a foley was placed given the aggressive
diuresis, this was discontinued after two days and the patient
had no difficulty urinaring subsequently.
6. Heme: The patient had stable HCT and platelets.  He was
continued on coumadin; initially his INR was therapeutic at 2.4,
the day after admission it was 3.6 and his coumadin was held
that day.  The following day he was once more therapeutic.  On
discharge, his INR was 2.3.
7. FEN: The patient's potassium was repleted, but otherwise his
electrolytes were normal.
8. Proph: He tolerated an oral diet, was placed on a bowel
regimen, was ambulatory, and was on coumadin.
9. Dispo: He was given [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts monitor; he will follow
up with his PCP for INR and check up next week, he will follow
up with Dr. [**Last Name (STitle) 73**] in two weeks, he has an appointment in the
[**Hospital 1902**] clinic in one month.

Medications on Admission:
Sotolol 120mg [**Hospital1 **]
Lisinopril 5mg daily
Coumadin 2.5mg daily 5 days a week; 5mg daily thursday and
friday

Discharge Medications:
1. Sotalol 120 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*
3. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
Disp:*30 Tablet(s)* Refills:*2*
4. Spironolactone 25 mg Tablet Sig: 0.5 Tablet PO QD (once a
day).
Disp:*15 Tablet(s)* Refills:*2*
5. Warfarin Sodium 2.5 mg Tablet Sig: One (1) Tablet PO ONCE
(once) for 1 doses.
6. Warfarin Sodium 2.5 mg Tablet Sig: One (1) Tablet PO 5X/WEEK
([**Doctor First Name **],MO,TU,WE,SA).
7. Hydrocortisone Acetate 25 mg Suppository Sig: One (1)
Suppository Rectal QID (4 times a day).
8. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Congestive Heart Failure
2. Atrial Fibrillation


Discharge Condition:
Stable, ambulatory, tolerating an oral diet, afebrile.

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet.
Please use your [**Doctor Last Name **] of hearts monitor.  Send information over
phone twice a day until you see Dr. [**Last Name (STitle) 73**].
Please take your prescribed medications including: Lasix 20mg
daily, Spironolactone 12.5 daily, Lisinopril 10mg daily (it was
increased during admission), Sotalol 120mg twice a day,
Atorvastatin 20mg daily, and Coumadin as previously prescribed.


Followup Instructions:
1. Please keep your appointment with Dr. [**Last Name (STitle) 5435**] on Thursday
[**9-19**] at 9:15am, [**Telephone/Fax (1) 5436**].  Bring your list of new
medications with you.
2. Please keep your appointment with Dr. [**Last Name (STitle) 73**] on [**9-27**]
at 11:30am, [**Hospital Ward Name 23**] 7 ([**Hospital Ward Name 516**]), [**Telephone/Fax (1) 902**].  Please
follow up with Dr. [**Last Name (STitle) 37078**] about a repeat ECHO in
approximately 2 months.
3.Provider: [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Where: [**Hospital6 29**] CARDIAC
SERVICES Phone:[**Telephone/Fax (1) 9486**] Date/Time:[**2116-3-13**] 10:00
{'Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Other specified disorders of rectum and anus,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Personal history of malignant neoplasm of prostate'}


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: Dypnea on Exertion

PRESENT ILLNESS: Cardiologist: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**], MD

MEDICAL HISTORY: 1. Atrial Fibrillation - discovered approx 4 years ago,
cardioverted and has been maintained on sotolol; 2 weeks ago at
his visit with Dr. [**Last Name (STitle) 73**] he was noted to be in afib again.
2. Prostate Cancer s/p xray therapy with radiation prostatitis
3. Recent ECHO [**4-30**] with preserved EF; recent catheterization
without significant disease
4. Hypertension

MEDICATION ON ADMISSION: Sotolol 120mg [**Hospital1 **]
Lisinopril 5mg daily
Coumadin 2.5mg daily 5 days a week; 5mg daily thursday and
friday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS (at [**Hospital1 18**]): afebrile, BP 140/50, P 70's irregular, RR 20,
99% facemask
Gen: reclining in bed with facemask initially but then switched
over to 2L NC and maintained sats in high 90s, in NAD, speaking
in full sentences, not using any accessory muscles.
HEENT: MMM, OP clear
Neck: moderate JVD
CV: irregularly irregular, no murmurs appreciated
Lungs: crackles [**1-29**] of the way up lung fields R>L
Abd: distended, soft, NT, +BS
Ext: right foot cooler than left with more discoloration [**1-28**]
venous stasis changes, strong pulses bilaterally, good strength,
1+ edema to mid shin.
Neuro: aox3.

FAMILY HISTORY: CAD in father (died MI age 80).

SOCIAL HISTORY: Former smoker.
Occasional alcohol.
Denies IVDU.
Lives with wife, son and daughter in law in [**Name (NI) 86**] area. 

### Response:
{'Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Other specified disorders of rectum and anus,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Personal history of malignant neoplasm of prostate'}
