CHIEF COMPLAINT: new onset SOB and fevers

PRESENT ILLNESS: 73 yo female with tissue AVR in [**2195**] ( [**Hospital1 112**]) presented to
[**Hospital1 11485**] Med. Ctr. on [**4-24**] from extended care facility with new
onset SOB and fevers. Had prior hospitalization at [**Hospital1 17436**] Med
[**Date range (1) 67001**] with fever and weakness. Had + blood cultures there for
strep. Had 4 week course of vanco, gentamicin and ceftriaxone.
TEE at that time showed no vegetations. She then developed C.
Diff. and was treated with flagyl and discharged back to her
ECF. Bone marrow asp. for WBC 0.6 done on [**4-26**] at [**Hospital1 11485**].
Results were pending. Echo on [**4-26**] showed vegetation on MV, no
significant MR. BCs + for staph from PICC line which has since
been removed.Became hypotensive on [**4-3**], and transferred to
ICU for dopamine and levophed drips. Gentamicin and vancomycin
restarted. Dopa weaned off . Developed AFib on [**4-28**] and started
on po digoxin. UO remained low at time of surgical
evaluation.Transferred in to [**Hospital1 18**] [**4-29**] for definitive treatment.

MEDICAL HISTORY: AVR [**2195**] ( tissue)
strep bacteremia
C. diff.
HTN
CHF
IBS
DM 2
thrombocytopenia
elev. chol.
anemia
GI bleed with colon AVM
bilat. TKR
TAH
cholecystectomy

MEDICATION ON ADMISSION: nexium 20 mg daily
gentamicin 50 mg q 8 hours
vancomycin 1 gm every 18 hours
KCL 20 daily
digoxin 0.125 mg daily
insulin gtt
lasix 40 mg daily
levophed 0.15 mcg/kg/min

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: awake, alert and oriented
98.5  117/71  HR 72  RR 20
PERRL, sclera anicteric
right IJ TLC
rhonchi in lungs
abd obese, soft, NT, no organomegaly
extrems with edema, and + distal pulses

FAMILY HISTORY: 

SOCIAL HISTORY: remote smoker
Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute and subacute bacterial endocarditis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Atrial fibrillation,Unspecified septicemia,Severe sepsis,Paralytic ileus,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Below knee amputation status,Dermatophytosis of groin and perianal area,Other disorders of plasma protein metabolism,Other specified antibiotics causing adverse effects in therapeutic use,Chronic ulcer of other specified sites
React-cardiac dev/graft,Ac/subac bact endocard,Acute kidney failure NOS,CHF NOS,Int inf clstrdium dfcile,Atrial fibrillation,Septicemia NOS,Severe sepsis,Paralytic ileus,Urin tract infection NOS,DMII wo cmp nt st uncntr,Status amput below knee,Dermatophytosis of groin,Dis plas protein met NEC,Adv eff antibiotics NEC,Chronic skin ulcer NEC
Admission Date:  [**2199-4-29**]              Discharge Date:   [**2199-5-11**]

Date of Birth:  [**2125-9-1**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
new onset SOB and fevers

Major Surgical or Invasive Procedure:
none

History of Present Illness:
73 yo female with tissue AVR in [**2195**] ( [**Hospital1 112**]) presented to
[**Hospital1 11485**] Med. Ctr. on [**4-24**] from extended care facility with new
onset SOB and fevers. Had prior hospitalization at [**Hospital1 17436**] Med
[**Date range (1) 67001**] with fever and weakness. Had + blood cultures there for
strep. Had 4 week course of vanco, gentamicin and ceftriaxone.
TEE at that time showed no vegetations. She then developed C.
Diff. and was treated with flagyl and discharged back to her
ECF. Bone marrow asp. for WBC 0.6 done on [**4-26**] at [**Hospital1 11485**].
Results were pending. Echo on [**4-26**] showed vegetation on MV, no
significant MR. BCs + for staph from PICC line which has since
been removed.Became hypotensive on [**4-3**], and transferred to
ICU for dopamine and levophed drips. Gentamicin and vancomycin
restarted. Dopa weaned off . Developed AFib on [**4-28**] and started
on po digoxin. UO remained low at time of surgical
evaluation.Transferred in to [**Hospital1 18**] [**4-29**] for definitive treatment.

Past Medical History:
AVR [**2195**] ( tissue)
strep bacteremia
C. diff.
HTN
CHF
IBS
DM 2
thrombocytopenia
elev. chol.
anemia
GI bleed with colon AVM
bilat. TKR
TAH
cholecystectomy

Social History:
remote smoker


Physical Exam:
awake, alert and oriented
98.5  117/71  HR 72  RR 20
PERRL, sclera anicteric
right IJ TLC
rhonchi in lungs
abd obese, soft, NT, no organomegaly
extrems with edema, and + distal pulses

Pertinent Results:
TTE [**4-25**] at OSH: EF 65-75%, poss. AV vegetation, MAC, mild to
mod. MR, MV vegetation, mild to mod. TR.

[**2199-5-10**] 02:11AM BLOOD WBC-23.4* RBC-3.17* Hgb-10.1* Hct-30.1*
MCV-95 MCH-31.8 MCHC-33.4 RDW-18.7* Plt Ct-147*
[**2199-5-8**] 02:22AM BLOOD Neuts-86.5* Lymphs-8.2* Monos-4.7 Eos-0.1
Baso-0.4
[**2199-5-8**] 02:22AM BLOOD Hypochr-1+ Anisocy-2+ Poiklo-1+
Macrocy-2+
[**2199-5-10**] 02:11AM BLOOD PT-18.3* PTT-42.0* INR(PT)-1.7*
[**2199-5-10**] 02:11AM BLOOD Plt Ct-147*
[**2199-5-9**] 01:54AM BLOOD Fibrino-183
[**2199-5-10**] 02:11AM BLOOD UreaN-32* Creat-3.0* Na-128* Cl-93*
HCO3-27
[**2199-5-3**] 01:26AM BLOOD ALT-27 AST-60* AlkPhos-122* Amylase-63
TotBili-2.0*
[**2199-5-3**] 01:26AM BLOOD Lipase-55
[**2199-5-10**] 02:11AM BLOOD Calcium-8.5 Phos-3.7 Mg-2.3
[**2199-5-6**] 03:09AM BLOOD calTIBC-135* TRF-104*
[**2199-5-9**] 03:14PM BLOOD Digoxin-1.8
[**2199-5-10**] 06:04AM BLOOD Type-ART pO2-87 pCO2-46* pH-7.41
calHCO3-30 Base XS-3
[**2199-5-10**] 02:27AM BLOOD freeCa-1.12

Brief Hospital Course:
Admitted here on [**4-29**]. Blood cultures repeated, echo done, and
ID/hematology/cardiology consults obtained. Abx therapy
continued for endocarditis. Dr. [**Last Name (STitle) 914**] consulted from cardiac
surgery. She remained in Afib/flutter. TEE showed MV vegetation,
no abscess and good LV function. Levophed weaning continued and
flagyl restarted. She received lovenox for prophylaxis and Afib.
 Dental consult completed and cath done [**5-2**]. This revealed
normal coronaries and surgery was planned for the following
week.Wound care ( skin impairments) and social work consults
also done.Received a feeding tube and had line changed on [**5-7**].
WBCs rose to 23.9. Dr. [**Last Name (STitle) 914**] had a detailed discussion with
patient and family about significant risks/ benefits of future
surgery.Could not tolerate levophed weaning completely.
Creatinine rose on [**5-8**], and urine output began to decrease on
[**5-9**] with creat now 2.5, rising to 3.0 on [**5-10**]. Patient stated
she wished to have care withdrawn on [**5-10**] and refused dialysis
or intubation. This was discussed by Dr. [**Last Name (STitle) 914**] with the
patient and family and it was her wish to have comfort measures
only and DNR instituted. She was alert and oriented at the time
of her decision. Morphine drip started and levophed drip/tube
feeds discontinued.Family remained at her side.Pt. expired at
3:05 PM on [**5-11**] and pronounced by Dr. [**Last Name (STitle) **].

Medications on Admission:
nexium 20 mg daily
gentamicin 50 mg q 8 hours
vancomycin 1 gm every 18 hours
KCL 20 daily
digoxin 0.125 mg daily
insulin gtt
lasix 40 mg daily
levophed 0.15 mcg/kg/min

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
endocarditis
sepsis
renal failure
AFib
HTN
CHF
NIDDM
IBS
thrombocytopenia
elev. chol.
anemia
prior GI bleed with colonic AVM
prior AVR [**2195**]

Discharge Condition:
expired

Discharge Instructions:
none


Completed by:[**2199-5-24**]
{'Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute and subacute bacterial endocarditis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Atrial fibrillation,Unspecified septicemia,Severe sepsis,Paralytic ileus,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Below knee amputation status,Dermatophytosis of groin and perianal area,Other disorders of plasma protein metabolism,Other specified antibiotics causing adverse effects in therapeutic use,Chronic ulcer of other specified sites'}


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: new onset SOB and fevers

PRESENT ILLNESS: 73 yo female with tissue AVR in [**2195**] ( [**Hospital1 112**]) presented to
[**Hospital1 11485**] Med. Ctr. on [**4-24**] from extended care facility with new
onset SOB and fevers. Had prior hospitalization at [**Hospital1 17436**] Med
[**Date range (1) 67001**] with fever and weakness. Had + blood cultures there for
strep. Had 4 week course of vanco, gentamicin and ceftriaxone.
TEE at that time showed no vegetations. She then developed C.
Diff. and was treated with flagyl and discharged back to her
ECF. Bone marrow asp. for WBC 0.6 done on [**4-26**] at [**Hospital1 11485**].
Results were pending. Echo on [**4-26**] showed vegetation on MV, no
significant MR. BCs + for staph from PICC line which has since
been removed.Became hypotensive on [**4-3**], and transferred to
ICU for dopamine and levophed drips. Gentamicin and vancomycin
restarted. Dopa weaned off . Developed AFib on [**4-28**] and started
on po digoxin. UO remained low at time of surgical
evaluation.Transferred in to [**Hospital1 18**] [**4-29**] for definitive treatment.

MEDICAL HISTORY: AVR [**2195**] ( tissue)
strep bacteremia
C. diff.
HTN
CHF
IBS
DM 2
thrombocytopenia
elev. chol.
anemia
GI bleed with colon AVM
bilat. TKR
TAH
cholecystectomy

MEDICATION ON ADMISSION: nexium 20 mg daily
gentamicin 50 mg q 8 hours
vancomycin 1 gm every 18 hours
KCL 20 daily
digoxin 0.125 mg daily
insulin gtt
lasix 40 mg daily
levophed 0.15 mcg/kg/min

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: awake, alert and oriented
98.5  117/71  HR 72  RR 20
PERRL, sclera anicteric
right IJ TLC
rhonchi in lungs
abd obese, soft, NT, no organomegaly
extrems with edema, and + distal pulses

FAMILY HISTORY: 

SOCIAL HISTORY: remote smoker 

### Response:
{'Infection and inflammatory reaction due to cardiac device, implant, and graft,Acute and subacute bacterial endocarditis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Atrial fibrillation,Unspecified septicemia,Severe sepsis,Paralytic ileus,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Below knee amputation status,Dermatophytosis of groin and perianal area,Other disorders of plasma protein metabolism,Other specified antibiotics causing adverse effects in therapeutic use,Chronic ulcer of other specified sites'}
