CHIEF COMPLAINT: Shortness of breath and anxiety

PRESENT ILLNESS: 68 year old male with diabetes and COPD, on home oxygen,
admitted to [**Hospital3 1443**] [**2113-7-18**] with increased shortness
of breath, thought to be a COPD exacerbation. He was started on
IV steroids and required occasional BiPAP. Pt has had multiple
admissions to the ER over the last week and has signed himself
out AMA; per pt, he was intubated 3 weeks ago for 24 hours for
difficulty breathing. He is electric-chair bound [**1-27**] chronic
SOB. He reports a baseline 5L 02 requirement at home.
.
At OSH, troponin negativex2 (24 hours apart), but MB elevated.
ECHO at OSH showed a newly discovered EF of 20%, LV hypokinesis.
Pt was transferred to [**Hospital1 18**] for cardiac catheterization and
evaluation of possible ischemic cardiomyopathy. The pt has no
known cardiac history, no h/o HTN, unknown cholesterol status,
family members died when pt was a child ([**1-27**] TB).
.
Pt underwent cardiac catheterization [**2113-7-21**] which showed
mild-moderate 2-vessel CAD, no interventions were done. Was
doing fine this evening when he developed anxiety and labored
breathing. ABG done was 7.32/57/379. Prior ABG was 7.39/57/122.
He sounded wheezy and was requesting Bipap ventillation which he
has had in the past. The MICU team evaluated him on the floor
and determined that he was appropriate for transfer to the unit.

MEDICAL HISTORY: Newly diagnosed cardiomyopathy
COPD, on home O2 5 liters at home, bipap at night,
diabetes type II
hyperlipidemia
? history of hepatitis B
s/p hernia repair
right cataract surgery with very poor vision.
anxiety

MEDICATION ON ADMISSION: TRANSFER MEDICATIONS:
plavix 300mg given on THURS [**7-20**], 75mg daily (new)
solumedrol 120mg IV BID started [**7-18**] (new)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - t96 HR 130 BP 143/90 RR 24 BP 99% BiPAP
Gen: large man, pink-faced, with labored breathing in mod
distress
HEENT: NCAT. Sclera anicteric. MMM.
Neck: Supple, unable to assess JVP, though neck veins seemed
distended.
CV: distant heart sounds, regular, tachycardic
Chest: barrel chest, bilateral air mvmt/no wheezes (anterior
exam)Abd: Soft, NTND.
Ext: No c/c/e. Femoral catheter site (R), c/d/i, no hematoma. R
extremity cool in temperature versus L
.
Pulses:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ DP: [**12-27**]+, PT trace

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt smoked heavily but quit 7 years ago. he lives alone with dog
and has 3 grandchildren, divorced.
Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Chronic respiratory failure,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia
CHF NOS,Obs chr bronc w(ac) exac,Chronic respiratory fail,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS
Admission Date:  [**2113-7-21**]              Discharge Date:   [**2113-7-22**]

Date of Birth:  [**2045-1-11**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2698**]
Chief Complaint:
Shortness of breath and anxiety

Major Surgical or Invasive Procedure:
cardiac catherization

History of Present Illness:
68 year old male with diabetes and COPD, on home oxygen,
admitted to [**Hospital3 1443**] [**2113-7-18**] with increased shortness
of breath, thought to be a COPD exacerbation. He was started on
IV steroids and required occasional BiPAP. Pt has had multiple
admissions to the ER over the last week and has signed himself
out AMA; per pt, he was intubated 3 weeks ago for 24 hours for
difficulty breathing. He is electric-chair bound [**1-27**] chronic
SOB. He reports a baseline 5L 02 requirement at home.
.
At OSH, troponin negativex2 (24 hours apart), but MB elevated.
ECHO at OSH showed a newly discovered EF of 20%, LV hypokinesis.
Pt was transferred to [**Hospital1 18**] for cardiac catheterization and
evaluation of possible ischemic cardiomyopathy. The pt has no
known cardiac history, no h/o HTN, unknown cholesterol status,
family members died when pt was a child ([**1-27**] TB).
.
Pt underwent cardiac catheterization [**2113-7-21**] which showed
mild-moderate 2-vessel CAD, no interventions were done. Was
doing fine this evening when he developed anxiety and labored
breathing. ABG done was 7.32/57/379. Prior ABG was 7.39/57/122.
He sounded wheezy and was requesting Bipap ventillation which he
has had in the past. The MICU team evaluated him on the floor
and determined that he was appropriate for transfer to the unit.

.
Pt denies any new chest pain, palpitations, n/v, does report
diaphoresis (constant), SOB is chronic w/ no acute worsening. He
denies any recent fevers or chills, no cough, no leg edema,
denies any current pain. He has persistently decreased appetite,
no diarrhea. Pt endorses daily anxiety attacks requiring him to
stop his car if he is driving, reports a chest tightness and
impending doom with attacks, reports no anxiety currently.


Past Medical History:
Newly diagnosed cardiomyopathy
COPD, on home O2 5 liters at home, bipap at night,
diabetes type II
hyperlipidemia
? history of hepatitis B
s/p hernia repair
right cataract surgery with very poor vision.
anxiety


Social History:
Pt smoked heavily but quit 7 years ago. he lives alone with dog
and has 3 grandchildren, divorced.

Family History:
NC

Physical Exam:
VS - t96 HR 130 BP 143/90 RR 24 BP 99% BiPAP
Gen: large man, pink-faced, with labored breathing in mod
distress
HEENT: NCAT. Sclera anicteric. MMM.
Neck: Supple, unable to assess JVP, though neck veins seemed
distended.
CV: distant heart sounds, regular, tachycardic
Chest: barrel chest, bilateral air mvmt/no wheezes (anterior
exam)Abd: Soft, NTND.
Ext: No c/c/e. Femoral catheter site (R), c/d/i, no hematoma. R
extremity cool in temperature versus L
.
Pulses:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ DP: [**12-27**]+, PT trace


Pertinent Results:
Labs at time of transfer to MICU:
[**2113-7-21**] 07:30PM BLOOD WBC-14.0* RBC-3.83* Hgb-13.0* Hct-39.7*
MCV-104* MCH-33.9* MCHC-32.7 RDW-15.5 Plt Ct-365
[**2113-7-21**] 07:30PM BLOOD Glucose-329* UreaN-31* Creat-1.0 Na-134
K-5.9* Cl-95* HCO3-28 AnGap-17
[**2113-7-21**] 10:09PM BLOOD proBNP-[**Numeric Identifier **]*
[**2113-7-21**] 07:30PM BLOOD CK-MB-NotDone cTropnT-0.04*
[**2113-7-21**] 07:30PM BLOOD Calcium-9.0 Phos-5.1* Mg-2.4
[**2113-7-21**] 04:50PM BLOOD Type-ART O2 Flow-5 pO2-122* pCO2-57*
pH-7.39 calTCO2-36* Base XS-8 Intubat-NOT INTUBA
[**2113-7-21**] 10:47AM BLOOD K-4.7

Cardiac Catherization:
COMMENTS:
1. Selective coronary angiography of this right dominant system
demonstrated moderate two vessel coronary artery disease. The
proximal RCA had a 40-50% eccentric area of stenosis. The
proximal LCx
had diffuse 50% stenosis. The mid LAD had a calcified diffuse
30%
stenosis. The LMCA had no angiographically apparent disease. Of
note,
there was diffuse PVD of the aorta, iliac, and femoral arterial
system.
2. Limited resting hemodyanmic measurement revealed a normal
systemic
arterial pressure at 116/68 mm Hg.

FINAL DIAGNOSIS:
1. Two vessel mild to moderate coronary artery disease.
2. Non-ischemic cardiomyopathy.


Brief Hospital Course:
#. Respiratory distress: Probably a combination of CHF, anxiety
and COPD. Pt sounded initially had few wheezes on exam and
responded well to nebs. Diuresed 1L neg with lasix; since
patient signed out AMA, sent with Rx for lasix 40mg po. Placed
on Bipap overnight for labored breathing; pt reportedly has Rx
for home CPAP for OSA. Elevated BNP c/w CHF exacerbation, but
cannot rule out COPD flare, so pulse steroids and prednisone
taper
.
#. CAD: Pt has no known cardiac history but low EF indicates
cardiomyopathy. S/p cardiac cath [**2113-7-21**] which showed proximal
RCA 40-50% stenosis, LCx 50% stenosis, LAD diffuse disease with
30% stenosis--no interventions were performed. EKG shows sinus
tachycardia with ?ST-depression in infero/lateral leads. Sent
SPEP, iron, for non-ischemic cardiomyopathy work-up.
.
# COPD: home O2 5L, electric chair-bound, h/o intubation, BiPAP
at home as needed. Pt was started on IV steroids x3 days, sent
home with prednisone taper.
- BiPAP overnight
- Advair, Spiriva, Albuterol PRN
.
#. Non-ischemic cardiomyopathy: pt does not have evidence of
ischemia, however given severity of lung disease, this may
explain heart failure which has only now been diagnosed via
ECHO.
- monitor VS
- Diuresied as above.
.
#. Sinus tachycardia: pt reports long history of tachycardia
thought listed in OSH records of 98, currently 130s. Pt is not
symptomatic. He does have history of anxiety with daily anxiety
attacks. Unfortunately, needed nebs now which may exacerbate
this.
.
#. Anxiety: very anxious on arrival to MICU, improved with home
BZD regimen.
.
#. FEN: hypervolemic, monitor lytes, repleted as needed,
cardiac/low sodium diet
.
#. Access: peripheral
.
#. PPx: pantoprazole, hep subq, colace/senna
.
#. Code: FULL

Patient signed out against medical advice on [**7-22**], before stable
diuretic dose was acheived and with several cardiomyopathy labs
pending.

Medications on Admission:
TRANSFER MEDICATIONS:
plavix 300mg given on THURS [**7-20**], 75mg daily (new)
solumedrol 120mg IV BID started [**7-18**] (new)

simvastatin 80mg qhs (new)
asa 81mg daily (new)
imdur 30mg daily (new)
lisinopril 10mg daily (new)
RISS
HR
Klonopin 1mg [**Hospital1 **]
glyburide 5mg daily
pantoprazole 20mg daily
pioglitazone 15mg daily
xanax 3mg TID/PRN anxiety  .
OUTPATIENT MEDICATIONS IN ADDITION TO ABOVE:
Advair 250/50
Spiriva 18mcg daily
Quinidine 325mg daily


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*100 Tablet, Chewable(s)* Refills:*2*
2. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
for heart failure.
Disp:*30 Tablet(s)* Refills:*2*
3. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day: for heart failure.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
for heart failure.
Disp:*30 Tablet(s)* Refills:*2*
5. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
Inhalation Q2-4H (every 2 to 4 hours).
6. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Pioglitazone 15 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Prednisone 10 mg Tablet Sig: ASDIR Tablet PO once a day: 6
tabs on Sun-Mon, 5 tabs Tues-Wed, 4 tabs Thurs-Fri, 3 tabs
Sat-Sun, 2 tabs Mon-Tues, 1 tab Wed-Thurs.
Disp:*42 Tablet(s)* Refills:*0*
10. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
12. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4H (every 4 hours) as needed.
13. Alprazolam 1 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime) as needed.
14. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for anxiety.


Discharge Disposition:
Home

Discharge Diagnosis:
non-ischemic cardiomyopathy
chronic obstructive pulmonary disease
anxiety


Discharge Condition:
fair, You are leaving against medical advice


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1500cc per day

You were admitted to evaluate your heart failure; cardiac
catheterization showed that you do not have flow-limiting
coronary disease. Other lab studies are pending at the time you
signed out.

Followup Instructions:
Call your PCP for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 702**] visit on Monday.
{'Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Chronic respiratory failure,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}


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: Shortness of breath and anxiety

PRESENT ILLNESS: 68 year old male with diabetes and COPD, on home oxygen,
admitted to [**Hospital3 1443**] [**2113-7-18**] with increased shortness
of breath, thought to be a COPD exacerbation. He was started on
IV steroids and required occasional BiPAP. Pt has had multiple
admissions to the ER over the last week and has signed himself
out AMA; per pt, he was intubated 3 weeks ago for 24 hours for
difficulty breathing. He is electric-chair bound [**1-27**] chronic
SOB. He reports a baseline 5L 02 requirement at home.
.
At OSH, troponin negativex2 (24 hours apart), but MB elevated.
ECHO at OSH showed a newly discovered EF of 20%, LV hypokinesis.
Pt was transferred to [**Hospital1 18**] for cardiac catheterization and
evaluation of possible ischemic cardiomyopathy. The pt has no
known cardiac history, no h/o HTN, unknown cholesterol status,
family members died when pt was a child ([**1-27**] TB).
.
Pt underwent cardiac catheterization [**2113-7-21**] which showed
mild-moderate 2-vessel CAD, no interventions were done. Was
doing fine this evening when he developed anxiety and labored
breathing. ABG done was 7.32/57/379. Prior ABG was 7.39/57/122.
He sounded wheezy and was requesting Bipap ventillation which he
has had in the past. The MICU team evaluated him on the floor
and determined that he was appropriate for transfer to the unit.

MEDICAL HISTORY: Newly diagnosed cardiomyopathy
COPD, on home O2 5 liters at home, bipap at night,
diabetes type II
hyperlipidemia
? history of hepatitis B
s/p hernia repair
right cataract surgery with very poor vision.
anxiety

MEDICATION ON ADMISSION: TRANSFER MEDICATIONS:
plavix 300mg given on THURS [**7-20**], 75mg daily (new)
solumedrol 120mg IV BID started [**7-18**] (new)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - t96 HR 130 BP 143/90 RR 24 BP 99% BiPAP
Gen: large man, pink-faced, with labored breathing in mod
distress
HEENT: NCAT. Sclera anicteric. MMM.
Neck: Supple, unable to assess JVP, though neck veins seemed
distended.
CV: distant heart sounds, regular, tachycardic
Chest: barrel chest, bilateral air mvmt/no wheezes (anterior
exam)Abd: Soft, NTND.
Ext: No c/c/e. Femoral catheter site (R), c/d/i, no hematoma. R
extremity cool in temperature versus L
.
Pulses:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ DP: [**12-27**]+, PT trace

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt smoked heavily but quit 7 years ago. he lives alone with dog
and has 3 grandchildren, divorced. 

### Response:
{'Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Chronic respiratory failure,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}
