CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 57 yo M h/o asthma, COPD (FEV1 44%, FEV/FVC 56% pred), HTN,
GERD, DM2, HL p/w dyspnea X 4 days. Pt was in USOH until 4 days
ago when developed congestion/green nasal discharge. Mildly
dyspneic at the time. The following day developed cough
productive of green sputum. Pt with worsening dyspnea this am,
unable to walk more than a few steps without becoming dyspneic
(baseline able to walk greater than 5 miles). Dyspnea not
responsive to inhaler. (+) subjective fever X 24 hours. Pt has
also had 2-3 episodes of L-sided CP, non-radiating, occuring
after cough while sitting down. Denies abd pain/n/v/d. ROS o/w
negative.
.
In ED vitals: 96.6, hr 107, bp 148/68, 19, 100% ra. Pt appeared
in resp distress with exp wheezes on exam. CXR demonstrated no
acute cardiopulmonary process. ABG 7.39/45/167. Labs notable for
wbc 12.6. Pt with albuterol neb continuously, later spaced out
to q2h, but pt could not tolerate any further spacing--pt would
begin coughing and become dyspneic. Otherwise pt given azithro
500 mgX1, prednisone 60 mg X1. Transferred to [**Hospital Unit Name 153**] for further
management.

MEDICAL HISTORY: 1.  Diabetes type 2.
2.  Hypertension.
3.  Asthma, COPD.
4.  Hypercholesterolemia.
5.  GERD.
6.  Chronic knee pain.
7.  Chronic renal insufficiency

MEDICATION ON ADMISSION: albuterol prn
aspirin 81 mg daily
avandia 4 mg [**Hospital1 **]
combivent 2 puffs qid
glucophage 850 mg tid
hctz 25 mg daily
glyburide 10 mg [**Hospital1 **]
lantus 10 units qhs
procardia 60 mg daily
wellbutrin 150 mg [**Hospital1 **]
protonix 40 mg daily

ALLERGIES: Anacin

PHYSICAL EXAM: Temp 98.3
BP 152/79
Pulse 100
Resp 28
O2 sat 93% 2L NC
Gen - Alert, no acute distress, presently breathing comfortably
HEENT - MMM, EOMI
Neck - no JVD, no cervical lymphadenopathy
Chest - mild exp wheezes at apices, rhonchi left base
CV - Normal S1/S2, RRR, no murmurs appreciated
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

FAMILY HISTORY: Mother had MI at 73 and HTN.
Father had DM.

SOCIAL HISTORY: Lives with daughter, smoked [**2-6**] ppd X 40 years, occ beer, no
illicits
Chronic obstructive asthma with (acute) exacerbation,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Esophageal reflux,Pure hypercholesterolemia
Ch obst asth w (ac) exac,DMII renal uncntrld,Chronic kidney dis NOS,Hy kid NOS w cr kid I-IV,Nephritis NOS in oth dis,Esophageal reflux,Pure hypercholesterolem
Admission Date:  [**2198-2-5**]              Discharge Date:   [**2198-2-8**]

Date of Birth:  [**2140-12-30**]             Sex:   M

Service: MEDICINE

Allergies:
Anacin

Attending:[**First Name3 (LF) 9240**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
None

History of Present Illness:
57 yo M h/o asthma, COPD (FEV1 44%, FEV/FVC 56% pred), HTN,
GERD, DM2, HL p/w dyspnea X 4 days. Pt was in USOH until 4 days
ago when developed congestion/green nasal discharge. Mildly
dyspneic at the time. The following day developed cough
productive of green sputum. Pt with worsening dyspnea this am,
unable to walk more than a few steps without becoming dyspneic
(baseline able to walk greater than 5 miles). Dyspnea not
responsive to inhaler. (+) subjective fever X 24 hours. Pt has
also had 2-3 episodes of L-sided CP, non-radiating, occuring
after cough while sitting down. Denies abd pain/n/v/d. ROS o/w
negative.
.
In ED vitals: 96.6, hr 107, bp 148/68, 19, 100% ra. Pt appeared
in resp distress with exp wheezes on exam. CXR demonstrated no
acute cardiopulmonary process. ABG 7.39/45/167. Labs notable for
wbc 12.6. Pt with albuterol neb continuously, later spaced out
to q2h, but pt could not tolerate any further spacing--pt would
begin coughing and become dyspneic. Otherwise pt given azithro
500 mgX1, prednisone 60 mg X1. Transferred to [**Hospital Unit Name 153**] for further
management.


Past Medical History:
1.  Diabetes type 2.
2.  Hypertension.
3.  Asthma, COPD.
4.  Hypercholesterolemia.
5.  GERD.
6.  Chronic knee pain.
7.  Chronic renal insufficiency

Social History:
Lives with daughter, smoked [**2-6**] ppd X 40 years, occ beer, no
illicits


Family History:
Mother had MI at 73 and HTN.
Father had DM.

Physical Exam:
Temp 98.3
BP 152/79
Pulse 100
Resp 28
O2 sat 93% 2L NC
Gen - Alert, no acute distress, presently breathing comfortably
HEENT - MMM, EOMI
Neck - no JVD, no cervical lymphadenopathy
Chest - mild exp wheezes at apices, rhonchi left base
CV - Normal S1/S2, RRR, no murmurs appreciated
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

Neuro - Alert and oriented x 3
Skin - No rash


Pertinent Results:
[**2198-2-5**] 11:59AM   PT-11.8 PTT-28.5 INR(PT)-1.0
[**2198-2-5**] 11:59AM   WBC-12.6* RBC-4.86 HGB-13.0* HCT-38.6*
MCV-80* MCH-26.8* MCHC-33.7 RDW-15.1
[**2198-2-5**] 11:59AM   NEUTS-93.7* BANDS-0 LYMPHS-4.1* MONOS-1.5*
EOS-0.5 BASOS-0.3
[**2198-2-5**] 11:59AM   CK-MB-6 cTropnT-<0.01
[**2198-2-5**] 11:59AM   CK(CPK)-353*
[**2198-2-5**] 07:19PM   CK-MB-12* MB INDX-1.9 cTropnT-<0.01
[**2198-2-5**] 07:19PM   CK(CPK)-631*
.
CXR: No acute pulmonary process identified.
.
TTE:
1. The left atrium is mildly dilated. The left atrium is
elongated.
2.There is mild symmetric left ventricular hypertrophy. The left
ventricular
cavity size is normal. Regional left ventricular wall motion is
normal. Left
ventricular systolic function is hyperdynamic (EF>75%). There is
a mild
resting left ventricular outflow tract obstruction. The gradient
increased
with the Valsalva manuever.
3. Right ventricular chamber size is normal. Right ventricular
systolic
function is normal.
4.The aortic valve leaflets are mildly thickened. No aortic
regurgitation is
seen.
5.The mitral valve leaflets are structurally normal. Trivial
mitral
regurgitation is seen.
6.There is mild pulmonary artery systolic hypertension.
7.There is no pericardial effusion.


Brief Hospital Course:
A/P:57 yo M h/o asthma, COPD (FEV1 44%, FEV/FVC 56% pred), HTN,
GERD, DM2, HL p/w dyspnea X 4 days.
.
Dyspnea: Appeared consistent with COPD exacerbation in setting
of recent viral URI. Treated with prednisone initially 60 mg,
sent home on a few week taper. Continued on albuterol/atrovent
nebs. Will follow up with o/p pulmonologist.
.
chest discomfort: Reports episodic chest pain, although not
exertional. TTE checked to rule out wall motion abnormality,
which showed no wall motion abnormality hyperdynamic EF and a
mild LV outflow tract obstruction. Pt. may benefit from
outpatient refer to a cardiologist.
.
DM2: Held oral meds when admitted but restarted on d/c,
continued on lantus.
.
HTN: cont home procardia, HCTZ
.
renal faliure: pt's cr 1.4, at his baseline, suspect DM
nephropathy, follow up with Dr. [**Last Name (STitle) 1366**] as o/p.
.
GERD: home ppi
.
comm: [**Name (NI) **] [**Name (NI) **] (hcp) [**Telephone/Fax (1) 108990**]

Medications on Admission:
albuterol prn
aspirin 81 mg daily
avandia 4 mg [**Hospital1 **]
combivent 2 puffs qid
glucophage 850 mg tid
hctz 25 mg daily
glyburide 10 mg [**Hospital1 **]
lantus 10 units qhs
procardia 60 mg daily
wellbutrin 150 mg [**Hospital1 **]
protonix 40 mg daily


Discharge Medications:
1. Prednisone 10 mg Tablet Sig: As directed Tablet PO once a
day: Take 6 tabs daily for 3 days, then take 5 tabs daily for 3
days, then take 4 tabs daily for three days, then 3 tabs daily
for three days, then 2 tabs daily for 3 days, then one tab daily
for three days, then stop.
Disp:*63 Tablet(s)* Refills:*0*
2. Azithromycin 250 mg Capsule Sig: One (1) Capsule PO Q24H
(every 24 hours) for 2 days.
Disp:*2 Capsule(s)* Refills:*0*
3. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb
Inhalation Q2H (every 2 hours) as needed.
Disp:*qs 1 month* Refills:*2*
4. Insulin Glargine 100 unit/mL Solution Sig: Ten (10) units
Subcutaneous at bedtime.
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
9. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) puff Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 inhaler* Refills:*2*
10. Nifedipine 60 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO DAILY (Daily).
11. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*qs 1 month* Refills:*2*
12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
14. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
15. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
16. Metformin 850 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
17. Avandia 4 mg Tablet Sig: One (1) Tablet PO twice a day.
18. Wellbutrin SR 150 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO twice a day.


Discharge Disposition:
Home

Discharge Diagnosis:
COPD Flare
Asthma Attack
Upper Respiratory Infection
Left Ventricular Outflow Tract Obstruction
Type 2 Diabetes, Uncontrolled
Hypertension


Discharge Condition:
stable


Discharge Instructions:
Please continue your medications as listed below. Please make
sure you follow up with your PCP in the next week. Please also
follow up with your pulmonologist in the next 2 weeks.

Followup Instructions:
1. Provider: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 5500**], M.D. Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2198-2-16**] 10:45

2. Provider: [**First Name8 (NamePattern2) 1238**] [**Last Name (NamePattern1) 1239**] [**Name8 (MD) **], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 250**]
Date/Time:[**2198-2-26**] 9:40

3. Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3150**], MD Phone:[**Telephone/Fax (1) 250**] Please
call for an appointment in the next week.

4. Please follow up with your pulmonologist in the next 2 weeks.
{'Chronic obstructive asthma with (acute) exacerbation,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Esophageal reflux,Pure hypercholesterolemia'}


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

PRESENT ILLNESS: 57 yo M h/o asthma, COPD (FEV1 44%, FEV/FVC 56% pred), HTN,
GERD, DM2, HL p/w dyspnea X 4 days. Pt was in USOH until 4 days
ago when developed congestion/green nasal discharge. Mildly
dyspneic at the time. The following day developed cough
productive of green sputum. Pt with worsening dyspnea this am,
unable to walk more than a few steps without becoming dyspneic
(baseline able to walk greater than 5 miles). Dyspnea not
responsive to inhaler. (+) subjective fever X 24 hours. Pt has
also had 2-3 episodes of L-sided CP, non-radiating, occuring
after cough while sitting down. Denies abd pain/n/v/d. ROS o/w
negative.
.
In ED vitals: 96.6, hr 107, bp 148/68, 19, 100% ra. Pt appeared
in resp distress with exp wheezes on exam. CXR demonstrated no
acute cardiopulmonary process. ABG 7.39/45/167. Labs notable for
wbc 12.6. Pt with albuterol neb continuously, later spaced out
to q2h, but pt could not tolerate any further spacing--pt would
begin coughing and become dyspneic. Otherwise pt given azithro
500 mgX1, prednisone 60 mg X1. Transferred to [**Hospital Unit Name 153**] for further
management.

MEDICAL HISTORY: 1.  Diabetes type 2.
2.  Hypertension.
3.  Asthma, COPD.
4.  Hypercholesterolemia.
5.  GERD.
6.  Chronic knee pain.
7.  Chronic renal insufficiency

MEDICATION ON ADMISSION: albuterol prn
aspirin 81 mg daily
avandia 4 mg [**Hospital1 **]
combivent 2 puffs qid
glucophage 850 mg tid
hctz 25 mg daily
glyburide 10 mg [**Hospital1 **]
lantus 10 units qhs
procardia 60 mg daily
wellbutrin 150 mg [**Hospital1 **]
protonix 40 mg daily

ALLERGIES: Anacin

PHYSICAL EXAM: Temp 98.3
BP 152/79
Pulse 100
Resp 28
O2 sat 93% 2L NC
Gen - Alert, no acute distress, presently breathing comfortably
HEENT - MMM, EOMI
Neck - no JVD, no cervical lymphadenopathy
Chest - mild exp wheezes at apices, rhonchi left base
CV - Normal S1/S2, RRR, no murmurs appreciated
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

FAMILY HISTORY: Mother had MI at 73 and HTN.
Father had DM.

SOCIAL HISTORY: Lives with daughter, smoked [**2-6**] ppd X 40 years, occ beer, no
illicits 

### Response:
{'Chronic obstructive asthma with (acute) exacerbation,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Esophageal reflux,Pure hypercholesterolemia'}
