CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 76 year old man
who developed dyspnea ten days prior to the day of admission with
progressive worsening.  He was in his usual state of health prior
to this, able to climb one flight of stairs, but noticed starting
about ten days ago that he needed to rest to be able to do so.
The dyspnea improved with rest.  He had no chest pain, no nausea
or vomiting, no diaphoresis and no palpitations.  Apparently, the
dyspnea continued for the next ten days, usually worse in the
morning.  He did not have paroxysmal nocturnal dyspnea and he
did not have orthopnea (never required any pillows).  Two
days prior to admission he went out to breakfast and noted a
sudden acute worsening of his dyspnea, again without chest pain,
diaphoresis, nausea, vomiting, palpitations.
Of note, he did not notice any lower extremity swelling during
the entire period.  He went to an outside hospital where a chest
x-ray showed congestive heart failure.  His brain natiuretic
peptide (BNP) was positive at 225.  He was given intravenous
Lasix with improvement in his symptoms and then transferred to
the [**Hospital1 69**] for evaluation, work-up
of etiology of the congestive heart failure and further
management.

MEDICAL HISTORY: 1.  Myocardial infarction, coronary artery bypass graft times
three 22 years ago.
2.  Abdominal aortic aneurysm repair ten years ago.
3.  Abdominal hernia status post repair times three.
4.  Hypertension.
5.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 1.  Lipitor 10 mg q. day.
2.  Atenolol 12.5 mg q. day.
3.  Aspirin 325 mg q. day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His father died from a myocardial infarction at
age 61, his brother possibly from an myocardial infarction at age
41.  His son had angioplasty at age 37.  There is no family
history of diabetes mellitus and a daughter with adrenal cancer
with no other cancer in the family.

SOCIAL HISTORY: He lives with his wife and daughter in [**Name (NI) 104812**].  He is a retired cabinet maker.  He has a 50 pack year
history of smoking; quit about 10 to 12 years ago. Rarely drinks
alcohol and denies use of any other illicit drugs.
Congestive heart failure, unspecified,Acute kidney failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Postinflammatory pulmonary fibrosis,Pure hypercholesterolemia,Unspecified essential hypertension,Aortocoronary bypass status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
CHF NOS,Acute kidney failure NOS,Accidental op laceration,Postinflam pulm fibrosis,Pure hypercholesterolem,Hypertension NOS,Aortocoronary bypass,Abn react-cardiac cath
Name:  [**Known lastname 12523**], [**Known firstname 2794**]                    Unit No:  [**Numeric Identifier 17025**]

Admission Date:  [**2144-7-28**]     Discharge Date:  [**2144-8-5**]

Date of Birth:   [**2067-12-24**]     Sex:  M

Service:

Addendum:

DISCHARGE DIAGNOSES:
1.  Congestive heart failure
2.  Pulmonary fibrosis, likely idiopathic




                          [**Name6 (MD) 1034**] [**Name8 (MD) 1035**], M.D.  [**MD Number(1) 1036**]

Dictated By:[**Last Name (NamePattern1) 1437**]

MEDQUIST36

D:  [**2144-8-7**]  22:04
T:  [**2144-8-11**]  10:50
JOB#:  [**Job Number 17026**]


Admission Date:  [**2144-7-28**]     Discharge Date:  [**2144-8-5**]

Date of Birth:   [**2067-12-24**]     Sex:  M

Service:  MEDICINE
HISTORY OF PRESENT ILLNESS:   The patient is a 76 year old man
who developed dyspnea ten days prior to the day of admission with
progressive worsening.  He was in his usual state of health prior
to this, able to climb one flight of stairs, but noticed starting
about ten days ago that he needed to rest to be able to do so.
The dyspnea improved with rest.  He had no chest pain, no nausea
or vomiting, no diaphoresis and no palpitations.  Apparently, the
dyspnea continued for the next ten days, usually worse in the
morning.  He did not have paroxysmal nocturnal dyspnea and he
did not have orthopnea (never required any pillows).  Two
days prior to admission he went out to breakfast and noted a
sudden acute worsening of his dyspnea, again without chest pain,
diaphoresis, nausea, vomiting, palpitations.
Of note, he did not notice any lower extremity swelling during
the entire period.  He went to an outside hospital where a chest
x-ray showed congestive heart failure.  His brain natiuretic
peptide (BNP) was positive at 225.  He was given intravenous
Lasix with improvement in his symptoms and then transferred to
the [**Hospital1 69**] for evaluation, work-up
of etiology of the congestive heart failure and further
management.

REVIEW OF SYSTEMS:  Review of systems was also negative for
cough, sputum production, sick contacts, dietary changes.  He
denies eating salty or pickled foods, new medications, sore
throats or recent travel.

PAST MEDICAL HISTORY:
1.  Myocardial infarction, coronary artery bypass graft times
three 22 years ago.
2.  Abdominal aortic aneurysm repair ten years ago.
3.  Abdominal hernia status post repair times three.
4.  Hypertension.
5.  Hypercholesterolemia.

MEDICATIONS ON ADMISSION:
1.  Lipitor 10 mg q. day.
2.  Atenolol 12.5 mg q. day.
3.  Aspirin 325 mg q. day.

ALLERGIES:   No known drug allergies.

FAMILY HISTORY:   His father died from a myocardial infarction at
age 61, his brother possibly from an myocardial infarction at age
41.  His son had angioplasty at age 37.  There is no family
history of diabetes mellitus and a daughter with adrenal cancer
with no other cancer in the family.

SOCIAL HISTORY:   He lives with his wife and daughter in [**Name (NI) 104812**].  He is a retired cabinet maker.  He has a 50 pack year
history of smoking; quit about 10 to 12 years ago. Rarely drinks
alcohol and denies use of any other illicit drugs.

PHYSICAL EXAMINATION:   Temperature was 98.8 F.; heart rate
64; blood pressure 100/58; heart rate of 18.  His oxygen
saturation was 93% on two liters.  On general examination he
was in no acute distress.  His HEENT revealed anicteric
sclerae.  Pupils were equal, round and reactive.  His
oropharynx was clear.  His neck was supple with no
lymphadenopathy and no jugular venous distention.  His
pulmonary examination showed bibasilar crackles about [**12-20**] to
1/3 up from the base, clear otherwise.  His heart examination
was regular rate and rhythm with normal S1, S2, with no
murmurs, rubs or gallops and no S3.  His abdomen was soft,
nontender, with active bowel sounds and an abdominal hernia
present.  There was no bruit appreciated.  The extremities
showed no edema.

On neurologic examination he was oriented times three.  His
cranial nerves II through XII were intact except for
decreased hearing with severely decreased hearing on the
right side and a hearing aid on the left ear.  Motor and
sensory examination were intact.  His reflexes were two in
the upper extremities, two in the knee and absent in the
Achilles tendon reflex.  The toes were downgoing.

LABORATORY:  Initial laboratory studies were white blood cell
count of 11.3, hematocrit 47.2, platelets 192.  Sodium 140,
potassium 4.7, chloride 101, bicarbonate 24, BUN 42,
creatinine 1.4 up from a baseline of 1.0, and a glucose of
129.  Initial CK was 29 with a troponin of less than 0.3.

EKG showed normal sinus rhythm without ST changes.

Chest x-ray was read as no definite congestive heart failure,
chronic obstructive pulmonary disease with bilateral
predominantly lower zone interstitial disease, increased
since prior study of [**2142-6-14**], with new ground glass
opacities in the lower zones that might be evidence of
inflammatory/infectious process.

HOSPITAL COURSE:   The patient was admitted to the Medicine
Service with a plan for a cardiac work-up of his congestive heart
failure as well as a pulmonary follow-up on the chest x-ray
findings.  The hospital course by issues was as follows:

1.  Cardiovascular:  The patient had had a normal exercise
stress echocardiogram in [**2144-4-15**], and the plan was to repeat
the echocardiogram and the stress test during the current
hospitalization.  He did require oxygen by nasal cannula to
maintain his oxygen saturations.  He was continued on his aspirin
and Atenolol, was given intravenous Lasix with good response,
however, his x-ray situation did not improve
much.

He did have an echocardiogram on [**7-29**], which was a limited study
but read as largely normal with an ejection fraction of 55 to
65%, with the possibility of diastolic dysfunction.  He underwent
an exercise stress test on [**2144-7-30**].  His stress images
showed a moderate inferior wall perfusion defect; resting
perfusion images showed significant reversibility of the
perfusion defect.

The patient's creatinine remained in the 1.2 to 1.4 range.  A
repeat chest x-ray showed no evidence of congestive heart failure
but persistent ground glass opacities and diuresis was stopped.
The patient continued to require oxygen by nasal cannula in order
to maintain oxygen saturation at 93 to 95% on two liters.

On [**7-31**], the patient was taken to the Catheterization
Laboratory for cardiac catheterization which revealed a total
diffusely diseased left middle coronary artery with total distal
occlusion, a total occlusion of the left anterior descending,
left circumflex and right coronary artery.  A 90% focal lesion of
his saphenous vein graft to right coronary artery and patency of
the saphenous vein graft to left anterior descending and
saphenous vein graft to obtuse marginal.

During catheterization, an attempt was made to dilate the focal
lesion of the saphenous vein graft to right coronary artery.
Post-dilation angiography revealed a vein graft perforation.  His
hemodynamics remained stable and the perforation was stented and
the patient was started on Plavix, Integrilin and admitted to the
Coronary Care Unit for overnight observation.

During the Coronary Care Unit stay he suffered from an
anaphylactic reaction requiring intravenous steroids, Benadryl
and Cimetidine.  The etiology of this unclear but the timing
suggested either Plavix or Integrilin as well as potentially the
contrast from the cardiac catheterization.  The Plavix and
Integrilin were discontinued and he was started on a 30 day
course of Ticlid and returned to the Medical Floor on [**8-3**] in
stable condition.

He had received a large amount of intravenous fluids during his
Coronary Care Unit stay and a chest CT scan as well as a chest x-
ray showed renewed congestive heart failure.  He improved with
diuresis and repeat chest x-rays again suggested no congestive
heart failure and again demonstrated bilateral ground glass
opacities.

2.  Pulmonary:  After the patient was thought to have cleared
his congestive heart failure, he underwent a high resolution CT
scan to further evaluate the possible underlying lung disease on
[**8-4**].  The chest CT scan demonstrated two well marginated
pulmonary nodules, one in the right upper lobe, which has been
stable for greater than two years with eccentric calcification
and a second nodule in the left base that had not been previously
seen.  The chest CT scan also showed peripheral subpleural
pulmonary fibrosis with bronchiectasis, honeycombing and subtle
ground glass opacities consistent with idiopathic pulmonary
fibrosis or collagen vascular disease.

The Pulmonary Service was consulted and felt that the patient's
findings were most consistent with idiopathic pulmonary fibrosis
and the plan was to follow-up with the Pulmonary Service as an
outpatient for further work-up.

The patient did continue to require oxygen to maintain baseline
saturation of 93 to 95% on two liters.  When taken off oxygen and
walked, his saturations dropped to the 84 to 88% range, however,
he stated that he felt that his breathing was normal suggesting
that he has been slightly hypoxic for a longer period of time
than originally suspected.

3.  Renal:  The patient's creatinine stayed steady in the 1.2
to 1.4 range during this admission.  Given that his baseline was
1.1, he was not discharged on an ACE inhibitor.  This can be
started at a later point as an outpatient.

DISCHARGE INSTRUCTIONS:
1.  The patient was discharged on [**8-5**] with instructions
to follow-up with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **].
2.  To follow-up with his new Cardiologist, Dr. [**Last Name (STitle) **].
3.  To follow-up with the Pulmonary Service for pulmonary
function tests and for further evaluation.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:   Full Code.

DISCHARGE MEDICATIONS:
1.  Lipitor 10 mg q. day.
2.  Atenolol 25 mg q. day.
3.  Aspirin 325 mg q. day.
4.  Ticlodopine 250 mg twice a day times 30 days.
5.  Oxygen via nasal cannula, two liters per minute, titrate
as needed.

                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4446**]

Dictated By:[**Last Name (NamePattern1) 423**]

MEDQUIST36

D:  [**2144-8-7**]  22:02
T:  [**2144-8-15**]  19:55
JOB#:  [**Job Number 104813**]
{'Congestive heart failure, unspecified,Acute kidney failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Postinflammatory pulmonary fibrosis,Pure hypercholesterolemia,Unspecified essential hypertension,Aortocoronary bypass status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: The patient is a 76 year old man
who developed dyspnea ten days prior to the day of admission with
progressive worsening.  He was in his usual state of health prior
to this, able to climb one flight of stairs, but noticed starting
about ten days ago that he needed to rest to be able to do so.
The dyspnea improved with rest.  He had no chest pain, no nausea
or vomiting, no diaphoresis and no palpitations.  Apparently, the
dyspnea continued for the next ten days, usually worse in the
morning.  He did not have paroxysmal nocturnal dyspnea and he
did not have orthopnea (never required any pillows).  Two
days prior to admission he went out to breakfast and noted a
sudden acute worsening of his dyspnea, again without chest pain,
diaphoresis, nausea, vomiting, palpitations.
Of note, he did not notice any lower extremity swelling during
the entire period.  He went to an outside hospital where a chest
x-ray showed congestive heart failure.  His brain natiuretic
peptide (BNP) was positive at 225.  He was given intravenous
Lasix with improvement in his symptoms and then transferred to
the [**Hospital1 69**] for evaluation, work-up
of etiology of the congestive heart failure and further
management.

MEDICAL HISTORY: 1.  Myocardial infarction, coronary artery bypass graft times
three 22 years ago.
2.  Abdominal aortic aneurysm repair ten years ago.
3.  Abdominal hernia status post repair times three.
4.  Hypertension.
5.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 1.  Lipitor 10 mg q. day.
2.  Atenolol 12.5 mg q. day.
3.  Aspirin 325 mg q. day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His father died from a myocardial infarction at
age 61, his brother possibly from an myocardial infarction at age
41.  His son had angioplasty at age 37.  There is no family
history of diabetes mellitus and a daughter with adrenal cancer
with no other cancer in the family.

SOCIAL HISTORY: He lives with his wife and daughter in [**Name (NI) 104812**].  He is a retired cabinet maker.  He has a 50 pack year
history of smoking; quit about 10 to 12 years ago. Rarely drinks
alcohol and denies use of any other illicit drugs. 

### Response:
{'Congestive heart failure, unspecified,Acute kidney failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Postinflammatory pulmonary fibrosis,Pure hypercholesterolemia,Unspecified essential hypertension,Aortocoronary bypass status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
