CHIEF COMPLAINT: shortness of breath and weakness

PRESENT ILLNESS: 77 F with h/o Alzheimer's dementia, HTN, Hypothyroid,
osteoporosis presents from NH with 24 hrs of increasing
shortness of breath and weakness. Patient was unable to provide
any history which was obtained from ED physician and review of
chart. Upon arrival to the ED patient's O2 sat was 74% with
excellent response to NRB. Pt given 60 mg IV lasix and put out
1L of urine in [**1-21**] hrs. CXR c/w pulm edema with b/l effusions.
CPAP was attempted but unsuccessful. EKG showed STE in V2-6 and
I, II. Cardiac enzymes with mild troponin elevation and flat CK.
Cardiology was consulted in the ED and after discussion with
patients health care proxy decision was made to manage
medically. No cath, intubation, resucitation. In the ED given
Plavix, heparin, sl nigto, lasix. Patient also started on
Azithro/Ceftriaxone for ?aspiration PNA.

MEDICAL HISTORY: Dementia - ?[**Last Name (un) 309**] Body
HTN
hypothyroidism
?NPH with gait benefit post-LP (at [**Hospital1 2025**])
Ulcerative proctitis
Nephrocalcinosis
L urethrostomy
osteoporosis
Recurrent falls

MEDICATION ON ADMISSION: ALLERGIES: NKDA
.
CURRENT MEDICATIONS:
Synthroid 75 mg daily
Lisinopril 40 mg daily
Actonel 70 q week
Atenolol 37.5 mg daily
Aricept 10 mg daily
Namenda 10 mg [**Hospital1 **]
Sulfasalazine 500 [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Per Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Temp 98.6, BP 198/86 HR 74 RR 28 98% NRB
tachypneic but no accessory muscle use
JVD increased to jaw at 10-15 cm
crackles at bases
nl S1S2 RRR no MGR
no LE edema
abd BS+ ntnd soft

FAMILY HISTORY: Mother [**Name (NI) 68337**] of uterine cancer; Father died of CVA, also
increased EtOH use

SOCIAL HISTORY: Lives at [**Hospital3 **] facility. 3 daughters, oldest is
resident in [**State 2690**] and health care proxy. Divorced from first
husband. Remarried 20 years ago and second husband died 15y ago.
Has close male friend. Previously employed as Head of [**Name (NI) **]
Department
HCP is [**Name (NI) 26196**]: reachable at [**Telephone/Fax (1) 68336**]
Subendocardial infarction, initial episode of care,Atrial fibrillation,Diseases of tricuspid valve,Mitral valve disorders,Acute diastolic heart failure,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
Subendo infarct, initial,Atrial fibrillation,Tricuspid valve disease,Mitral valve disorder,Ac diastolic hrt failure,Chronic kidney dis NOS,Acute kidney failure NOS,Alzheimer's disease,Dementia w/o behav dist,Osteoporosis NOS,Hypothyroidism NOS,Hy kid NOS w cr kid I-IV
Admission Date:  [**2186-6-2**]              Discharge Date:   [**2186-6-8**]

Date of Birth:  [**2108-9-29**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2901**]
Chief Complaint:
shortness of breath and weakness

Major Surgical or Invasive Procedure:
none


History of Present Illness:
77 F with h/o Alzheimer's dementia, HTN, Hypothyroid,
osteoporosis presents from NH with 24 hrs of increasing
shortness of breath and weakness. Patient was unable to provide
any history which was obtained from ED physician and review of
chart. Upon arrival to the ED patient's O2 sat was 74% with
excellent response to NRB. Pt given 60 mg IV lasix and put out
1L of urine in [**1-21**] hrs. CXR c/w pulm edema with b/l effusions.
CPAP was attempted but unsuccessful. EKG showed STE in V2-6 and
I, II. Cardiac enzymes with mild troponin elevation and flat CK.
Cardiology was consulted in the ED and after discussion with
patients health care proxy decision was made to manage
medically. No cath, intubation, resucitation. In the ED given
Plavix, heparin, sl nigto, lasix. Patient also started on
Azithro/Ceftriaxone for ?aspiration PNA.

Past Medical History:
Dementia - ?[**Last Name (un) 309**] Body
HTN
hypothyroidism
?NPH with gait benefit post-LP (at [**Hospital1 2025**])
Ulcerative proctitis
Nephrocalcinosis
L urethrostomy
osteoporosis
Recurrent falls

Social History:
Lives at [**Hospital3 **] facility. 3 daughters, oldest is
resident in [**State 2690**] and health care proxy. Divorced from first
husband. Remarried 20 years ago and second husband died 15y ago.
Has close male friend. Previously employed as Head of [**Name (NI) **]
Department
HCP is [**Name (NI) 26196**]: reachable at [**Telephone/Fax (1) 68336**]




Family History:
Mother [**Name (NI) 68337**] of uterine cancer; Father died of CVA, also
increased EtOH use

Physical Exam:
Per Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Temp 98.6, BP 198/86 HR 74 RR 28 98% NRB
tachypneic but no accessory muscle use
JVD increased to jaw at 10-15 cm
crackles at bases
nl S1S2 RRR no MGR
no LE edema
abd BS+ ntnd soft


Pertinent Results:
EKG: NSR at 70, normal axis and intervals, mild ST elevations I,
II; V3-V6; pos LVH
.
141  106  46
--------------< 174
6.2  26  2.1
.
      12.5
15.9 >-----<  299
      36.6
N:90.9 L:5.3 M:3.6 E:0 Bas:0.1
.
PT: 11.5  PTT: 22.8  INR: 1.0
Admission CXR [**6-2**]: Perihilar and basilar pulmonary edema
accompanied by bilateral pleural effusions
.
Echo [**6-5**]: The left atrium is dilated. The right atrium is
moderately dilated. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. Overall
left ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and
free wall motion are normal.  The aortic valve leaflets are
mildly thickened. There is no aortic valve stenosis. Mild (1+)
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Moderate to severe (3+) mitral regurgitation
is seen. The tricuspid
valve leaflets are mildly thickened. Moderate [2+] tricuspid
regurgitation is seen. There is a trivial/physiologic
pericardial effusion. There is at least moderate to severe
pulmonary artery systolic hypertension.
.
trends:
WBC 15 - 11 - 12 - 8
Hct 36 - 29
Creatinine 2.1 - 3 - 2.2
K 4.9 - 5.8 - 5.0
CK [**Medical Record Number 68338**]
Trop 0.12 - 0.15
TSH 2.7
.
Micro:
Urine and blood cx NGTD

Brief Hospital Course:
Pt is a 77 F with h/o dementia (Alzheimer's vs. [**Last Name (un) 309**] body) from
NH presented with pulmonary edema.  Hospital course by problem
.
#) CAD: The patient had a concerning ECG as well as a troponin
leak.  We were concerned she had an NSTEMI.  Heparin, aspirin,
plavix, and metoprolol were administered.  We discussed options
of therapy with the patient's HCP who recommended no cardiac
catheterization.  Instead we optimized medical management of her
CAD.  She did not have any episodes of chest pain or acute
distress after her respiratory issues resolved.  On discharge,
she was on aspirin, plavix, and Toprol XL for CAD treatment.
.
#) Rhythm:  The patient developed atrial fibrillation with RVR.
It was difficult to rate control so we uptitrated metoprolol.
We also briefly treated with diltiazem gtt.  This was weaned and
she returned to NSR.  To maintain NSR upon discharge, amiodarone
was initiated.  We discharged her on a tapering regimen.  We
also discharged her with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts monitor to have
results obtained and faxed to Dr. [**Last Name (STitle) **] for med monitoring.  She
should continue on this medication unless told otherwise.  In
terms of anticoagulation, we discussed anticoagulation with the
patient's HCP.  [**Name (NI) 227**] her other medical issues, it was
determined that she is not a good anticoagulation candidate.
.
#) Pump:  Pump function as per echo.  On presentation, she was
hypertensive and tachycardic (with atrial fibrillation).  We
believe this led to diastolic dysfunction causing her acute
pulmonary edema.  With diuresis, blood pressure control, rate
and rhythm control her function improved.  She received
intermittent dosages of lasix 20IV if she had increased O2
requirement.
.
#) Acute on CRI: Patient has baseline Cr of 2.0.  After
diuresis, it increased to 3.0 but improved to 2.2 prior to
discharge.  We renally dosed meds.
.
#) HTN: She was quite hypertensive on admission and throughout
parts of her hospitalization.  We stopped the atenolol given her
Acute on CRI.  We started metoprolol and uptitrated.  She also
was on a nitro gtt initially (also for CHF).  Once this was
weaned to off, we initiated therapy with amlodipine as well as
HCTZ.  Her BP meds may need further adjustment as an outpatient.
 We held her lisinopril on admit given her ARF.  We continued to
hold it given her borderline hyperkalemia. She will be
discharged with Toprol XL 50mg po Qday, HZCT 25mg po qday, and
Amlodipine 10mg poi Qday.
.
#) Hypothyroidism: TSH normal.  rx with synthroid
.
#) Dementia: rx with home meds
.
#) FEN: regular with supplements
.
#) Dispo status: patient is minimally verbal.  She has
difficulty with simple commands.  She was on RA or up to only 2L
prior to discharge.  She was pleasant and comfortable.
.
#) Code: DNR/DNI.  Discussed with daughter/HCP.  She also
requests no escalation of care.  IE: no pressors or central
venous lines.
Comm: [**Name (NI) 26196**] daughter [**Telephone/Fax (1) 68336**]


Medications on Admission:
ALLERGIES: NKDA
.
CURRENT MEDICATIONS:
Synthroid 75 mg daily
Lisinopril 40 mg daily
Actonel 70 q week
Atenolol 37.5 mg daily
Aricept 10 mg daily
Namenda 10 mg [**Hospital1 **]
Sulfasalazine 500 [**Hospital1 **]


Discharge Medications:
1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO twice a day
for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
2. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
please take this dosage after 1 week of [**Hospital1 **].
Disp:*30 Tablet(s)* Refills:*2*
3. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Actonel 75 mg Tablet Sig: One (1) Tablet PO once a week.
5. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

6. Namenda 10 mg Tablet Sig: One (1) Tablet PO twice a day.
7. Sulfasalazine 500 mg Tablet Sig: One (1) Tablet PO twice a
day.
8. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
9. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
11. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
13. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
Units Injection TID (3 times a day).
14. Pantoprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
15. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed.
16. Memantine 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
17. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1186**] - [**Location (un) 538**]

Discharge Diagnosis:
Primary:
- CAD, likely NSTEMI
- CHF exacerbation with diastolic failure
- atrial fibrillation with rapid ventricular response
- Alzheimer's dementia
- hypertension
Secondary:
- hypothyroidism
- osteoporosis


Discharge Condition:
fair


Discharge Instructions:
You were admitted with increasing shortness of breath and
weakness.  You were treated with high dose oxygen and diuresis.
You had evidence of a heart attack.  After discussion with your
family, we opted to treat your heart failure and heart attack
with medications.  You also had a fast heart rate called atrial
fibrillation.  We changed some of your medications to assist
with control of the heart rate.  We also recommend that you use
[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of heart monitor to assess for any medication side
effects.
.
Please take your medications as instructed.  Please followup
with your PCP within the next 1-2 weeks.  Please have the heart
monitor results faxed to Dr. [**Last Name (STitle) **] as instructed while in the
hospital.
.
Please contact your PCP if you experience shortness of breath,
chest pain, palpitations, abdominal pain, worsening weakness.

Followup Instructions:
Please followup with your PCP within the next 1-2 weeks.
Please have the results of your heart monitor faxed to Dr. [**Name (NI) 65218**] office as instructed during your hospital stay.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**]
{"Subendocardial infarction, initial episode of care,Atrial fibrillation,Diseases of tricuspid valve,Mitral valve disorders,Acute diastolic heart failure,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified"}


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 weakness

PRESENT ILLNESS: 77 F with h/o Alzheimer's dementia, HTN, Hypothyroid,
osteoporosis presents from NH with 24 hrs of increasing
shortness of breath and weakness. Patient was unable to provide
any history which was obtained from ED physician and review of
chart. Upon arrival to the ED patient's O2 sat was 74% with
excellent response to NRB. Pt given 60 mg IV lasix and put out
1L of urine in [**1-21**] hrs. CXR c/w pulm edema with b/l effusions.
CPAP was attempted but unsuccessful. EKG showed STE in V2-6 and
I, II. Cardiac enzymes with mild troponin elevation and flat CK.
Cardiology was consulted in the ED and after discussion with
patients health care proxy decision was made to manage
medically. No cath, intubation, resucitation. In the ED given
Plavix, heparin, sl nigto, lasix. Patient also started on
Azithro/Ceftriaxone for ?aspiration PNA.

MEDICAL HISTORY: Dementia - ?[**Last Name (un) 309**] Body
HTN
hypothyroidism
?NPH with gait benefit post-LP (at [**Hospital1 2025**])
Ulcerative proctitis
Nephrocalcinosis
L urethrostomy
osteoporosis
Recurrent falls

MEDICATION ON ADMISSION: ALLERGIES: NKDA
.
CURRENT MEDICATIONS:
Synthroid 75 mg daily
Lisinopril 40 mg daily
Actonel 70 q week
Atenolol 37.5 mg daily
Aricept 10 mg daily
Namenda 10 mg [**Hospital1 **]
Sulfasalazine 500 [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Per Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Temp 98.6, BP 198/86 HR 74 RR 28 98% NRB
tachypneic but no accessory muscle use
JVD increased to jaw at 10-15 cm
crackles at bases
nl S1S2 RRR no MGR
no LE edema
abd BS+ ntnd soft

FAMILY HISTORY: Mother [**Name (NI) 68337**] of uterine cancer; Father died of CVA, also
increased EtOH use

SOCIAL HISTORY: Lives at [**Hospital3 **] facility. 3 daughters, oldest is
resident in [**State 2690**] and health care proxy. Divorced from first
husband. Remarried 20 years ago and second husband died 15y ago.
Has close male friend. Previously employed as Head of [**Name (NI) **]
Department
HCP is [**Name (NI) 26196**]: reachable at [**Telephone/Fax (1) 68336**] 

### Response:
{"Subendocardial infarction, initial episode of care,Atrial fibrillation,Diseases of tricuspid valve,Mitral valve disorders,Acute diastolic heart failure,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified"}
