CHIEF COMPLAINT: sinus tachycardia and hypotension

PRESENT ILLNESS: Ms. [**Known lastname 20226**] is a 66yo F with MS, Afib, Chronic UTIs, transferred
from nursing home [**3-7**] hypotension 106/60 and tachycardia 118
noted in NH. In ambulance, repeat vitals were 108/82 and 110.
Pt. is a very poor historian, but per nursing home records and
limited pt. history, pt. had a PNA in early [**Month (only) 596**] treated with
levofloxacin, nebs. She denies fever, CP, SOB, urinary sx,
constipation/diarrhea. Does report non-productive cough, unclear
of chronicity.
Pt. in nursing home, not completely clear reasons, likely [**3-7**]
MS, but states she is at her baseline with re: to baseline
activity.

MEDICAL HISTORY: MS
Chronic UTIs
Afib on coumadin
Hypercholesterolemia

MEDICATION ON ADMISSION: 1. Nitrofurantoin (Macrodantin) 50 mg PO HS
2. Ranitidine 150 mg PO HS
3. Copaxone *NF* 20 mg Subcutaneous qday
4. Tizanidine HCl 4 mg PO BID
5. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
6. Senna 2 TAB PO HS
7. Docusate Sodium 100 mg PO BID
8. Vitamin E 400 UNIT PO DAILY
9. traZODONE HCl 50 mg PO HS
10.Coumadin 3mg, being held [**3-7**] supratherapeutic INR

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 96.5 BP: 142/80 HR: 107 RR:20 93%RA
Gen: tired-appearing elderly woman, NAD, wanting to watch red
sox game, with dry cough
HEENT: PERRL, EOMI, MMM
Lungs decreased BS at bases, egophany at bases, + crackles to
[**2-5**]
CV: RRR, nl s1s2no MRGs
Abd: soft, ND NT, +BS
Ext: warm, 2+ DP B, no edema.
Neuro: FS all 4 ext

FAMILY HISTORY: unable to elicit

SOCIAL HISTORY: moved to nursing home years ago, per pt. after husband [**Name (NI) 20227**]'t
care for her
Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Dehydration,Atrial fibrillation,Multiple sclerosis,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Retention of urine, unspecified,Abnormal coagulation profile,Long-term (current) use of anticoagulants,Pure hypercholesterolemia
Food/vomit pneumonitis,Acute respiratry failure,Dehydration,Atrial fibrillation,Multiple sclerosis,CHF NOS,Urin tract infection NOS,Retention urine NOS,Abnrml coagultion prfile,Long-term use anticoagul,Pure hypercholesterolem
Admission Date:  [**2109-8-30**]              Discharge Date:   [**2109-9-6**]

Date of Birth:  [**2043-7-11**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
sinus tachycardia and hypotension

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname 20226**] is a 66yo F with MS, Afib, Chronic UTIs, transferred
from nursing home [**3-7**] hypotension 106/60 and tachycardia 118
noted in NH. In ambulance, repeat vitals were 108/82 and 110.
Pt. is a very poor historian, but per nursing home records and
limited pt. history, pt. had a PNA in early [**Month (only) 596**] treated with
levofloxacin, nebs. She denies fever, CP, SOB, urinary sx,
constipation/diarrhea. Does report non-productive cough, unclear
of chronicity.
Pt. in nursing home, not completely clear reasons, likely [**3-7**]
MS, but states she is at her baseline with re: to baseline
activity.


Past Medical History:
MS
Chronic UTIs
Afib on coumadin
Hypercholesterolemia


Social History:
moved to nursing home years ago, per pt. after husband [**Name (NI) 20227**]'t
care for her

Family History:
unable to elicit

Physical Exam:
VS: T: 96.5 BP: 142/80 HR: 107 RR:20 93%RA
Gen: tired-appearing elderly woman, NAD, wanting to watch red
sox game, with dry cough
HEENT: PERRL, EOMI, MMM
Lungs decreased BS at bases, egophany at bases, + crackles to
[**2-5**]
CV: RRR, nl s1s2no MRGs
Abd: soft, ND NT, +BS
Ext: warm, 2+ DP B, no edema.
Neuro: FS all 4 ext


Pertinent Results:

TTE [**2112-9-4**]:

Marked tachycardiac (HR>140/min).
The left atrium is normal in size. Left ventricular wall
thicknesses and cavity size are normal. There is moderate to
severe global left ventricular hypokinesis. Basal segments
contract best. No left ventricular thormbus is identified, but
apical segments are not well visualized. The right ventricular
cavity is moderately dilated with severe global free wall
hypokinesis. There is abnormal septal motion/position consistent
with right ventricular pressure/volume overload. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion. Trace aortic regurgitation is seen. The mitral valve
leaflets are structurally normal. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. There is mild
pulmonary artery systolic hypertension. There is a
trivial/physiologic pericardial effusion. There is an anterior
space which most likely represents a fat pad.

IMPRESSION: Severe global left ventricular hypokinesis c/w
diffuse process (tachycardia, toxin, metabolic, multivessel CAD,
etc.). Right ventricular cavity enlargement with free wall
hypokinesis. Mild pulmonary artery systolic hypertension.

Based on [**2100**] AHA endocarditis prophylaxis recommendations, the
echo findings indicate a low risk (prophylaxis not recommended).
Clinical decisions regarding the need for prophylaxis should be
based on clinical and echocardiographic data.

[**9-4**] CXR:

IMPRESSION: AP chest compared to [**8-30**] through [**9-3**]:

ET tube, right internal jugular line, and nasogastric tube are
in standard
placements, respectively.

There has been no change over 48 hours in the severe
infiltrative abnormality
predominantly in the lower lungs. This is probably pulmonary
edema, cardiac
or otherwise. Heart is top normal size and there is persistent
but mild
distention of mediastinal veins and a small right pleural
effusion. No
pneumothorax.







Brief Hospital Course:
This is a 69 y/o female with a medical history significant for
MS, prior PE, recurrent pneumonias, who was admitted on [**2112-8-30**]
from her NH with hypotension and tachycardia.  Initial VS at the
NH were a BP of 106/60 and HR 118.  Her CXR upon admission
demonstrated bibasilar opacities consistent with infiltrate vs.
effusion with pulmonary edema, so she was given Ceftriaxone and
Metronidazole to cover possible CAP +/- aspiration PNA.
On [**2112-8-31**], the patient triggered for tachycardia with HR in the
140s.  Initial labs were significant for a normal D-dimer,
normal BNP, and normal cardiac enzymes.  Her heart rate
stabilized with fluid boluses; however she triggered again on
[**9-1**] with a HR of 150s and BP of 90/p, necessitating transfer to
the ICU. She was given adenosine with some improvement in her
heart rate.  She had evidence of volume overload by exam and
with a markedly elevated BNP, so she was initially treated with
lasix boluses as well as a diltizem drip for her tachycardia,
however the diltiazem was discontinued after consultation with
Cardiology, given her rhythm was consistent with sinus
tachycardia. An echocardiogram demonstrated acute systolic heart
failure, with a depressed EF of 20% and severe LV global
hypokinesis, consistent with a diffuse process (toxin,
metabolic, multivessal CAD, Takosubo's cardiomyopathy).  The
patient was intubated emergently overnight on [**2112-9-3**] due to
impending hypoxic respiratory failure.  She was continued on
lasix for diuresis, however was begun on vasopressor support
with levophed and dobumatine for persistent hypotension
secondary to cardiogenic shock.  Extensive work-up failed to
reveal an etiology for her acute systolic CHF.  The patient
failed to improve over the next few days and continued to have
persistent hypotension.
After discussion with the patient's husband and family regarding
her poor prognosis, it was decided that aggressive support would
be withdrawn on [**2112-9-6**].  The patient expired on [**2112-9-6**], at
approximately 220 AM.

Medications on Admission:
1. Nitrofurantoin (Macrodantin) 50 mg PO HS
2. Ranitidine 150 mg PO HS
3. Copaxone *NF* 20 mg Subcutaneous qday
4. Tizanidine HCl 4 mg PO BID
5. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
6. Senna 2 TAB PO HS
7. Docusate Sodium 100 mg PO BID
8. Vitamin E 400 UNIT PO DAILY
9. traZODONE HCl 50 mg PO HS
10.Coumadin 3mg, being held [**3-7**] supratherapeutic INR


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Acute pulmonary edema
Acute respiratory failure
Acute systolic heart failure
Hypotension

Discharge Condition:
Expired

Discharge Instructions:
None

Followup Instructions:
None

                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

Completed by:[**2112-8-16**]
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Dehydration,Atrial fibrillation,Multiple sclerosis,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Retention of urine, unspecified,Abnormal coagulation profile,Long-term (current) use of anticoagulants,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: sinus tachycardia and hypotension

PRESENT ILLNESS: Ms. [**Known lastname 20226**] is a 66yo F with MS, Afib, Chronic UTIs, transferred
from nursing home [**3-7**] hypotension 106/60 and tachycardia 118
noted in NH. In ambulance, repeat vitals were 108/82 and 110.
Pt. is a very poor historian, but per nursing home records and
limited pt. history, pt. had a PNA in early [**Month (only) 596**] treated with
levofloxacin, nebs. She denies fever, CP, SOB, urinary sx,
constipation/diarrhea. Does report non-productive cough, unclear
of chronicity.
Pt. in nursing home, not completely clear reasons, likely [**3-7**]
MS, but states she is at her baseline with re: to baseline
activity.

MEDICAL HISTORY: MS
Chronic UTIs
Afib on coumadin
Hypercholesterolemia

MEDICATION ON ADMISSION: 1. Nitrofurantoin (Macrodantin) 50 mg PO HS
2. Ranitidine 150 mg PO HS
3. Copaxone *NF* 20 mg Subcutaneous qday
4. Tizanidine HCl 4 mg PO BID
5. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
6. Senna 2 TAB PO HS
7. Docusate Sodium 100 mg PO BID
8. Vitamin E 400 UNIT PO DAILY
9. traZODONE HCl 50 mg PO HS
10.Coumadin 3mg, being held [**3-7**] supratherapeutic INR

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 96.5 BP: 142/80 HR: 107 RR:20 93%RA
Gen: tired-appearing elderly woman, NAD, wanting to watch red
sox game, with dry cough
HEENT: PERRL, EOMI, MMM
Lungs decreased BS at bases, egophany at bases, + crackles to
[**2-5**]
CV: RRR, nl s1s2no MRGs
Abd: soft, ND NT, +BS
Ext: warm, 2+ DP B, no edema.
Neuro: FS all 4 ext

FAMILY HISTORY: unable to elicit

SOCIAL HISTORY: moved to nursing home years ago, per pt. after husband [**Name (NI) 20227**]'t
care for her 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Dehydration,Atrial fibrillation,Multiple sclerosis,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Retention of urine, unspecified,Abnormal coagulation profile,Long-term (current) use of anticoagulants,Pure hypercholesterolemia'}
