CHIEF COMPLAINT: Altered mental status.

PRESENT ILLNESS: Mr. [**Known lastname 80687**] is a 82-yo-man who presented with altered mental
status x 2 weeks.  He has baseline dementia, but over 2 weeks
PTA with increased agitation and difficulty walking, progressive
inability to perform ADLs.  Has had recent falls, but no head
trauma, syncope, or dyspnea.

MEDICAL HISTORY: HTN, PAF, AVNRT s/p ablation [**2154**], IDDM w/ nephropathy/
neuropathy/ retinopathy, h/o CVA '[**46**], ESRD on HD t/t/s, gout,
colonic polyps, BPH s/p rsxn, PVD, hyperlipidemia, dementia,
depression

MEDICATION ON ADMISSION: ASA 325 QD
Norvasc 5 QD
Phoslo 667 TID
NPH 14 U QAM
RISS
Hydralazine 30 QD
Lipitor 10 qhs
Metoprolol 12.5 QD
Quinidine 100 TID
Lisinopril 10 QD
Vitamin C
Ocufer ? QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen:  awake, alert, nad
HEENT:  PERRLA, anicteric, EOMI, no JVD
CV:  irregular s1/s2, no s3/s4/m/r
Pulm:  slight crackles at lung bases bilaterally
Abd:  soft, NT, +BS
Extrem:  chronic skin pigment changes bilaterally, cool, trace
DP pulses B, trace edema to knees B.
Neuro:  oriented x 1 (person only), 5/5 strength throughout, CN
[**12-28**] intact.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Lives in [**Location **] with wife.
Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Other persistent mental disorders due to conditions classified elsewhere,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes
AMI anterior wall, init,CHF NOS,Hyp kid NOS w cr kid V,Atrial fibrillation,Crnry athrscl natve vssl,Pure hypercholesterolem,Mental disor NEC oth dis,DMII neuro nt st uncntrl,Neuropathy in diabetes
Admission Date:  [**2159-5-29**]              Discharge Date:   [**2159-6-1**]


Service: [**Hospital Unit Name 196**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2356**]
Chief Complaint:
Altered mental status.

Major Surgical or Invasive Procedure:
Cardiac catheterization ([**2159-5-29**]):  stent placement in LAD and
RCA.


History of Present Illness:
Mr. [**Known lastname 80687**] is a 82-yo-man who presented with altered mental
status x 2 weeks.  He has baseline dementia, but over 2 weeks
PTA with increased agitation and difficulty walking, progressive
inability to perform ADLs.  Has had recent falls, but no head
trauma, syncope, or dyspnea.

In ED had negative head CT, CXR showed mild CHF, EKG notable for
1-1.[**Street Address(2) 1755**] elevations in V2-V3.  Pt taken to cath lab for
immediate intervention after receiving ASA, NTG gt, and heparin
gtt.

Past Medical History:
HTN, PAF, AVNRT s/p ablation [**2154**], IDDM w/ nephropathy/
neuropathy/ retinopathy, h/o CVA '[**46**], ESRD on HD t/t/s, gout,
colonic polyps, BPH s/p rsxn, PVD, hyperlipidemia, dementia,
depression


Social History:
Lives in [**Location **] with wife.

Family History:
Non-contributory.

Physical Exam:
Gen:  awake, alert, nad
HEENT:  PERRLA, anicteric, EOMI, no JVD
CV:  irregular s1/s2, no s3/s4/m/r
Pulm:  slight crackles at lung bases bilaterally
Abd:  soft, NT, +BS
Extrem:  chronic skin pigment changes bilaterally, cool, trace
DP pulses B, trace edema to knees B.
Neuro:  oriented x 1 (person only), 5/5 strength throughout, CN
[**12-28**] intact.

Pertinent Results:
[**2159-5-31**] 06:15AM BLOOD WBC-4.8 RBC-3.65* Hgb-11.3* Hct-36.2*
MCV-99* MCH-30.9 MCHC-31.2 RDW-17.7* Plt Ct-84*
[**2159-5-29**] 12:35PM BLOOD Neuts-85.1* Lymphs-9.0* Monos-5.1 Eos-0.7
Baso-0.1
[**2159-5-31**] 06:15AM BLOOD Plt Ct-84*
[**2159-5-31**] 06:15AM BLOOD Glucose-223* UreaN-46* Creat-5.7*# Na-140
K-4.6 Cl-99 HCO3-25 AnGap-21*
[**2159-5-30**] 05:50AM BLOOD CK(CPK)-26*
[**2159-5-30**] 05:50AM BLOOD CK-MB-NotDone cTropnT-1.96*
[**2159-5-29**] 12:35PM BLOOD CK-MB-NotDone cTropnT-1.51*
[**2159-5-31**] 06:15AM BLOOD Calcium-8.1* Phos-5.2* Mg-2.2
[**2159-5-29**] 12:35PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

Brief Hospital Course:
1.  STEMI:  evaluated in ER, found to be in ST elevation MI,
sent to cath lab for immediate intervention.  Cath completed
with stents placed in LAD and RCA, no complications.  Monitored
on the cardiac med floor for 72 hours with no significant
events.  Vital signs were stable and he remained asymptomatic
during his recovery.  After cath, medical management was
continued with ASA, plavix, BB, ACEI, and statin.

2.  CHF:  remained without significant peripheral or pulm edema
throughout admission.  Was kept on fluid restriction at 1.5L/day
and received hemodialysis x 1 during his hospital stay with good
success.

3.  PAF:  he remained with normal sinus rhythm on quinidine
during his admission.

4. ESRD:  received HD once during admission, with no
complications.

5. DM:  blood glucose welll-controlled during admission with
outpt NPH regimen.

6.  Thrombocytopenia:  platelets low at admission with unclear
etiology.  This was prior to receiving heparin, so HIT is not
likely.  Platelets have consistently increased in the hospital,
now at 85 at DC.

7.  HTN:  not well-controlled at admission.  We increased
captopril dose to 50 mg PO QD with fair response, but BP remains
with sub-optimal control at DC.

8.  Mental status:  he was disoriented at admission, with marked
somnolence/confusion after cath.  MS progressively improved
throughout stay; at DC, remains with variable confusion, but at
best is verbally interactive and oriented to person and
sometimes place.

Medications on Admission:
ASA 325 QD
Norvasc 5 QD
Phoslo 667 TID
NPH 14 U QAM
RISS
Hydralazine 30 QD
Lipitor 10 qhs
Metoprolol 12.5 QD
Quinidine 100 TID
Lisinopril 10 QD
Vitamin C
Ocufer ? QHS

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD (once a day).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO QD
(once a day).
Disp:*60 Tablet(s)* Refills:*2*
4. Calcium Acetate (Phos Binder) 667 mg Tablet Sig: One (1)
Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*90 Tablet(s)* Refills:*2*
5. Quinidine Sulfate 200 mg Tablet Sig: 0.5 Tablet PO Q8H (every
8 hours).
Disp:*45 Tablet(s)* Refills:*2*
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
Disp:*30 Tablet(s)* Refills:*2*
7. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig:
1.5 Tablet Sustained Release 24HRs PO QD (once a day).
Disp:*45 Tablet Sustained Release 24HR(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] - [**Location (un) **]

Discharge Diagnosis:
ST elevation myocardial infarction status post stent placement.


Discharge Condition:
Stable to go to extended care.

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1.5L/day.

Take all medications as prescribed.  Return to ER for evaluation
if you have chest pain, significant Shorntess of Breath, fevers,
bleeding, dizziness/light-headedness.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 354**] [**Last Name (NamePattern4) 3013**], M.D. Where: [**Hospital6 29**]
[**Hospital3 1935**] CENTER Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2159-7-18**] 9:45

Follow-up with PCP ([**Last Name (LF) **],[**First Name3 (LF) 1730**] [**0-0-**]) in [**1-18**]
weeks.


                             [**First Name4 (NamePattern1) 1730**] [**Last Name (NamePattern1) **] MD [**MD Number(1) 2362**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Other persistent mental disorders due to conditions classified elsewhere,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes'}


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: Altered mental status.

PRESENT ILLNESS: Mr. [**Known lastname 80687**] is a 82-yo-man who presented with altered mental
status x 2 weeks.  He has baseline dementia, but over 2 weeks
PTA with increased agitation and difficulty walking, progressive
inability to perform ADLs.  Has had recent falls, but no head
trauma, syncope, or dyspnea.

MEDICAL HISTORY: HTN, PAF, AVNRT s/p ablation [**2154**], IDDM w/ nephropathy/
neuropathy/ retinopathy, h/o CVA '[**46**], ESRD on HD t/t/s, gout,
colonic polyps, BPH s/p rsxn, PVD, hyperlipidemia, dementia,
depression

MEDICATION ON ADMISSION: ASA 325 QD
Norvasc 5 QD
Phoslo 667 TID
NPH 14 U QAM
RISS
Hydralazine 30 QD
Lipitor 10 qhs
Metoprolol 12.5 QD
Quinidine 100 TID
Lisinopril 10 QD
Vitamin C
Ocufer ? QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen:  awake, alert, nad
HEENT:  PERRLA, anicteric, EOMI, no JVD
CV:  irregular s1/s2, no s3/s4/m/r
Pulm:  slight crackles at lung bases bilaterally
Abd:  soft, NT, +BS
Extrem:  chronic skin pigment changes bilaterally, cool, trace
DP pulses B, trace edema to knees B.
Neuro:  oriented x 1 (person only), 5/5 strength throughout, CN
[**12-28**] intact.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Lives in [**Location **] with wife. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Other persistent mental disorders due to conditions classified elsewhere,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes'}
