CHIEF COMPLAINT: Dyspnea on exertion.

PRESENT ILLNESS: Mr. [**Known lastname **] is a 39 year-old
gentleman with a past medical history of pulmonary
sarcoidosis recently diagnosed congestive heart failure who
was transferred to [**Hospital1 18**] for cardiac hesitation due to recent
symptomatic exacerbation.  His cardiac history dates back to
[**2184-6-20**] where he presented with symptoms of congestive
heart failure.  TTE revealed mild right ventricle dilatation
with preserved function, severe global left ventricular
hypokinesis, inferior and posterior wall akinesis with an EF
of 20%, moderate MR [**First Name (Titles) **] [**Last Name (Titles) **] PA systolic pressure around
15 mmHg.  On [**7-21**] the Holter showed recurrent
nonsustained ventricular tachycardia for which he had an
electrophysiology study done, which was noninducible for
ventricular tachycardia.  He had a cardiac catheterization in
[**Month (only) 216**], which revealed severe biventricular failure with mild
pulmonary hypertension, 2+ mitral regurgitation and normal
coronary arteries.  An RV endomyocardial biopsy was negative
for sarcoidosis.  He was admitted to the Coronary Care Unit
for Milrinone drip and for several days after the
catheterization.  In [**2184-8-21**] an AICD was placed
prophylactically for ventricular ectopy.

MEDICAL HISTORY: 1.  Pulmonary sarcoidosis diagnosed in
[**2179**].  ESR was 5, base was 16.  Chest x-ray revealed stable
perihilar parenchymal changes.  His last pulmonary function
tests from [**2185-1-27**] was FVC 53%, FEV1 1.85, FEV1 was 1.85,
FEV/FVC was 86%, total lung capacity 55%, forced 0 capacity
44%.  2.  Congestive heart failure from idiopathic dilated
cardiomyopathy.  The patient's biopsy was negative for
sarcoidosis.  He has an EF of 20%.  3.  Runs of nonsustained
ventricular tachycardia status post ICD placement.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Brother with congenital heart disease.

SOCIAL HISTORY: He is married.  He lives in [**State 20651**].  He drinks alcohol socially until this summer.
Congestive heart failure, unspecified,Other primary cardiomyopathies,Sarcoidosis,Primary pulmonary hypertension,Automatic implantable cardiac defibrillator in situ
CHF NOS,Prim cardiomyopathy NEC,Sarcoidosis,Prim pulm hypertension,Status autm crd dfbrltr
Admission Date:  [**2185-2-9**]     Discharge Date:  [**2185-2-16**]

Date of Birth:   [**2145-9-3**]     Sex:  M

Service:  CCU

CHIEF COMPLAINT:  Dyspnea on exertion.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 39 year-old
gentleman with a past medical history of pulmonary
sarcoidosis recently diagnosed congestive heart failure who
was transferred to [**Hospital1 18**] for cardiac hesitation due to recent
symptomatic exacerbation.  His cardiac history dates back to
[**2184-6-20**] where he presented with symptoms of congestive
heart failure.  TTE revealed mild right ventricle dilatation
with preserved function, severe global left ventricular
hypokinesis, inferior and posterior wall akinesis with an EF
of 20%, moderate MR [**First Name (Titles) **] [**Last Name (Titles) **] PA systolic pressure around
15 mmHg.  On [**7-21**] the Holter showed recurrent
nonsustained ventricular tachycardia for which he had an
electrophysiology study done, which was noninducible for
ventricular tachycardia.  He had a cardiac catheterization in
[**Month (only) 216**], which revealed severe biventricular failure with mild
pulmonary hypertension, 2+ mitral regurgitation and normal
coronary arteries.  An RV endomyocardial biopsy was negative
for sarcoidosis.  He was admitted to the Coronary Care Unit
for Milrinone drip and for several days after the
catheterization.  In [**2184-8-21**] an AICD was placed
prophylactically for ventricular ectopy.

Over the next several months congestive heart failure
improved from class three to class one and he was able to go
back to work on an assembly line.  Symptoms of dyspnea and
fatigue returned about a month ago when he began working
full time.  At that time he became several short of breath
when walking up a flight of stairs, which is consistent with
congestive heart failure class three.  His medications had
been adjusted in the past several weeks with resulting
hypertension.  He had a stress test on [**2185-2-8**] to evaluate
exercise tolerance where he exercised for fifteen minutes on
the Dobutamine protocol, which was then stopped for
hypertension at peak exercise.  His blood pressures decreased
from 112/60 to 90/64.  He was taken for a cardiac
catheterization on [**2185-2-9**], which showed a PA sat prior to
dobutamine was 59%.  After 8 micrograms per kilogram of
Dobutamine was 70%.  Before Dobutamine his pulmonary
capillary wedge pressure was 32, PA of 41, right atrial
pressure of HRV pressure 55/8, PA pressures of 55/29 with a
mean of 39.  After the Dobutamine his PA pressures were 58/20
with a mean of 38.  Pulmonary capillary wedge pressure was 25
with V wave of 40.

He was then transferred to the Coronary Care Unit on
Dobutamine drip.  Hemodynamic monitoring, diuresis were
continued and anatropic support.  He was also being
considered for a cardiac transplant.

PAST MEDICAL HISTORY:  1.  Pulmonary sarcoidosis diagnosed in
[**2179**].  ESR was 5, base was 16.  Chest x-ray revealed stable
perihilar parenchymal changes.  His last pulmonary function
tests from [**2185-1-27**] was FVC 53%, FEV1 1.85, FEV1 was 1.85,
FEV/FVC was 86%, total lung capacity 55%, forced 0 capacity
44%.  2.  Congestive heart failure from idiopathic dilated
cardiomyopathy.  The patient's biopsy was negative for
sarcoidosis.  He has an EF of 20%.  3.  Runs of nonsustained
ventricular tachycardia status post ICD placement.

MEDICATIONS:  Coreg 12.5 mg po b.i.d., Zestril 5 mg po q.d.,
Lasix 40 mg po q.d., Tikosyn 0.25 mg b.i.d., aspirin 81 mg po
q.d.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  He is married.  He lives in [**State 20651**].  He drinks alcohol socially until this summer.

FAMILY HISTORY:  Brother with congenital heart disease.

PHYSICAL EXAMINATION:  Vital signs, temperature 98.  Heart
rate 97.  Blood pressure 110/70.  Respiratory rate 19.  O2
sats 96%.  Oxygen saturation was 93%.  Pulmonary pressure was
50/26.  Mean PA pressure was 38.  Cardiac output 5.3.
Cardiac index 2.45 on 8 mics per kilogram per minute of
Dobutamine.  Weight was 90 kilograms.  In general he was a
middle aged man lying comfortably in no acute distress.
HEENT pupils are equal, round and reactive to light.
Extraocular movements intact.  Oropharynx moist and
nonerythematous.  Neck supple.  JVP to 7 cm.  Chest clear to
auscultation anteriorly.  Heart regular rate and rhythm,
intermittent S3 with no murmurs or rubs.  Abdomen soft,
nontender, nondistended with good bowel sounds.  Extremities
no clubbing, cyanosis or edema.  2+ dorsalis pedis pulses
bilaterally.  He has a right arterial line and right vein
sheath with a Swan in place.

LABORATORY:  White blood cell count 4.4, hematocrit 39.8,
platelets 303, sodium 140, potassium 4.1, chloride 101,
bicarb 20, BUN 21, creatinine 0.9, PT 13.8, PTT 31.4, INR
1.3, ALT 21, AST 18, alkaline phosphatase 107, total bili
0.9.  Arterial blood gas pH 7.4, PCO2 35, PAO2 84%.  Chest
x-ray revealed that he was in congestive heart failure.

HOSPITAL COURSE:  1.  Cardiovascular:  He was transferred to
the Coronary Care Unit on a Dobutamine drip with very good
cardiac indices.  He was fully diuresed to keep his PA
diastolic pressure to 17 mmHg and his Dobutamine drip was
fully weaned off.  Because his cardiac index remained above
2.20 and his systolic blood pressure was greater then 90 mmHg
for two days a Swan-Ganz catheter was discontinued.  Later on
his systolic blood pressure while sitting in a chair was
found to be consistently above 80 mmHg.  The arterial line
was discontinued and he was transferred to the floor on a 2
gram sodium diet with a 1.5 liter fluid restriction.  On the
floor he did exceptionally well with stable systolic blood
pressures above 80 with absolutely no shortness of breath on
ambulation.  During his admission he was evaluated as stated
for a cardiac transplant by the [**Hospital 4415**]
congestive heart failure team, a carotid ultrasound, ankle
brachial indices and 24 hour urine collection for creatinine
clearance and protein were obtained for a preop workup.  Upon
discharge the patient was issued a CT of his chest.  A CT
scan of his chest done on [**7-21**] for evaluation by the [**Hospital1 336**]
transplant team.  Captopril was added for after load
reduction and Digoxin was started to increase inotrophy.

2.  Pulmonary:  A pulmonary consult was obtained to evaluate
his pulmonary sarcoidosis.  They came to the conclusion that
there was no evidence of reactivation of his sarcoidosis.
They stated that they did not believe that the patient
warranted any treatment.  They also examined his recent
pulmonary function tests and determined that the patient
would tolerate any surgery well.  His O2 sats were well above
93% on room air by the time of discharge.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Discharged to home.

DISCHARGE MEDICATIONS:  Coreg 12.5 mg po b.i.d., Tikosyn 0.25
mg b.i.d., aspirin 81 mg po q.d., Digoxin 0.125 mg po q.d.,
Lasix 40 mg po q.d., Captopril 6.25 mg po t.i.d.

FOLLOW UP:  Return to the hospital if you develop worsening
shortness of breath or weight gain.  Follow up with Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] of [**Hospital1 18**] cardiology at her clinic in two and a
half weeks.  Please follow up with the CHF team via telephone
three times a week.

DISCHARGE DIAGNOSES:
1.  Congestive heart failure secondary to idiopathic dilated
cardiomyopathy.
2.  Pulmonary sarcoidosis.
3.  History of nonsustained ventricular tachycardia status
post AICD placement.



                          [**First Name11 (Name Pattern1) 420**] [**Last Name (NamePattern4) 421**], M.D.  [**MD Number(1) 422**]

Dictated By:[**Last Name (NamePattern1) 7690**]

MEDQUIST36

D:  [**2185-2-17**]  12:29
T:  [**2185-2-17**]  13:08
JOB#:  [**Job Number 35816**]
{'Congestive heart failure, unspecified,Other primary cardiomyopathies,Sarcoidosis,Primary pulmonary hypertension,Automatic implantable cardiac defibrillator in situ'}


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: Dyspnea on exertion.

PRESENT ILLNESS: Mr. [**Known lastname **] is a 39 year-old
gentleman with a past medical history of pulmonary
sarcoidosis recently diagnosed congestive heart failure who
was transferred to [**Hospital1 18**] for cardiac hesitation due to recent
symptomatic exacerbation.  His cardiac history dates back to
[**2184-6-20**] where he presented with symptoms of congestive
heart failure.  TTE revealed mild right ventricle dilatation
with preserved function, severe global left ventricular
hypokinesis, inferior and posterior wall akinesis with an EF
of 20%, moderate MR [**First Name (Titles) **] [**Last Name (Titles) **] PA systolic pressure around
15 mmHg.  On [**7-21**] the Holter showed recurrent
nonsustained ventricular tachycardia for which he had an
electrophysiology study done, which was noninducible for
ventricular tachycardia.  He had a cardiac catheterization in
[**Month (only) 216**], which revealed severe biventricular failure with mild
pulmonary hypertension, 2+ mitral regurgitation and normal
coronary arteries.  An RV endomyocardial biopsy was negative
for sarcoidosis.  He was admitted to the Coronary Care Unit
for Milrinone drip and for several days after the
catheterization.  In [**2184-8-21**] an AICD was placed
prophylactically for ventricular ectopy.

MEDICAL HISTORY: 1.  Pulmonary sarcoidosis diagnosed in
[**2179**].  ESR was 5, base was 16.  Chest x-ray revealed stable
perihilar parenchymal changes.  His last pulmonary function
tests from [**2185-1-27**] was FVC 53%, FEV1 1.85, FEV1 was 1.85,
FEV/FVC was 86%, total lung capacity 55%, forced 0 capacity
44%.  2.  Congestive heart failure from idiopathic dilated
cardiomyopathy.  The patient's biopsy was negative for
sarcoidosis.  He has an EF of 20%.  3.  Runs of nonsustained
ventricular tachycardia status post ICD placement.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Brother with congenital heart disease.

SOCIAL HISTORY: He is married.  He lives in [**State 20651**].  He drinks alcohol socially until this summer. 

### Response:
{'Congestive heart failure, unspecified,Other primary cardiomyopathies,Sarcoidosis,Primary pulmonary hypertension,Automatic implantable cardiac defibrillator in situ'}
