CHIEF COMPLAINT: dyspnea, peripheral edema

PRESENT ILLNESS: 54 yo man currently undergoing evaluation for heart transplant
for severe cardiomyopathy previously treated with weekly
nesiritide infusions in [**Hospital 1902**] clinic admitted [**3-8**] with
progressive dyspnea, LE edema, and weight gain (home scale up to
315 lbs from 298) over the past two weeks.  Three weeks prior to
admission, pt was admitted to OSH for diuresis with furosemide.
Patient states his LE edema improved but was not diminished to
the same degree as it was following his hospitalization here in
[**1-28**].  Since his discharge from the OSH two weeks ago, he has
had progressive exertional dyspnea and LE edema despite
compliance with his sodium and volume restriction.  He phoned
the [**Hospital 1902**] clinic [**3-8**] and was referred for hospitalization for
tailored diuresis.

MEDICAL HISTORY: 1. Non-ischemic cardiomyopathy (LVEF 15-20% [**1-28**])
2. DM-II c/b neuropathy
3. hypertension
4. dyslipidemia
5. obesity
6. chronic renal failure (baseline Cr 1.6)
7. RLE cellulitis [**12-28**]
8. thyroid lymphoma s/p XRT [**2084**], now hypothyroid

MEDICATION ON ADMISSION: 1. carvedilol 25 mg twice daily
2. spironolactone 25 mg twice daily
3. furosemide 80 mg twice daily
4. lisinopril 10 mg once daily
5. metolazone 2.5 mg every Friday
6. NPH 15 units twice daily
7. potassium chloride 40 mEq once daily
8. glyburide 10 mg daily
9. aspirin 81 mg once daily
10. levothyroxine
11. colchicine 0.6 mg twice daily
12. gabapentin 800 mg twice daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp 98.7, BP 113/80, HR 69, RR 16, SpO2 98% RA
Gen: Very pleasant, comfortable, non-toxic
HEENT: Diminished but significant L > R maxillary sinus
tenderness, no frontal sinus tenderness
Neck: Soft, supple, no cervical adenopathy, 2+ carotid pulses,
minimal JVD (?7 cm, limited by body habitus), post-thyroidectomy
scar
CV: RRR, normal S1 and S2, no m/r/g
Pulm: CTA bilaterally
Abd: Soft, non-tender, non-distended, active bowel sounds
Back: No CVA or paraspinal tenderness
Ext: Trace BLE pitting edema, 2+ DP and 1+ PT pulses
bilaterally, right greater than left LE chronic venous stasis
changes, equal warmth bilaterally

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Pt is retired from owning a printing business. Works in wife's
daycare. Pt is married with three grown children. No EtOH. Quit
tobacco 20 yrs ago (smoked <1 pack per week).
Systolic heart failure, unspecified,Acute kidney failure, unspecified,Other primary cardiomyopathies,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified sinusitis (chronic),Retention of urine, unspecified,Other postablative hypothyroidism,Gout, unspecified,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Obesity, unspecified,Unspecified sleep apnea,Long-term (current) use of insulin,Personal history of malignant neoplasm of thyroid
Systolic hrt failure NOS,Acute kidney failure NOS,Prim cardiomyopathy NEC,DMII neuro nt st uncntrl,Hyp kid NOS w cr kid V,Chronic sinusitis NOS,Retention urine NOS,Postablat hypothyr NEC,Gout NOS,Chr pulmon heart dis NEC,Hyperlipidemia NEC/NOS,Neuropathy in diabetes,Obesity NOS,Sleep apnea NOS,Long-term use of insulin,Hx of thyroid malignancy
Admission Date:  [**2102-5-8**]              Discharge Date:   [**2102-5-13**]

Date of Birth:  [**2048-2-11**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9554**]
Chief Complaint:
dyspnea, peripheral edema

Major Surgical or Invasive Procedure:
1. Right heart catheterization


History of Present Illness:
54 yo man currently undergoing evaluation for heart transplant
for severe cardiomyopathy previously treated with weekly
nesiritide infusions in [**Hospital 1902**] clinic admitted [**3-8**] with
progressive dyspnea, LE edema, and weight gain (home scale up to
315 lbs from 298) over the past two weeks.  Three weeks prior to
admission, pt was admitted to OSH for diuresis with furosemide.
Patient states his LE edema improved but was not diminished to
the same degree as it was following his hospitalization here in
[**1-28**].  Since his discharge from the OSH two weeks ago, he has
had progressive exertional dyspnea and LE edema despite
compliance with his sodium and volume restriction.  He phoned
the [**Hospital 1902**] clinic [**3-8**] and was referred for hospitalization for
tailored diuresis.

Also of note, on [**3-8**] he noted maxillary > frontal sinus pain
with nasal discharge (initially brown, now chartreuse per
patient) and cough productive of similarly colored sputum.  No
f/c/s.  Symptoms are persistent but improving.  He has been
taking naproxen and OTC decongestants for relief.

He denies increasing orthopnea, chest pain, palpitations,
abdominal pain, n/v, diaphoresis, or dysuria.

Past Medical History:
1. Non-ischemic cardiomyopathy (LVEF 15-20% [**1-28**])
2. DM-II c/b neuropathy
3. hypertension
4. dyslipidemia
5. obesity
6. chronic renal failure (baseline Cr 1.6)
7. RLE cellulitis [**12-28**]
8. thyroid lymphoma s/p XRT [**2084**], now hypothyroid

Social History:
Pt is retired from owning a printing business. Works in wife's
daycare. Pt is married with three grown children. No EtOH. Quit
tobacco 20 yrs ago (smoked <1 pack per week).

Family History:
Non-contributory

Physical Exam:
Temp 98.7, BP 113/80, HR 69, RR 16, SpO2 98% RA
Gen: Very pleasant, comfortable, non-toxic
HEENT: Diminished but significant L > R maxillary sinus
tenderness, no frontal sinus tenderness
Neck: Soft, supple, no cervical adenopathy, 2+ carotid pulses,
minimal JVD (?7 cm, limited by body habitus), post-thyroidectomy
scar
CV: RRR, normal S1 and S2, no m/r/g
Pulm: CTA bilaterally
Abd: Soft, non-tender, non-distended, active bowel sounds
Back: No CVA or paraspinal tenderness
Ext: Trace BLE pitting edema, 2+ DP and 1+ PT pulses
bilaterally, right greater than left LE chronic venous stasis
changes, equal warmth bilaterally

Pertinent Results:
Labs on admission:

WBC-7.2 (N-80.4 L-10.6 M-6.0 E-2.8 B-0.3) Hct-48.1 MCV-83
Plt-268
PT-13.6 PTT-27.4 INR-1.2
Na-143 K-3.5 Cl-98 Bicarb-32 BUN-32 Cr-1.6 Glu-166
U/A negative

Labs on transfer:

WBC-7.6 Hct-42.9 MCV-85 Plt-240
Na-143 K-3.6 Cl-101 Bicarb-32 BUN-29 Cr-1.5 Glu-78 Ca-9.1 Mg-1.9
Phos-3.7

R Heart Cath ([**2102-3-9**]): C.I. 1.60 L/min/m2, PCWP 22, PA 47/25,
RV 47/5, RA mean 10

Metabolic Stress Test [**2-25**]: VO2 of 8

TTE [**1-28**]: Mild symmetric LVH, moderately dilated LV, severe
global LVHK, severely depressed LVEF (15-20%), moderately
dilated aortic root and arch, moderately dilated ascending
aorta, 1+ MR

CCath [**12-27**]: Clean coronary arteries, moderate diastolic
dysfunction, low cardiac index (1.6-1.8 L/min/m2).


Brief Hospital Course:
54 yo man with severe dilated cardiomyopathy admitted for
tailored diuresis, now nearly at his baseline clinical status.

1. Congestive Heart Failure: Patient with known, severe,
non-ischemic, dilated cardiomyopathy as per HPI.  Precipitant
for deterioration in cardiac function on admission unclear,
although patient may simply have severe CHF refractory to
outpatient control.  No symptoms to suggest cardiac ischemia.
Recent NSAID and probable viral sinusitis may have been
contributing factors.  Since admission, right heart cath
demonstrated elevated right and left sided filling pressures and
a depressed cardiac index.  Attempted tailored diuresis with
milrinone resulted in an increased cardiac index and decreased
PCWP but was complicated by acute renal failure due either to
peripheral vasodilatation and poor renal perfusion or
obstructive nephropathy (the patient's Foley catheter may have
been obstructed).  Since the milrinone was stopped on [**5-10**], his
renal function has returned to baseline, and he has diuresed
well.  His net fluid balance this admission is roughly three
liters negative.  His PA catheter has been removed and he is
stable for transfer to the floor.
  - Furosemide 80 mg twice daily, carvedilol 25 mg twice daily,
ASA 81 mg daily
  - Spironolactone 25 mg once daily, lisinopril 20 mg once
daily, metolazone qFri
  - Daily weights
  - Continue fluid and sodium restriction
  - No further NSAIDs
  - Transplant evaluation unremarkable to date

2. Sinusitis: Most likely viral given course of symptoms
(gradually improving), although exquisiste maxillary sinus
tenderness suggests possible bacterial superinfection,
especially given colored nasal discharge.  Symptoms persist but
are improving.
  - Doxycycline 100 mg twice daily for three more days
  - Continue saline and steroid nasal sprays (pt instructed re:
proper usage)
  - Consider sinus CT if symptoms do not continue to improve

3. Acute Renal Failure: Creatinine now back at baseline.
  - Lisinopril dose increased today
  - Recheck BUN and creatinine in the morning

4. Diabetes: Adequacy of outpatient control not clear.
  - Continue twice daily NPH, add RISS while in-house
  - Restart outpatient glyburide
  - Continue gabapentin for neuropathic pain

5. Hypothyroidism: Continue levothyroxine 250 mcg daily

6. Gout: Patient reports gouty attacks have been precipitated by
high-dose furosemide in the past.  He reports that plans to
transition from colchicine to allopurinol have been thwarted by
recurrent hospitalizations.  He has, however, been stable off
colchicine thus far.
  - Continue to hold colchicine
  - Plan outpatient transition to allopurinol

7. Proph: Low-sodium diet, OOB

8. F/E/N: Fluid and sodium restriction as above.  Recheck AM
lytes.

9. Access: Peripheral IVs.

10. Code: Full.

11. Dispo: Possible discharge tomorrow.

Medications on Admission:
1. carvedilol 25 mg twice daily
2. spironolactone 25 mg twice daily
3. furosemide 80 mg twice daily
4. lisinopril 10 mg once daily
5. metolazone 2.5 mg every Friday
6. NPH 15 units twice daily
7. potassium chloride 40 mEq once daily
8. glyburide 10 mg daily
9. aspirin 81 mg once daily
10. levothyroxine
11. colchicine 0.6 mg twice daily
12. gabapentin 800 mg twice daily

Discharge Disposition:
Home

Discharge Diagnosis:
1. non-ischemic dilated cardiomyopathy
2. systolic congestive heart failure
3. acute renal failure
4. sinusitis
5. diabetes mellitus type II
6. hypothyroidism
7. hypertension
8. obesity
9. chronic renal failure


Discharge Condition:
Pt appears to be at his dry weight, symptom-free with no lower
extremity edema.


Discharge Instructions:
1. Take all medications as prescribed.
2. Remember to weigh yourself daily and call Dr.[**Name (NI) 23312**] office
with any weight gain.
3. Continue to abide by a low-sodium (less than two grams daily)
diet.
4. Continue your fluid restriction at less than 1500 mL daily.

Followup Instructions:
1. Call Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 3512**]) on Monday [**2102-5-15**] to arrange for
a follow-up appointment with her at her discretion.
2. Follow-up with your primary care physician as previously
arranged.`


                             [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2139**]

Completed by:[**2104-1-1**]
{'Systolic heart failure, unspecified,Acute kidney failure, unspecified,Other primary cardiomyopathies,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified sinusitis (chronic),Retention of urine, unspecified,Other postablative hypothyroidism,Gout, unspecified,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Obesity, unspecified,Unspecified sleep apnea,Long-term (current) use of insulin,Personal history of malignant neoplasm of thyroid'}


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, peripheral edema

PRESENT ILLNESS: 54 yo man currently undergoing evaluation for heart transplant
for severe cardiomyopathy previously treated with weekly
nesiritide infusions in [**Hospital 1902**] clinic admitted [**3-8**] with
progressive dyspnea, LE edema, and weight gain (home scale up to
315 lbs from 298) over the past two weeks.  Three weeks prior to
admission, pt was admitted to OSH for diuresis with furosemide.
Patient states his LE edema improved but was not diminished to
the same degree as it was following his hospitalization here in
[**1-28**].  Since his discharge from the OSH two weeks ago, he has
had progressive exertional dyspnea and LE edema despite
compliance with his sodium and volume restriction.  He phoned
the [**Hospital 1902**] clinic [**3-8**] and was referred for hospitalization for
tailored diuresis.

MEDICAL HISTORY: 1. Non-ischemic cardiomyopathy (LVEF 15-20% [**1-28**])
2. DM-II c/b neuropathy
3. hypertension
4. dyslipidemia
5. obesity
6. chronic renal failure (baseline Cr 1.6)
7. RLE cellulitis [**12-28**]
8. thyroid lymphoma s/p XRT [**2084**], now hypothyroid

MEDICATION ON ADMISSION: 1. carvedilol 25 mg twice daily
2. spironolactone 25 mg twice daily
3. furosemide 80 mg twice daily
4. lisinopril 10 mg once daily
5. metolazone 2.5 mg every Friday
6. NPH 15 units twice daily
7. potassium chloride 40 mEq once daily
8. glyburide 10 mg daily
9. aspirin 81 mg once daily
10. levothyroxine
11. colchicine 0.6 mg twice daily
12. gabapentin 800 mg twice daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp 98.7, BP 113/80, HR 69, RR 16, SpO2 98% RA
Gen: Very pleasant, comfortable, non-toxic
HEENT: Diminished but significant L > R maxillary sinus
tenderness, no frontal sinus tenderness
Neck: Soft, supple, no cervical adenopathy, 2+ carotid pulses,
minimal JVD (?7 cm, limited by body habitus), post-thyroidectomy
scar
CV: RRR, normal S1 and S2, no m/r/g
Pulm: CTA bilaterally
Abd: Soft, non-tender, non-distended, active bowel sounds
Back: No CVA or paraspinal tenderness
Ext: Trace BLE pitting edema, 2+ DP and 1+ PT pulses
bilaterally, right greater than left LE chronic venous stasis
changes, equal warmth bilaterally

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Pt is retired from owning a printing business. Works in wife's
daycare. Pt is married with three grown children. No EtOH. Quit
tobacco 20 yrs ago (smoked <1 pack per week). 

### Response:
{'Systolic heart failure, unspecified,Acute kidney failure, unspecified,Other primary cardiomyopathies,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Unspecified sinusitis (chronic),Retention of urine, unspecified,Other postablative hypothyroidism,Gout, unspecified,Other chronic pulmonary heart diseases,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Obesity, unspecified,Unspecified sleep apnea,Long-term (current) use of insulin,Personal history of malignant neoplasm of thyroid'}
