CHIEF COMPLAINT: Shortness of breath / Transfer for Percutaneous Cardiac
Intervention

PRESENT ILLNESS: (Obtained from medical records and family since patient
intubated):
89 year old woman admitted with CAD/cardiomyopathy, s/p prior
LAD stenting, admitted [**5-15**] with MI and CHF, intubated in ER for
hypoxia. Had Troponin leak to 0.75. Cathed [**5-16**] and found to have
LAD stent patent, RCA occluded w/ good collaterals, and Cx w/
diffuse disease. By OSH report, ECHO w/ LVEF 10-20%, mild MVP,
moderate MR. Spiked temp to 101.8 on [**5-17**]. Was cultured and Abx
started , went into Afib w/ RVR, received IV lopressor. Also,
anemia w/ hct of 26, CT abd/pelvis r/o RP bleed. Known hernia
w/o obstruction. Received 2U PRBC.
Patient transferred to [**Hospital1 18**] CCU today with PCI later in
afternoon.
.
ROS: unable to obtain

MEDICAL HISTORY: CAD s/p PCI x2 ([**2193**])
ischemic CM, most recent EF 10% (last week) from 30% in [**2199**]; 3
recent admissions to hospital for CHF since [**2-/2200**]
Severe PVD
AAA s/p repair [**2191**]
HTN
Hyperchol
anemia
dementia

MEDICATION ON ADMISSION: ASA 325
Coreg 3.125 [**Hospital1 **]
lisinopril 10 [**Hospital1 **]
simvastatin 20
digoxin 0.125
plavix 75
colace
hep SQ
erythromycin eye ointment
morphine IV prn
ativan IV prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T98.8 , BP119/32 , HR52 , RR18 , 98O2 % on AC 12x400, FiO2
0.4, PEEP 5
Gen: frail elderly lady in bed, intubated
HEENT: NCAT. Sclera anicteric. PERRL, EOMI.
Neck: Supple with JVP of 5 cm.
CV: brady, regular, no S3, no murmurs
Chest: CTAB on anterior exam
Abd: soft, ventral herniam ND, +BS No abdominial bruits.
Ext: No c/c/e. right fem line in place
Skin: bruising on arms
Pulses: radial 2+ b/l, d. pedis 1+ b/l

FAMILY HISTORY: Father with MI in 60's.

SOCIAL HISTORY: Lives w/ husband, no [**Name2 (NI) 1139**] or EtOH.
Subendocardial infarction, initial episode of care,Acute systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Pneumonia due to Klebsiella pneumoniae,Ventral, unspecified, hernia with obstruction,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension
Subendo infarct, initial,Ac systolic hrt failure,Acute kidney failure NOS,Acute respiratry failure,K. pneumoniae pneumonia,Obstr ventral hernia NOS,Anemia NOS,Crnry athrscl natve vssl,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2200-5-21**]              Discharge Date:   [**2200-5-29**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
Shortness of breath / Transfer for Percutaneous Cardiac
Intervention

Major Surgical or Invasive Procedure:
Cardiac Catheterization [**2200-5-21**]:
COMMENTS:     1. Initial angiography in this right-dominant
circulation was limited to the left coronary artery. The LM was
normal but short.  The LAD stent was widely patent and the LAD,
diagonals all had mild luminal irregularity. The LC had
extensive diffuse proximal and mid vessel disease up to 90-95%.
The ostium of OM2 had a 95% focal stenosis.
2. Limited hemodynamics revealed a central aortic pressure of
136/32.
Right heart cath pressures as noted. C.O was 4.5
3. Successful ptca and stenting of the proximal and mid LCx with

overlapping 2.5x28,2.5x28 and 2.5x12mm mini -vision stents
respectively in the mid,mid and proximal Lcx. Successful poba
ofthe OM2 ostium. Final angiography revealed 0% residual
stenosis in the lcx, 40% residual in OM2, no angiographically
apparent dissection and timi 3 flow. The patient left the lab
intubated and in unchanged clinical condition.

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Successful ptca and stenting of LCx
3. Successful POBA of the OM2
.
[**2200-5-23**] IR-guided PICC placement
IMPRESSION: Uncomplicated ultrasound and fluoroscopic guided
right brachial vein double-lumen PIC line placement. Final
internal length is 30 cm, with the tip positioned in the SVC.
The line is ready to use.

History of Present Illness:
(Obtained from medical records and family since patient
intubated):
89 year old woman admitted with CAD/cardiomyopathy, s/p prior
LAD stenting, admitted [**5-15**] with MI and CHF, intubated in ER for
hypoxia. Had Troponin leak to 0.75. Cathed [**5-16**] and found to have
LAD stent patent, RCA occluded w/ good collaterals, and Cx w/
diffuse disease. By OSH report, ECHO w/ LVEF 10-20%, mild MVP,
moderate MR. Spiked temp to 101.8 on [**5-17**]. Was cultured and Abx
started , went into Afib w/ RVR, received IV lopressor. Also,
anemia w/ hct of 26, CT abd/pelvis r/o RP bleed. Known hernia
w/o obstruction. Received 2U PRBC.
Patient transferred to [**Hospital1 18**] CCU today with PCI later in
afternoon.
.
ROS: unable to obtain


Past Medical History:
CAD s/p PCI x2 ([**2193**])
ischemic CM, most recent EF 10% (last week) from 30% in [**2199**]; 3
recent admissions to hospital for CHF since [**2-/2200**]
Severe PVD
AAA s/p repair [**2191**]
HTN
Hyperchol
anemia
dementia

Social History:
Lives w/ husband, no [**Name2 (NI) 1139**] or EtOH.

Family History:
Father with MI in 60's.

Physical Exam:
VS: T98.8 , BP119/32 , HR52 , RR18 , 98O2 % on AC 12x400, FiO2
0.4, PEEP 5
Gen: frail elderly lady in bed, intubated
HEENT: NCAT. Sclera anicteric. PERRL, EOMI.
Neck: Supple with JVP of 5 cm.
CV: brady, regular, no S3, no murmurs
Chest: CTAB on anterior exam
Abd: soft, ventral herniam ND, +BS No abdominial bruits.
Ext: No c/c/e. right fem line in place
Skin: bruising on arms
Pulses: radial 2+ b/l, d. pedis 1+ b/l


Pertinent Results:
ADMISSION LABS:
[**2200-5-21**] 11:47PM   UREA N-24* CREAT-1.2* POTASSIUM-3.8 TOTAL
CO2-25
[**2200-5-21**] 11:47PM   CK(CPK)-104
[**2200-5-21**] 11:47PM   CK-MB-6 cTropnT-0.16*
[**2200-5-21**] 11:47PM   HGB-9.9* HCT-29.0*
[**2200-5-21**] 09:04PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2200-5-21**] 07:42PM   TYPE-ART PO2-117* PCO2-42 PH-7.39 TOTAL
CO2-26 BASE XS-0
[**2200-5-21**] 05:02PM   TYPE-ART RATES-/12 TIDAL VOL-400 PEEP-5
PO2-207* PCO2-38 PH-7.43 TOTAL CO2-26 BASE XS-1 -ASSIST/CON
INTUBATED-INTUBATED
[**2200-5-21**] 12:40PM   CK-MB-NotDone cTropnT-0.16*
.
DISCHARGE LABS:
[**2200-5-29**] Hct 27.1
Na 145
K 3.9
Cl 106
HCO3 29
BUN 35
Cr 1.5
Plt 147
Ca 8.6
Mg 2.2
Phos 3.0
.
Cardiac Cath:
1. Two vessel coronary artery disease.
2. Successful ptca and stenting of LCx
3. Successful POBA of the OM2
.
Surface ECHO:
The left atrium is mildly dilated. Left ventricular wall
thicknesses and cavity size are normal. There is mild regional
left ventricular systolic dysfunction with severe inferior,
inferolateral, and anterolateral wall hypokinesis. Overall left
ventricular systolic function is mildly depressed (LVEF= 45 %).
Tissue Doppler imaging suggests an increased left ventricular
filling pressure (PCWP>18mmHg). Right ventricular chamber size
is normal with normal wall motion. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. Mild
(1+) aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is mild mitral valve prolapse. Mild (1+)
mitral regurgitation is seen. The tricuspid valve leaflets are
mildly thickened. The estimated pulmonary artery systolic
pressure is normal. The end-diastolic pulmonic regurgitation
velocity is increased suggesting pulmonary artery diastolic
hypertension. There is a small pericardial effusion.
.
IMPRESSION: Mild regional left ventricular dysfunction
consistent with coronary artery disease. Mild aortic
regurgitation. Mild mitral regurgitation.


Brief Hospital Course:
Brief hospital course by systems as outlined below:
1) Cardiovascular:
The patient was admitted intubated from [**Hospital **] Hospital for
percutaneous cardiac intervention.  She underwent
catheterization on [**5-21**] and received a bare metal stent to the L
circumflex artery and balloon angioplasty to the obtuse marginal
II artery.  Following the intervention she was chest pain free
but showed persistant ST-T abnormalities on ECG. She is
discharged on medical regimen with ASA, plavix, statin, beta
[**Last Name (un) 26914**] and ACE-Inhibitor. See above for cath and ECHO reports.

.
2) Respiratory failure: We were able to extubate patient with
aggressive preload and afterload reduction with increased
BBlocker, nitro drip, morphine, lasix and non-rebreather mask.
Upon discharge patient was weaned off nitro drip and
supplemental oxygen. We also treated her for Klebsiella
pneumonia. She will need to finish a 14-day course of
levofloxacin. Patient is afebrile.
Patient tends to develop flash pulmonary edema in setting of
uncontrolled hypertension. She had several episodes of acute
dyspnea which were treated with IV morphine, nitro, and lasix.
Therefore, tight blood pressure control is essential for her
respiratory status. Her blood pressure medication can be
increased as tolerated. Renal funtion monitoring prior to
increasing lisinopril.
.
3) Anemia: Hematocrit stable here between 27-30. Will need more
work-up as outpatient.
.
4) Renal failure: likely intrinsic etiology. Creatinine now
trending down. Monitor renal function.
.
5) Nutrition: Patient seen after extubation by speech and
swallow service. Recommendation: nectar consistancy to avoid
aspiration. [**Month (only) 116**] re-evaluate in ~ 2 weeks.
.
6) Access: PICC line.
.
7) Code: FULL

Medications on Admission:
ASA 325
Coreg 3.125 [**Hospital1 **]
lisinopril 10 [**Hospital1 **]
simvastatin 20
digoxin 0.125
plavix 75
colace
hep SQ
erythromycin eye ointment
morphine IV prn
ativan IV prn


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Tablet(s)
2. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Erythromycin 5 mg/g Ointment Sig: One (1)  Ophthalmic QID (4
times a day).
5. Artificial Tear with Lanolin 0.1-0.1 % Ointment Sig: One (1)
Appl Ophthalmic PRN (as needed).
6. Carvedilol 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).



Discharge Disposition:
Extended Care

Facility:
[**Hospital 19453**] Nursing and Rehab Center

Discharge Diagnosis:
Primary Diagnoses:
Coronary Artery Disease
Systolic Congestive Heart Failure
Respiratory failure
Hypertension
Anemia
.
Secondary Diagnoses:
Peripheral Vascular Disease
Dementia


Discharge Condition:
Improved.  Stable.


Discharge Instructions:
You were admitted to the hospital because you were short of
breath.  You underwent cardiac catheterization where you were
found to have occlusion of the arteries that supply blood to
your heart.  These arteries were opened with a small balloon to
improve blood flow to your heart.  You also had an ultrasound of
your heart, which showed that it was not pumping normally.  This
improved prior to discharge from the hospital.
You also had episodes of increased blood pressure.  Your blood
pressure medications were increased accordingly.
.
While you were in the hospital the following changes were made
to your medications:
1) Decrease Lisinopril 10mg twice daily to 10mg once daily
2) Increase Simvastatin 20mg daily to 80mg daily
3) Increase Carvedilol from 3.125mg to 25mg twice daily
4) Stop digoxin 0.125 daily
5) Start Furosemide 40mg by mouth twice daily
.
Otherwise, we have not made any changes to your medications
.
Please keep the following appointments with Dr. [**Last Name (STitle) 20222**] and Dr. [**Name (NI) 26915**], which has been outlined below.
.
If you develop shortness of breath, chest pain, palpitations, or
any other worrisome symptoms, please return to the emergency
department.

Followup Instructions:
- Dr. [**First Name8 (NamePattern2) 3924**] [**Last Name (NamePattern1) 20222**] (cardiology): Wednesday, [**2203-6-11**]:20AM
Location: [**Last Name (NamePattern1) 26916**]., [**Location (un) 47**], [**Numeric Identifier 7398**]
Phone: ([**Telephone/Fax (1) 26917**]
.
- Dr. [**First Name4 (NamePattern1) 3403**] [**Last Name (NamePattern1) **] (primary care): [**Last Name (LF) 766**], [**6-16**], 2:45PM
Location, [**Hospital1 26918**], [**Location (un) 26919**], MA
Phone: ([**Telephone/Fax (1) 26920**]



Completed by:[**2200-5-29**]
{'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Pneumonia due to Klebsiella pneumoniae,Ventral, unspecified, hernia with obstruction,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension'}


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 / Transfer for Percutaneous Cardiac
Intervention

PRESENT ILLNESS: (Obtained from medical records and family since patient
intubated):
89 year old woman admitted with CAD/cardiomyopathy, s/p prior
LAD stenting, admitted [**5-15**] with MI and CHF, intubated in ER for
hypoxia. Had Troponin leak to 0.75. Cathed [**5-16**] and found to have
LAD stent patent, RCA occluded w/ good collaterals, and Cx w/
diffuse disease. By OSH report, ECHO w/ LVEF 10-20%, mild MVP,
moderate MR. Spiked temp to 101.8 on [**5-17**]. Was cultured and Abx
started , went into Afib w/ RVR, received IV lopressor. Also,
anemia w/ hct of 26, CT abd/pelvis r/o RP bleed. Known hernia
w/o obstruction. Received 2U PRBC.
Patient transferred to [**Hospital1 18**] CCU today with PCI later in
afternoon.
.
ROS: unable to obtain

MEDICAL HISTORY: CAD s/p PCI x2 ([**2193**])
ischemic CM, most recent EF 10% (last week) from 30% in [**2199**]; 3
recent admissions to hospital for CHF since [**2-/2200**]
Severe PVD
AAA s/p repair [**2191**]
HTN
Hyperchol
anemia
dementia

MEDICATION ON ADMISSION: ASA 325
Coreg 3.125 [**Hospital1 **]
lisinopril 10 [**Hospital1 **]
simvastatin 20
digoxin 0.125
plavix 75
colace
hep SQ
erythromycin eye ointment
morphine IV prn
ativan IV prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T98.8 , BP119/32 , HR52 , RR18 , 98O2 % on AC 12x400, FiO2
0.4, PEEP 5
Gen: frail elderly lady in bed, intubated
HEENT: NCAT. Sclera anicteric. PERRL, EOMI.
Neck: Supple with JVP of 5 cm.
CV: brady, regular, no S3, no murmurs
Chest: CTAB on anterior exam
Abd: soft, ventral herniam ND, +BS No abdominial bruits.
Ext: No c/c/e. right fem line in place
Skin: bruising on arms
Pulses: radial 2+ b/l, d. pedis 1+ b/l

FAMILY HISTORY: Father with MI in 60's.

SOCIAL HISTORY: Lives w/ husband, no [**Name2 (NI) 1139**] or EtOH. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Pneumonia due to Klebsiella pneumoniae,Ventral, unspecified, hernia with obstruction,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension'}
