CHIEF COMPLAINT: SOB and atrial fibrillation

PRESENT ILLNESS: HPI: 81F with h/o HTN, hypercholesterol, PAF, and s/p TIA 17yrs
ago presented to the ED today with complaint of shortness of
breath x1 day. Pt. complains of about 2 weeks of cough -
occasionally productive of greenish sputum - though mostly
feeling she has post-nasal drip that she is unable to clear. Pt.
awoke this am feeling quite week and short of breath - difficult
to characterize other than feeling difficult to breath with all
the junk in her throat. Of note, the daughter has noticed her
mother having difficulty completing sentences (secondary to
coughing near the enc) for about as long as she has had the
cough. Pt. denies fevers, chills, nausea, emesis, headache,
stomach pain, chest pain, palpitations, diarrhea, dysuria, or
rash. The patient's daughter felt she was wheezing this am.
.
ED course: Vitals on presentation: 97.3 146 104/58 28 94%ra ->
pt. was given dilt 5mg IV followed by 30mg PO. Her SBP initially
dropped into the 70s and she was given ~4L IVF with good
responce in SBP - pt. also converted back to sinus. The initial
UA was dirty -> repeat negative. Pt. was give levaquin for ?
pna. Vitals on transfer to floor: 97.8 91 121/49 20 99% 2Lnc
CXR: read as no acute cardio-pulm process
EKG: afib/RVR

MEDICAL HISTORY: HTN
CVA [**59**] yrs ago
Hypercholesterolemia
Osteoporosis

MEDICATION ON ADMISSION: - fosamax 70mg qWeek
- Lisinopril 20'
- Atenolol 50'
- HCTZ 12.5'
- Simvastatin 20'
- Coumadin 2 / 1 alternating

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admit Exam:
.
VS: 98.8 88 132/60 20 93 2Lnc
GEN: WD, WN, NAD
HEENT: NCAT, EOMI
NECK: supple, no lad
Chest: CTAB, no w/c/r
Cardiac: RRR, 2/6 systolic murmur at RUSB
Abd: soft, nt, nd, nabs
ext: no c/c/e, DP 2+ bilaterally
neuro: A & O x3, MAE, II-XII intact
....................................................
Exam on discharge:
.
VS: 96.5  64  126/60  20  96% 2l nc
GEN: WD, WN, NAD
HEENT: NCAT, EOMI
NECK: supple, no lad
Chest: diffuse bilateral wheezes, occasional ronchi - clear
somewhat with coughing
Cardiac: RRR, 2/6 systolic murmur at RUSB
Abd: soft, nt, nd, nabs
ext: no c/c/e, DP 2+ bilaterally
neuro: A & O x3, MAE, II-XII intact

FAMILY HISTORY: NC

SOCIAL HISTORY: Live in her house in [**Location (un) 620**] by herself.  Has 2 daughters, one
lives in [**Name (NI) **].  Quit smoking 22 years ago.  Sporadic EtOH.
No recreational drugs.
Pneumonia, organism unspecified,Acute on chronic diastolic heart failure,Dehydration,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Osteoporosis, unspecified
Pneumonia, organism NOS,Ac on chr diast hrt fail,Dehydration,Atrial fibrillation,Pure hypercholesterolem,Hypertension NOS,Osteoporosis NOS
Admission Date:  [**2153-1-23**]              Discharge Date:   [**2153-1-30**]

Date of Birth:  [**2071-9-16**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
SOB and atrial fibrillation

Major Surgical or Invasive Procedure:
none


History of Present Illness:
HPI: 81F with h/o HTN, hypercholesterol, PAF, and s/p TIA 17yrs
ago presented to the ED today with complaint of shortness of
breath x1 day. Pt. complains of about 2 weeks of cough -
occasionally productive of greenish sputum - though mostly
feeling she has post-nasal drip that she is unable to clear. Pt.
awoke this am feeling quite week and short of breath - difficult
to characterize other than feeling difficult to breath with all
the junk in her throat. Of note, the daughter has noticed her
mother having difficulty completing sentences (secondary to
coughing near the enc) for about as long as she has had the
cough. Pt. denies fevers, chills, nausea, emesis, headache,
stomach pain, chest pain, palpitations, diarrhea, dysuria, or
rash. The patient's daughter felt she was wheezing this am.
.
ED course: Vitals on presentation: 97.3 146 104/58 28 94%ra ->
pt. was given dilt 5mg IV followed by 30mg PO. Her SBP initially
dropped into the 70s and she was given ~4L IVF with good
responce in SBP - pt. also converted back to sinus. The initial
UA was dirty -> repeat negative. Pt. was give levaquin for ?
pna. Vitals on transfer to floor: 97.8 91 121/49 20 99% 2Lnc
CXR: read as no acute cardio-pulm process
EKG: afib/RVR


Past Medical History:
HTN
CVA [**59**] yrs ago
Hypercholesterolemia
Osteoporosis

Social History:
Live in her house in [**Location (un) 620**] by herself.  Has 2 daughters, one
lives in [**Name (NI) **].  Quit smoking 22 years ago.  Sporadic EtOH.
No recreational drugs.


Family History:
NC

Physical Exam:
Admit Exam:
.
VS: 98.8 88 132/60 20 93 2Lnc
GEN: WD, WN, NAD
HEENT: NCAT, EOMI
NECK: supple, no lad
Chest: CTAB, no w/c/r
Cardiac: RRR, 2/6 systolic murmur at RUSB
Abd: soft, nt, nd, nabs
ext: no c/c/e, DP 2+ bilaterally
neuro: A & O x3, MAE, II-XII intact
....................................................
Exam on discharge:
.
VS: 96.5  64  126/60  20  96% 2l nc
GEN: WD, WN, NAD
HEENT: NCAT, EOMI
NECK: supple, no lad
Chest: diffuse bilateral wheezes, occasional ronchi - clear
somewhat with coughing
Cardiac: RRR, 2/6 systolic murmur at RUSB
Abd: soft, nt, nd, nabs
ext: no c/c/e, DP 2+ bilaterally
neuro: A & O x3, MAE, II-XII intact

Pertinent Results:
[**Name (NI) 706**]  Final Report
CHEST (PORTABLE AP)  [**2153-1-23**] 10:46 AM

IMPRESSION: No acute cardiopulmonary process.
..................................
   [**Year/Month/Day 706**]  Final Report

CHEST (PA & LAT)  [**2153-1-24**] 9:32 AM
HISTORY: Two weeks of cough and shortness of breath.

IMPRESSION: AP chest compared to [**2155-1-23**]:56 a.m.

New opacification of the right lower lobe accompanied by
elevation of the right lung base and elevation and rightward
displacement of the heart is most likely atelectasis accompanied
by small right pleural effusion. Left lung clear. Heart size top
normal. No pneumothorax. Dr. [**First Name (STitle) **] was paged to report
these findings, at the time of dictation.
.........................................
   [**First Name (STitle) 706**]  Final Report
CHEST (PORTABLE AP)  [**2153-1-25**] 12:17 PM

IMPRESSION:
1. New left lower lobe linear atelectasis and a more hazy
opacity. Aspiration cannot be excluded and followup is
recommended.
2. Unchanged right lower lobe opacity which more likely
represents atelectasis.
>
>
>
>
>
>
>
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
   [**Month/Day/Year 706**]   Preliminary Report
CHEST (PORTABLE AP)  [**2153-1-26**] 1:05 PM

IMPRESSION:
1. Slightly worsened right-sided atelectasis at the base with
new right-sided small pleural effusion.
2. Improved left-sided opacification at the base with new
paramediastinal opacity which, with such rapid appearance, most
likely represents atelectasis or pleural effusion.
.
.
.
.
.
.
.
.
.
................................................................
Echo [**2153-1-26**]:
.
The left atrium is elongated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Left ventricular systolic function is hyperdynamic (EF
70-80%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. Trivial mitral regurgitation is seen. The
tricuspid valve leaflets are mildly thickened. There is mild
pulmonary artery systolic hypertension. There is no pericardial
effusion.

Compared with the findings of the prior report (images
unavailable for review) of [**2145-8-2**], the findings are
similar.
.
.
.
.
.
.
.
.
.
................................................................
[**Year (4 digits) 706**]  Final Report
CHEST (PA & LAT)  [**2153-1-29**] 10:20 AM

FINDINGS: In comparison to the previous radiograph, the
right-sided atelectasis has resolved. Unchanged is the extent of
the left-sided atelectasis. The size of the cardiac silhouette
is unchanged. No evidence of pleural effusion. No newly appeared
parenchymal opacities.
.
.
.
.
.
.
.
.
.
................................................................

[**2153-1-30**] 06:50AM BLOOD WBC-7.3 RBC-3.93* Hgb-11.8* Hct-36.5
MCV-93 MCH-30.0 MCHC-32.3 RDW-13.0 Plt Ct-252
[**2153-1-29**] 06:45AM BLOOD WBC-6.9 RBC-4.10* Hgb-12.8 Hct-37.7
MCV-92 MCH-31.2 MCHC-34.0 RDW-12.9 Plt Ct-222
[**2153-1-28**] 05:15AM BLOOD WBC-7.4 RBC-3.98* Hgb-12.8 Hct-37.4
MCV-94 MCH-32.1* MCHC-34.2 RDW-12.7 Plt Ct-185
[**2153-1-23**] 10:50AM BLOOD WBC-7.1 RBC-4.43 Hgb-13.7 Hct-40.6 MCV-92
MCH-31.0 MCHC-33.8 RDW-12.9 Plt Ct-227
[**2153-1-30**] 06:50AM BLOOD Plt Ct-252
[**2153-1-29**] 06:45AM BLOOD PT-22.7* INR(PT)-2.2*
[**2153-1-30**] 06:50AM BLOOD Glucose-106* UreaN-21* Creat-1.0 Na-143
K-3.8 Cl-101 HCO3-36* AnGap-10
[**2153-1-29**] 06:45AM BLOOD Glucose-103 UreaN-17 Creat-0.8 Na-143
K-3.7 Cl-101 HCO3-35* AnGap-11
[**2153-1-28**] 05:15AM BLOOD Glucose-96 UreaN-15 Creat-0.8 Na-142
K-3.8 Cl-100 HCO3-34* AnGap-12
[**2153-1-26**] 04:27AM BLOOD ALT-21 AST-26 AlkPhos-33* TotBili-0.3
[**2153-1-25**] 12:21PM BLOOD CK-MB-6 cTropnT-0.01
[**2153-1-25**] 06:25AM BLOOD CK-MB-7 cTropnT-<0.01
[**2153-1-24**] 06:00AM BLOOD cTropnT-0.01
[**2153-1-24**] 05:50AM BLOOD CK-MB-7
[**2153-1-23**] 07:48PM BLOOD CK-MB-7 cTropnT-0.01
[**2153-1-23**] 10:50AM BLOOD cTropnT-0.01
[**2153-1-23**] 10:50AM BLOOD CK-MB-6
[**2153-1-30**] 06:50AM BLOOD Calcium-9.4 Phos-3.9 Mg-2.4
[**2153-1-26**] 04:27AM BLOOD TSH-4.7*
[**2153-1-25**] 03:33PM BLOOD freeCa-1.21

Brief Hospital Course:
Pt. was admitted to the general medical floor after being
treated for pneumonia, atrial fibrillation, and hypotension in
the emergency department.  She underwent pulmonary toilet/pt on
the floor and her beta blockade was being titrated during the
initial part of her stay.  Over night on the second day of her
admission the patient became tachycardic and was given diltiazem
with marginal effect of slowing her heart rate.  However, she
had several episoded of bradycardia after the medication was
given - with her heart rate settling in the 90-100s.  During the
morning of HD 3 the pt. was with persistant tachycardia - was
given some additional doses of IV lopressor - with close
monitoring because of her prior episodes of bradycardia.  Around
noon on HD 3 the pt. dropped her O2 saturations to the hight
70s/low 80s -> was given nitro, lopressor, lasix, and lopressor,
a CXR and EKG were done, and coardiology was consulted.  She
improved clinically with this, however, several hours later the
pt. again dropped her o2 saturation.  During this time the pt
was given additional lopressor but was persistantly tachycardic.
 The pt. was then transferred to the cardiac intensive care unit
- monitored closely overnight - and started on amiodarone under
the guidance of the cardiology consult service.  The evening of
HD 5 the pt. transferred out to the general medical floor.  Here
she underwent continued diuresis, phyiscal therapy, continued
antibiotic therapy, and gradually improved.  On HD 8 the patient
has a low oxygen requirement - 2L nc - and will need continued
pulmonary and physical therapy - but is ready for discharge to
rehab.
.
# Afib: pt. with known history of afib documented in prior
notes.  For this she is on coumadin.  Pt. with acute
exacerbation of afib may be related to volume status - as
patient's blood pressure responded well to IV hydration in the
ED.  Also, risk of pt. having had cardiac ischemic event sending
her into the abnormal rhythm.
- check labs and fluids as indicated for dehydration
- EKG in ED -> afib
- check lytes and repleat as necessary
- cycle cardiac enzymes -> negative x3
- telemetry monitoring -> has been NSR overnight -> atrial tach
prior to transfer to the CCU -> has now been in sinus and rate
controlled x24 horus
- Added amiodarone when pt. xfr to the ccu - continue loading as
we are and f/u EP recs
- [**1-29**] amiodarone changed to 200mg qday and pt. will need to
continue this until follow-up with cardiology
- [**1-29**] doing well with the amio -> continuing to monitor
- WBC normal, ua negative with culture pending
- repeat CXR pa and lateral [**1-24**] -> RLL infiltrate: atelect vs
pna --> continue antibiotics; changed to doxy -> total of 10
days
.
# Hypertention: history of, although pt. transiently hypotensive
to systolic of the 80s in the ED.  she responded to fluids -
likely due to dehydration after rate controlled.
- continue home meds
- changing to metoprolol while in house as easier to titrate and
can convert on d/c --> presently on 50mg tid
.
# Hypercholesterol: continue home meds
.
# Osteoporosis: continue fosamax
.
# h/o TIA: On admission pt. INR is 3.1
- hold evening dose 3/11
- recheck INR in am -> 2.2 today -> giving 2mg dose tonight and
will start her qOday doses
- INR pending today but will need daily INR checks and coumadin
dosing -> likely will need 1mg qHS since starting amio but this
has yet to be determined -> goal INR [**12-17**]
.
# elevated Cr: pt. with initially elevated Cr in ED at 1.3 that
came down with IV fluids - likely due simply to dehydration
- will follow am labs
- stable and normal now -> improved with hydration
- [**1-29**]: slight elevation in Cr today (0.8-->1.0) so will hold on
further diuresis as of now and continue aggressive pulmonary
toilet
.
# FEN:
- Cardiac diet
- daily lytes w/repleation prn
.
# ACCESS: PIVs
.
# PPX:
- protonix
- coumadin -> INR pending today -> will need coumadin dosed
daily
.
# CODE: FULL
.
# Communication: with patient; daughter in HCP

Medications on Admission:
- fosamax 70mg qWeek
- Lisinopril 20'
- Atenolol 50'
- HCTZ 12.5'
- Simvastatin 20'
- Coumadin 2 / 1 alternating


Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
6. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day.
7. Doxycycline Hyclate 100 mg Capsule Sig: One (1) Capsule PO
Q12H (every 12 hours) for 3 days.
8. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO BID (2 times a day) as needed.

10. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
11. Albuterol Sulfate 2.5 mg/3 mL Solution for Nebulization Sig:
One (1)  Inhalation Q6H (every 6 hours).
12. Coumadin 1 mg Tablet Sig: One (1) Tablet PO at bedtime: - to
be adjusted according to your INR.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 599**] of [**Location (un) 55**]

Discharge Diagnosis:
atrial fibrillation
pneumonia
pulmonary edema

Secondary:
hypertension
hypercholesterol
osteoporosis
h/o TIA


Discharge Condition:
fair - still with minimal oxygen requirement of 2L nc


Discharge Instructions:
You were admitted and treated for your irregular heart beat and
shortness of breath.  Your dose of beta blocker was titrated up
and you were given antibiotics.  You were started on a new
medication that you will need to take regularly - this is to
help control your heart rate.  You have improved greatly.  You
were also seen by physical therapy and it was determined that
you would benifit from intensive physical therapy and continued
pulmonary physical therapy prior to going home.

You will need to take all medications as prescribed.

You will need to keep all of the following appointemnts.

Call your primary care doctor or return to the ED if T>101.5,
chills, nausea, vomiting, chest pain, shortness of breath,
worsening pain, irregular heart beat, or any other concern.

Followup Instructions:
- you have a follow-up appointment with Dr. [**Last Name (STitle) **] scheduled for
[**2153-2-8**] at 10:45 in the morning - please call to confirm this
appointment.
- You have an appointment scheduled with Dr. [**Last Name (STitle) **] of Cardiology
on [**2153-2-5**] at 10:20 in the morning - [**Hospital Ward Name 23**] building [**Location (un) 436**].
 Please call [**Telephone/Fax (1) 285**] to confirm this appointment.
- Once out of rehab you will need to follow-up with the
pulmonary function lab to have your lung function tested -> this
can be arranged through your primary care doctor or you can call
([**Telephone/Fax (1) 12124**] to schedule an appointment with the pulmonary
function lab here at the [**Hospital1 18**].
- You need to schedule an appointment with an ophthomologist and
have your eyes evaluated as well.  This should be set up once
you have completed rehab and can be done through your primary
care doctor.

*It is very important that you keep the following appointments*
- Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 252**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2153-2-12**] 10:00
- Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2153-10-15**]
10:20
- Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2153-10-15**]
10:40
{'Pneumonia, organism unspecified,Acute on chronic diastolic heart failure,Dehydration,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Osteoporosis, unspecified'}


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: SOB and atrial fibrillation

PRESENT ILLNESS: HPI: 81F with h/o HTN, hypercholesterol, PAF, and s/p TIA 17yrs
ago presented to the ED today with complaint of shortness of
breath x1 day. Pt. complains of about 2 weeks of cough -
occasionally productive of greenish sputum - though mostly
feeling she has post-nasal drip that she is unable to clear. Pt.
awoke this am feeling quite week and short of breath - difficult
to characterize other than feeling difficult to breath with all
the junk in her throat. Of note, the daughter has noticed her
mother having difficulty completing sentences (secondary to
coughing near the enc) for about as long as she has had the
cough. Pt. denies fevers, chills, nausea, emesis, headache,
stomach pain, chest pain, palpitations, diarrhea, dysuria, or
rash. The patient's daughter felt she was wheezing this am.
.
ED course: Vitals on presentation: 97.3 146 104/58 28 94%ra ->
pt. was given dilt 5mg IV followed by 30mg PO. Her SBP initially
dropped into the 70s and she was given ~4L IVF with good
responce in SBP - pt. also converted back to sinus. The initial
UA was dirty -> repeat negative. Pt. was give levaquin for ?
pna. Vitals on transfer to floor: 97.8 91 121/49 20 99% 2Lnc
CXR: read as no acute cardio-pulm process
EKG: afib/RVR

MEDICAL HISTORY: HTN
CVA [**59**] yrs ago
Hypercholesterolemia
Osteoporosis

MEDICATION ON ADMISSION: - fosamax 70mg qWeek
- Lisinopril 20'
- Atenolol 50'
- HCTZ 12.5'
- Simvastatin 20'
- Coumadin 2 / 1 alternating

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admit Exam:
.
VS: 98.8 88 132/60 20 93 2Lnc
GEN: WD, WN, NAD
HEENT: NCAT, EOMI
NECK: supple, no lad
Chest: CTAB, no w/c/r
Cardiac: RRR, 2/6 systolic murmur at RUSB
Abd: soft, nt, nd, nabs
ext: no c/c/e, DP 2+ bilaterally
neuro: A & O x3, MAE, II-XII intact
....................................................
Exam on discharge:
.
VS: 96.5  64  126/60  20  96% 2l nc
GEN: WD, WN, NAD
HEENT: NCAT, EOMI
NECK: supple, no lad
Chest: diffuse bilateral wheezes, occasional ronchi - clear
somewhat with coughing
Cardiac: RRR, 2/6 systolic murmur at RUSB
Abd: soft, nt, nd, nabs
ext: no c/c/e, DP 2+ bilaterally
neuro: A & O x3, MAE, II-XII intact

FAMILY HISTORY: NC

SOCIAL HISTORY: Live in her house in [**Location (un) 620**] by herself.  Has 2 daughters, one
lives in [**Name (NI) **].  Quit smoking 22 years ago.  Sporadic EtOH.
No recreational drugs. 

### Response:
{'Pneumonia, organism unspecified,Acute on chronic diastolic heart failure,Dehydration,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Osteoporosis, unspecified'}
