CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 59 y/o male with Hyperlipidemia, Mild Emphysema, GERD, and
Obstructive Sleep Apnea presented to [**Hospital1 **] [**Location (un) 620**] on [**2195-7-15**] with
shortness of breath described as inability to get in a
satisfying breath. Patient has been experiencing symptoms for
last 4-5 days. Symptoms associated with increased fatigue,
subjective fevers/chills, swollen neck glands, and palpitations.
Patient denies any chest pain or light-headedness. In the last
week, patient had developed of a vesicular rash, which began on
abdomen, with 2-3 areas of patchy involvement progressing
towards back. He began taking acyclovir for presumed herpes
zoster.
.
Initial vitals at [**Location (un) 620**] were T 98.5, HR 99, BP 109/79 RR 16
SAT 98% RA. Found to be in rapid AFib with HR in the 190's.
Given two pushes of lopressor, which did induce improvement
ventricular rate, but precipitous fall in systolic blood
pressures to 70-80s. Patient was cardioverted with 50, 100, and
finally three hundred joules, with successful breaking of atrial
fibrillation. The patient re-entered AFibb within one hour, and
was loaded with amiodarone. Patient's CXR showed an enlarged
cardiac silloute, and CT showed large pericardial effusion.
Patient was transfered to [**Hospital1 18**] CCU for further manegement.
.
Patient denies any history of arrythmias, joint pain, cancer,
past heart attack, cardiac surgery, hemoptysis, or recent
thoracic trauma. He reports recent intentional weight loss of 30
pounds in last nine months. On two previous CT's patient had
small noted 4mm non-calcified lung nodule, which has not
increased in size.

MEDICAL HISTORY: Hyperlipidemia
Obstructive Sleep Apnea
Mild Emphysema PFT's [**2-20**] showed mild obstructive ventilatory
defect
GERD
Hiatal Hernia
Celiac Disease
Colon Polyps
Diverticulosis

MEDICATION ON ADMISSION: ASA
Lipitor
Androgel
Prevacid
MVI
Fishoil
Flomax

ALLERGIES: Gluten

PHYSICAL EXAM: T 99.1 HR 105 BP 113/89 RR 18 SAT 96% PULSUS 15
HEENT: No scleral icterus, injected conjunctiva, PERRL, no
submandibular, sublingual, ant/post cervical adenopathy.
Oralpharynx without edema or erythema, no purulence. No oral
lesions noted.
NECK: No jugular venous distension, no lyphadenopathy, no
hepatojugular reflex
CHEST: No axillary lymphadenopathy noted. Slight cardiac rub
appreciated in RLL upon expiration.
HEART: Tachycardic. S1S2. No murmurs or gallops appreciated.
Cardiac rub appreciated, best at apex, with patient leaning
forward.
ABD: Soft, non-tender, non-distended. Normoactive bowel sounds.
No pulsitile mass noted. 2cm by 2cm escar noted on LLQ of
abdomen.
EXT: No edema noted in extremities. 2+
DP/PT/Poplitieal/Femoral/and Radial pulses. No cycanosis.
Neuro: Answers appropriatly to questioning. AAOx3. No focal
motor/sensory deficits. Cranial Nerves intact.

FAMILY HISTORY: There is a family history of sudden death, with his father dying
of cardiac arrest at age 75. His mother died at 79 of cancer. He
has a brother with seizure disorder and another with crohns
disease.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. He is a former smoker of two packs a day for twenty years,
quit 17 years ago. There is no history of alcohol abuse.
Unspecified disease of pericardium,Other emphysema,Celiac disease,Unspecified pleural effusion,Atrial fibrillation,Pure hypercholesterolemia,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Diverticulosis of colon (without mention of hemorrhage),Personal history of colonic polyps,Obstructive sleep apnea (adult)(pediatric)
Pericardial disease NOS,Emphysema NEC,Celiac disease,Pleural effusion NOS,Atrial fibrillation,Pure hypercholesterolem,Esophageal reflux,Diaphragmatic hernia,Dvrtclo colon w/o hmrhg,Prsnl hst colonic polyps,Obstructive sleep apnea
Admission Date:  [**2195-7-16**]              Discharge Date:   [**2195-7-19**]

Date of Birth:  [**2135-8-2**]             Sex:   M

Service: MEDICINE

Allergies:
Gluten

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
Pericardiocentesis


History of Present Illness:
59 y/o male with Hyperlipidemia, Mild Emphysema, GERD, and
Obstructive Sleep Apnea presented to [**Hospital1 **] [**Location (un) 620**] on [**2195-7-15**] with
shortness of breath described as inability to get in a
satisfying breath. Patient has been experiencing symptoms for
last 4-5 days. Symptoms associated with increased fatigue,
subjective fevers/chills, swollen neck glands, and palpitations.
Patient denies any chest pain or light-headedness. In the last
week, patient had developed of a vesicular rash, which began on
abdomen, with 2-3 areas of patchy involvement progressing
towards back. He began taking acyclovir for presumed herpes
zoster.
.
Initial vitals at [**Location (un) 620**] were T 98.5, HR 99, BP 109/79 RR 16
SAT 98% RA. Found to be in rapid AFib with HR in the 190's.
Given two pushes of lopressor, which did induce improvement
ventricular rate, but precipitous fall in systolic blood
pressures to 70-80s. Patient was cardioverted with 50, 100, and
finally three hundred joules, with successful breaking of atrial
fibrillation. The patient re-entered AFibb within one hour, and
was loaded with amiodarone. Patient's CXR showed an enlarged
cardiac silloute, and CT showed large pericardial effusion.
Patient was transfered to [**Hospital1 18**] CCU for further manegement.
.
Patient denies any history of arrythmias, joint pain, cancer,
past heart attack, cardiac surgery, hemoptysis, or recent
thoracic trauma. He reports recent intentional weight loss of 30
pounds in last nine months. On two previous CT's patient had
small noted 4mm non-calcified lung nodule, which has not
increased in size.

Past Medical History:
Hyperlipidemia
Obstructive Sleep Apnea
Mild Emphysema PFT's [**2-20**] showed mild obstructive ventilatory
defect
GERD
Hiatal Hernia
Celiac Disease
Colon Polyps
Diverticulosis

No known drug allergies

Social History:
Social history is significant for the absence of current tobacco
use. He is a former smoker of two packs a day for twenty years,
quit 17 years ago. There is no history of alcohol abuse.

Family History:
There is a family history of sudden death, with his father dying
of cardiac arrest at age 75. His mother died at 79 of cancer. He
has a brother with seizure disorder and another with crohns
disease.

Physical Exam:
T 99.1 HR 105 BP 113/89 RR 18 SAT 96% PULSUS 15
HEENT: No scleral icterus, injected conjunctiva, PERRL, no
submandibular, sublingual, ant/post cervical adenopathy.
Oralpharynx without edema or erythema, no purulence. No oral
lesions noted.
NECK: No jugular venous distension, no lyphadenopathy, no
hepatojugular reflex
CHEST: No axillary lymphadenopathy noted. Slight cardiac rub
appreciated in RLL upon expiration.
HEART: Tachycardic. S1S2. No murmurs or gallops appreciated.
Cardiac rub appreciated, best at apex, with patient leaning
forward.
ABD: Soft, non-tender, non-distended. Normoactive bowel sounds.
No pulsitile mass noted. 2cm by 2cm escar noted on LLQ of
abdomen.
EXT: No edema noted in extremities. 2+
DP/PT/Poplitieal/Femoral/and Radial pulses. No cycanosis.
Neuro: Answers appropriatly to questioning. AAOx3. No focal
motor/sensory deficits. Cranial Nerves intact.

Pertinent Results:
LABORATORY DATA:
WBC 8.9 HCT 44 PLT 431
Na 141 Cl 104 K 5.5 Bicarb 28 BUN 15
Ca 8.9
Tprot 6.9 Alb 3.1 Tbili 0.62 Alk Phos 356 ALT 113 AST 58
Amylase 32 Lipase 192
Cr 1.1
INR 1.1
TSH 1.8
CK 92
CK-MB 2 CK Index 2.2
Troponin T <0.01
D Dimer 8.53 (0-0.99)
.
EKG showed sinus tachycardia with a ventricular rate of 104bpm.
Normal axis. PR depressions noted in I, II, V3. Upsloping ST
segment elevations of 1mm in V3, V4, V5. Minimal electrical
alternans noted in precordium.
.
CXR at [**Location (un) 620**]: Massive Cardiomegaly
.
CT CHEST at [**Location (un) 620**]: Large Pericardial Effusion, Small Bilateral
Pleural Effusions
.
CT scan of Chest [**2-20**]:
Several small mediastinal nodes are seen which do not meet the
criteria of pathological lymph node enlargement and they are
stable in
comparison.  The heart size is normal. No pericardial effusion
or thickening is seen. Small calcification in LAD is noted. The
thoracic aorta is unremarkable as well as the pulmonary
arteries. Stable 4-mm left upper lobe nodule is seen on series
2, image 10. A calcified pulmonary nodule is again seen near the
fissure in the left upper lobe, series 2, image 22. No other
pulmonary nodules or lesions suspicious for malignancy are seen.
 Stable mild predominantly centrilobular emphysema is again
noted mostly involving the upper lobes. Bilateral symmetric
gynecomastia is present unchanged in comparison to the previous
film.
The upper images of the abdomen again demonstrate unchanged
small porta hepatis lymph nodes.  The imaged portion of the
liver, pancreas, kidneys, spleen do not reveal any pathology.
Degenerative spine changes are seen predominantly in the upper
thoracic spine.
.
2D-ECHOCARDIOGRAM performed on [**2193-8-1**] (baseline) demonstrated:

Mildly Dilated RA. The LA is normal in size. LV wall thicknesses
are normal. The LV cavity size is normal. Overall left
ventricular systolic function is normal (LVEF>55%). RV chamber
size and free wall motion are normal. The aortic root is
moderately dilated. The ascending aorta is mildly dilated. The
aortic valve leaflets (3) are mildly thickened. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Trivial mitral regurgitation is seen. There is no
pericardial effusion.
.
Echo [**2195-7-16**]:
Overall left ventricular systolic function is normal (LVEF>55%).
The right ventricular cavity is unusually small. Right
ventricular systolic function is normal. The aortic valve
leaflets are mildly thickened. The mitral valve leaflets are
mildly thickened. There is a large pericardial effusion. There
is sustained right atrial collapse. There is right ventricular
diastolic collapse and probable compression, consistent with
impaired fillling/tamponade physiology. There is significant,
accentuated respiratory variation in mitral/tricuspid valve
inflows, consistent with impaired ventricular filling.
.
Post-pericardiocentesis Echo [**2195-7-16**]:
The left ventricular cavity size is normal. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size is normal. Right ventricular systolic
function is normal. There is a pericardial effusion that is very
small anteriorly and upto 1.7 cm wide and echodense (consistent
with organization/possible thrombus) posterior to the basal left
ventricle. There are no echocardiographic signs of tamponade.
Compared to the study earlier today, the pericardial effusion is
now much smaller.
.
Echo [**2195-7-17**]:
Left ventricular wall thickness, cavity size and regional/global
systolic
function are normal (LVEF >55%) There is a small pericardial
effusion
subtending the right atrial free wall. There are no
echocardiographic signs of  tamponade. No right atrial or right
ventricular diastolic collapse is seen.  Compared with the
findings of the prior study (images reviewed) of [**2195-7-16**],
there has been some reaccumulation of fluid around the right
atrial free wall.
.
Echo [**2195-7-19**]:
There is a small to moderate sized pericardial effusion
measuring 1.2 cm
subtending the right atrial free wall and 1.1 cm inferior to the
LV basal to mid inferior wall. No right atrial or right
ventricular diastolic collapse is seen. Compared with the prior
study (images reviewed) of [**2195-7-17**], there is no change in the
size of pericardial effusion.
.
CT chest, abdomen, pelvis [**2195-7-17**]:
1. Unchanged centrilobular emphysema and 4 mm left upper lobe
pulmonary
nodule. Continued follow up in 12 months is recommended.
.
2. Large bilateral pleural effusions with dependent atelectasis.

.
3. Moderately large pericardial effusion with prominent
hyperenhancing
pericardium.  This could be related to patient's recent
pericardiocentesis and drain placement. No definite nodularity.
.
4. Mild ascites with mild retroperitoneal free fluid. No
retroperitoneal
lesions or masses or disease process was seen.  No definitive
evidence of
malignancy.

Brief Hospital Course:
59 y/o male with pericardial effusion causing shortness of
breath.
.
1. Pericardial effusion:
Echocardiogram demonstrated pericardial effusion with
compression of right ventricle during diastole consistent with
tamponade physiology.  Patient had 1100cc pericardiocentesis
performed with resolution of dyspnea.  Follow-up echo performed
the day of pericardiocentesis as well as 1 day later did not
show significant reaccumulation of his effusion.  His drain was
pulled without creating a pericardial window, and follow-up
echocardiogram on [**7-19**] did not show further accumulation of
effusion.
.
The etiology for the effusion was unclear.  Differential for a
pericardial effusion includes viral infection, including HIV,
purulent pericarditis, tuberculosis, myocardial infarction,
cardiac surgery, chest trauma, drugs and toxins, metabolic
disorders (especially uremia, dialysis, and hypothyroidism),
malignancy, collagen-vascular diseases.  No evidence of uremia
lab work, normal TSH, no description of symptoms consistent with
lupus, no history of heart diseae or chest pain and negative
troponins, and no correlation between patient's current
medications and pericardial effusion.
.
The patient describes recent syndroms consistent with a viral
podrome, which lends itself to a viral etiology. However, given
the massive size of the effusion compared to symptoms, it would
seem more chronic in nature, making an malignant cause seem more
likely.
.
Patient reports that he had a negative colonoscopy at age 55.
PPD was placed and was negative 48 hours later.  HIV test was
sent with the patient's consent, and came back negative.
Cytology from his pericardiocentesis revealed "Predominantly
lymphocytes with few reactive mesothelial cells and blood."  CT
of chest, abdomen, and pelvis was performed to search for occult
malignancy, and there was no evidence of malignancy or
lymphadenopathy.  He was advised to follow-up with his PCP for
further care, including obtaining a second colonoscopy.
Moreover, the covering physician for his PCP was [**Name (NI) 653**]
regarding his hospital admission and the need for follow-up.  He
has a follow-up appointment with cardiology in 1 week with a
preceding echocardiogram to evaluate for any reaccumulation of
his pericardial effusion.
.
2. Atrial Fibrillation:
The patient has no history of cardiac arrythmia, and it was felt
that his AFib was due to compressive pericardial effusion.  His
only symptom was a vague feeling of flutter in his chest.  He
continued to have episodes of AFib even after
pericardiocentesis.  He was put on an amiodarone drip and then
switched to oral amiodarone.   For breakthrough episodes of
AFib, pt was given IV metoprolol, which caused him to become
hypotensive to 90s systolic.  AFib did respond to diltiazem.
Prior to discharge, patient was placed on oral metoprolol and
oral amiodarone with good control of his AFib and he was
discharged on these medications.  He was directed to take one
extra dose of metoprolol if he felt he was in AFib.
.
3. GERD--maintained on PPI during admission
.
4. Hypercholesterolemia: will maintain home dose of lipitor.
.
5. Patient had thrombophlebitis on right forearm.  On exam, the
area was erythematous and warm to the touch, though the area
involved had become smaller on the day of discharge.  He was
given a 5 day course of Keflex for treatment.

Medications on Admission:
ASA
Lipitor
Androgel
Prevacid
MVI
Fishoil
Flomax

Discharge Medications:
1. Atorvastatin 10 mg Tablet [**Name (NI) **]: One (1) Tablet PO DAILY
(Daily).
2. Zolpidem 5 mg Tablet [**Name (NI) **]: 1-2 Tablets PO HS (at bedtime) as
needed for insomnia.
3. Metoprolol Tartrate 50 mg Tablet [**Name (NI) **]: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*0*
4. Amiodarone 400 mg Tablet [**Name (NI) **]: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*
5. Aspirin 81 mg Tablet [**Name (NI) **]: One (1) Tablet PO once a day.
6. AndroGel 1 % (25 mg/2.5 g) Gel in Packet [**Name (NI) **]: as directed as
directed Transdermal as directed.
7. Prevacid 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] twice a day.
8. Flomax 0.4 mg Capsule, Sust. Release 24 hr [**Last Name (STitle) **]: One (1)
Capsule, Sust. Release 24 hr PO once a day.
9. Keflex 500 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO twice a day for
5 days.
Disp:*10 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Dx: Pericardial effusion.
Secondary Dx: Paroxysmal atrial fibrillation


Discharge Condition:
Patient's shortness of breath had greatly improved following
pericardiocentesis.  He had several episodes of paroxysmal
Atrial fibrillation, which were controlled with metoprolol upon
discharge.  He was sent home in stable condition with amiodarone
and metoprolol for control of AFib.  He has follow-up within [**11-18**]
weeks with cardiology to assess for reaccumulation of the
pericardial effusion.  The covering physician for his PCP was
[**Name (NI) 653**] regarding the need for this follow-up.


Discharge Instructions:
You were admitted with fluid around your heart, called a
"pericardial effusion."  This fluid was tapped and we followed
you to make sure that it did not reaccumulate.
1. Please take all medications as prescribed.
2. Please attend all follow-up appointments as listed below.
3. Please return to the hospital if you have shortness of
breath, chest pain, fevers, or any other concerning symptom.

Followup Instructions:
Please call the cardiology office at [**Telephone/Fax (1) 62**] on Tuesday
morning to find out if you have an appointment already
scheduled.  If you do not have an appointment yet, you need to
have an appointment within the next 1-2 weeks.  Your primary
doctor, Dr. [**Last Name (STitle) 1728**], knows that you need this appointment and can
help you get it soon if you are having difficulties.  Your dose
of amiodarone will be adjusted at this cardiology appointment.
Also, you should see Dr. [**Last Name (STitle) 1728**] within the next month.

Addendum--patient informed prior to discharge that he had a
cardiology appointment on Friday, [**7-24**].  He was to call the
above cardiology number to get the exact time and place.


Completed by:[**2195-7-22**]
{'Unspecified disease of pericardium,Other emphysema,Celiac disease,Unspecified pleural effusion,Atrial fibrillation,Pure hypercholesterolemia,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Diverticulosis of colon (without mention of hemorrhage),Personal history of colonic polyps,Obstructive sleep apnea (adult)(pediatric)'}


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

PRESENT ILLNESS: 59 y/o male with Hyperlipidemia, Mild Emphysema, GERD, and
Obstructive Sleep Apnea presented to [**Hospital1 **] [**Location (un) 620**] on [**2195-7-15**] with
shortness of breath described as inability to get in a
satisfying breath. Patient has been experiencing symptoms for
last 4-5 days. Symptoms associated with increased fatigue,
subjective fevers/chills, swollen neck glands, and palpitations.
Patient denies any chest pain or light-headedness. In the last
week, patient had developed of a vesicular rash, which began on
abdomen, with 2-3 areas of patchy involvement progressing
towards back. He began taking acyclovir for presumed herpes
zoster.
.
Initial vitals at [**Location (un) 620**] were T 98.5, HR 99, BP 109/79 RR 16
SAT 98% RA. Found to be in rapid AFib with HR in the 190's.
Given two pushes of lopressor, which did induce improvement
ventricular rate, but precipitous fall in systolic blood
pressures to 70-80s. Patient was cardioverted with 50, 100, and
finally three hundred joules, with successful breaking of atrial
fibrillation. The patient re-entered AFibb within one hour, and
was loaded with amiodarone. Patient's CXR showed an enlarged
cardiac silloute, and CT showed large pericardial effusion.
Patient was transfered to [**Hospital1 18**] CCU for further manegement.
.
Patient denies any history of arrythmias, joint pain, cancer,
past heart attack, cardiac surgery, hemoptysis, or recent
thoracic trauma. He reports recent intentional weight loss of 30
pounds in last nine months. On two previous CT's patient had
small noted 4mm non-calcified lung nodule, which has not
increased in size.

MEDICAL HISTORY: Hyperlipidemia
Obstructive Sleep Apnea
Mild Emphysema PFT's [**2-20**] showed mild obstructive ventilatory
defect
GERD
Hiatal Hernia
Celiac Disease
Colon Polyps
Diverticulosis

MEDICATION ON ADMISSION: ASA
Lipitor
Androgel
Prevacid
MVI
Fishoil
Flomax

ALLERGIES: Gluten

PHYSICAL EXAM: T 99.1 HR 105 BP 113/89 RR 18 SAT 96% PULSUS 15
HEENT: No scleral icterus, injected conjunctiva, PERRL, no
submandibular, sublingual, ant/post cervical adenopathy.
Oralpharynx without edema or erythema, no purulence. No oral
lesions noted.
NECK: No jugular venous distension, no lyphadenopathy, no
hepatojugular reflex
CHEST: No axillary lymphadenopathy noted. Slight cardiac rub
appreciated in RLL upon expiration.
HEART: Tachycardic. S1S2. No murmurs or gallops appreciated.
Cardiac rub appreciated, best at apex, with patient leaning
forward.
ABD: Soft, non-tender, non-distended. Normoactive bowel sounds.
No pulsitile mass noted. 2cm by 2cm escar noted on LLQ of
abdomen.
EXT: No edema noted in extremities. 2+
DP/PT/Poplitieal/Femoral/and Radial pulses. No cycanosis.
Neuro: Answers appropriatly to questioning. AAOx3. No focal
motor/sensory deficits. Cranial Nerves intact.

FAMILY HISTORY: There is a family history of sudden death, with his father dying
of cardiac arrest at age 75. His mother died at 79 of cancer. He
has a brother with seizure disorder and another with crohns
disease.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. He is a former smoker of two packs a day for twenty years,
quit 17 years ago. There is no history of alcohol abuse. 

### Response:
{'Unspecified disease of pericardium,Other emphysema,Celiac disease,Unspecified pleural effusion,Atrial fibrillation,Pure hypercholesterolemia,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Diverticulosis of colon (without mention of hemorrhage),Personal history of colonic polyps,Obstructive sleep apnea (adult)(pediatric)'}
