CHIEF COMPLAINT: Shortness of breath for one day

PRESENT ILLNESS: 78 y.o. female with h/o CAD s/p CABG x 2 [**2146-12-8**], who presented
to OSH with SOB x 1 day and was found to have pulmonary embolus
along with RV failure and was started on heparin.
She originally presented to an OSH on [**12-4**] with a left
swollen leg secondary to trauma and was found to have a leaking
popliteal aneurysm.  In the midst of [**Month (only) 1106**] w/u she was noted
to have TWI inversions and elevated troponins and thus underwent
L popliteal stent placement and cath on [**12-6**]. See results
below.  She then underwent 2 V CABG on [**2146-12-8**]. She
was then discharged to rehab on [**12-14**] and was at rehab
when she developed 1 day of shortness of breath for which she
was admitted to [**Hospital3 **] and found to have a PE and
hypotension along with RV dilatation on echo. She was then
transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: PMH:
CAD s/p cardiac cath on [**2146-12-6**] which revealed:
70% distal LMCA lesion,
90% proximal LAD lesion,
80% LCX stenosis, and 50% RCA stenosis.
s/p L popliteal aneursym stent placed.
s/p CABG on [**2146-12-8**]- LIMA to descending LAD, reverse SVG from
from LIMA to OMCA
s/p cataract surgery
H/o L leaking popliteal artery aneurysm s/p stent placement
[**2147-12-6**]
.
Cataracts, s/p surgery

MEDICATION ON ADMISSION: Lasix 20 mg [**Hospital1 **]
Plavix 75 mg qd
ASA 81 mg qd
Levo/flagyl x 7 dats
Lipitor 10 mg qd
Lopressor 50 mg [**Hospital1 **]
From [**Hospital3 **]- Levaquin 250 mg IV q 24 hours, Tobramycin
50 mg IV q 12.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T = 98.0, BP = 79-101/44-54, HR = 103-111, RR = 25, SaO2= 15L
NRB.
Gen: Thin elderly female laying in bed, mildly tachypneic,
appears slightly uncomfortable
CV: nml S1, S2, no m/r/g
Lungs: Bibasilar crackles 1/3 up from the bases
Abdomen: nabs, soft, nt.
Extremities: 2+ DPP appreciated with dopplers.

FAMILY HISTORY: + CAD

SOCIAL HISTORY: Lives alone.Cigs: 3ppd x 50 years, quit 14 years ago.ETOH: [**12-18**]
glass wine/day.
Other pulmonary embolism and infarction,Other complications due to other vascular device, implant, and graft,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Rash and other nonspecific skin eruption,Aortocoronary bypass status,Nonspecific abnormal findings in stool contents
Pulm embol/infarct NEC,Comp-oth vasc dev/graft,Obs chr bronc w(ac) exac,Pneumonia, organism NOS,Atrial fibrillation,CHF NOS,Nonspecif skin erupt NEC,Aortocoronary bypass,Abn find-stool contents
Admission Date:  [**2146-12-24**]              Discharge Date:   [**2146-12-30**]

Date of Birth:  [**2068-1-31**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 7539**]
Chief Complaint:
Shortness of breath for one day

Major Surgical or Invasive Procedure:
s/p Inferior vena cava filter placement

History of Present Illness:
78 y.o. female with h/o CAD s/p CABG x 2 [**2146-12-8**], who presented
to OSH with SOB x 1 day and was found to have pulmonary embolus
along with RV failure and was started on heparin.
She originally presented to an OSH on [**12-4**] with a left
swollen leg secondary to trauma and was found to have a leaking
popliteal aneurysm.  In the midst of [**Month (only) 1106**] w/u she was noted
to have TWI inversions and elevated troponins and thus underwent
L popliteal stent placement and cath on [**12-6**]. See results
below.  She then underwent 2 V CABG on [**2146-12-8**]. She
was then discharged to rehab on [**12-14**] and was at rehab
when she developed 1 day of shortness of breath for which she
was admitted to [**Hospital3 **] and found to have a PE and
hypotension along with RV dilatation on echo. She was then
transferred to [**Hospital1 18**] for further management.


Past Medical History:
PMH:
CAD s/p cardiac cath on [**2146-12-6**] which revealed:
70% distal LMCA lesion,
90% proximal LAD lesion,
80% LCX stenosis, and 50% RCA stenosis.
s/p L popliteal aneursym stent placed.
s/p CABG on [**2146-12-8**]- LIMA to descending LAD, reverse SVG from
from LIMA to OMCA
s/p cataract surgery
H/o L leaking popliteal artery aneurysm s/p stent placement
[**2147-12-6**]
.
Cataracts, s/p surgery

Social History:
Lives alone.Cigs: 3ppd x 50 years, quit 14 years ago.ETOH: [**12-18**]
glass wine/day.

Family History:
+ CAD

Physical Exam:
T = 98.0, BP = 79-101/44-54, HR = 103-111, RR = 25, SaO2= 15L
NRB.
Gen: Thin elderly female laying in bed, mildly tachypneic,
appears slightly uncomfortable
CV: nml S1, S2, no m/r/g
Lungs: Bibasilar crackles 1/3 up from the bases
Abdomen: nabs, soft, nt.
Extremities: 2+ DPP appreciated with dopplers.

Pertinent Results:
[**2146-12-24**] 10:24PM   TYPE-ART TEMP-36.1 RATES-/36 O2-100 PO2-80*
PCO2-40 PH-7.41 TOTAL CO2-26 BASE XS-0 AADO2-619 REQ O2-97
INTUBATED-NOT INTUBA COMMENTS-SHOVEL MAS
[**2146-12-24**] 10:24PM   O2 SAT-96
[**2146-12-24**] 08:27PM   TYPE-ART TEMP-36.1 PO2-136* PCO2-46* PH-7.40
TOTAL CO2-30 BASE XS-3
[**2146-12-24**] 08:27PM   GLUCOSE-112* LACTATE-0.7
[**2146-12-24**] 08:27PM   O2 SAT-98
[**2146-12-24**] 08:27PM   freeCa-1.05*
[**2146-12-24**] 08:00PM   GLUCOSE-116* UREA N-13 CREAT-0.4 SODIUM-139
POTASSIUM-4.5 CHLORIDE-107 TOTAL CO2-27 ANION GAP-10
[**2146-12-24**] 08:00PM   CALCIUM-7.1* PHOSPHATE-2.8 MAGNESIUM-1.7
[**2146-12-24**] 08:00PM   WBC-8.7 RBC-3.00* HGB-8.9* HCT-27.6* MCV-92
MCH-29.6 MCHC-32.1 RDW-15.5
[**2146-12-24**] 08:00PM   PLT COUNT-290
[**2146-12-24**] 08:00PM   PT-13.0 PTT-25.7 INR(PT)-1.1
[**2146-12-24**] 12:40PM   PT-13.7* INR(PT)-1.2
[**2146-12-24**] 12:40PM   PROT C-**
[**2146-12-24**] 12:31PM   TYPE-ART PO2-86 PCO2-50* PH-7.42 TOTAL
CO2-34* BASE XS-6
[**2146-12-24**] 11:16AM   TYPE-ART PO2-214* PCO2-54* PH-7.42 TOTAL
CO2-36* BASE XS-9
[**2146-12-24**] 08:29AM   GLUCOSE-110* UREA N-19 CREAT-0.5 SODIUM-139
POTASSIUM-5.6* CHLORIDE-105 TOTAL CO2-29 ANION GAP-11
[**2146-12-24**] 08:29AM   CK-MB-2 cTropnT-<0.01
[**2146-12-24**] 08:29AM   CALCIUM-8.1* PHOSPHATE-2.7 MAGNESIUM-2.5
[**2146-12-24**] 08:29AM   WBC-10.4 RBC-3.33* HGB-10.0* HCT-30.6* MCV-92
MCH-30.1 MCHC-32.8 RDW-15.4
[**2146-12-24**] 08:29AM   NEUTS-86.9* LYMPHS-7.5* MONOS-2.7 EOS-2.5
BASOS-0.4
[**2146-12-24**] 08:29AM   MACROCYT-1+
[**2146-12-24**] 08:29AM   PLT COUNT-284
[**2146-12-24**] 08:29AM   PT-13.9* PTT-71.5* INR(PT)-1.2
[**2146-12-24**] 03:20AM   TYPE-ART TEMP-36.7 O2-100 PO2-121* PCO2-54*
PH-7.34* TOTAL CO2-30 BASE XS-2 AADO2-564 REQ O2-90
INTUBATED-NOT INTUBA
[**2146-12-24**] 03:20AM   K+-3.5
[**2146-12-24**] 03:20AM   K+-3.5
[**2146-12-24**] 03:20AM   K+-3.5
[**2146-12-24**] 03:20AM   O2 SAT-97
[**2146-12-24**] 12:59AM   TYPE-MIX TEMP-36.7 RATES-/24 PO2-36* PCO2-57*
PH-7.38 TOTAL CO2-35* BASE XS-6 INTUBATED-NOT INTUBA
COMMENTS-NON-REBREA
[**2146-12-24**] 12:59AM   LACTATE-1.0
[**2146-12-24**] 12:59AM   LACTATE-1.0
[**2146-12-24**] 12:59AM   O2 SAT-69
[**2146-12-24**] 12:59AM   freeCa-1.15
[**2146-12-24**] 12:46AM   GLUCOSE-106* UREA N-28* CREAT-0.6 SODIUM-143
POTASSIUM-4.0 CHLORIDE-107 TOTAL CO2-31* ANION GAP-9
[**2146-12-24**] 12:46AM   CK(CPK)-33
[**2146-12-24**] 12:46AM   CK-MB-NotDone cTropnT-<0.01
[**2146-12-24**] 12:46AM   CALCIUM-8.0* PHOSPHATE-2.8 MAGNESIUM-1.6
[**2146-12-24**] 12:46AM   CK-MB-NotDone cTropnT-<0.01
[**2146-12-24**] 12:46AM   CALCIUM-8.0* PHOSPHATE-2.8 MAGNESIUM-1.6
[**2146-12-24**] 12:46AM   WBC-11.3* RBC-3.38* HGB-10.1* HCT-31.3*
MCV-93 MCH-29.9 MCHC-32.4 RDW-15.3
[**2146-12-24**] 12:46AM   PLT COUNT-292
[**2146-12-24**] 12:46AM   PT-14.0* PTT-65.2* INR(PT)-1.2
OSH Imaging:
LLE US: L popliteal stent with no flow
.
Chest x ray at OSH: COPD changes, Focal L basilar opacity c/w
atelectasis or infiltrate, Small bilateral pleural effusions
.
Spiral CT:Extensive pulmonary embolus of the right main
pulmonary artery extending into the right upper, right middle
and right lower lobe arteries and left uppoer lobe artery. Right
brachiocephalic. Small bilateral pleural effusions, atelectasis
and emphysema.
.
Echo report from OSH: R ventricular dilatation with nml LV size
and function

ART DUP EXT LO UNI;F/U PORT
Duplex evaluations are performed on the left lower extremity
arterial system. The proximal above knee popliteal artery is
patent. At the level of the knee, there is increased velocity of
541 cm per second, no flow was seen in the popliteal artery
below that. Distal to the stent, there is a significant
turbulent flow with diminished velocity in the popliteal artery.

Chest AP:
IMPRESSION:

Improving CHF, decreasing bilateral pleural effusions. Bibasilar
consolidation, probably representing atelectasis, however,
pneumonia cannot be totally excluded.


Brief Hospital Course:
A/P 78 year old female with h/o CAD s/p 2V CABG who now presents
with massive pulmonary embolus accompanied by hypotension
requring dopamine.
.
1. Massive PE:
Hypotension:
The patient was started on levophed in order to maintain an MAP
of 60. Upon review of her old records from her previous
discharge we learned that her normal BP is 90/60 and upon
floating a Swan Ganz catheter her PCWP was 6. We thus realized
that her hypotension was most likely secondary to dehydration
and she was gently re-hydrating with IV fluids and weaned off
dopamine. She was not given lytics because of her recent
surgery. She was taken to the cath lab for embolectomy and found
to have adequate clot dissolution and no RV compromise. A
temporary optese IVC filter was then placed and she was started
on heparin. (The removal of this filter should be discussed at
her appointment with Dr. [**Last Name (STitle) 22423**].) Her hypoxemia continued to
improve on heparin until the day of discharge when she was
sating well on 2.5L of O2 and able to ambulate independently
without difficulty.
.
2. CAD:
s/p recent CABG [**11-19**] (Lima to LAD, reverse SVG from Lima to
OMCa). Upon admission her enyzymes were flat and thus we had no
evidence of acute ischemia. She was thus continued on aspirin
and plavix.
.
3. CHF: EF 30%, near-global akinesis, 1+MR, mild pulm HTN
We thought that she was grossly fluid overloaded but she was
intra-vascularly dry. She also became tachycardic which we
thought was secondary to her being dry and thus her lasix was
held and she was gently hydrated by encouraging po intake. In
light of her low EF we suggest that she start on low dose lasix
20 mg qd upon discharge from [**Hospital1 **].  We also
suggest a chemistry 7 be drawn within 1 week of her resumption
of lasix.
.
4. Heme-occult positive stools:
During her hospitalization she was found to have heme-positive
stool with a stable HCT and thus we recommend an outpatient GI
work up.

5. LLE aneurysym:
Arterial duplexes demonstrated that her L popliteal artery stent
was occluded and thus her plavix was discontinued. Since she did
have good collateral flow surgery decided it best to wait until
she had completed her treatment for her pulmonary embolus prior
to [**Hospital1 1106**] surgery.

6.
Pneumonia/COPD exacerbation:
The patient developed a productive cough and had bilateral
infiltrates.  She was thus started on levoquin to complete a 7
day course on [**2146-1-1**].

7. FEN: cardiac 2g Na diet, fluid restrict
.
Code: FULL


Medications on Admission:
Lasix 20 mg [**Hospital1 **]
Plavix 75 mg qd
ASA 81 mg qd
Levo/flagyl x 7 dats
Lipitor 10 mg qd
Lopressor 50 mg [**Hospital1 **]
From [**Hospital3 **]- Levaquin 250 mg IV q 24 hours, Tobramycin
50 mg IV q 12.

Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] House Nursing Home - [**Location 9583**]

Discharge Diagnosis:
Primary:
Massive Pulmonary Embolus
Occluded L popliteal artery
Hemoccult positive stools
Secondary
Coronary artery disease-s/p CABG


Discharge Condition:
Good, stable.  She has required 2.5 L of oxygen via NC during
her stay here.

Discharge Instructions:
Please return to the emergency room if you experience shortness
of breath, light headedness, chest pain, black stools, or bright
red rectum.

Followup Instructions:
Provider: [**Name10 (NameIs) 1111**],[**First Name7 (NamePattern1) 1112**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY Where: [**Last Name (NamePattern4) **]
SURGERY Date/Time:[**2147-1-5**] 1:30

Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] CARDIAC SURGERY LMOB 2A Where: CARDIAC
SURGERY LMOB 2A Date/Time:[**2147-1-18**] 3:15

Dr. [**Last Name (STitle) 59769**] medical director of [**Location (un) **] House ([**Telephone/Fax (1) 59770**]) has
agreed to take responsibility for your care at [**Location (un) **] House.
{'Other pulmonary embolism and infarction,Other complications due to other vascular device, implant, and graft,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Rash and other nonspecific skin eruption,Aortocoronary bypass status,Nonspecific abnormal findings in stool contents'}


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 for one day

PRESENT ILLNESS: 78 y.o. female with h/o CAD s/p CABG x 2 [**2146-12-8**], who presented
to OSH with SOB x 1 day and was found to have pulmonary embolus
along with RV failure and was started on heparin.
She originally presented to an OSH on [**12-4**] with a left
swollen leg secondary to trauma and was found to have a leaking
popliteal aneurysm.  In the midst of [**Month (only) 1106**] w/u she was noted
to have TWI inversions and elevated troponins and thus underwent
L popliteal stent placement and cath on [**12-6**]. See results
below.  She then underwent 2 V CABG on [**2146-12-8**]. She
was then discharged to rehab on [**12-14**] and was at rehab
when she developed 1 day of shortness of breath for which she
was admitted to [**Hospital3 **] and found to have a PE and
hypotension along with RV dilatation on echo. She was then
transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: PMH:
CAD s/p cardiac cath on [**2146-12-6**] which revealed:
70% distal LMCA lesion,
90% proximal LAD lesion,
80% LCX stenosis, and 50% RCA stenosis.
s/p L popliteal aneursym stent placed.
s/p CABG on [**2146-12-8**]- LIMA to descending LAD, reverse SVG from
from LIMA to OMCA
s/p cataract surgery
H/o L leaking popliteal artery aneurysm s/p stent placement
[**2147-12-6**]
.
Cataracts, s/p surgery

MEDICATION ON ADMISSION: Lasix 20 mg [**Hospital1 **]
Plavix 75 mg qd
ASA 81 mg qd
Levo/flagyl x 7 dats
Lipitor 10 mg qd
Lopressor 50 mg [**Hospital1 **]
From [**Hospital3 **]- Levaquin 250 mg IV q 24 hours, Tobramycin
50 mg IV q 12.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T = 98.0, BP = 79-101/44-54, HR = 103-111, RR = 25, SaO2= 15L
NRB.
Gen: Thin elderly female laying in bed, mildly tachypneic,
appears slightly uncomfortable
CV: nml S1, S2, no m/r/g
Lungs: Bibasilar crackles 1/3 up from the bases
Abdomen: nabs, soft, nt.
Extremities: 2+ DPP appreciated with dopplers.

FAMILY HISTORY: + CAD

SOCIAL HISTORY: Lives alone.Cigs: 3ppd x 50 years, quit 14 years ago.ETOH: [**12-18**]
glass wine/day. 

### Response:
{'Other pulmonary embolism and infarction,Other complications due to other vascular device, implant, and graft,Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Rash and other nonspecific skin eruption,Aortocoronary bypass status,Nonspecific abnormal findings in stool contents'}
