CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 70 year old male with
end stage renal disease on hemodialysis with a question of
coronary artery disease who was initially admitted to [**Hospital3 9683**] on [**2110-11-20**] with a clotted arteriovenous
fistula.  He was taken to the Operating Room and declotted.
Subsequently he had a Quinton catheter placed and was
dialyzed from [**11-21**] until [**11-24**] without any
incident.  On [**2110-11-24**] the patient had an episode of
dyspnea with atrial fibrillation and rapid ventricular
response.  He subsequently developed chest pain with that
arrhythmia and ruled in for troponin-positive myocardial
infarction.  His atrial fibrillation was resolved with Beta
blocker treatment.  He was then transferred to [**Hospital6 1760**] for further care and cardiac
catheterization.  The patient was brought to [**Hospital6 1760**] on [**2110-11-24**].

MEDICAL HISTORY: Significant for end stage renal
disease, hypertension, question of remote myocardial
infarction as well as new myocardial infarction, obstructive
sleep apnea.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Negative for heart disease or cancer.

SOCIAL HISTORY: Significant for cigar smoke and alcohol.  He
lives with his wife.
Acute myocardial infarction of unspecified site, initial episode of care,Atrial fibrillation,Other complications due to other vascular device, implant, and graft,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonitis due to inhalation of food or vomitus,Acidosis,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
AMI NOS, initial,Atrial fibrillation,Comp-oth vasc dev/graft,CHF NOS,Hyp kid NOS w cr kid V,Food/vomit pneumonitis,Acidosis,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr
Admission Date: [**2110-11-24**]       Discharge Date:  10//25/[**2110**]

Date of Birth:                    Sex:  M

Service:  Medicine

HISTORY OF PRESENT ILLNESS:  This is a 70 year old male with
end stage renal disease on hemodialysis with a question of
coronary artery disease who was initially admitted to [**Hospital3 9683**] on [**2110-11-20**] with a clotted arteriovenous
fistula.  He was taken to the Operating Room and declotted.
Subsequently he had a Quinton catheter placed and was
dialyzed from [**11-21**] until [**11-24**] without any
incident.  On [**2110-11-24**] the patient had an episode of
dyspnea with atrial fibrillation and rapid ventricular
response.  He subsequently developed chest pain with that
arrhythmia and ruled in for troponin-positive myocardial
infarction.  His atrial fibrillation was resolved with Beta
blocker treatment.  He was then transferred to [**Hospital6 1760**] for further care and cardiac
catheterization.  The patient was brought to [**Hospital6 1760**] on [**2110-11-24**].

Upon presentation to [**Hospital6 256**] the
patient was transferred to the Cardiac Intensive Care
Service.

MEDICATIONS:  His medications on presentation were
Nephrocaps, Vasotec, Aspirin, Sulfasalazine, Lopid, Prevacid,
PhosLo,      , Isordil, Tenormin and Ambien.

PAST MEDICAL HISTORY:  Significant for end stage renal
disease, hypertension, question of remote myocardial
infarction as well as new myocardial infarction, obstructive
sleep apnea.

SOCIAL HISTORY:  Significant for cigar smoke and alcohol.  He
lives with his wife.

FAMILY HISTORY:  Negative for heart disease or cancer.

PHYSICAL EXAMINATION:  Physical examination upon presentation
to the Cardiac Care Unit was temperature of 97?????? with a pulse
of 76, blood pressure 108/64, respirations 22, oxygen
saturation 94% on 8 liters face mask.  Generally he was an
elderly thin male in moderate respiratory distress.  Head,
eyes, ears, nose and throat revealed normocephalic,
atraumatic, pupils equal, round and reactive to light.  Neck
was soft and supple with right internal jugular Quinton
catheter.  No thyromegaly.  Heart was regular with a II/VI
systolic ejection murmur.  His lungs revealed bibasilar
crackles with decreased breathsounds on the right without
egophony.  His abdomen was soft, nontender, nondistended
without hepatosplenomegaly.  Extremities, bilateral lower
extremity edema, 1+, left upper extremity fistula site was
edematous with palpable thrill.  The site was warm and
nonfunctional.  His carotids revealed no bruits.

LABORATORY DATA:  Laboratory values upon presentation
revealed the patient with a white count of 18, hematocrit 37,
platelets 357.  Basic metabolic panel revealed a sodium of
137, potassium 4.1, chloride 99, bicarbonate 21, BUN 27,
creatinine 4.8 with a glucose of 216.  His liver function
tests were unremarkable.  His albumin was 3.6 with a calcium
of 10.2, magnesium 1.7 and a phosphorus of 3.7.  His
electrocardiogram revealed atrial fibrillation with ST
inversions in 1, 2 and V4 through V6 with left ventricular
hypertrophy or stream pattern.  Chest x-ray revealed mildly
flattened diaphragms with a question of a right middle lobe
density.

HOSPITAL COURSE:  1.  Cardiac - The patient was noted to be
in atrial fibrillation with rapid ventricular response and
developed congestive heart failure from this.  He was then
rate-controlled with beta blockers and nitroglycerin and has
remained in sinus rhythm throughout his hospitalization.  The
patient had a cardiac catheterization performed which
revealed diffuse left anterior descending disease with 50%
stenosis of the circumflex and a total occlusion of the right
coronary artery with multiple collaterals.  The patient's
left ventricular ejection fraction was normal.  He had 1 to
2% mitral valve regurgitation.  The patient was started on
Coumadin for atrial fibrillation anticoagulation.  He had no
further issues with congestive heart failure during his
hospitalization once he was rate-controlled with beta
blockers, ACE inhibitor and nitroglycerin prn for dyspnea.

2.  Pulmonary - The patient had a question of an aspiration
pneumonia with right middle lobe and right upper lobe
infiltrate on chest x-ray.  He was started on Flagyl and
Levaquin.  The patient never had a cough or fever during his
hospitalization.  A question of aspiration chemical
pneumonitis was raised.  The patient's pulmonary status
improved with hemodialysis and fluid removal as well as the
institution of beta blocker and ACE inhibitor to decrease
both his preload and afterload.  The patient's pulmonary
status stabilized.  He was sating 90 to 99% on room air
without dyspnea throughout his hospitalization.  The
patient's tachypnea resolved with hemodialysis subsequent to
the relief of his metabolic acidosis.

3.  Renal - The patient does have end stage renal disease.
The patient is on hemodialysis Tuesday, Thursday and Saturday
schedule.  He was dilated multiple times while at [**Hospital6 1760**], subsequent to the use of his
Hickman Port-A-Cath.  The patient initially had a small leak
from his Hickman Port-A-Cath so he had to undergo a serial
hemodialysis to correct his hyperkalemia.  It was thought the
patient tolerated the hemodialysis without difficulty.

4.  Infectious disease - It was noted that the patient had a
question of pneumonia versus asymmetric pulmonary edema on
his chest x-ray.  He subsequently underwent a chest
computerized tomography scan which revealed bilateral pleural
effusions, greater on the right than the left and
subsequently underwent thoracentesis which revealed fluid of
a transudative nature without any organisms and a negative
gram stain.  The patient has remained afebrile throughout his
hospitalization and has had multiple blood cultures drawn
which all were negative for growth.  His antibiotic of
Levaquin and Flagyl were stopped and the patient remained
afebrile and without complaints.  The question was raised of
a possible vascular infection.  The patient has remained
afebrile without positive blood cultures throughout his
hospitalization which makes the possibility of endovascular
infection unlikely.  It is recommended the patient receive
serial blood cultures during hemodialysis to rule out the
possible occult bacteremia.  The patient was noted to have an
increased leukocytosis throughout his hospitalization with an
average white blood cell count of 10 to 15 going as high as
30.  The patient never had any bands in his differential.  It
was noted that the patient had persistently elevated white
blood cell count throughout his hospitalization with an
increase of a high of 30 subsequently to the beginning of
Prednisone for pretreatment for his computerized axial
tomography scan.  It is possible the patient has an occult
infection that has not been detected with serial blood
cultures as well as chest computerized tomography scan.
However, it is also possible the patient had a leukemoid
reaction secondary to the multiple insults of myocardial
infarction, pulmonary edema and several vascular
interventions.

5.  Gastrointestinal/genitourinary - The patient was noted to
be heme positive times one in his stool.  His hematocrit was
checked and remained stable throughout his hospitalization.
He was on Protonix for gastrointestinal prophylaxis.  She was
also on heparin during his one episode of gastrointestinal
bleeding.  The patient had no melena or bright red blood per
rectum.  It is recommended that the patient receive
outpatient follow up for his occult gastrointestinal bleed.

6.  Hematology - The patient was noted to have a high white
blood cell count throughout his hospitalization, however, the
cause of this had not been elucidated.  The patient has
remained afebrile with negative blood cultures throughout his
hospitalization.  The chest x-ray was questionable for a
possible pneumonia versus aspiration pneumonitis with a
negative thoracentesis.  The patient is on Coumadin for
anticoagulation for his atrial fibrillation.  He will need
Coumadin anticoagulation for a total of 30 days status post
his episode of atrial fibrillation with rapid ventricular
response.  He also had a left forearm arteriovenous fistula
placed status post surgery at [**Hospital3 **].  It is
recommended the patient follow up with his surgeons at
[**Hospital1 **], prior to the use of his arteriovenous fistula.  The
patient has a right subclavian Hickman catheter which can be
used for dialysis as an outpatient.

7.  Endocrine - It was noted that the patient had a blood
glucose as high as 600 at an outside hospital and has
remained in the upper 150s to low 250s throughout his
hospitalization here.  He had a hemoglobin A1c of 6.1 which
established the diagnosis of a new onset diabetes.  The
patient will need follow up regarding new onset of diabetes
per his primary care physician.  [**Name10 (NameIs) **] is recommended the
patient have close follow up regarding his new diagnosis of
diabetes.

8.  Access - The patient had a venogram and arteriovenous
fistulogram while hospitalized to elucidate the possibility
of future use of his left arteriovenous fistula.  It was
noted by Vascular Surgery as well as Transplant Surgery at
[**Hospital6 256**] that the patient's
fistula is patent and will be usable in two to three weeks
when his postoperative changes have resolved.  It is
recommended that the patient see his vascular surgeon, Dr.
[**Last Name (STitle) 44747**] at [**Hospital3 **] prior to the use of his
arteriovenous fistula.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Discharged home with home [**Hospital6 1587**] as well as home physical therapy.

DISCHARGE DIAGNOSIS:
1.  Status post troponin-positive myocardial infarction
2.  Atrial fibrillation with rapid ventricular response now
in normal sinus rhythm on Coumadin
3.  Diabetes mellitus, new onset
4.  Left subclavian vein stenosis, status post total
parenteral alimentation and stent
5.  End stage renal disease on hemodialysis
6.  Status post right middle lobe pneumonia versus
pneumonitis
7.  Hypercalcemia resolved, the patient has a parathyroid
hormone level pending at discharge.  It is recommended the
patient have follow up for his transient hypercalcemia while
hospitalized.
8.  Hypertension

MEDICATIONS ON DISCHARGE:
Warfarin 2 mg p.o. q.h.s.
Atenolol 25 mg p.o. q.d.
      1600 mg p.o. t.i.d.
Lisinopril 10 mg p.o. b.i.d.
Isosorbide Dinitrate 20 mg p.o. t.i.d.
Gemfibrozil 30 mg p.o. q.d.
Ambien 5 mg p.o. q.h.s. prn
Amiodarone 200 mg p.o. q.d.
Atorvastatin 20 mg p.o. q.d.
Zantac 40 mg p.o. q.d.
Nephrocaps 1 capsule p.o. q.d.

FOLLOW UP:  The patient is to follow up with Dr. [**Last Name (STitle) 44748**] his
Nephrologist in hemodialysis on Saturday as well as to follow
up with Dr. [**Last Name (STitle) 44748**] more closely, phone [**Telephone/Fax (1) 44749**].  The
patient is also instructed to follow up with Dr. [**Last Name (STitle) 11510**] his
primary care physician, [**Name Initial (NameIs) **] [**Telephone/Fax (1) 4475**].  The patient is
also to follow up with Dr. [**Last Name (STitle) 44750**] at the Veteran's
Administration Hospital, phone [**Telephone/Fax (1) 34340**].  Dr. [**Last Name (STitle) 11510**]
was contact[**Name (NI) **] the patient had an appointment scheduled for
Monday, [**12-8**] at 11:30 AM.  The patient was also
instructed to follow up with Dr. [**Last Name (STitle) 44751**] his vascular surgeon
upon discharge.

RECOMMENDATIONS:  The patient will need full follow up
secondary to his new diagnosis of myocardial infarction and
atrial fibrillation with rapid ventricular responses.  It is
recommended the patient receive a cardiologist as an
outpatient for follow up of his myocardial infarction as well
as for Amiodarone management.  The patient also needs close
follow up secondary to his new diagnosis of diabetes mellitus
and possible medication and/or diet control.  The patient
will also need close follow up regarding his hemodialysis.
He is to follow up with Dr. [**Last Name (STitle) 44748**], his nephrologist who
knows him well.  He is to receive dialysis on Tuesday,
Thursday and Saturday and it is recommended that surveillance
blood cultures be drawn during this time.





                            [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 1775**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(2) 10451**]

Dictated By:[**Last Name (NamePattern1) 5747**]
MEDQUIST36

D:  [**2110-12-5**]  10:45
T:  [**2110-12-5**]  11:32
JOB#:  [**Job Number 44752**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Atrial fibrillation,Other complications due to other vascular device, implant, and graft,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonitis due to inhalation of food or vomitus,Acidosis,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: 

PRESENT ILLNESS: This is a 70 year old male with
end stage renal disease on hemodialysis with a question of
coronary artery disease who was initially admitted to [**Hospital3 9683**] on [**2110-11-20**] with a clotted arteriovenous
fistula.  He was taken to the Operating Room and declotted.
Subsequently he had a Quinton catheter placed and was
dialyzed from [**11-21**] until [**11-24**] without any
incident.  On [**2110-11-24**] the patient had an episode of
dyspnea with atrial fibrillation and rapid ventricular
response.  He subsequently developed chest pain with that
arrhythmia and ruled in for troponin-positive myocardial
infarction.  His atrial fibrillation was resolved with Beta
blocker treatment.  He was then transferred to [**Hospital6 1760**] for further care and cardiac
catheterization.  The patient was brought to [**Hospital6 1760**] on [**2110-11-24**].

MEDICAL HISTORY: Significant for end stage renal
disease, hypertension, question of remote myocardial
infarction as well as new myocardial infarction, obstructive
sleep apnea.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Negative for heart disease or cancer.

SOCIAL HISTORY: Significant for cigar smoke and alcohol.  He
lives with his wife. 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Atrial fibrillation,Other complications due to other vascular device, implant, and graft,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonitis due to inhalation of food or vomitus,Acidosis,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
