CHIEF COMPLAINT: Cough, URI symptoms

PRESENT ILLNESS: 84 M h/o HTN, DM, HL, CAD, recent PE on coumadin, overnight
hospitalization in [**2148-1-15**] for epistaxis in setting of
supratheraputic INR.
.
Was otherwise in USOH until earlier this week when developed "a
cold", complaining of fever, congestion, and cough productive of
"dark sputum." Was prescribed amoxicillin on [**5-2**] for likely
bronchitis, possibly early pneumonia. Today, developed fever to
104.6, referred to ED for evaluation.
.
In ED, CXR showed no infiltrate or edema. Received 3L normal
saline for SBP 80s, with prompt response.
.
ROS significant for stable angina with walking, unchanged
recently. No rest angina.

MEDICAL HISTORY: Diabetes Mellitus
- blood glucose 130-150 at home
Hypertension
Coronary Artery Disease
- s/p 3v CABG in [**2142**] (SVG->LAD, PDA, and OM)
- s/p cath [**2148-1-25**]: 3VD, no intervention
Pulmonary artery hypertension
Hyperlipidemia
Chronic renal insufficiency
- baseline Creat was 1.4-1.8 until [**12-18**], more recently 1.6-2.2

MEDICATION ON ADMISSION: ASA 325 QD
Metoprolol 50 [**Hospital1 **]
Insulin
- humalin 70/30 15 U qam, 10 U qhs
Imdur 120 qam
Lipitor 80 qd
Coumadin
Amoxicillin 500 tid
Colchicine 0.6 prn
Dyazide 37.5/25 [**Hospital1 **]
SLNTG prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - T 98.2, BP 101/55, HR 100, RR 24, O2 sat 100% 3L NC
General - elderly male, extremely hard of hearing, no acute
distress
HEENT - PERRL, sclera anicteric, OP clr, MMM, no LAD, JVP ~ 8cm

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Lives with his son, wife died 18 months ago, quite sad about
this, independent in ADLS, assist with IADL's. Has help in the
home three days a week. Denies current tobacco, smoked cigars
but quit 50 years ago, denies ETOH/illicit drug use.
Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Subendocardial infarction, initial episode of care,Hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Chronic systolic heart failure,Severe sepsis,Gout, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Other chronic pulmonary heart diseases,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Septicemia NOS,Food/vomit pneumonitis,Subendo infarct, initial,Hdgk dis unsp xtrndl org,Chronic kidney dis NOS,Acute kidney failure NOS,Chr systolic hrt failure,Severe sepsis,Gout NOS,Ocl crtd art wo infrct,Hy kid NOS w cr kid I-IV,Hyperlipidemia NEC/NOS,Chr pulmon heart dis NEC,Aortocoronary bypass,Long-term use anticoagul,DMII wo cmp nt st uncntr
Admission Date:  [**2148-5-3**]              Discharge Date:   [**2148-5-8**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 663**]
Chief Complaint:
Cough, URI symptoms

Major Surgical or Invasive Procedure:
None

History of Present Illness:
84 M h/o HTN, DM, HL, CAD, recent PE on coumadin, overnight
hospitalization in [**2148-1-15**] for epistaxis in setting of
supratheraputic INR.
.
Was otherwise in USOH until earlier this week when developed "a
cold", complaining of fever, congestion, and cough productive of
"dark sputum." Was prescribed amoxicillin on [**5-2**] for likely
bronchitis, possibly early pneumonia. Today, developed fever to
104.6, referred to ED for evaluation.
.
In ED, CXR showed no infiltrate or edema. Received 3L normal
saline for SBP 80s, with prompt response.
.
ROS significant for stable angina with walking, unchanged
recently. No rest angina.


Past Medical History:
Diabetes Mellitus
- blood glucose 130-150 at home
Hypertension
Coronary Artery Disease
- s/p 3v CABG in [**2142**] (SVG->LAD, PDA, and OM)
- s/p cath [**2148-1-25**]: 3VD, no intervention
Pulmonary artery hypertension
Hyperlipidemia
Chronic renal insufficiency
- baseline Creat was 1.4-1.8 until [**12-18**], more recently 1.6-2.2

Recent pulmonary embolus
- per records, w/u of occult malignancy deferred
Gout
- not on treatment
Right carotid artery stenosis: 100%
h/o focal motor seizure x 1 in [**7-/2143**]

Social History:
Lives with his son, wife died 18 months ago, quite sad about
this, independent in ADLS, assist with IADL's. Has help in the
home three days a week. Denies current tobacco, smoked cigars
but quit 50 years ago, denies ETOH/illicit drug use.

Family History:
Unknown.

Physical Exam:
Vitals - T 98.2, BP 101/55, HR 100, RR 24, O2 sat 100% 3L NC
General - elderly male, extremely hard of hearing, no acute
distress
HEENT - PERRL, sclera anicteric, OP clr, MMM, no LAD, JVP ~ 8cm

CV - RRR, nl s1, s2, no m/r/g
Chest - upper airway gurgling, diffuse crackles 1/2 up
Abdomen - NABS, soft, NT/ND, no g/r tenderness, no
hepatosplenomegaly
Extremities - 2+ bilat pitting edema, WWP
Neuro - A&Ox3


Pertinent Results:
[**2148-5-5**] 11:00PM BLOOD CK-MB-18* MB Indx-2.6 cTropnT-4.27*
[**2148-5-4**] 02:17PM BLOOD CK(CPK)-[**2160**]*
[**2148-5-5**] 05:15PM BLOOD proBNP-[**Numeric Identifier 62763**]*
[**2148-5-3**] 01:40PM BLOOD WBC-9.8 RBC-3.76* Hgb-10.6* Hct-32.4*
MCV-86 MCH-28.2 MCHC-32.7 RDW-16.6* Plt Ct-208
[**2148-5-3**] 11:39PM BLOOD WBC-11.6* RBC-3.64* Hgb-10.5* Hct-31.2*
MCV-86 MCH-28.8 MCHC-33.7 RDW-16.7* Plt Ct-196
[**2148-5-3**] 01:40PM BLOOD Neuts-84.3* Lymphs-8.2* Monos-6.4 Eos-0.6
Baso-0.4
[**2148-5-4**] 05:32AM BLOOD Neuts-52 Bands-31* Lymphs-6* Monos-11
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2148-5-3**] 01:40PM BLOOD Glucose-132* UreaN-25* Creat-2.0* Na-137
K-4.5 Cl-105 HCO3-19* AnGap-18
[**2148-5-3**] 11:39PM BLOOD Glucose-151* UreaN-23* Creat-1.5* Na-139
K-4.1 Cl-111* HCO3-16* AnGap-16
[**2148-5-4**] 05:32AM BLOOD Glucose-134* UreaN-22* Creat-1.5* Na-138
K-4.1 Cl-108 HCO3-17* AnGap-17
[**2148-5-4**] 05:32AM BLOOD PT-46.2* PTT-56.0* INR(PT)-5.4*
[**2148-5-5**] 08:08AM BLOOD PT-74.3* PTT-102.3* INR(PT)-9.6*
[**2148-5-8**] 07:45AM BLOOD PT-20.5* PTT-55.3* INR(PT)-2.0*

Brief Hospital Course:
84 year-old man with HTN, DM2, hyperlipidemia, CAD, recent PE on
coumadin, who was initially admitted to the [**Hospital1 18**] MICU on
[**2148-5-3**] for sepsis secondary to pneumonia (thought to be
community-acquired vs aspiration).  His antihypertensives were
initially held, though they were restarted in the setting of his
NSTEMI.  He was put on empiric ceftriaxone, azithromycin, and
metronidazole to cover both community-acquired and aspiration
bacterial pathogens and has symptomatically improved.  A speech
and swallow evaluation was concerning for esophageal dysphagia;
since this was known to be old by his PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) **], further
evaluation was deferred for now; he was kept on a diet of ground
solids and thin liquids.  Prior to discharge, his antibiotic
regimen was simplified to levofloxacin and metronidazole to
complete a 10-day course.
.
On admission, he was also found to have an NSTEMI with CKs
peaking at [**2160**] in the setting of marked anterior ST depressions
which subsequently improved; he was not heparinized due to his
supratherapeutic INR, and he was loaded with clopidogrel.  A TTE
showed a marked drop in his LVEF to 25% (from 71% on nuclear
stress in [**10/2146**]) presumed secondary to ischemia.  In the
setting of this NSTEMI and also due to clinical volume overload,
he was diuresed with a series of Lasix boluses.  The MICU team
chose to start him on Plavix to help maximize his medical
management.  A cardiology consultation was obtained; they
recommended adding an ACEi to help maximize his medical
management.  They also reviewed his cardiac cath report from
[**1-/2148**] and recommended that he have a P-MIBI due to this new,
large drop in his LVEF.  Per cardiology, even if he had a large
reversible defect on his MIBI, his [**1-/2148**] cath report showed few
(if any) options for potential further revascularization.  In
light of this, both the patient and his PCP chose to defer the
MIBI at this time and maximize his medical management.
.
He was on home warfarin given his recent diagnosis of pulmonary
embolism.  On admission, however, he was noted to have a
markedly elevated INR which was presumed to be due to his
concurrent antibiotic use.  His INR subsequently rose >9 and he
was given 2 units of FFP while in the MICU.  His warfarin was
initially held but, as his INR came down, he was restarted on a
reduced dose (1mg) of warfarin.  On the day prior to discharge,
his INR dropped to 1.8, which is below therapeutic level; he was
bridged with treatment-dose enoxaparin on that day and his INR
was 2.0 by the next day.
.
Mr. [**Known lastname **] was noted to be in acute-on-chronic renal failure
upon admission.  Following aggressive hydration in the ED,
however, his creatinine quickly returned to baseline.

Medications on Admission:
ASA 325 QD
Metoprolol 50 [**Hospital1 **]
Insulin
- humalin 70/30 15 U qam, 10 U qhs
Imdur 120 qam
Lipitor 80 qd
Coumadin
Amoxicillin 500 tid
Colchicine 0.6 prn
Dyazide 37.5/25 [**Hospital1 **]
SLNTG prn


Discharge Medications:
1. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.

2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
3. Warfarin 1 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*60 Tablet(s)* Refills:*3*
4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*3*
5. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
6. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every
8 hours) for 6 days.
Disp:*18 Tablet(s)* Refills:*0*
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*3*
8. Dyazide 37.5-25 mg Capsule Sig: One (1) Capsule PO twice a
day.
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.
10. Humulin 70/30 100 unit/mL (70-30) Suspension Sig: Fifteen
(15) units Subcutaneous qam.
11. Humulin 70/30 100 unit/mL (70-30) Suspension Sig: Ten (10)
units Subcutaneous at bedtime.
12. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual prn as needed for chest pain.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Primary diagosis:
sepsis secondary to aspiration pneumonia
NSTEMI
.
Secondary diagnoses:
coronary artery disease
pulmonary hypertension
type 2 diabetes mellitus
recent pulmonary embolism
systolic congestive heart failure
chronic renal insufficiency

Discharge Condition:
stable

Discharge Instructions:
You were admitted to the hospital with a severe pneumonia as
well as a heart attack.  Your pneumonia has improved with
antibiotics, and we will send you home to complete a course of
these antibiotics.  For your heart attack, you and your PCP have
decided to maximize your medical management rather than pursue a
stress test and possible invasiuve catheterization since it is
unlikely that a catheterization would be of much benefit.
.
You were seen by the cardiology service while you were here who
recommended starting you on two new medications (lisinopril and
Plavix) which we will give you prescriptions for.  We also
decreased the dose of your Coumadin to only 1mg.
.
Please attend all follow up appointments.  Please take all
medications as prescribed.
.
If you experience high fevers, shortness of breath, chest pain,
loss of consciousness, or other concerning symptoms, then you
need to seek medical attention.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2148-5-14**] 2:30
{"Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Subendocardial infarction, initial episode of care,Hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Chronic systolic heart failure,Severe sepsis,Gout, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Other chronic pulmonary heart diseases,Aortocoronary bypass status,Long-term (current) use of anticoagulants,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: Cough, URI symptoms

PRESENT ILLNESS: 84 M h/o HTN, DM, HL, CAD, recent PE on coumadin, overnight
hospitalization in [**2148-1-15**] for epistaxis in setting of
supratheraputic INR.
.
Was otherwise in USOH until earlier this week when developed "a
cold", complaining of fever, congestion, and cough productive of
"dark sputum." Was prescribed amoxicillin on [**5-2**] for likely
bronchitis, possibly early pneumonia. Today, developed fever to
104.6, referred to ED for evaluation.
.
In ED, CXR showed no infiltrate or edema. Received 3L normal
saline for SBP 80s, with prompt response.
.
ROS significant for stable angina with walking, unchanged
recently. No rest angina.

MEDICAL HISTORY: Diabetes Mellitus
- blood glucose 130-150 at home
Hypertension
Coronary Artery Disease
- s/p 3v CABG in [**2142**] (SVG->LAD, PDA, and OM)
- s/p cath [**2148-1-25**]: 3VD, no intervention
Pulmonary artery hypertension
Hyperlipidemia
Chronic renal insufficiency
- baseline Creat was 1.4-1.8 until [**12-18**], more recently 1.6-2.2

MEDICATION ON ADMISSION: ASA 325 QD
Metoprolol 50 [**Hospital1 **]
Insulin
- humalin 70/30 15 U qam, 10 U qhs
Imdur 120 qam
Lipitor 80 qd
Coumadin
Amoxicillin 500 tid
Colchicine 0.6 prn
Dyazide 37.5/25 [**Hospital1 **]
SLNTG prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - T 98.2, BP 101/55, HR 100, RR 24, O2 sat 100% 3L NC
General - elderly male, extremely hard of hearing, no acute
distress
HEENT - PERRL, sclera anicteric, OP clr, MMM, no LAD, JVP ~ 8cm

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Lives with his son, wife died 18 months ago, quite sad about
this, independent in ADLS, assist with IADL's. Has help in the
home three days a week. Denies current tobacco, smoked cigars
but quit 50 years ago, denies ETOH/illicit drug use. 

### Response:
{"Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Subendocardial infarction, initial episode of care,Hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Chronic systolic heart failure,Severe sepsis,Gout, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Other chronic pulmonary heart diseases,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled"}
