CHIEF COMPLAINT: Respiratory Failure/Pulmonary hypertension/Cor pulmonale

PRESENT ILLNESS: Mrs. [**Known lastname 88134**] is a 69-year-old woman who was admitted to
hospital on [**2151-5-24**] for acute respiratory failure.  She has a
long history of advanced pulmonary hypertension for which she
has sought medical attention at [**Hospital1 1170**] under the care of Dr. [**Last Name (STitle) **]. On admission to [**Hospital1 **] she
was identified as having probable mild congestive heart failure
and a possible bacterial pneumonia as well as severe pulmonary
hypertension. At [**Hospital1 **], she was admitted to the intensive care
unit for aggressive augmentation of FiO2. Initially she was
started on BiPAP but this was changed to OPTIFLO at 100% O2.
Workup included the imaging outlined below.  The patient was
treated with antibiotics as well as diuretics. Despite her
aggressive treatment and respiratory support she continues to
have poor oxygenation. Pulse oximetry readings have been
consistently in the low 80s percent.The patient was restarted on
Viagra during this hospitalization. Given this, and the fact
that her pulmonologist, as well as her cardiologist are at
[**Hospital1 18**], she was transferred here for further care.

MEDICAL HISTORY: Asthma,
GERD,
severe pulmonary hypertension ranging approximately 70+ RVSP
lower GI bleed
adrenal mass (detected in [**2147**], not clear where she followed up)
Macular degeneration
Cataracts
Discordant Blood pressures (right arm is the good one)

MEDICATION ON ADMISSION: DISCHARGE MEDICATIONS FROM [**Hospital1 **]
1.  Viagra 25 mg orally 3 times daily
2.  Nystatin 5 mg orally 4 times daily
3.  Levofloxacin 250 mg IV every 24 hours
4.  50 MG ORALLY DAILY
5.  PROCARDIA XL 30 MG ORALLY DAILY
6.  LOPRESSOR 25 MG ORALLY TWICE DAILY
7.  FUROSEMIDE 40 MG ORALLY TWICE DAILY
8 AREA AT FLONASE ONE SPRAY INTRANASALLY DAILY
9.  FAMOTIDINE 20 MG ORALLY TWICE DAILY
10.  LOVENOX 30 MG SUBCUTANEOUSLY DAILY
11.  NITROGLYCERIN 0.4 MG SUBLINGUALLY EVERY 5 MINUTES WHEN
NECESSARY CHEST PAIN X3
[**50**].  MILK OF MAGNESIA 10 ML ORALLY DAILY
13.  LIDOCAINE AVAILABLE FOR DYSRHYTHMIA
14.  ATROPINE 1 MG IV AVAILABLE FOR BRADYCARDIA

ALLERGIES: Ampicillin / Penicillins / Amoxicillin

PHYSICAL EXAM: On Admission
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP difficult to assess, no LAD
CV: tachycardic to low 100s, no murmurs, distant.
Lungs: mildly rhonchorous, with crackles bilaterally.
GU: no foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, good strength.

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Lives at home with her daughter in [**Name (NI) 701**], ambulates with
cane. On home O2 4L. Previously smoked ~2ppd x20 yrs though quit
27 yrs ago. No ETOH or illicits.
Acute and chronic respiratory failure,Pneumonia, organism unspecified,Pneumonia due to Streptococcus, group B,Acute kidney failure, unspecified,Chronic diastolic heart failure,Do not resuscitate status,Other chronic pulmonary heart diseases,Esophageal reflux,Leukocytosis, unspecified,Asthma, unspecified type, unspecified
Acute & chronc resp fail,Pneumonia, organism NOS,Pneumonia strptococcus b,Acute kidney failure NOS,Chr diastolic hrt fail,Do not resusctate status,Chr pulmon heart dis NEC,Esophageal reflux,Leukocytosis NOS,Asthma NOS
Admission Date:  [**2151-5-27**]              Discharge Date:   [**2151-6-1**]

Date of Birth:  [**2081-9-12**]             Sex:   F

Service: MEDICINE

Allergies:
Ampicillin / Penicillins / Amoxicillin

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
Respiratory Failure/Pulmonary hypertension/Cor pulmonale

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mrs. [**Known lastname 88134**] is a 69-year-old woman who was admitted to
hospital on [**2151-5-24**] for acute respiratory failure.  She has a
long history of advanced pulmonary hypertension for which she
has sought medical attention at [**Hospital1 1170**] under the care of Dr. [**Last Name (STitle) **]. On admission to [**Hospital1 **] she
was identified as having probable mild congestive heart failure
and a possible bacterial pneumonia as well as severe pulmonary
hypertension. At [**Hospital1 **], she was admitted to the intensive care
unit for aggressive augmentation of FiO2. Initially she was
started on BiPAP but this was changed to OPTIFLO at 100% O2.
Workup included the imaging outlined below.  The patient was
treated with antibiotics as well as diuretics. Despite her
aggressive treatment and respiratory support she continues to
have poor oxygenation. Pulse oximetry readings have been
consistently in the low 80s percent.The patient was restarted on
Viagra during this hospitalization. Given this, and the fact
that her pulmonologist, as well as her cardiologist are at
[**Hospital1 18**], she was transferred here for further care.

On arrival to the MICU, patient was afebrile, BP in 100s, HR in
low 100s, and SaO2 ~85% on high flow mask. She did not complaint
of any discomfort. Specifically, she denied any shortness of
breath, chest pain, headache, nausea, vomiting, abdominal pain,
muscle aches, or other complaints.



Past Medical History:
Asthma,
GERD,
severe pulmonary hypertension ranging approximately 70+ RVSP
lower GI bleed
adrenal mass (detected in [**2147**], not clear where she followed up)
Macular degeneration
Cataracts
Discordant Blood pressures (right arm is the good one)


Social History:
Lives at home with her daughter in [**Name (NI) 701**], ambulates with
cane. On home O2 4L. Previously smoked ~2ppd x20 yrs though quit
27 yrs ago. No ETOH or illicits.

Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
On Admission
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP difficult to assess, no LAD
CV: tachycardic to low 100s, no murmurs, distant.
Lungs: mildly rhonchorous, with crackles bilaterally.
GU: no foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, good strength.


Pertinent Results:
[**2151-5-27**] 07:39PM   WBC-16.3*# RBC-3.98* HGB-12.3 HCT-36.5
MCV-92# MCH-30.9# MCHC-33.6 RDW-14.2
[**2151-5-27**] 07:39PM   NEUTS-88.1* LYMPHS-5.0* MONOS-5.4 EOS-1.1
BASOS-0.3
[**2151-5-27**] 07:39PM   PLT COUNT-325
[**2151-5-27**] 07:39PM   PT-12.4 PTT-31.0 INR(PT)-1.1
[**2151-5-27**] 07:39PM   GLUCOSE-114* UREA N-20 CREAT-1.2* SODIUM-136
POTASSIUM-3.5 CHLORIDE-96 TOTAL CO2-29 ANION GAP-15
[**2151-5-27**] 07:39PM   CALCIUM-9.3 PHOSPHATE-3.1 MAGNESIUM-2.1

Relevant labs:
[**2151-5-29**] 04:17PM BLOOD Lactate-2.5*
[**2151-5-30**] 04:21AM BLOOD Lactate-2.0
[**2151-5-29**] 04:26AM BLOOD proBNP-[**Numeric Identifier **]*
[**2151-5-30**] 07:58AM BLOOD ANCA-NEGATIVE B

Microbio:
Blood cultures x2 negative

[**5-27**] CXR:
Moderate cardiomegaly and severe dilatation of pulmonary
arteries are
comparable to the appearance on the [**MD Number(3) 25633**] radiograph a year
ago.  Greater
opacification at the lung bases today could be due to dependent
edema or both
dependent edema and new aspiration or pneumonia in the left
lower lobe.

[**5-28**] Echo:
The left atrium is mildly elongated. No right-to-left shunt is
identified on intravenous agitated saline injection at rest.
Left ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%). The right ventricular
cavity is moderately dilated with severe global free wall
hypokinesis. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic stenosis or
aortic regurgitation. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is severe
pulmonary artery systolic hypertension. There is no pericardial
effusion.

IMPRESSION: Suboptimal image quality. Right ventricular cavity
enlargement with free wall hypokinesis. Severe pulmonary artery
hypertension. No intracardiac shunt identified. Compared with
the prior study (images reviewed) of [**2151-4-1**], the estimated PA
systolic pressure and severity of tricuspid regurgitation are
slightly reduced.

[**5-28**]:
LE dopplers:
No evidence of right or left lower extremity DVT.


Brief Hospital Course:
Mrs. [**Known lastname 88134**] is a 69-year-old woman who was admitted to OSH on
[**2151-5-24**] for acute respiratory failure in setting of history
of pulmonary hypertension with question of Pneumonia at osh.

# Acute on chronic respiratory failure/Pulmonary
hypertension/Cor pulmonale.  The patient required 90-95% high
flow facemask oxygen in addition to 6L nasal cannula to maintain
oxygen saturations in the mid 80s--a large change from only [**12-14**]
months previous where she only required nasal cannula for oxygen
saturations in the low 90s.  With any movement, the patients
saturations dipped into the 70s.  The etiology of her
respiratory failure is related to pulmonary hypertension and cor
pulmonale, although intrapulmonary shunt was also entertained
given her refractoriness to oxygen.  Her last cardiac
catheterization in [**12-23**] revealed in the baseline state, a
pulmonary artery systolic pressure of 102 mmHg, mean pulmonary
artery pressure of 59 mmHg, a mean pulmonary capillary wedge
pressure of 12 mmHg, a mean transpulmonary pressure gradient of
47 mmHg, and a preserved cardiac index of 2.52 L/min per sq m
body surface area with modest degree of reactivity to oxygen and
NO but unable to be completely characterized due incomplete
measurements during adminstration of these agents.  A TTE was
performed on [**5-28**] revealing no right-to-left cardiac shunt,
dilated right ventricular cavity  with severe global free wall
hypokinesis and severe pulmonary artery systolic hypertension.
The patient was diagnosed as having pneumonia at OSH, but did
not have fever, cough, or overt evidence of pneumonia on chest
xray.  Nonetheless, given her compromised state, she was given a
week long course of levofloxacin.  The patient's pulmonary
hypertension was most likely Type I, given her lack of left
heart disease or significant respiratory disease. She tested
rheumatoid factor, [**Doctor First Name **], and ANCA negative.  She has no known
history of pulmonary embolism and last V/Q scan in [**3-24**] was
negative.  LENIs on this admission were negative.  In terms of
treatment, the patient was diuresed but did not require much as
she was dry at baseline and diuresis led to [**Last Name (un) **].  Her sildenafil
was uptitrated.  She started digoxin in an attempt to augment
right sided heart function.  Her home nifedipine was
discontinued since it was not helping the patient.  Repeat
imaging for PE was not performed on this admission since it was
unlikely that the patient could tolerate this; thus the patient
was not anticoagulated.  Discussions were ongoing to begin
therapy with a prostanoid such as Flolan.  However, in the early
morning of [**6-1**], the patient went into PEA arrest.  The patient
was DNR/DNI, and thus no further measures were taken and the
patient passed away.

#Leukocytosis - Most likely stress response.  Cultures did not
reveal any sign of infection and the patient had no fever.  The
patient did complete a course of levofloxacin for pneumonia
diagnosed at OSH.

#GERD - continue famotidine

#Acute renal failure - reported at OSH, last creatinine at 1.0.
Patient was very preload sensitive and required minimal
diuresis.  [**Last Name (un) **] likely from worsening of forward flow [**1-14**] to
pulmonary htn and right heart failure.

# Code: DNR/DNI - discussed with patient at lenght.


Medications on Admission:
DISCHARGE MEDICATIONS FROM [**Hospital1 **]
1.  Viagra 25 mg orally 3 times daily
2.  Nystatin 5 mg orally 4 times daily
3.  Levofloxacin 250 mg IV every 24 hours
4.  50 MG ORALLY DAILY
5.  PROCARDIA XL 30 MG ORALLY DAILY
6.  LOPRESSOR 25 MG ORALLY TWICE DAILY
7.  FUROSEMIDE 40 MG ORALLY TWICE DAILY
8 AREA AT FLONASE ONE SPRAY INTRANASALLY DAILY
9.  FAMOTIDINE 20 MG ORALLY TWICE DAILY
10.  LOVENOX 30 MG SUBCUTANEOUSLY DAILY
11.  NITROGLYCERIN 0.4 MG SUBLINGUALLY EVERY 5 MINUTES WHEN
NECESSARY CHEST PAIN X3
[**50**].  MILK OF MAGNESIA 10 ML ORALLY DAILY
13.  LIDOCAINE AVAILABLE FOR DYSRHYTHMIA
14.  ATROPINE 1 MG IV AVAILABLE FOR BRADYCARDIA

Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
PEA arrest from cor pulmonale and pulmonary hypertension

Discharge Condition:
expired

Discharge Instructions:
n/a

Followup Instructions:
n/a

                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]

Completed by:[**2151-6-8**]
{'Acute and chronic respiratory failure,Pneumonia, organism unspecified,Pneumonia due to Streptococcus, group B,Acute kidney failure, unspecified,Chronic diastolic heart failure,Do not resuscitate status,Other chronic pulmonary heart diseases,Esophageal reflux,Leukocytosis, unspecified,Asthma, unspecified type, 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: Respiratory Failure/Pulmonary hypertension/Cor pulmonale

PRESENT ILLNESS: Mrs. [**Known lastname 88134**] is a 69-year-old woman who was admitted to
hospital on [**2151-5-24**] for acute respiratory failure.  She has a
long history of advanced pulmonary hypertension for which she
has sought medical attention at [**Hospital1 1170**] under the care of Dr. [**Last Name (STitle) **]. On admission to [**Hospital1 **] she
was identified as having probable mild congestive heart failure
and a possible bacterial pneumonia as well as severe pulmonary
hypertension. At [**Hospital1 **], she was admitted to the intensive care
unit for aggressive augmentation of FiO2. Initially she was
started on BiPAP but this was changed to OPTIFLO at 100% O2.
Workup included the imaging outlined below.  The patient was
treated with antibiotics as well as diuretics. Despite her
aggressive treatment and respiratory support she continues to
have poor oxygenation. Pulse oximetry readings have been
consistently in the low 80s percent.The patient was restarted on
Viagra during this hospitalization. Given this, and the fact
that her pulmonologist, as well as her cardiologist are at
[**Hospital1 18**], she was transferred here for further care.

MEDICAL HISTORY: Asthma,
GERD,
severe pulmonary hypertension ranging approximately 70+ RVSP
lower GI bleed
adrenal mass (detected in [**2147**], not clear where she followed up)
Macular degeneration
Cataracts
Discordant Blood pressures (right arm is the good one)

MEDICATION ON ADMISSION: DISCHARGE MEDICATIONS FROM [**Hospital1 **]
1.  Viagra 25 mg orally 3 times daily
2.  Nystatin 5 mg orally 4 times daily
3.  Levofloxacin 250 mg IV every 24 hours
4.  50 MG ORALLY DAILY
5.  PROCARDIA XL 30 MG ORALLY DAILY
6.  LOPRESSOR 25 MG ORALLY TWICE DAILY
7.  FUROSEMIDE 40 MG ORALLY TWICE DAILY
8 AREA AT FLONASE ONE SPRAY INTRANASALLY DAILY
9.  FAMOTIDINE 20 MG ORALLY TWICE DAILY
10.  LOVENOX 30 MG SUBCUTANEOUSLY DAILY
11.  NITROGLYCERIN 0.4 MG SUBLINGUALLY EVERY 5 MINUTES WHEN
NECESSARY CHEST PAIN X3
[**50**].  MILK OF MAGNESIA 10 ML ORALLY DAILY
13.  LIDOCAINE AVAILABLE FOR DYSRHYTHMIA
14.  ATROPINE 1 MG IV AVAILABLE FOR BRADYCARDIA

ALLERGIES: Ampicillin / Penicillins / Amoxicillin

PHYSICAL EXAM: On Admission
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP difficult to assess, no LAD
CV: tachycardic to low 100s, no murmurs, distant.
Lungs: mildly rhonchorous, with crackles bilaterally.
GU: no foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, good strength.

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Lives at home with her daughter in [**Name (NI) 701**], ambulates with
cane. On home O2 4L. Previously smoked ~2ppd x20 yrs though quit
27 yrs ago. No ETOH or illicits. 

### Response:
{'Acute and chronic respiratory failure,Pneumonia, organism unspecified,Pneumonia due to Streptococcus, group B,Acute kidney failure, unspecified,Chronic diastolic heart failure,Do not resuscitate status,Other chronic pulmonary heart diseases,Esophageal reflux,Leukocytosis, unspecified,Asthma, unspecified type, unspecified'}
