CHIEF COMPLAINT: [**Hospital 55515**] transferred from OSH

PRESENT ILLNESS: 73 yo male with h/o CHF (EF 30%); ischemic CM, 4+ MR; PAF; s/p
[**Hospital1 **]-V ICD; s/p recent admission in [**Month (only) **], in and out of
hospital for the past few months with chf.  Pt describes
increased DOE and has 3+ LE edema refractory to diuresis. No CP,
N/V, diaphoresis, palpitations.  + orthopnea, (-)PND.  Pt
reports falling three times on Fri w/o head trauma or LOC.
-
OSH tried to diurese with lasix; pt required Natrecor and
eventually Dopamine to achieve adequate output on last [**Hospital1 18**]
admission per review of his records.  Pt presents for further
mgmt of CHF.

MEDICAL HISTORY: CAD; s/p CABG; Ischemic CM (EF 30%); 4+ MR; htn; hyperlipidemia;
obesity; s/p [**Hospital1 **]-V ICD; PAF; COPD; Fe deficiency anemia; mild AS

MEDICATION ON ADMISSION: Lexapro 10mg QD
Advair 50/500 1 puff
lasix 100 mg [**Hospital1 **]
prtonix 40mg qd
digoxin 62.5mcg qd
colace 100mg [**Hospital1 **]
Vitamin E 800mg QD
Glucosamine 1 pill [**Hospital1 **]
allopurinol 100mg QD
Zocor 40mg QD
Restoril 15mg QHS
Levoxyl 125mcg QD
Aldactone 25mg QD
Procrit 9000u Qfridays

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 96.7  100/66  75  18  100%2L
PERRLA, EOMI, no LAD, neck supple
Decreased BS @ bases bil
Nl S1/S2, II/VI loudest at LUSB
NABS, nt, nd, no organomegaly
Warm X 4 with pulses X 4, bil edema to just above knees
CNII-XII intact

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives w/four roomate in townhouse/?friends vs facility in [**Name (NI) **].
No smoking, etoh, ivda per records
Acute on chronic combined systolic and diastolic heart failure,Aortic valve disorders,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other specified cardiac device in situ,Constipation, unspecified,Gout, unspecified,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Unspecified disorder of kidney and ureter,Iron deficiency anemia, unspecified
Ac/chr syst/dia hrt fail,Aortic valve disorder,Atrial fibrillation,Chr airway obstruct NEC,Status oth spcf crdc dvc,Constipation NOS,Gout NOS,Hypothyroidism NOS,Atrph gastrtis w/o hmrhg,Renal & ureteral dis NOS,Iron defic anemia NOS
Admission Date:  [**2190-1-11**]              Discharge Date:   [**2190-2-2**]

Date of Birth:  [**2116-2-5**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9569**]
Chief Complaint:
[**Hospital 55515**] transferred from OSH

Major Surgical or Invasive Procedure:
None

History of Present Illness:
73 yo male with h/o CHF (EF 30%); ischemic CM, 4+ MR; PAF; s/p
[**Hospital1 **]-V ICD; s/p recent admission in [**Month (only) **], in and out of
hospital for the past few months with chf.  Pt describes
increased DOE and has 3+ LE edema refractory to diuresis. No CP,
N/V, diaphoresis, palpitations.  + orthopnea, (-)PND.  Pt
reports falling three times on Fri w/o head trauma or LOC.
-
OSH tried to diurese with lasix; pt required Natrecor and
eventually Dopamine to achieve adequate output on last [**Hospital1 18**]
admission per review of his records.  Pt presents for further
mgmt of CHF.


Past Medical History:
CAD; s/p CABG; Ischemic CM (EF 30%); 4+ MR; htn; hyperlipidemia;
obesity; s/p [**Hospital1 **]-V ICD; PAF; COPD; Fe deficiency anemia; mild AS



Social History:
Lives w/four roomate in townhouse/?friends vs facility in [**Name (NI) **].
No smoking, etoh, ivda per records

Family History:
Non-contributory

Physical Exam:
96.7  100/66  75  18  100%2L
PERRLA, EOMI, no LAD, neck supple
Decreased BS @ bases bil
Nl S1/S2, II/VI loudest at LUSB
NABS, nt, nd, no organomegaly
Warm X 4 with pulses X 4, bil edema to just above knees
CNII-XII intact


Pertinent Results:
[**2190-1-11**] cxr: INDICATION: CHF exacerbation. Check for failure,
infiltrates, effusion.

FINDINGS: A single AP upright image. Comparison study taken
[**2189-10-23**].
The heart again shows enlargement of the cardiac silhouette. An
ICD pacemaker
is noted with electrodes in the SVC, the right atrium, the right
ventricle and
a left ventricular venous tributary. The pulmonary vessels do
not indicate
cardiac failure at this time. The lungs are fairly well
inflated. Some minor
linear atelectases are present at the bases. S/P CABG surgery
again noted.

IMPRESSION: No acute cardiopulmonary abnormality. Pacemaker
electrodes
satisfactorily positioned. No cardiac failure. No definite
effusion.
-
[**1-23**] CXR:
INDICATION: 73 year old post CABG with CHF exacerbation. Now
post right
subclavian line placement, assess for pneumothorax.

PORTABLE UPRIGHT FRONTAL RADIOGRAPH.

COMPARISON: [**2190-1-11**].

FINDINGS:

The heart is enlarged, but stable in appearance. There has been
interval
placement of a right subclavian central venous catheter with its
tip
terminating in the mid SVC. There is no pneumothorax. The lung
fields are
essentially clear, unchanged from the prior study. The pulmonary
vasculature
is normal. The patient is post CABG. A left-sided pacemaker is
unchanged in
position.

IMPRESSION:

Interval placement of right subclavian central venous catheter
in satisfactory
position. No pneumothorax. Stable cardiomegaly without CHF.
-
[**1-19**] kub: INDICATIONS: 73-year-old man with constipation.
Question of obstruction or
ileus.

ABDOMEN, TWO AP VIEWS: There is no free air under the diaphragm.
Multiple
large calcified gallstones are seen. Bowel gas pattern is
unremarkable
without air-fluid levels. There is not a large amount of stool
seen in the
colon. The lung bases are poorly visualized but appear clear. A
dual- lead
pacemaker appears in satisfactory position. Degenerative changes
are seen in
the lower lumbar spine and sacroiliac joints.

IMPRESSION: No evidence of obstruction or free air.
-
ELECTROCARDIOGRAM PERFORMED ON: [**2190-1-12**]
A-V paced rhythm
Since pervious tracing, no significant change


Read by: [**Last Name (LF) 2889**],[**First Name3 (LF) 2890**] K.
 Intervals Axes
Rate PR QRS QT/QTc P QRS T
75 110 30 452/478 -77 132 130
 -
ELECTROCARDIOGRAM PERFORMED ON: [**2190-1-14**]
A-V paced rhythm - ? also atrial pacing spikes
Since previous tracing, no significant change


Read by: [**Last Name (LF) 2889**],[**First Name3 (LF) 2890**] K.
 Intervals Axes
Rate PR QRS QT/QTc P QRS T
75 0 42 446/472 0 -47 129
 -
ELECTROCARDIOGRAM PERFORMED ON: [**2190-1-29**]
Dual chamber electronic pacemaker in atrio-ventricular
sequential pacing mode.
Compared to the previous tracing of [**2190-1-22**] atrial pacing now
seen.


Read by: [**Last Name (LF) **],[**First Name3 (LF) **] D.
 Intervals Axes
Rate PR QRS QT/QTc P QRS T
75 0 42 446/472 0 -58 116



Brief Hospital Course:
The patient was admitted to cardiology with decompensated
[**Hospital1 **]-vCHF w/4+MR.  The patient had required nesirite and dopamine
in the past for diuresis.  These were initiated.  The patient
was placed on telemetry, which demonstrated paced rhythm.  The
patient diuresed slowly.  The rates on the drips were increased
(.01-->.015 and 2-->4).  Given the slow rate of diuresis and
large amount of fluid to be removed, the patient was transferred
to the CCU to allow for ultrafiltration.  TLC was placed in the
right subclavian and 10kg were removed, but a clot in his
ultrafiltration filters due to PTT limited this mode of
diuresis.  The patient had dramatic improvement in his breathing
following ultrifiltration.  Once diuresis was complete,
hydral/imdur were started and tolerated for two days.  The
patients pressures then dropped, not allowing continuation of
these medications.  It came up again before DC and he was
discharged on imdur with the hopes that hydralazine could be
added on discharge.
-
The patient was transferred back to cardiology service and
nesiritide and dopamine were started.  Bumex was started and the
nesiritide and dopamine drips were weaned.  Ultimately, 2mg of
bumex twice per day were needed to maintain constant I/O and
weight.
-
The patient had a gout flair concurrent with constipation.
These were treated together with colchicine .6mg Q2H X 3 then QD
with success.
-
The patient became guiac positive.    His stools became loose
(following colchicine)and CDif X 2 were taken and negative.  His
crit decreased and he became hypotensive; he had passed his dry
weight.  1U of blood w/o diuresis was adminstered and the
patient became asymptomatic.  Records of his recent colonoscopy
and EGD were obtained.  These demonstrated AVMs, diverticulosis,
hemmorhoids, a jejunal filling defect, and erosive gastritis.
GI was consulted and enteroscopy was performed.  It demonstrated
erythema in the antrum of the stomache c/w gastritis and a
single nonbleeding diverticulum with large opening in distal
descending duodenum or proximal jejunum.
-
Thyroid studies taken on admission came back demonstrating
hyopthyroidism so levoxyl dose was increased from 125 to 150.
Follow up labs one week later demonstrated normal T4 but high
TSH.  Given that TSH can lag T4 but is also a more sensitive
indicator, outpatient followup was advised.
-
The patient was seen by PT who worked with the patient on gait
training and endurance.
-
For his COPD, his flovent and solumeterol inhalers were
continued.
-
On admission, creatinine was 2.4  This value varied with
diuresis, peaking at 3.4 and hitting a nadir of 1.7.  It was 2.4
at discharge.
-
The patient was DNR/DNI throughout his stay.

Medications on Admission:
Lexapro 10mg QD
Advair 50/500 1 puff
lasix 100 mg [**Hospital1 **]
prtonix 40mg qd
digoxin 62.5mcg qd
colace 100mg [**Hospital1 **]
Vitamin E 800mg QD
Glucosamine 1 pill [**Hospital1 **]
allopurinol 100mg QD
Zocor 40mg QD
Restoril 15mg QHS
Levoxyl 125mcg QD
Aldactone 25mg QD
Procrit 9000u Qfridays

Discharge Medications:
1. Escitalopram Oxalate 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
2. Salmeterol Xinafoate 50 mcg/Dose Disk with Device Sig: One
(1) Disk with Device Inhalation Q12H (every 12 hours).
Disp:*2 Disk with Device(s)* Refills:*2*
3. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Four
(4) Puff Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 puffer* Refills:*2*
4. Vitamin E 400 unit Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Temazepam 15 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime) as needed.
8. Levothyroxine Sodium 150 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  TID
(3 times a day) as needed.
Disp:*1 unit* Refills:*0*
10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Potassium Chloride 20 mEq Packet Sig: One (1)  PO once a
day.
Disp:*90 packets* Refills:*2*
12. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
13. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1)  Injection
QMOWEFR (Monday -Wednesday-Friday).
14. Bumetanide 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
15. Digoxin 125 mcg Tablet Sig: [**2-6**] tablet Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*3*
17. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Decompensated congestive heart failure

Discharge Condition:
Fair

Discharge Instructions:
Please weigh yourself every morning and call your doctor if your
weight increases more than 3 pounds in a day or more than 5
pounds in a week.  Please limit your fluid intake to less than
1.5 liters per day.  Please limit your salt intake to 2gm or
less per day.

Please call your doctor or return to the emergency room if you
experience chest pain, shortness of breath, nausea/vomitting,
pain, or any other symptoms of concern to you.

Followup Instructions:
Call your cardiologist for a followup appointment in one week.
If you do not have a cardiologist, call [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at ([**Telephone/Fax (1) 29956**] for an appointment.
-
Call your PCP: [**Name10 (NameIs) 15144**],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 15145**] immediately for a
followup appointment in [**2-6**] weeks to follow up on your blood
pressure, gout and rectal bleeding.
-
Call your gastroenterologist, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for a followup
appointment.  Please be sure that he is aware that enteroscopy
was performed @ [**Hospital1 18**] and that records of both enteroscopy and
hospital course are available.
{'Acute on chronic combined systolic and diastolic heart failure,Aortic valve disorders,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other specified cardiac device in situ,Constipation, unspecified,Gout, unspecified,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Unspecified disorder of kidney and ureter,Iron deficiency anemia, 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: [**Hospital 55515**] transferred from OSH

PRESENT ILLNESS: 73 yo male with h/o CHF (EF 30%); ischemic CM, 4+ MR; PAF; s/p
[**Hospital1 **]-V ICD; s/p recent admission in [**Month (only) **], in and out of
hospital for the past few months with chf.  Pt describes
increased DOE and has 3+ LE edema refractory to diuresis. No CP,
N/V, diaphoresis, palpitations.  + orthopnea, (-)PND.  Pt
reports falling three times on Fri w/o head trauma or LOC.
-
OSH tried to diurese with lasix; pt required Natrecor and
eventually Dopamine to achieve adequate output on last [**Hospital1 18**]
admission per review of his records.  Pt presents for further
mgmt of CHF.

MEDICAL HISTORY: CAD; s/p CABG; Ischemic CM (EF 30%); 4+ MR; htn; hyperlipidemia;
obesity; s/p [**Hospital1 **]-V ICD; PAF; COPD; Fe deficiency anemia; mild AS

MEDICATION ON ADMISSION: Lexapro 10mg QD
Advair 50/500 1 puff
lasix 100 mg [**Hospital1 **]
prtonix 40mg qd
digoxin 62.5mcg qd
colace 100mg [**Hospital1 **]
Vitamin E 800mg QD
Glucosamine 1 pill [**Hospital1 **]
allopurinol 100mg QD
Zocor 40mg QD
Restoril 15mg QHS
Levoxyl 125mcg QD
Aldactone 25mg QD
Procrit 9000u Qfridays

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 96.7  100/66  75  18  100%2L
PERRLA, EOMI, no LAD, neck supple
Decreased BS @ bases bil
Nl S1/S2, II/VI loudest at LUSB
NABS, nt, nd, no organomegaly
Warm X 4 with pulses X 4, bil edema to just above knees
CNII-XII intact

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives w/four roomate in townhouse/?friends vs facility in [**Name (NI) **].
No smoking, etoh, ivda per records 

### Response:
{'Acute on chronic combined systolic and diastolic heart failure,Aortic valve disorders,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other specified cardiac device in situ,Constipation, unspecified,Gout, unspecified,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Unspecified disorder of kidney and ureter,Iron deficiency anemia, unspecified'}
