CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75 year old
male with a past medical history significant for coronary
artery disease, diabetes and chronic renal insufficiency,
admitted to Coronary Care Unit following cardiac
catheterization for ventilatory support and Intensive Care
Unit monitoring.  The patient originally presented to an
outside hospital the morning of admission complaining of
chest pain and symptoms of congestive heart failure.  An
electrocardiogram showed a new left bundle branch block.  He
was then transferred to [**Hospital6 256**]
for emergent cardiac catheterization.  The patient went
immediately to the Catheterization Laboratory upon arrival.
Catheterization showed three vessel coronary artery disease,
patent graft, left internal mammary artery to the left
anterior descending, patent saphenous vein graft to the
posterior descending artery and patent saphenous vein graft
to obtuse marginal 1.  It was significant for increased right
and left filling pressures.  Angioplasty was then performed
on the aortoiliac bypass graft, left circumflex coronary
artery with failed angioplasty of obtuse marginal 1.  The
patient developed significant respiratory distress following
catheterization and was ventilated for ventilatory support
with transfer to the Coronary Care Unit on a ventilator.

MEDICAL HISTORY: Coronary artery disease status post
coronary artery bypass graft redo, three vessels in [**2159**],
four vessels in [**2170**], diabetes mellitus times 13 years,
chronic renal insufficiency with baseline creatinine 2.3,
prostate cancer diagnosed in [**2171**] refractory to hormone
therapy followed by Dr. [**Last Name (STitle) **], gout, depression, anemia,
congestive heart failure with unknown ejection fraction.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: History of tobacco use, 30 pack years, quit
in [**2158**], occasional alcohol.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Primary pulmonary hypertension,Acute kidney failure, unspecified,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery
Subendo infarct, initial,CHF NOS,Prim pulm hypertension,Acute kidney failure NOS,Int inf clstrdium dfcile,Urin tract infection NOS,Crnry athrscl natve vssl
Admission Date:  [**2182-9-16**]       Discharge Date: [**2182-9-20**]

Date of Birth:   [**2107-2-27**]       Sex:  M

Service:

NOTE - An addendum will be dictated when the patient is
discharged.

HISTORY OF PRESENT ILLNESS:  The patient is a 75 year old
male with a past medical history significant for coronary
artery disease, diabetes and chronic renal insufficiency,
admitted to Coronary Care Unit following cardiac
catheterization for ventilatory support and Intensive Care
Unit monitoring.  The patient originally presented to an
outside hospital the morning of admission complaining of
chest pain and symptoms of congestive heart failure.  An
electrocardiogram showed a new left bundle branch block.  He
was then transferred to [**Hospital6 256**]
for emergent cardiac catheterization.  The patient went
immediately to the Catheterization Laboratory upon arrival.
Catheterization showed three vessel coronary artery disease,
patent graft, left internal mammary artery to the left
anterior descending, patent saphenous vein graft to the
posterior descending artery and patent saphenous vein graft
to obtuse marginal 1.  It was significant for increased right
and left filling pressures.  Angioplasty was then performed
on the aortoiliac bypass graft, left circumflex coronary
artery with failed angioplasty of obtuse marginal 1.  The
patient developed significant respiratory distress following
catheterization and was ventilated for ventilatory support
with transfer to the Coronary Care Unit on a ventilator.

PAST MEDICAL HISTORY:  Coronary artery disease status post
coronary artery bypass graft redo, three vessels in [**2159**],
four vessels in [**2170**], diabetes mellitus times 13 years,
chronic renal insufficiency with baseline creatinine 2.3,
prostate cancer diagnosed in [**2171**] refractory to hormone
therapy followed by Dr. [**Last Name (STitle) **], gout, depression, anemia,
congestive heart failure with unknown ejection fraction.

SOCIAL HISTORY:  History of tobacco use, 30 pack years, quit
in [**2158**], occasional alcohol.

HOME MEDICATIONS:
1.  Calcitriol .25 mcg q. day
2.  Calcium acetate 657 mg t.i.d.
3.  Docusate 100 mg b.i.d.
4.  Epogen 10,000 units subcutaneous q. Thursday
5.  Felodipine 5 mg q. day
6.  Iron 325 mg t.i.d.
7.  Fluoxetine 20 mg q. day
8.  Glipizide 5 mg q. AM
9.  Hydralazine 40 mg b.i.d.
10. Hydroxyzine 25 mg b.i.d.
11. Metoprolol 25 mg t.i.d.
12. Omeprazole 40 mg q. day
13. Senna two tablets b.i.d.
14. Simvastatin 20 mg q. day
15. Allopurinol 50 mg q. day
16. Isosorbide mononitrate 60 mg q. day
17. Lasix 60 mg b.i.d.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs, temperature
96, heartrate 60, blood pressure 179/57, oxygen saturation
100% on 30% FIO2, weight 108 kg.  General:  Elderly male in
no acute distress.  Head, eyes, ears, nose and throat, pupils
equal, round and reactive to light and accommodation.
Oropharynx clear.  Neck supple.  No lymphadenopathy.  Chest
clear to auscultation anteriorly, no wheezes.  Heart, regular
rhythm, II/VI systolic murmur at the lower left sternal
border with no radiation.  Abdomen, soft, nontender,
nondistended, positive bowel sounds.  Extremities, 1+ edema.
Pulses dopplerable bilaterally.  Venous stasis changes
bilaterally.  Neurological, intubated, sedated.  Moves
extremities times four.

LABORATORY DATA:  White blood count 15.8, hematocrit 29.8,
platelets 228.  Sodium 142, potassium 4.7, chloride 111,
bicarbonate 18, BUN 86, creatinine 5.0, glucose 138.  Calcium
8.7, magnesium 1.7, phosphorus 4.6.  Chest x-ray:
Cardiomegaly, mild congestive heart failure.
Electrocardiogram, sinus rate at 80, left bundle branch
without ST changes.

HOSPITAL COURSE:  Cardiovascular - Ischemia, the patient with
a history of coronary artery disease, transferred from an
outside hospital for emergent cardiac catheterization
following new left bundle branch block at an outside
hospital.  During catheterization, the patient underwent
percutaneous transluminal coronary angioplasty to the left
circumflex with serial percutaneous transluminal coronary
angioplasty of obtuse marginal 1.  Following catheterization
he was maintained on a statin, Plavix, and Aspirin.  He was
initially on a nitroglycerin drip which was then converted
over to p.o.  He was also started on Hydralazine and titrated
up on a beta blocker.  This was subsequently converted to
Carvedilol.  The patient did not have any further episodes of
chest pain or ischemia during the hospitalization.

Pump, the patient with congestive heart failure Class 4.  The
patient underwent echocardiogram following cardiac
catheterization which showed an ejection fraction of 30 to
40% and severe hypokinesis inferiorly and posteriorly along
with 1+ mitral regurgitation and impaired ventricular
relaxation.  Immediately following catheterization the
patient was diuresed on a Natrecor drip.  He was quickly
weaned off of this and titrated over to daily intravenous
Lasix.  He was initially started on beta blocker and later
converted over to Carvedilol which he tolerated well.  He was
also started on Hydralazine and put back on his
nitroglycerin.  He continued to receive prn Lasix for
symptoms of fluid overload.

Rhythm, the patient remained in sinus rhythm and was
monitored on Telemetry throughout his hospital course.

Pulmonary - The patient was intubated following cardiac
catheterization for respiratory distress following minimal
diuresis with Natrecor drip.  The patient was quickly weaned
off of the ventilator and successfully extubated without any
complications.  He did not require any additional oxygen
requirements throughout the hospitalization and had no
symptoms of respiratory distress.

Infectious disease - The patient developed leukocytosis and
diarrhea during hospitalization and a stool sample was
positive for Clostridium difficile toxin.  He was started on
Vancomycin therapy for treatment of Clostridium difficile
colitis.  His symptoms of diarrhea improved following
initiation of antibiotic therapy.

Renal - The patient with chronic renal insufficiency with
baseline creatinine of 2.3.  At admission, his creatinine was
acutely elevated up to 5.0, thought to be due to dye load
during catheterization.  He was aggressively hydrated and his
creatinine trended down.  He briefly bumped his creatinine
due to hypovolemia during his diarrhea but this resolved with
hydration.  He was eventually put back on his daily Lasix
dose for maintenance.

Fluids, electrolytes and nutrition - The patient's volume
status and electrolytes were followed throughout admission.
He received multiple electrolyte repletions.

Heme - Anemia, the patient with baseline anemia believed due
to chronic renal insufficiency.  He was continued on iron and
Epogen per his home regimen.  He required transfusion of 2
units of packed red blood cells during the hospitalization.
His acute drop was thought to be following his
catheterization procedure.  He responded appropriately to the
transfusions and remained hemodynamically stable.

Endocrine - Patient with diabetes mellitus.  His Glipizide
was held initially and he was placed on sliding scale
insulin.  Following resumption of the regular diet he was
converted back to home medicines.

Prophylaxis - The patient was maintained on subcutaneous
heparin and proton pump inhibitor throughout his
hospitalization.

Code status - The patient was a full code throughout the
hospitalization.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Home.

DISCHARGE DIAGNOSIS:
1.  Myocardial infarction with cardiac catheterization
2.  Congestive heart failure
3.  Acute and chronic renal failure

DISCHARGE MEDICATIONS/FOLLOW UP INSTRUCTIONS:  Will be
dictated in an addendum to this discharge summary.



                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D.  [**MD Number(1) 5211**]

Dictated By:[**Last Name (NamePattern1) 5212**]
MEDQUIST36

D:  [**2182-9-20**]  15:06
T:  [**2182-9-20**]  16:22
JOB#:  [**Job Number 5213**]




Admission Date:  [**2182-9-16**]       Discharge Date:  [**2182-9-29**]

Date of Birth:   [**2107-2-27**]       Sex:  M

Service:  CCU

ADDENDUM:  The current summary will cover hospital stay from
[**2182-9-20**] through [**2182-9-29**].

1.  GASTROINTESTINAL BLEED:  The patient developed
progressive throat and esophageal pain and had an episode of
hematemesis in which he vomited approximately 500 cc of
blood.  GI was consulted.  The patient had an EGD which
showed esophagitis consistent with likely ischemic changes.
The patient was intubated for the EGD and transferred to the
ICU for closer monitoring.  He was started on a Pantoprazole
drip.  Following several days of the drip, he was transferred
over to p.o. Pantoprazole and his diet was slowly advanced.
He did not have any further episodes of hematemesis and his
throat discomfort resolved.

2.  RENAL FAILURE:  The patient was admitted with baseline
chronic renal insufficiency and symptoms of uremia over the
previous three months.  During the hospitalization, he had an
acute bump in his creatinine thought to be ATN from
catheterization dye load.  Renal consulted and the patient
was started on dialysis on [**2182-9-24**].  He underwent
several hemodialysis sessions to remove excess fluid and then
was started on a regimen of hemodialysis three times each
week.  The patient tolerated dialysis well.

3.  ACUTE CORONARY SYNDROME:  The patient had a non-ST
elevation MI on [**2182-9-21**].  Given his acute GI
bleed, he was not a candidate for anticoagulation and instead
was managed medically.  He was established on a regimen of
Carvedilol, Captopril, hydralazine, and Isordil and was also
started on aspirin.  The plan is to start the patient on
Plavix when he is further out from his GI bleed.  His cardiac
medications were titrated up as tolerated throughout his
hospitalization.

4.  INFECTIOUS DISEASE:  The patient was treated for C.
difficile colitis with a ten day regimen of Flagyl.  He also
developed an Enterococcus UTI and was successfully treated
with Levaquin.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS: The patient was discharged to
rehabilitation.

DISCHARGE DIAGNOSIS:
1.  Non-ST elevation myocardial infarction.
2.  Cardiac catheterization.
3.  Chronic renal insufficiency with acute renal failure
requiring hemodialysis.
4.  Clostridium difficile colitis.
5.  Urinary tract infection.
6.  ischemic esophagitis.

DISCHARGE MEDICATIONS:
1.  Docusate 100 mg b.i.d.
2.  Fluoxetine 20 mg q.d.
3.  Hydroxyzine 25 mg b.i.d.
4.  Simvastatin 20 mg q.d.
5.  Isosorbide dinitrate 20 mg t.i.d.
6.  Aspirin 81 mg q.d.
7.  Viscous lidocaine 2% 20 ml t.i.d. p.r.n.
8.  Pantoprazole 40 mg p.o. q. 12 hours.
9.  Calcium acetate 1,334 mg p.o. t.i.d. with meals.
10. Carvedilol 50 mg p.o. b.i.d.
11. Sliding scale insulin.
12. Lisinopril 20 mg p.o. q.d.
13. Metoclopramide 5 mg IV q. eight hours p.r.n.
14. Metronidazole 500 mg t.i.d. times one week.

FOLLOW-UP PLANS:  The patient is to follow-up with primary
care doctor in one week.  Follow-up with GI in two weeks for
repeat EGD.




                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5214**]

Dictated By:[**Last Name (NamePattern1) 5212**]
MEDQUIST36

D:  [**2182-9-29**]  01:48
T:  [**2182-9-29**]  14:20
JOB#:  [**Job Number 5215**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Primary pulmonary hypertension,Acute kidney failure, unspecified,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery'}


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: The patient is a 75 year old
male with a past medical history significant for coronary
artery disease, diabetes and chronic renal insufficiency,
admitted to Coronary Care Unit following cardiac
catheterization for ventilatory support and Intensive Care
Unit monitoring.  The patient originally presented to an
outside hospital the morning of admission complaining of
chest pain and symptoms of congestive heart failure.  An
electrocardiogram showed a new left bundle branch block.  He
was then transferred to [**Hospital6 256**]
for emergent cardiac catheterization.  The patient went
immediately to the Catheterization Laboratory upon arrival.
Catheterization showed three vessel coronary artery disease,
patent graft, left internal mammary artery to the left
anterior descending, patent saphenous vein graft to the
posterior descending artery and patent saphenous vein graft
to obtuse marginal 1.  It was significant for increased right
and left filling pressures.  Angioplasty was then performed
on the aortoiliac bypass graft, left circumflex coronary
artery with failed angioplasty of obtuse marginal 1.  The
patient developed significant respiratory distress following
catheterization and was ventilated for ventilatory support
with transfer to the Coronary Care Unit on a ventilator.

MEDICAL HISTORY: Coronary artery disease status post
coronary artery bypass graft redo, three vessels in [**2159**],
four vessels in [**2170**], diabetes mellitus times 13 years,
chronic renal insufficiency with baseline creatinine 2.3,
prostate cancer diagnosed in [**2171**] refractory to hormone
therapy followed by Dr. [**Last Name (STitle) **], gout, depression, anemia,
congestive heart failure with unknown ejection fraction.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: History of tobacco use, 30 pack years, quit
in [**2158**], occasional alcohol. 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Primary pulmonary hypertension,Acute kidney failure, unspecified,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery'}
