CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 86-year-old female
with a past medical history of diabetes and hypertension who
presented to the Emergency Department with a two day history
of shortness of breath and easy fatigability.  She also noted
increased dyspnea on exertion.  Prior to this patient could
walk upstairs but now cannot.  She denies chest pain,
orthopnea, paroxysmal nocturnal dyspnea.  However, the
patient has noted some abdominal pain, intermittent times a
couple of days, none on the day of admission.  Denied nausea,
vomiting, diaphoresis, bowel movement changes.  She has noted
increased urinary frequency.  Denies fever or chills.  Of
note, she has had recent medication changes which included
discontinuing Diovan and starting terazosin.

MEDICAL HISTORY: 1.  Diabetes mellitus.
2.  Hypertension.
3.  Osteoarthritis.
4.  _______________

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for diabetes.  No coronary artery
disease.

SOCIAL HISTORY: The patient lives alone.  Has a remote
tobacco history.  No ethanol.
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Combined systolic and diastolic heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other pulmonary insufficiency, not elsewhere classified,Atherosclerosis of renal artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified
Subendo infarct, initial,Acute kidney failure NOS,Syst/diast hrt fail NOS,Hyp kid NOS w cr kid V,Other pulmonary insuff,Renal artery atheroscler,DMII renl nt st uncntrld,Anemia NOS
Admission Date:  [**2189-4-20**]       Discharge Date:  [**2189-5-2**]


Service:

HISTORY OF PRESENT ILLNESS:  This is an 86-year-old female
with a past medical history of diabetes and hypertension who
presented to the Emergency Department with a two day history
of shortness of breath and easy fatigability.  She also noted
increased dyspnea on exertion.  Prior to this patient could
walk upstairs but now cannot.  She denies chest pain,
orthopnea, paroxysmal nocturnal dyspnea.  However, the
patient has noted some abdominal pain, intermittent times a
couple of days, none on the day of admission.  Denied nausea,
vomiting, diaphoresis, bowel movement changes.  She has noted
increased urinary frequency.  Denies fever or chills.  Of
note, she has had recent medication changes which included
discontinuing Diovan and starting terazosin.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus.
2.  Hypertension.
3.  Osteoarthritis.
4.  _______________

ALLERGIES:  No known drug allergies.

HOME MEDICATIONS:
1.  Aspirin 325 mg p.o. q. day.
2.  Norvasc 10 mg p.o. q. day.
3.  Isosorbide mononitrate 30 q. day.
4.  Terazosin 1 mg p.o. q. day.

SOCIAL HISTORY:  The patient lives alone.  Has a remote
tobacco history.  No ethanol.

FAMILY HISTORY:  Positive for diabetes.  No coronary artery
disease.

PHYSICAL EXAMINATION:  On admission, blood pressure 151/61,
heart rate 75, SaO2 93% on room air.  In general, patient in
no acute distress.  Speaks in full sentences.  Neck:  Jugular
venous pressure notable at the mid neck upright about 80
degree angles.  Cardiovascular regular rate and rhythm with a
1-2/6 holosystolic murmur.  Pulmonary:  Crackles bilaterally
one-third to one-half the way up.  Abdomen:  Bowel sounds
positive, soft, non-tender, non-distended.  Extremities:  1+
lower extremity edema.

LABORATORIES ON ADMISSION:  Included normal CBC, BUN 47,
creatinine 2.4 up from baseline of about 1.5.  Troponin 4.7,
CK 101, MB 3.

RADIOLOGY:  Chest x-ray showed patient was in congestive
heart failure.

ELECTROCARDIOGRAM:  Showed normal sinus rhythm at 107 beats
per minute with left axis deviation and poor R-wave
progression.  However, no acute changes were apparent.

HOSPITAL COURSE:  The patient was admitted to the Cardiac
Medicine Service and treated for presumed diastolic and
systolic dysfunction.  Echocardiogram was obtained which
showed moderately depressed left ventricular systolic
function as well as hypokinesis of the lower half of septum
and apex.  Also of note was the distal lateral wall
hypokinesis.  The wall motion abnormalities were noted to be
new.  It was believed that a troponin on admission in
addition to the wall motion abnormalities she underwent a
non-Q wave myocardial infarction prior to resulted in her
current cardiac failure.  Throughout hospital course
patient's troponin trended down to less than 0.3.  Heart
Failure Service was involved.  She was continued with
aggressive diuresis.  She was started on _________ with
excellent diuresis, however, her renal functioning worsening.
A cardiac catheterization was deferred until the renal issue
could be resolved.  However, her creatinine continued to
increase.  Diuresis was halted and without improvement in
creatinine.  Renal was consulted.  A renal ultrasound was
obtained.  It showed a right kidney size of 6.3 cm and a left
kidney size of 8.4 cm.  Given her hypertension which was very
difficult to control, it was felt that she had renal artery
stenosis and thus she underwent MRA of the kidney which
showed severe right renal artery stenosis at its origin.
There was also moderate to severe focal stenosis of the left
renal artery approximately 1.3 cm from its origin.  Dr.
______________ consulted on the case.  She was transferred to
the unit overnight to assess volume which was noted to be
optimal.  On [**4-28**] she underwent catheterization and
subsequent stenting of the left renal artery.  Due to dye
load required to assess the coronary disease were not
visualized.  After the procedure the patient did well.
However, her creatinine has worsened up to 4.2.  However, her
urine output has improved.  She has not required hemodialysis
at this time.  She will need close follow up of her renal
functioning.  The patient is discharged to an extended
discharge facility.

DISCHARGE DIAGNOSES:
1.  Non-Q wave myocardial infarction.
2.  Systolic and diastolic congestive heart failure.
3.  Bilateral renal artery stenosis status post stent left
renal artery.
4.  Acute renal failure.
5.  Hypertension.

FOLLOW UP:  She is to follow up with her primary care
physician in one week.  She is to follow up Heart Failure and
Cardiology in one week as well.  In addition, patient is to
have her own appointment with Podiatry.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg p.o. q. day.
2.  Norvasc 10 mg p.o. q. day.
3.  Atorvastatin 10 mg p.o. q. day.
4.  Protonix 20 mg p.o. q. day.
5.  Multivitamin one p.o. q. day.
6.  Carvedilol 3.125 p.o. b.i.d.
7.  ___________ dinitrate 20 mg p.o. t.i.d.
8.  Erythropoietin 10,000 units two times a week Tuesday and
Saturday.
9.  Calcium acetate Tums one p.o. t.i.d. with meals.
10. Tylenol 325 mg p.o. q. 4-6h. p.r.n.
11. Iron sulfate 325 mg p.o. q. day.
12. Colace 100 mg p.o. b.i.d.
13. Hydralazine 10 mg p.o. q. 6h.
14. Plavix 75 mg p.o. q. day times 30 days.




                            [**First Name8 (NamePattern2) 2053**] [**Last Name (NamePattern1) 2052**], M.D.  [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern1) 34434**]
MEDQUIST36

D:  [**2189-4-30**]  14:29
T:  [**2189-4-30**]  14:10
JOB#:  [**Job Number 110330**]
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Combined systolic and diastolic heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other pulmonary insufficiency, not elsewhere classified,Atherosclerosis of renal artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,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: 

PRESENT ILLNESS: This is an 86-year-old female
with a past medical history of diabetes and hypertension who
presented to the Emergency Department with a two day history
of shortness of breath and easy fatigability.  She also noted
increased dyspnea on exertion.  Prior to this patient could
walk upstairs but now cannot.  She denies chest pain,
orthopnea, paroxysmal nocturnal dyspnea.  However, the
patient has noted some abdominal pain, intermittent times a
couple of days, none on the day of admission.  Denied nausea,
vomiting, diaphoresis, bowel movement changes.  She has noted
increased urinary frequency.  Denies fever or chills.  Of
note, she has had recent medication changes which included
discontinuing Diovan and starting terazosin.

MEDICAL HISTORY: 1.  Diabetes mellitus.
2.  Hypertension.
3.  Osteoarthritis.
4.  _______________

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for diabetes.  No coronary artery
disease.

SOCIAL HISTORY: The patient lives alone.  Has a remote
tobacco history.  No ethanol. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Combined systolic and diastolic heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other pulmonary insufficiency, not elsewhere classified,Atherosclerosis of renal artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified'}
