CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 78-year-old
female with history of HIV, end stage renal disease on
hemodialysis secondary to HIV nephropathy, diabetes mellitus
type 2, spinal tuberculosis, hypertension,
hypercholesterolemia who presents with chest pain, back pain
and shortness of breath.  The patient has no other associated
symptoms including no nausea or vomiting, diaphoresis,
fevers, or chills.  In the Emergency Department, a chest CTA
was done to rule out dissection.  The patient then developed
flash pulmonary edema and an ET tube was placed emergently.
The patient had also been noted to have right upper quadrant
epigastric tenderness.  The patient had not been responsive
to nitroglycerin drip, morphine, and Lasix.  Chest CTA showed
no evidence of dissection but did show findings more
consistent with CHF.  When the patient presented to the ED,
her blood pressure was 253/120.

MEDICAL HISTORY: Human immunodeficiency virus with a
most recent CD4 count of 76 and a viral load less than 50
from [**3-7**].
Endstage renal disease on hemodialysis secondary to HIV
nephropathy.
Diabetes mellitus type 2, diet controlled.
History of spinal tuberculosis.
Hypertension.
Hypercholesterolemia.
Gout.
Anemia.
History of TIA.
History of hepatitis C.
Recent hospital admission in [**4-7**], fever of unknown origin
with negative cultures.

MEDICATION ON ADMISSION: 1. Lipitor 10 p.o. q.d.
2. Bactrim Double Strength 1 q.d.
3. AZT 300 mg p.o. b.i.d.
4. Lopressor 25 mg p.o. b.i.d.
5. Nevirapine 200 mg p.o. b.i.d.
6. Protonix 40 mg p.o. q.d.
7. Aspirin 325 mg p.o. q.d.
8. Imdur 30 mg p.o. q.d.
9. Zestril 20 mg p.o. q.d.
10.      3TC 150 mg p.o. q.d.
11.      Percocet 1 to 2 tablets p.o. q.[**4-9**] h. p.r.n. pain.
12.      Prednisone taper for gout.

ALLERGIES: Colchicine.
Efavirenz .
Allopurinol.
Ethambutol.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient denies any tobacco use, alcohol
use, or IV drug use.
Subendocardial infarction, initial episode of care,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Human immunodeficiency virus [HIV] disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute respiratory failure,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia
Subendo infarct, initial,Rheumatic heart failure,Mitral/aortic val insuff,Tricuspid valve disease,Human immuno virus dis,Hyp kid NOS w cr kid V,Acute respiratry failure,Crnry athrscl natve vssl,Pure hypercholesterolem
Admission Date: [**2154-6-3**]        Discharge Date: [**2154-6-11**]

Date of Birth:  [**2083-8-18**]        Sex:  F

Service:  MED


HISTORY OF PRESENT ILLNESS:  The patient is a 78-year-old
female with history of HIV, end stage renal disease on
hemodialysis secondary to HIV nephropathy, diabetes mellitus
type 2, spinal tuberculosis, hypertension,
hypercholesterolemia who presents with chest pain, back pain
and shortness of breath.  The patient has no other associated
symptoms including no nausea or vomiting, diaphoresis,
fevers, or chills.  In the Emergency Department, a chest CTA
was done to rule out dissection.  The patient then developed
flash pulmonary edema and an ET tube was placed emergently.
The patient had also been noted to have right upper quadrant
epigastric tenderness.  The patient had not been responsive
to nitroglycerin drip, morphine, and Lasix.  Chest CTA showed
no evidence of dissection but did show findings more
consistent with CHF.  When the patient presented to the ED,
her blood pressure was 253/120.

PAST MEDICAL HISTORY:  Human immunodeficiency virus with a
most recent CD4 count of 76 and a viral load less than 50
from [**3-7**].
Endstage renal disease on hemodialysis secondary to HIV
nephropathy.
Diabetes mellitus type 2, diet controlled.
History of spinal tuberculosis.
Hypertension.
Hypercholesterolemia.
Gout.
Anemia.
History of TIA.
History of hepatitis C.
Recent hospital admission in [**4-7**], fever of unknown origin
with negative cultures.

MEDICATIONS ON ADMISSION:
1. Lipitor 10 p.o. q.d.
2. Bactrim Double Strength 1 q.d.
3. AZT 300 mg p.o. b.i.d.
4. Lopressor 25 mg p.o. b.i.d.
5. Nevirapine 200 mg p.o. b.i.d.
6. Protonix 40 mg p.o. q.d.
7. Aspirin 325 mg p.o. q.d.
8. Imdur 30 mg p.o. q.d.
9. Zestril 20 mg p.o. q.d.
10.      3TC 150 mg p.o. q.d.
11.      Percocet 1 to 2 tablets p.o. q.[**4-9**] h. p.r.n. pain.
12.      Prednisone taper for gout.


ALLERGIES:  Colchicine.
Efavirenz .
Allopurinol.
Ethambutol.

SOCIAL HISTORY:  The patient denies any tobacco use, alcohol
use, or IV drug use.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION:  On admission, temperature of 96.0
degrees, blood pressure 164/79 on a nitroglycerin drip, heart
rate of 78, respiratory rate of 20, O2 saturation of 100
percent on assist control with a tidal volume of plus 100,
rate of 14, PEEP of 15, and FiO2 of 100 percent.  In general,
the patient is ill appearing, intubated, and sedated.  HEENT
exam reveals pupils equally round and reactive to light.
Neck exam:  Right IJ unable to assess for JVP.
Cardiovascular exam:  Regular rate and rhythm with the PMI
displaced laterally.  No murmurs, rubs, or gallops.
Pulmonary exam:  Coarse rales bilaterally.  Abdominal exam:
Benign.  Extremities show no edema and a left upper extremity
thrill at the site of her AV fistula.

LABORATORY DATA ON ADMISSION:  Notable for a white count of
7.8 with a neutrophil predominance at 77 percent, hematocrit
41.3, and platelets 174.  Potassium 5.0, magnesium 1.8, CK
88, troponin T 0.5, amylase 206, ALT 29, AST 38, and total
bilirubin 0.4.

EKG shows normal sinus rhythm with left axis deviation, left
ventricular hypertrophy, T-wave inversions in leads I, aVL,
V4 through V6, as well as ST depression 1 mm in lead I and V4
through V6.  Chest x-ray shows small bilateral pleural
effusion and cardiomegaly.  Chest CTA showed no dissection
but bilateral patchy opacities, cardiomegaly, and small
bilateral pleural effusion on the right greater than left
consistent with congestive heart failure.  Most recent echo
from [**3-6**], showed an EF of 60 percent with diastolic
dysfunction, 1 plus AR, 1 plus MR, and borderline pulmonary
artery hypertension.  Nuclear stress test from [**2153**] shows
mild diffuse hypokinesis with an EF of 47 percent.  No
reversible defects.

HOSPITAL COURSE:  The patient presented to the Emergency
Department with hypertensive emergency, chest pain, and
shortness of breath.  Chest CTA showed no evidence of
dissection.  It did, however, show evidence for CHF.  The
patient developed flash pulmonary edema following chest CTA
and was intubated emergently.  The patient was transferred to
the MICU for further management.  Since the EKG showed
changes concerning for ischemia including ST depression and
since the troponin T started to rise, the patient was placed
on a heparin drip.  Excess volume was removed via
hemodialysis.  The patient was successfully extubated on
hospital day number 2.  Heparin was stopped when her
troponins peaked at 0.89.  Following extubation, the patient
was noted to have some stridorous breath sounds.  ENT was
consulted.  She was found to have laryngeal edema and was
started on high-dose steroids with improvement.  Steroids
were successfully tapered off without any worsening of her
symptoms.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], [**MD Number(1) 5617**]

Dictated By:[**Doctor Last Name 9566**]
MEDQUIST36
D:  [**2154-6-11**] 13:27:01
T:  [**2154-6-11**] 22:50:06
Job#:  [**Job Number 12420**]


Name:  [**Known lastname 1839**], [**Known firstname 1840**]               Unit No:  [**Numeric Identifier 1841**]

Admission Date: [**2154-6-3**]        Discharge Date: [**2154-6-11**]

Date of Birth:  [**2083-8-18**]        Sex:  F

Service:  MED


ADDENDUM:  I was previously dictating and for some reason was
accidentally cut off; so I do not even know if this really
needs to be an Addendum, but if you could please add this on
to the previous dictation that had been started on Ms. [**Known firstname **]
[**Known lastname **] for this particular hospital admission.

SUMMARY OF HOSPITAL COURSE CONTINUED:  When the patient was
stabilized she was transferred to the [**Hospital1 **] for further
management.

A Cardiology consultation was obtained regarding the
patient's possible non-ST-elevation myocardial infarction.  A
repeat transthoracic echocardiogram was obtained which showed
mild LVH but a worsening ejection fraction of 25 percent to
30 percent in comparison to the ejection fraction seen on a
nuclear stress test from one year ago (at which the time
ejection fraction was 47 percent).  She also had global right
ventricular hypokinesis, 1 plus to 2 plus atrial
regurgitation, 2 plus mitral regurgitation, and 1 plus
tricuspid regurgitation.

Due to these findings, the Cardiology Service recommended a
cardiac catheterization.  The patient underwent cardiac
catheterization on [**2154-6-7**] which showed three vessel
disease.  The patient received a Taxus stent to the 80
percent mid circumflex.  She was treated with Integrilin at
renal doses following cardiac catheterization and was started
on Plavix 75 mg daily to be treated for nine months.  The
patient had no complications following cardiac
catheterization.  She did feel nauseous and vomited a few
times initially, but was eventually successfully able to take
oral intake.  Telemetry revealed frequent premature
ventricular contractions and occasional ventricular bigeminy
following cardiac catheterization and stent placement.
However, the patient remained asymptomatic and her creatine
kinase and troponin levels continued to trend down.  There
were no new electrocardiogram changes.

Due to the patient's persistent hypertension, her blood
pressure medications were titrated up.  Her dose of
lisinopril was changed from 20 mg to 40 mg by mouth once per
day, which she tolerated well.  In addition, her Lopressor
was changed from 25 mg by mouth twice per day to Toprol-XL
150 mg by mouth once per day.  The patient was instructed to
hold her blood pressure medications on the morning of
hemodialysis.  The patient was also started on Plavix 75 mg.
She was continued on her regular hemodialysis schedule of
Monday, Wednesday, and Friday.

Prior to discharge, the patient complained of a sore throat
which had been present since the time of extubation but
appeared to be improving with Cepacol as needed.  There was
no evidence for thrush on clinical examination, and it was
felt that her sore throat was entirely due to intubation.

The patient was seen by her outpatient Infectious Disease
attending during the course of the hospitalization.  Her
antiretroviral medications were changed for renal dialysis
doses as per Infectious Disease attending.

CONDITION ON DISCHARGE:  Hemodynamically stable, breathing on
room air, and chest pain free.

DISCHARGE STATUS:  The patient was discharged home with home
physical therapy as well as evaluation for home services.

DISCHARGE DIAGNOSES:  Non-ST-elevation myocardial infarction.

Congestive heart failure (with an ejection fraction of 25
percent to 30 percent).

Flash pulmonary edema due to volume overload.

Human immunodeficiency virus.

Gout.

Laryngeal edema following intubation.

Three vessel coronary artery disease; status post left
circumflex stent placement.


MEDICATIONS ON DISCHARGE:
1. Lipitor 10 mg by mouth every day.
2. Bactrim 160/800 mg by mouth every day.
3. Nevirapine 200 mg by mouth twice per day.
4. Aspirin 325 mg by mouth once per day.
5. Isosorbide mononitrate sustain release 30 mg by mouth once
   per day.
6. Calcium acetate [**2151**] by mouth three times per day with
   meals.
7. Docusate 100 mg by mouth twice per day as needed (for
   constipation).
8. Nephrocaps by mouth every day.
9. Renagel 800 mg by mouth three times per day.
10.      Plavix 75 mg by mouth once per day (to be taken for
   the next nine months).
11.      Zidovudine 100 mg by mouth twice per day.
12.      Lamivudine 60 mg by mouth once per day.
13.      Lisinopril 40 mg by mouth once per day.
14.      Cepacol lozenges twice per day as needed (for sore
   throat).
15.      Toprol-XL 150 mg by mouth once per day.
16.      Pantoprazole 40 mg by mouth once per day.


DISCHARGE FOLLOW-UP PLANS:  The patient was scheduled to
follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (her primary care
physician) on [**6-25**].

The patient was scheduled to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 25**]
from Infectious Disease on [**7-9**].

The patient was scheduled to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
from Cardiology regarding her recent cardiac catheterization
on [**7-2**].

The patient was asked to resume her regular outpatient
hemodialysis.

The patient was asked to follow up with ENT in one week.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], [**MD Number(1) 1842**]

Dictated By:[**Doctor Last Name 1843**]
MEDQUIST36
D:  [**2154-6-11**] 13:39:20
T:  [**2154-6-11**] 16:54:46
Job#:  [**Job Number 1844**]
{'Subendocardial infarction, initial episode of care,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Human immunodeficiency virus [HIV] disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute respiratory failure,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia'}


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 78-year-old
female with history of HIV, end stage renal disease on
hemodialysis secondary to HIV nephropathy, diabetes mellitus
type 2, spinal tuberculosis, hypertension,
hypercholesterolemia who presents with chest pain, back pain
and shortness of breath.  The patient has no other associated
symptoms including no nausea or vomiting, diaphoresis,
fevers, or chills.  In the Emergency Department, a chest CTA
was done to rule out dissection.  The patient then developed
flash pulmonary edema and an ET tube was placed emergently.
The patient had also been noted to have right upper quadrant
epigastric tenderness.  The patient had not been responsive
to nitroglycerin drip, morphine, and Lasix.  Chest CTA showed
no evidence of dissection but did show findings more
consistent with CHF.  When the patient presented to the ED,
her blood pressure was 253/120.

MEDICAL HISTORY: Human immunodeficiency virus with a
most recent CD4 count of 76 and a viral load less than 50
from [**3-7**].
Endstage renal disease on hemodialysis secondary to HIV
nephropathy.
Diabetes mellitus type 2, diet controlled.
History of spinal tuberculosis.
Hypertension.
Hypercholesterolemia.
Gout.
Anemia.
History of TIA.
History of hepatitis C.
Recent hospital admission in [**4-7**], fever of unknown origin
with negative cultures.

MEDICATION ON ADMISSION: 1. Lipitor 10 p.o. q.d.
2. Bactrim Double Strength 1 q.d.
3. AZT 300 mg p.o. b.i.d.
4. Lopressor 25 mg p.o. b.i.d.
5. Nevirapine 200 mg p.o. b.i.d.
6. Protonix 40 mg p.o. q.d.
7. Aspirin 325 mg p.o. q.d.
8. Imdur 30 mg p.o. q.d.
9. Zestril 20 mg p.o. q.d.
10.      3TC 150 mg p.o. q.d.
11.      Percocet 1 to 2 tablets p.o. q.[**4-9**] h. p.r.n. pain.
12.      Prednisone taper for gout.

ALLERGIES: Colchicine.
Efavirenz .
Allopurinol.
Ethambutol.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient denies any tobacco use, alcohol
use, or IV drug use. 

### Response:
{'Subendocardial infarction, initial episode of care,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Human immunodeficiency virus [HIV] disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute respiratory failure,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia'}
