CHIEF COMPLAINT: Respiratory distress

PRESENT ILLNESS: 88F with CAD, chronic diastolic CHF, Afib on coumadin,
cardioembolic CVA, DM admitted with respiratory distress. Felt
well until the day of admission when she began to feel
progressive generalized weakness. She awoke in the middle of the
night to use the bathroom and suddenly felt weak, "hot" and
short of breath. No increase in dietary salt or water intake, no
recent med changes. Denies fever, chills, headache, sore throat,
chest pain, palpitations, cough, orthopnea, abdominal pain,
nausea, vomiting, diarrhea, edema, or dysuria. Home health aide
reportedly noted patient to appear in some distress, short of
breath, and diaphoretic and EMS was called to transport patient
to ED.
In the ED, initial V/S 105 irreg 153/111 32 94%NRB. EKGs showed
AFib/flutter at 74-100 bpm without ischemic changes. CXR showed
mild CHF. Placed on BiPAP 8/8 FiO2 0.5 and given lasix 40 mg IV
with improvement (700 cc UOP). Nitro gtt d/c'd due to
hypotension 85/59 (recovered to 109/49 after stopping nitro).
Blood and urine cultures sent. Given vanc & ceftriaxone,
albuterol nebs. Levofloxacin started but discontinued due to
concerns re INR elevation. ABG 7.33/43/155/24 on BiPAP 8/8 FiO2
0.5. BNP 1440. Vital signs prior to transfer 82 119/52 24 99%
BiPAP 8/8 FiO2 0.4.

MEDICAL HISTORY: CAD s/p MI & PCI [**1-15**]
Chronic diastolic CHF
DM
Right-sided cardioembolic CVA [**5-17**]
Hypertension
Hypercholesterolemia
Spinal stenosis
s/p ERCP with biliary stent placement for choledocholithiasis
s/p ventral hernia repair
s/p appendectomy
s/p cataract surgery

MEDICATION ON ADMISSION: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - T 96.2 BP 127/60 HR 90 RR 19 02sat 98% on 40% FiO2
GENERAL: Well-appearing, resp non-labored, speaks in full
sentences
HEENT: PERRL OP clear dry MM
NECK: JVD difficult to appreciate due to habitus
CARDIAC: irreg irreg no m/r/g
LUNGS: diminished at bases no w/r/r
ABDOMEN: soft obese NTND normoactive BS
EXT: tr pitting edema to ankles bilat
NEURO: awake, alert, conversing appropriately oriented to
person, place, month/year

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Lives alone with 24[**Hospital 109318**] home health aides. Daughter lives nearby.
Former light smoker, quit in her 20s. No ETOH.
Acute on chronic diastolic heart failure,Other pulmonary insufficiency, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Spinal stenosis, unspecified region,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Long-term (current) use of anticoagulants,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Ac on chr diast hrt fail,Other pulmonary insuff,DMII wo cmp nt st uncntr,Atrial fibrillation,Depressive disorder NEC,Hyperlipidemia NEC/NOS,Spinal stenosis NOS,Hypertension NOS,Crnry athrscl natve vssl,Long-term use anticoagul,Status-post ptca,Hx TIA/stroke w/o resid
Admission Date:  [**2143-10-31**]              [**Month/Day/Year **] Date:   [**2143-11-3**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2356**]
Chief Complaint:
Respiratory distress

Major Surgical or Invasive Procedure:
None


History of Present Illness:
88F with CAD, chronic diastolic CHF, Afib on coumadin,
cardioembolic CVA, DM admitted with respiratory distress. Felt
well until the day of admission when she began to feel
progressive generalized weakness. She awoke in the middle of the
night to use the bathroom and suddenly felt weak, "hot" and
short of breath. No increase in dietary salt or water intake, no
recent med changes. Denies fever, chills, headache, sore throat,
chest pain, palpitations, cough, orthopnea, abdominal pain,
nausea, vomiting, diarrhea, edema, or dysuria. Home health aide
reportedly noted patient to appear in some distress, short of
breath, and diaphoretic and EMS was called to transport patient
to ED.
In the ED, initial V/S 105 irreg 153/111 32 94%NRB. EKGs showed
AFib/flutter at 74-100 bpm without ischemic changes. CXR showed
mild CHF. Placed on BiPAP 8/8 FiO2 0.5 and given lasix 40 mg IV
with improvement (700 cc UOP). Nitro gtt d/c'd due to
hypotension 85/59 (recovered to 109/49 after stopping nitro).
Blood and urine cultures sent. Given vanc & ceftriaxone,
albuterol nebs. Levofloxacin started but discontinued due to
concerns re INR elevation. ABG 7.33/43/155/24 on BiPAP 8/8 FiO2
0.5. BNP 1440. Vital signs prior to transfer 82 119/52 24 99%
BiPAP 8/8 FiO2 0.4.


Past Medical History:
CAD s/p MI & PCI [**1-15**]
Chronic diastolic CHF
DM
Right-sided cardioembolic CVA [**5-17**]
Hypertension
Hypercholesterolemia
Spinal stenosis
s/p ERCP with biliary stent placement for choledocholithiasis
s/p ventral hernia repair
s/p appendectomy
s/p cataract surgery

Social History:
Lives alone with 24[**Hospital 109318**] home health aides. Daughter lives nearby.
Former light smoker, quit in her 20s. No ETOH.

Family History:
Noncontributory.

Physical Exam:
Vitals - T 96.2 BP 127/60 HR 90 RR 19 02sat 98% on 40% FiO2
GENERAL: Well-appearing, resp non-labored, speaks in full
sentences
HEENT: PERRL OP clear dry MM
NECK: JVD difficult to appreciate due to habitus
CARDIAC: irreg irreg no m/r/g
LUNGS: diminished at bases no w/r/r
ABDOMEN: soft obese NTND normoactive BS
EXT: tr pitting edema to ankles bilat
NEURO: awake, alert, conversing appropriately oriented to
person, place, month/year


Pertinent Results:
Admission labs:
[**2143-10-31**] 03:20AM   WBC-20.8*# RBC-4.68 HGB-14.3 HCT-42.3 MCV-91
MCH-30.7 MCHC-33.9 RDW-14.0
[**2143-10-31**] 03:20AM   NEUTS-66.7 LYMPHS-28.5 MONOS-3.2 EOS-0.9
BASOS-0.6
[**2143-10-31**] 03:20AM   PLT COUNT-295
[**2143-10-31**] 03:20AM   GLUCOSE-242* UREA N-25* CREAT-1.0 SODIUM-138
POTASSIUM-6.0* CHLORIDE-106 TOTAL CO2-19* ANION GAP-19
[**2143-10-31**] 03:20AM   CK(CPK)-144*
[**2143-10-31**] 03:20AM   CK-MB-5 proBNP-1440*
[**2143-10-31**] 03:20AM   cTropnT-<0.01
[**2143-10-31**] 03:20AM   PT-29.5* PTT-26.3 INR(PT)-2.9*

[**Month/Day/Year **] Labs:

[**2143-11-3**] 06:25AM BLOOD WBC-10.9 RBC-4.40 Hgb-13.3 Hct-39.3
MCV-89 MCH-30.3 MCHC-33.8 RDW-14.0 Plt Ct-212
[**2143-11-3**] 06:25AM BLOOD Neuts-58.7 Lymphs-34.6 Monos-3.7 Eos-2.4
Baso-0.5
[**2143-11-3**] 06:25AM BLOOD Plt Ct-212
[**2143-11-3**] 06:25AM BLOOD Glucose-163* UreaN-35* Creat-1.0 Na-139
K-4.0 Cl-102 HCO3-30 AnGap-11
[**2143-11-2**] 06:00AM BLOOD proBNP-811*
[**2143-11-3**] 06:25AM BLOOD Calcium-9.3 Phos-3.5 Mg-2.1

Brief Hospital Course:
Patient presented with exacerbation of her CHF.  A brief
description of her hospital course according to system is
described below:

#Acute diastolic CHF - Attributed to acute hypertension with an
unclear precipitant given that prior TTE showed evidence of LVH,
grade II diastolic dysfunction, hyperdynamic LV and elevated
PCWP. No evidence of acute ischemia or rapid atrial arrhythmia
on EKG. Cardiac biomarkers cycled with 3 negative sets. Treated
with BiPAP initially then weaned to nasal cannula and then room
air.  Diuresed with lasix boluses. Repeat TTE [**11-1**] without
changes.
.
#Atrial fibrillation - Continued metoprolol and coumadin while
in the hospital.
.
#HTN - Continued her home medications which included an ACEi, BB
and CCB.
.
#DM - Held her oral hypoglycemic and covered her with sliding
scale insulin.
.
#Hyperlipidemia - Continued zetia.
.
#Code status - Patient is DNR/DNI per discussion with her
daughter on [**2143-10-31**].
.
#Dispo- Patient felt much improved at time of [**Date Range **].  She
was no longer feeling short of breath or light headed.  Her
vitals signs were within normal range.  She was tolerating oral
medications and a normal diet.

Medications on Admission:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Amlodipine 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
6. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for pain/fever.
7. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as
needed for LBP.
8. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
9. Citalopram 20 mg Tablet Sig: 0.25 Tablet PO DAILY (Daily).
10. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day.


[**Date Range **] Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Amlodipine 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
6. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for pain/fever.
7. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as
needed for LBP.
8. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
9. Citalopram 20 mg Tablet Sig: 0.25 Tablet PO DAILY (Daily).
10. Azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 3 days.
Disp:*3 Tablet(s)* Refills:*0*
11. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Cefpodoxime 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours) for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
13. Glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day.


[**Date Range **] Disposition:
Home

[**Date Range **] Diagnosis:
Primary diagnosis:
- Acute diastolic heart failure

Secondary diagnoses:
- Community acquired pneumonia
- Hypertension
- Coronary artery disease
- Atrial fibrillation
- Diabetes Mellitus


[**Date Range **] Condition:
Stable, ambulating without assistance, oxygen saturation 93% on
room air.


[**Date Range **] Instructions:
Ms. [**Known lastname **],

You were admitted for shortness of breath. It was felt that this
was related to worsening heart failure, and possibly a pneumonia
as well. You were given medications to help remove fluid and
antibiotics, and improved.

Please note the following changes to your medications:
- Lasix 40 mg daily was STARTED
- Cefpodoxime 200 mg twice a day was STARTED, please take this
for 5 more days to treat a possible pneumonia
- Azithromycin 250 mg daily was STARTED, please take this for 3
more days to treat a possible pneumonia

No other medication changes were made.

Please contact your primary care physician or go to the
emergency room if you experience any difficulty breathing, chest
pain, fevers, cough, or other concerning symptoms.

Followup Instructions:
Please follow up with your primary care provider, [**Last Name (NamePattern4) **].
[**Last Name (STitle) 1270**], within the next 1-2 weeks after [**Last Name (STitle) **] and
discuss with him whether you need to stay on lasix.


                             [**First Name4 (NamePattern1) 1730**] [**Last Name (NamePattern1) **] MD [**MD Number(1) 2362**]

Completed by:[**2143-11-26**]
{'Acute on chronic diastolic heart failure,Other pulmonary insufficiency, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Spinal stenosis, unspecified region,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Long-term (current) use of anticoagulants,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}


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 distress

PRESENT ILLNESS: 88F with CAD, chronic diastolic CHF, Afib on coumadin,
cardioembolic CVA, DM admitted with respiratory distress. Felt
well until the day of admission when she began to feel
progressive generalized weakness. She awoke in the middle of the
night to use the bathroom and suddenly felt weak, "hot" and
short of breath. No increase in dietary salt or water intake, no
recent med changes. Denies fever, chills, headache, sore throat,
chest pain, palpitations, cough, orthopnea, abdominal pain,
nausea, vomiting, diarrhea, edema, or dysuria. Home health aide
reportedly noted patient to appear in some distress, short of
breath, and diaphoretic and EMS was called to transport patient
to ED.
In the ED, initial V/S 105 irreg 153/111 32 94%NRB. EKGs showed
AFib/flutter at 74-100 bpm without ischemic changes. CXR showed
mild CHF. Placed on BiPAP 8/8 FiO2 0.5 and given lasix 40 mg IV
with improvement (700 cc UOP). Nitro gtt d/c'd due to
hypotension 85/59 (recovered to 109/49 after stopping nitro).
Blood and urine cultures sent. Given vanc & ceftriaxone,
albuterol nebs. Levofloxacin started but discontinued due to
concerns re INR elevation. ABG 7.33/43/155/24 on BiPAP 8/8 FiO2
0.5. BNP 1440. Vital signs prior to transfer 82 119/52 24 99%
BiPAP 8/8 FiO2 0.4.

MEDICAL HISTORY: CAD s/p MI & PCI [**1-15**]
Chronic diastolic CHF
DM
Right-sided cardioembolic CVA [**5-17**]
Hypertension
Hypercholesterolemia
Spinal stenosis
s/p ERCP with biliary stent placement for choledocholithiasis
s/p ventral hernia repair
s/p appendectomy
s/p cataract surgery

MEDICATION ON ADMISSION: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - T 96.2 BP 127/60 HR 90 RR 19 02sat 98% on 40% FiO2
GENERAL: Well-appearing, resp non-labored, speaks in full
sentences
HEENT: PERRL OP clear dry MM
NECK: JVD difficult to appreciate due to habitus
CARDIAC: irreg irreg no m/r/g
LUNGS: diminished at bases no w/r/r
ABDOMEN: soft obese NTND normoactive BS
EXT: tr pitting edema to ankles bilat
NEURO: awake, alert, conversing appropriately oriented to
person, place, month/year

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Lives alone with 24[**Hospital 109318**] home health aides. Daughter lives nearby.
Former light smoker, quit in her 20s. No ETOH. 

### Response:
{'Acute on chronic diastolic heart failure,Other pulmonary insufficiency, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Spinal stenosis, unspecified region,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Long-term (current) use of anticoagulants,Percutaneous transluminal coronary angioplasty status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}
