CHIEF COMPLAINT: 

PRESENT ILLNESS: This 85-year-old male with a
history of coronary artery disease, in the coronary care unit
status post myocardial infarction, congestive heart failure,
aortic valve endocarditis, GI bleed, diabetes mellitus,
chronic obstructive pulmonary disease, paroxysmal atrial
fibrillation, and thalassemia, who was transferred from [**Hospital 37805**] Community hospital to the [**Hospital1 188**] coronary care unit for continued management of
hypotension presumed secondary to heart failure.  He was
admitted to the outside hospital initially with fever and
found to have a pneumonia for which he was treated with
fluoroquinolone antibiotics.  He was found to have a pleural
effusion as well as a pericardial effusion that was
identified by transesophageal echocardiogram without evidence
of tamponade.  He underwent both thoracentesis and
pericardiocentesis with a laboratory analysis of both
consistent with transudative fluid.  He was also DC
cardioverted to normal sinus rhythm at the outside hospital.
He was felt to have developed pulmonary edema secondary to
congestive heart failure and for this reason he was started
on dobutamine.  On [**2132-2-17**] he was transferred to the [**Hospital1 1444**] at the request of the family
with chronic atrial fibrillation.  On transfer his
medications included dobutamine, digoxin, enalapril Lasix and
Aldactone.

MEDICAL HISTORY: 1. GI bleed in the setting of
anticoagulation.  2. Staphylococcus aortic valve endocarditis
in [**2130-11-4**].  3. Coronary artery disease status post
inferior myocardial infarction.  4. Congestive heart failure
with ejection fraction of 40%.  5. Type 2 diabetes mellitus.
6. Chronic obstructive pulmonary disease.  7. Paroxysmal
atrial fibrillation.  8. Thalassemia.  9. Anemia with a
negative GI work-up.  10. Osteoarthritis.  11. Hypertension.
12. Gout.  13. Peripheral neuropathy.  14. Abdominal aortic
aneurysm status post surgical repair.  15. Steroid-induced
osteoporosis.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is a former smoker.  His family is
supportive.  He lives in the [**Location (un) 86**] area and spends [**Doctor Last Name 6165**]
in [**State 108**].
Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Mitral valve disorders,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified septicemia,Unspecified pleural effusion,Other primary cardiomyopathies
Food/vomit pneumonitis,CHF NOS,Mitral valve disorder,Atrial fibrillation,Chr airway obstruct NEC,Septicemia NOS,Pleural effusion NOS,Prim cardiomyopathy NEC
Admission Date:  [**2132-2-17**]       Discharge Date:  [**2132-2-29**]


Service:  CCU

HISTORY OF PRESENT ILLNESS:  This 85-year-old male with a
history of coronary artery disease, in the coronary care unit
status post myocardial infarction, congestive heart failure,
aortic valve endocarditis, GI bleed, diabetes mellitus,
chronic obstructive pulmonary disease, paroxysmal atrial
fibrillation, and thalassemia, who was transferred from [**Hospital 37805**] Community hospital to the [**Hospital1 188**] coronary care unit for continued management of
hypotension presumed secondary to heart failure.  He was
admitted to the outside hospital initially with fever and
found to have a pneumonia for which he was treated with
fluoroquinolone antibiotics.  He was found to have a pleural
effusion as well as a pericardial effusion that was
identified by transesophageal echocardiogram without evidence
of tamponade.  He underwent both thoracentesis and
pericardiocentesis with a laboratory analysis of both
consistent with transudative fluid.  He was also DC
cardioverted to normal sinus rhythm at the outside hospital.
He was felt to have developed pulmonary edema secondary to
congestive heart failure and for this reason he was started
on dobutamine.  On [**2132-2-17**] he was transferred to the [**Hospital1 1444**] at the request of the family
with chronic atrial fibrillation.  On transfer his
medications included dobutamine, digoxin, enalapril Lasix and
Aldactone.

PAST MEDICAL HISTORY:  1. GI bleed in the setting of
anticoagulation.  2. Staphylococcus aortic valve endocarditis
in [**2130-11-4**].  3. Coronary artery disease status post
inferior myocardial infarction.  4. Congestive heart failure
with ejection fraction of 40%.  5. Type 2 diabetes mellitus.
6. Chronic obstructive pulmonary disease.  7. Paroxysmal
atrial fibrillation.  8. Thalassemia.  9. Anemia with a
negative GI work-up.  10. Osteoarthritis.  11. Hypertension.
12. Gout.  13. Peripheral neuropathy.  14. Abdominal aortic
aneurysm status post surgical repair.  15. Steroid-induced
osteoporosis.

MEDICATIONS ON TRANSFER:  1. Dobutamine.  2. Allopurinol 100
mg p.o. q.d.  3. Digoxin 0.125 mg p.o. q.d.  4. Colace 100 mg
p.o. b.i.d.  5. Enalapril 20 mg p.o. b.i.d.  6. Famotidine 20
mg p.o. b.i.d.  7. Flovent 2 puffs inhaled b.i.d.  8. Lasix
40 mg b.i.d.  9. Neurontin 100 mg p.o. t.i.d.  10. Regular
Insulin sliding scale.  11. Iron sulfate.  12. Levothyroxine.
13. Aldactone 25 mg p.o. q.d.  14. Theophylline 300 mg p.o.
b.i.d.  15. Tylenol.  16. Ativan.  17. Meperidine.  18.
Promethazine.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  He is a former smoker.  His family is
supportive.  He lives in the [**Location (un) 86**] area and spends [**Doctor Last Name 6165**]
in [**State 108**].

PHYSICAL EXAMINATION:  Temperature 97.6, heart rate 82 in
sinus, blood pressure 109/40, respiratory rate 16, oxygen
saturation 95% on four liters nasal cannula.  General:  No
apparent distress.  HEENT:  Pupils were equal, round, and
reactive to light.  Heart:  Regular rate and rhythm with a
positive S3 and a 2/6 systolic ejection murmur audible at the
left sternal border.  Jugular venous pressure was 8 cm.
Chest:  Audible crackles at the bases bilaterally.  Abdomen:
Nontender, nondistended, soft with normal active bowel
sounds.  Extremities:  No edema.

LABORATORY DATA:  Sodium 137, potassium 3.6, chloride 96,
bicarbonate 32, BUN 27, creatinine 1.3, glucose 197, INR 1.3,
patient 4.0, PTT 26.9, ALT 11, AST 10, alkaline phosphatase
62, total bilirubin 0.6.

Chest x-ray on admission showed a small bilateral pleural
effusion and vascular markings consistent with mild
congestive heart failure.

HOSPITAL COURSE:  The initial impression on admission was
that Mr. [**Known lastname 37806**] was transferred for continued management
of congestive heart failure and volume overload in the
setting of a reported history of ischemic cardiomyopathy and
depressed ejection fraction of 40%.  He was initially
continued on dobutamine and attempts were initially made at
aggressive diuresis to which he responded suboptimally.  His
hemodynamic and volume status was not entirely clear and for
this reason he underwent placement of a Swan-Ganz pulmonary
artery catheter which revealed cardiac filling pressures and
physiology consistent with sepsis.  For this reason he had
volume replacement with both blood and intravenous fluids.
He was started on broad-spectrum antibiotics and his pressor
support was changed from dobutamine to dopamine.  Over the
course of the next several days he demonstrated decreased
requirement of dopamine and eventually was able to wean off
of dopamine.  His blood pressures stabilized and he was able
to be started on an ACE inhibitor.

On [**2132-2-20**] a CAT scan of the chest was performed to rule out
an abscess or other etiology that would lead to persistent
pneumonia or predispose to sepsis after having received an
adequate course of antibiotics at the outside hospital.  This
study demonstrated persistent bilateral pleural effusions on
the right greater than the left and patchy bibasilar
consolidations consistent with aspiration or pneumonia.
There was mild pulmonary edema noted as well as cardiomegaly
and a small to moderate sized pericardial effusion suggestive
of either chronic pericarditis or complex pericardial fluid
collection.

The etiology of the persistent pleural effusions was felt
secondary to decompensated congestive heart failure, yet the
etiology remained not entirely clear, and for this reason the
pulmonary service was consulted.  The patient underwent two
thoracenteses.  The first revealed again transudative fluid.
The second thoracentesis performed removed about a liter of
fluid and resulted in symptomatic improvement in his
shortness of breath.

On [**2132-2-18**] a transthoracic echocardiogram was performed that
revealed mild left ventricular hypertrophy and moderate LV
dilation with moderately depressed LV systolic function,
severe inferior and posterior hypokinesis, ejection fraction
30-40%, 2+ mitral regurgitation and a small pericardial
effusion without evidence of tamponade.  This study was not
felt to be significantly changed since that of [**2131-1-4**].  The patient's pneumonia appeared to stabilize on a
regimen of Levaquin and Flagyl.  His pulmonary status
improved with thoracentesis, treatment of the pneumonia, and
nebulizer treatments.

The patient was back in atrial fibrillation shortly after his
transfer from [**State 108**] while in the setting of ongoing
infection and use of dobutamine and dopamine.  He was noted
to be in atrial fibrillation with a slow ventricular rate off
medications but without pauses.  The electrophysiology
service was consulted for the question of indications for
repeat elective cardioversion versus permanent pacemaker
placement to allow the use of beta blockers in the setting of
congestive heart failure and coronary artery disease.  He was
started on amiodarone to facilitate sinus rhythm restoration
although he did not convert on his own.  For this reason, he
was DC cardioverted to sinus rhythm on [**2132-2-28**] and continued
on amiodarone.  He was not felt to have an indication for
pacemaker implantation unless he were to develop significant
and symptomatic sinus bradycardia while on amiodarone.

Given his history of recurrent atrial fibrillation it was
recommended that he be anticoagulated despite his history of
significant GI bleed.  This matter was discussed at length
with the patient and his family.  Despite the associated
risks of deferring anticoagulation in the setting of his
history of paroxysmal atrial fibrillation and low ejection
fraction, the family and patient have deferred
anticoagulation.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Mr. [**Known lastname 37806**] will be transferred to
rehabilitation where he will need continued monitoring of his
fluid status and physical therapy for his deconditioned
state.  He will require follow-up appointments with Dr.
[**Last Name (STitle) 1911**] on [**2132-3-17**].  He has an appointment with
Dr. [**Last Name (STitle) 1911**] scheduled for this date at 1:15 PM.  Dr.[**Name (NI) 36806**] office number is [**Telephone/Fax (1) 902**].  He will also
need a follow-up appointment scheduled with his primary care
doctor, Dr. [**First Name4 (NamePattern1) 4597**] [**Last Name (NamePattern1) 37807**].

DISCHARGE MEDICATIONS:
1. Amiodarone 200 mg p.o. b.i.d. x 30 days, then switch to
200 mg p.o. q.d.
2. Lisinopril 5 mg p.o. q.d.
3. Levaquin 250 mg p.o. q.d. x 14 days then discontinue.
4. Flagyl 500 mg p.o. t.i.d. x 14 days then discontinue.
5. Lipitor 10 mg p.o. q.h.s.
6. Enteric-coated aspirin 325 mg p.o. q.d.
7. Levothyroxine 0.125 mg p.o. q.d.
8. Gabapentin 100 mg p.o. t.i.d.
9. Fluticasone inhaler 110 mcg 2 puffs inhaled b.i.d.
10. Miconazole powder applied to affected area b.i.d. p.r.n.
11. Nateglinide 120 mg p.o. t.i.d., give 10-20 minutes before
meals.
12. Lasix 20 mg p.o. q.d.
13. Albuterol nebulizer q. 4 hours p.r.n.
14. Atrovent metered dose inhaler four puffs inhaled b.i.d.
15. Albuterol inhaler 2 puffs inhaled q. 4 hours p.r.n.
16. Colace 100 mg p.o. b.i.d.
17. Senna 2 tablets p.o. q.h.s. p.r.n. constipation.

OTHER COMMENTS:
1. Use metered dose inhalers with spacers.
2. Provide and instruct in use of an incentive spirometer.
3. Fingerstick blood sugar q.i.d. with use of a Regular
Insulin sliding scale as needed.

DISCHARGE DIAGNOSES:
1. Pneumonia.
2. Right and left pleural effusion status post thoracentesis.
3. Paroxysmal atrial fibrillation status post DC
cardioversion.
4. Dilated cardiomyopathy, ejection fraction 30-40%.
5. Anemia/thalassemia with baseline hematocrit 27.
6. Chronic obstructive pulmonary disease.





                            [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(2) 2139**]

Dictated By:[**Last Name (NamePattern1) 25313**]
MEDQUIST36

D:  [**2132-2-29**]  13:23
T:  [**2132-2-29**]  13:54
JOB#:  [**Job Number 37808**]
{'Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Mitral valve disorders,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified septicemia,Unspecified pleural effusion,Other primary cardiomyopathies'}


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 85-year-old male with a
history of coronary artery disease, in the coronary care unit
status post myocardial infarction, congestive heart failure,
aortic valve endocarditis, GI bleed, diabetes mellitus,
chronic obstructive pulmonary disease, paroxysmal atrial
fibrillation, and thalassemia, who was transferred from [**Hospital 37805**] Community hospital to the [**Hospital1 188**] coronary care unit for continued management of
hypotension presumed secondary to heart failure.  He was
admitted to the outside hospital initially with fever and
found to have a pneumonia for which he was treated with
fluoroquinolone antibiotics.  He was found to have a pleural
effusion as well as a pericardial effusion that was
identified by transesophageal echocardiogram without evidence
of tamponade.  He underwent both thoracentesis and
pericardiocentesis with a laboratory analysis of both
consistent with transudative fluid.  He was also DC
cardioverted to normal sinus rhythm at the outside hospital.
He was felt to have developed pulmonary edema secondary to
congestive heart failure and for this reason he was started
on dobutamine.  On [**2132-2-17**] he was transferred to the [**Hospital1 1444**] at the request of the family
with chronic atrial fibrillation.  On transfer his
medications included dobutamine, digoxin, enalapril Lasix and
Aldactone.

MEDICAL HISTORY: 1. GI bleed in the setting of
anticoagulation.  2. Staphylococcus aortic valve endocarditis
in [**2130-11-4**].  3. Coronary artery disease status post
inferior myocardial infarction.  4. Congestive heart failure
with ejection fraction of 40%.  5. Type 2 diabetes mellitus.
6. Chronic obstructive pulmonary disease.  7. Paroxysmal
atrial fibrillation.  8. Thalassemia.  9. Anemia with a
negative GI work-up.  10. Osteoarthritis.  11. Hypertension.
12. Gout.  13. Peripheral neuropathy.  14. Abdominal aortic
aneurysm status post surgical repair.  15. Steroid-induced
osteoporosis.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is a former smoker.  His family is
supportive.  He lives in the [**Location (un) 86**] area and spends [**Doctor Last Name 6165**]
in [**State 108**]. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Mitral valve disorders,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified septicemia,Unspecified pleural effusion,Other primary cardiomyopathies'}
