CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 85 year old
female with a history of coronary artery disease, chronic
renal insufficiency, colonic polyps, breast cancer, diabetes
mellitus, and hyperlipidemia, who was transferred to [**Hospital1 1444**] from [**Hospital 1474**] Hospital with
an upper gastrointestinal bleed.

MEDICAL HISTORY: 1.  Coronary artery disease, status post myocardial
infarction fifteen years ago.
2.  Diabetes mellitus.
3.  Chronic renal insufficiency.
4.  Status post pacemaker placement.
5.  Hyperlipidemia.
6.  Breast cancer.
7.  Status post right mastectomy.
8.  Anemia.
9.  Neuropathy.
10. Peripheral vascular disease.
11. Colonic polyps.

MEDICATION ON ADMISSION: 

ALLERGIES: She has an allergy to Ciprofloxacin, Keflex,
Ampicillin, Sulfa and Morphine.

PHYSICAL EXAM: 

FAMILY HISTORY: She denies any family history of
gastrointestinal cancer.

SOCIAL HISTORY: The patient lives with her son.  She denies
any tobacco or alcohol use.
Angiodysplasia of stomach and duodenum with hemorrhage,Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Atrial fibrillation,Other specified forms of chronic ischemic heart disease,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Angio stm/dudn w hmrhg,Subendo infarct, initial,Urin tract infection NOS,Ac posthemorrhag anemia,Atrial fibrillation,Chr ischemic hrt dis NEC,Hypotension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2131-8-25**]     Discharge Date:  [**2131-8-30**]


Service:  MEDICINE/[**Doctor Last Name 1181**]

Transferred to Medicine service on [**2131-8-29**], and discharged
[**2131-8-30**].

HISTORY OF PRESENT ILLNESS:  The patient is an 85 year old
female with a history of coronary artery disease, chronic
renal insufficiency, colonic polyps, breast cancer, diabetes
mellitus, and hyperlipidemia, who was transferred to [**Hospital1 1444**] from [**Hospital 1474**] Hospital with
an upper gastrointestinal bleed.

In summary, on the morning of [**2131-8-23**], she passed melanotic
stools, passed out, and called EMS and was sent to [**Hospital 1474**]
Hospital.  At the outside hospital, nasogastric lavage was
positive for coffee ground gastric contents, and her initial
hematocrit was 32.0 which fell to 23.0 the following morning.
She was transfused four units of packed red blood cells, and
esophagogastroduodenoscopy on [**2131-8-23**], showed large amounts
of blood, but no bleeding source was found.  Repeat
esophagogastroduodenoscopy at [**Hospital 1474**] Hospital on [**2131-8-24**],
showed small blood and small erosions and an area of
angiodysplasia which was cauterized.  The patient
subsequently became hypotensive to the 80s, was given four
more units of blood, was started on Protonix and Octreotide
and then was transferred to [**Hospital1 188**] for further treatment on [**2131-8-25**].

Of note, she was noted to have a urinary tract infection on
presentation which was treated with Steclin and she was also
noted to have a non ST elevation myocardial infarction with a
peak troponin of 2.2.

At [**Hospital1 69**], Octreotide was
discontinued and serial hematocrit was followed, requiring no
further blood transfusions.  She was also given Protonix
twice a day.  She remained stable and was called out from the
Medical Intensive Care Unit to the floor on [**2131-8-29**].  At
that time of transfer, she stated that she had not seen any
dark stools that day, and only had complaints of a dry mouth.

PAST MEDICAL HISTORY:
1.  Coronary artery disease, status post myocardial
infarction fifteen years ago.
2.  Diabetes mellitus.
3.  Chronic renal insufficiency.
4.  Status post pacemaker placement.
5.  Hyperlipidemia.
6.  Breast cancer.
7.  Status post right mastectomy.
8.  Anemia.
9.  Neuropathy.
10. Peripheral vascular disease.
11. Colonic polyps.

SOCIAL HISTORY:  The patient lives with her son.  She denies
any tobacco or alcohol use.

FAMILY HISTORY:  She denies any family history of
gastrointestinal cancer.

ALLERGIES:  She has an allergy to Ciprofloxacin, Keflex,
Ampicillin, Sulfa and Morphine.

MEDICATIONS ON TRANSFER FROM MEDICAL INTENSIVE CARE UNIT:
[**Unit Number **].  Sliding scale insulin.
2.  NPH.
3.  Potassium Chloride supplement.
4.  Metoprolol 50 mg twice a day.
5.  Levofloxacin 250 mg once daily.
6.  Trazodone 25 mg once daily.
7.  Protonix 40 mg twice a day.
8.  Neutra-Phos.
9.  Ativan p.r.n.
10. Tylenol p.r.n.
11. Tolterodine 2 mg once daily.

PHYSICAL EXAMINATION:  Vital signs revealed a blood pressure
of 124/74, heart rate 81, respiratory rate 15, oxygen
saturation 98% in room air.  In general, the patient is a
well appearing elderly female in no acute distress.  Her
heart was regular, with a II/VI systolic ejection murmur
heard best at the left upper sternal border with no rubs or
gallops.  Her lungs were clear to auscultation bilaterally.
Her abdomen was obese, soft, nontender, nondistended.  She
had active bowel sounds.  Extremity examination revealed
pneumatic boots were in place bilaterally.  Her extremities
were cool, and she had no cyanosis, clubbing or edema.  She
had 2+ dorsalis pedis pulses bilaterally.

LABORATORY DATA:  On admission, complete blood count revealed
a white blood cell count of 7.6, hematocrit 32.1, platelet
count 158,000.  All her chemistries were within normal
limits.  She had an albumin of 3.3.  She had negative blood
cultures.

She had an echocardiogram on [**2131-8-28**], which revealed left
atrial enlargement and a moderately dilated right atrium.
Left ventricular wall motion abnormality could not be
excluded.  There was some hypokinesis of anterior apex.  She
had trace aortic regurgitation, mild 1+ mitral regurgitation,
but overall examination quality was suboptimal.

HOSPITAL COURSE:
1.  Gastrointestinal - The patient was transferred to [**Hospital1 1444**] as mentioned above from
[**Hospital 1474**] Hospital for maintenance of upper gastrointestinal
bleed due to her hypotension and falling hematocrit at
[**Hospital 1474**] Hospital.  She was transferred to the floor on
[**2131-8-29**], due to stability and status post cauterization of
angiodysplasia found on esophagogastroduodenoscopy at
[**Hospital 1474**] Hospital.  Once she came to the floor, her
hematocrit remained stable and she required no further blood
transfusions.  Her stools were persistently slightly occult
blood positive, but this was felt normal due to the passage
of old blood.  She was continued on Protonix 40 mg twice a
day and she was scheduled for follow-up
esophagogastroduodenoscopy as an outpatient in two to three
weeks at [**Hospital 1474**] Hospital.  Her Aspirin was continually held
and will be restarted as an outpatient after repeat
esophagogastroduodenoscopy.  On the day prior to admission,
she was also noted to have several episodes of diarrhea with
no evidence of bright red blood per rectum.  She had stool
cultures done at [**Hospital1 69**] for
Clostridium difficile due to recent antibiotic use and this
was conveyed to her primary care physician with the results
being followed up as an outpatient.

2.  Cardiovascular - The patient has a course of coronary
artery disease with myocardial infarction fifteen years ago.
Her Aspirin was held on admission due to upper
gastrointestinal bleed.  However, when she was stable at [**Hospital1 1444**], her Atenolol was restarted.
On the day prior to discharge, she was started on Lisinopril
5 mg once daily for cardiac and renal production in the
setting of diabetes mellitus and coronary artery disease.  It
is unclear why she is not on a statin and it is recommended
that this be further evaluated as an outpatient.  She was
restarted on her Gemfibrozil prior to discharge.  Throughout
admission, she was continued paced with a rate in the 80s
with no cardiac events.  She was also noted to have a right
carotid bruit on admission and throughout which was conveyed
to her primary care physician and will need further
outpatient evaluation.  The patient was initially placed on
Metoprolol 50 mg twice a day while in the Medical Intensive
Care Unit.  However, prior to discharge, this was changed
back to her home dose of Sotalol, in addition to Norvasc 10
mg once daily.  She tolerated restarting her medications
without any problems.

3.  Infectious disease - As mentioned above, once she was
admitted to [**Hospital 1474**] Hospital, she was noted to have an
Enterococcus urinary tract infection and she was changed to
Levofloxacin and completed a seven day course of antibiotics
prior to discharge.  Also, as mentioned above, her stool was
checked for Clostridium difficile toxin prior to discharge
which will need to be followed up by her primary care
physician.

4.  Musculoskeletal - The patient also had a physical therapy
evaluation while admitted and they felt she was cleared for
discharge home.

DISCHARGE DIAGNOSES:
1.  Upper gastrointestinal bleed.
2.  Hypotension.
3.  Urinary tract infection.
4.  Diarrhea.

MEDICATIONS ON DISCHARGE:
1.  Tolterodine 2 mg once daily.
2.  Protonix 40 mg p.o. twice a day.
3.  Lisinopril 5 mg p.o. once daily.
4.  Gemfibrozil 600 mg once daily.
5.  Sotalol 80 mg twice a day.
6.  Humalog insulin as previously prescribed at home.
7.  Norvasc 10 mg once daily.

FOLLOW-UP PLANS:  The patient was scheduled and will
follow-up with Dr. [**First Name (STitle) **], her primary care physician, [**Name10 (NameIs) **] one
to two weeks.  She was also notified, as well as her son and
her primary care physician, [**Name10 (NameIs) **] she needs to schedule a
follow-up esophagogastroduodenoscopy at [**Hospital 1474**] Hospital
within the next two to three weeks.  She also had stool
cultures done on the day of discharge which will need to be
followed up by her primary care physician with possible
repeat cultures if necessary.  This information was conveyed
to her, her son, and her primary care physician by Dr.
[**Last Name (STitle) **].

CONDITION ON DISCHARGE:  The patient was stable and without
complaints the day of discharge.  As mentioned above, she
will have a repeat esophagogastroduodenoscopy in two to three
weeks at [**Hospital 1474**] Hospital which needs to be scheduled.

As also mentioned above, she was started on an ace inhibitor
prior to being discharged which was discussed with her
primary care physician and will need to be titrated as an
outpatient.

DISPOSITION:  She was discharged to home with her son.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4122**], M.D.  [**MD Number(1) 33539**]

Dictated By:[**Last Name (NamePattern1) 14268**]

MEDQUIST36

D:  [**2131-10-4**]  17:04
T:  [**2131-10-7**]  08:41
JOB#:  [**Job Number 51708**]
{'Angiodysplasia of stomach and duodenum with hemorrhage,Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Atrial fibrillation,Other specified forms of chronic ischemic heart disease,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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 an 85 year old
female with a history of coronary artery disease, chronic
renal insufficiency, colonic polyps, breast cancer, diabetes
mellitus, and hyperlipidemia, who was transferred to [**Hospital1 1444**] from [**Hospital 1474**] Hospital with
an upper gastrointestinal bleed.

MEDICAL HISTORY: 1.  Coronary artery disease, status post myocardial
infarction fifteen years ago.
2.  Diabetes mellitus.
3.  Chronic renal insufficiency.
4.  Status post pacemaker placement.
5.  Hyperlipidemia.
6.  Breast cancer.
7.  Status post right mastectomy.
8.  Anemia.
9.  Neuropathy.
10. Peripheral vascular disease.
11. Colonic polyps.

MEDICATION ON ADMISSION: 

ALLERGIES: She has an allergy to Ciprofloxacin, Keflex,
Ampicillin, Sulfa and Morphine.

PHYSICAL EXAM: 

FAMILY HISTORY: She denies any family history of
gastrointestinal cancer.

SOCIAL HISTORY: The patient lives with her son.  She denies
any tobacco or alcohol use. 

### Response:
{'Angiodysplasia of stomach and duodenum with hemorrhage,Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Atrial fibrillation,Other specified forms of chronic ischemic heart disease,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
