CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 69-year-old woman
with a history of diabetes, hypertension, and
hypercholesterolemia, who was transferred from [**Hospital3 1280**]
Hospital for cardiac catheterization.  She presented there
the same morning complaining of three days of shortness of
breath, productive cough, and epigastric/chest pain with
radiation to her arms, as well as some diaphoresis.  She was
initially hypoxic to 89% on room air and was placed on a
nonrebreather.  Electrocardiogram shows some lateral ST
depressions.  Chest x-ray was consistent with congestive
heart failure.  She received aspirin, intravenous
nitroglycerin, heparin, and was started on an Integrilin
drip.  She reportedly became pain free in the Emergency
Department with intravenous nitroglycerin.  She then received
a total of 120 mg of intravenous Lasix and put out
approximately 850 cc of urine.  Her CK at [**Hospital3 1280**] was 174
with a troponin I of 3.25.

MEDICAL HISTORY: 1.  Diabetes.
2.  Hypertension.
3.  Hyperlipidemia.
4.  Hypothyroidism.
5.  Depression.
6.  Possible history of a CVA at age 50.
7.  History of left patellar fracture.
8.  History of total abdominal hysterectomy.
9.  History of gastric ulcer in [**2187**].
10. Chronic chest pain with multiple prior Persantine
thallium studies which were negative.  Patient refused
cardiac catheterization over the past one to two years.
11. Chronic headaches.
12. Question of peripheral neuropathy.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine, Macrobid, tetracycline,
hydrochlorothiazide, thallium dye, Tylenol and statins, later
of which reportedly causes shortness of breath.

PHYSICAL EXAM: 

FAMILY HISTORY: Notable for coronary artery disease and
hypercholesterolemia.

SOCIAL HISTORY: The patient is a retired
secretary/bookkeeper.  She denies any alcohol or tobacco use.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Surgical or other procedure not carried out because of patient's decision
Subendo infarct, initial,CHF NOS,Crnry athrscl natve vssl,Hypertension NOS,DMII wo cmp nt st uncntr,Hypothyroidism NOS,No proc/patient decision
Admission Date:  [**2194-12-16**]     Discharge Date:  [**2194-12-21**]

Date of Birth:   [**2125-1-31**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  Patient is a 69-year-old woman
with a history of diabetes, hypertension, and
hypercholesterolemia, who was transferred from [**Hospital3 1280**]
Hospital for cardiac catheterization.  She presented there
the same morning complaining of three days of shortness of
breath, productive cough, and epigastric/chest pain with
radiation to her arms, as well as some diaphoresis.  She was
initially hypoxic to 89% on room air and was placed on a
nonrebreather.  Electrocardiogram shows some lateral ST
depressions.  Chest x-ray was consistent with congestive
heart failure.  She received aspirin, intravenous
nitroglycerin, heparin, and was started on an Integrilin
drip.  She reportedly became pain free in the Emergency
Department with intravenous nitroglycerin.  She then received
a total of 120 mg of intravenous Lasix and put out
approximately 850 cc of urine.  Her CK at [**Hospital3 1280**] was 174
with a troponin I of 3.25.

She underwent diagnostic catheterization there, which
revealed a 95% left circumflex ostial lesion, and an 80%
right coronary artery lesion and was subsequently transferred
to the [**Hospital1 **].  She reportedly received 300 mg
of Plavix prior to transfer.  At [**Hospital1 **],
cardiac catheterization showed elevated left and right heart
filling pressures, 3+ mitral regurgitation, an ejection
fraction of 55%, inferior hypokinesis, a 50% left anterior
descending lesion, 95% left circumflex, 90% right coronary
artery.  She underwent stenting to her left circumflex and
her right coronary artery.  Her pulmonary artery pressure was
50/20 and her wedge pressure was 23.

PAST MEDICAL HISTORY:
1.  Diabetes.
2.  Hypertension.
3.  Hyperlipidemia.
4.  Hypothyroidism.
5.  Depression.
6.  Possible history of a CVA at age 50.
7.  History of left patellar fracture.
8.  History of total abdominal hysterectomy.
9.  History of gastric ulcer in [**2187**].
10. Chronic chest pain with multiple prior Persantine
thallium studies which were negative.  Patient refused
cardiac catheterization over the past one to two years.
11. Chronic headaches.
12. Question of peripheral neuropathy.

ALLERGIES:  Codeine, Macrobid, tetracycline,
hydrochlorothiazide, thallium dye, Tylenol and statins, later
of which reportedly causes shortness of breath.

HOME MEDICATIONS:
1.  Glyburide 10 mg po q.d.
2.  Glucophage 1000 g po b.i.d.
3.  Levoxyl.
4.  Aspirin.
5.  Lidoderm patch.
6.  Actos 15 mg po q.d.
7.  Question of Lisinopril 10 mg po q.d.

MEDICATIONS ON TRANSFER:
1.  Aspirin.
2.  Protonix.
3.  Glyburide.
4.  Regular insulin sliding scale.
5.  Lopressor.
6.  Colace.
7.  Ceftriaxone 500 mg intravenously given in the Emergency
Department.
8.  Integrilin drip.
9.  Heparin drip.
10. Albuterol and Atrovent nebulizers.

FAMILY HISTORY:  Notable for coronary artery disease and
hypercholesterolemia.

SOCIAL HISTORY:  The patient is a retired
secretary/bookkeeper.  She denies any alcohol or tobacco use.

PHYSICAL EXAMINATION:  Vital signs:  Temperature:  Afebrile.
Pulse 74.  Blood pressure 122/58.  Pulse oxygen 94% on five
liters.  General appearance:  Patient mildly dyspneic in no
acute distress.  Head, eyes, ears, nose and throat:  Pupils
equal, round and reactive to light.  Extraocular movements
intact.  Sclerae are anicteric.  Dry mucous membranes.  Neck:
 Elevated jugular venous pressure.  Cardiovascular:  Regular
rate and rhythm, normal S1, S2, no murmurs.  Lungs with
crackles at the bases bilaterally.  There was some trace
anterior wheezes.  Abdomen was soft, some mild epigastric
tenderness.  There were active bowel sounds.  Extremities:
No edema, 2+ distal pulses.

INITIAL LABORATORY STUDIES:  Notable for a white blood cell
count of 15.1, creatinine of 1.2, which appears to be
baseline.

HOSPITAL COURSE:  By system:

1.  Cardiovascular:  Coronary artery disease:  Patient with
stents to her left circumflex and right coronary arteries.
Her peak CK was 195 with a positive troponin, thus, patient
ruled in for non Q wave myocardial infarction.  She was
started on Plavix, continued on aspirin and beta-blocker and
was initiated on a low dose ACE inhibitor during her hospital
stay.  Echocardiogram prior to her transfer to the
catheterization laboratory revealed mild dilation of the left
atrium with mildly depressed left ventricular systolic
function with an ejection fraction of approximately 45%,
inferior hypokinesis, 2+ mitral regurgitation, and no flail
leaflet.

Patient was initially noted to be severely volume overloaded
and was diuresed with Lasix to which she responded minimally.
She continued to have an oxygen requirements and crackles at
the bases bilaterally which may have been partly related to
superimposed pneumonia.  After initial diuresis in the
Coronary Care Unit, the patient continued to auto diurese
with improvement in her oxygen requirement while she was on
the floor.  On [**2194-12-21**], the patient was saturating
95% on room air, but still had bibasilar crackles and was
written for single dose of 20 mg of intravenous Lasix with
the thought of adding a small dose of standing po Lasix at
discharge.

We hope to initiate a statin post myocardial infarction, but
the patient had a well documented history of a statin
allergy, which she described as respiratory related.  We
attempted to get Zetia as an inpatient, but were not able
too.  Patient was briefly on gemfibrozil, but did not
tolerate secondary to gastrointestinal issues.  Patient had
no recurrence of her chest pain symptoms.

2.  Infectious Disease:  The patient spiked several fevers
during her hospital stay of approximately 101 to 102. Chest
x-ray revealed bibasilar infiltrates, left greater than
right, with small bilateral pleural effusions.  On [**2194-12-18**], the patient was empirically started on Levaquin with
gradual resolution of her infiltrates.  ON [**2194-12-20**],
patient was noted to have persistent left-sided pleural
effusion with resolution of the right-sided effusion.
Bedside ultrasound revealed that the effusion was only
approximately 10-15 cc in size.  Therefore, not a minimal to
tap.  Lateral decubitus film revealed layering of that fluid.
Thoracentesis was deferred given the small size and clinical
improvement as the patient had no further fevers.  She will
complete a ten day course of Levaquin as an outpatient.

3.  Renal:  Patient had a small bump in her creatinine in the
setting of efforts to diurese, but had trended back to
baseline at the time of discharge.

4.  Endocrine:  Patient was maintained on her outpatient
diabetes regimen.  She was persistently hypoglycemic to the
50s in the early morning in the setting of poor po intake and
her glyburide was held for most of her hospitalization.  For
her hypothyroidism, she was continued on her Synthroid.

5.  Chronic pain issue:  Patient was continued on NSAIDs prn.
We discussed initiation of a SSRI which should be further
explored as an outpatient.

6.  Hematological:  Patient's hematocrit was noted to trend
down from roughly 31 to 32 to 27.8.  On [**2194-12-20**], the
patient was transfused one unit of packed red blood cells
with appropriate response.

DISCHARGE CONDITION:  Stable.

DISCHARGE DIAGNOSES:
1.  Non Q wave myocardial infarction, status post stenting to
her right circumflex and right coronary artery.
2.  Hypoxia and fever, likely pneumonia.
3.  Diabetes.
4.  Mild congestive heart failure.
5.  Anemia.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg po q.d.
2.  Plavix 75 mg po q.d.
3.  Levoxyl 112 mcg po q.d.
4.  Gabapentin 300 mg po q.h.s. prn.
5.  Protonix 40 mg po q.d.
6.  Levofloxacin 250 mg po q.d. for five days.
7.  Lisinopril 2.5 mg po q.d.
8.  Metformin 1000 mg po b.i.d.
9. Atenolol 25 mg po q.d.
10. Glyburide 10 mg po b.i.d. (to be initiated if does not
remain persistently hypoglycemic).

DISCHARGE INSTRUCTIONS:  Patient evaluated by Physical
Therapy and thought appropriate for acute rehabilitation.
After discharge from rehabilitation, patient should follow-up
with her outpatient cardiologist, Dr. [**Last Name (STitle) 1295**], who is
located at [**Hospital3 1280**] Hospital in [**Location (un) 47**].






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], M.D.  [**MD Number(1) 9615**]

Dictated By:[**Dictator Info **]

MEDQUIST36

D:
T:  [**2194-12-21**]  15:02
JOB#:
{"Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Surgical or other procedure not carried out because of patient's decision"}


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: Patient is a 69-year-old woman
with a history of diabetes, hypertension, and
hypercholesterolemia, who was transferred from [**Hospital3 1280**]
Hospital for cardiac catheterization.  She presented there
the same morning complaining of three days of shortness of
breath, productive cough, and epigastric/chest pain with
radiation to her arms, as well as some diaphoresis.  She was
initially hypoxic to 89% on room air and was placed on a
nonrebreather.  Electrocardiogram shows some lateral ST
depressions.  Chest x-ray was consistent with congestive
heart failure.  She received aspirin, intravenous
nitroglycerin, heparin, and was started on an Integrilin
drip.  She reportedly became pain free in the Emergency
Department with intravenous nitroglycerin.  She then received
a total of 120 mg of intravenous Lasix and put out
approximately 850 cc of urine.  Her CK at [**Hospital3 1280**] was 174
with a troponin I of 3.25.

MEDICAL HISTORY: 1.  Diabetes.
2.  Hypertension.
3.  Hyperlipidemia.
4.  Hypothyroidism.
5.  Depression.
6.  Possible history of a CVA at age 50.
7.  History of left patellar fracture.
8.  History of total abdominal hysterectomy.
9.  History of gastric ulcer in [**2187**].
10. Chronic chest pain with multiple prior Persantine
thallium studies which were negative.  Patient refused
cardiac catheterization over the past one to two years.
11. Chronic headaches.
12. Question of peripheral neuropathy.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine, Macrobid, tetracycline,
hydrochlorothiazide, thallium dye, Tylenol and statins, later
of which reportedly causes shortness of breath.

PHYSICAL EXAM: 

FAMILY HISTORY: Notable for coronary artery disease and
hypercholesterolemia.

SOCIAL HISTORY: The patient is a retired
secretary/bookkeeper.  She denies any alcohol or tobacco use. 

### Response:
{"Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Surgical or other procedure not carried out because of patient's decision"}
