CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 80-year-old female
who has a history of coronary artery disease, hypertension,
congestive obstructive pulmonary disease, who presented to an
outside hospital with sudden onset of shortness of breath.
She was found to be in congestive heart failure, treated with
diuretics, nitroglycerin, albuterol.  She has been
transferred to [**Hospital1 69**] for
catheterization which revealed baseline cardiac output of
[**1-25**].  Cardiac index of 1.57 with improvement after milrinone
therapy for a cardiac output of 4.83, cardiac index of 2.34.
Prior her milrinone, her PCW was 37.  After milrinone, PAD
was 22, after milrinone 16 with low of blood pressure.

MEDICAL HISTORY: 1. Coronary artery disease.
2. Hypertension.
3. Diabetes mellitus 2.
4. Congestive heart failure.
5. Stroke.
6. Seizure.
7. Arthritis.

MEDICATION ON ADMISSION: 

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Her mom had a myocardial infarction at age
67.  Her son died of a myocardial infarction.

SOCIAL HISTORY: She quit smoking six years ago.  Denies
alcohol abuse and lives with her daughter.
Congestive heart failure, unspecified,Primary pulmonary hypertension,Chronic airway obstruction, not elsewhere classified,Other convulsions,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
CHF NOS,Prim pulm hypertension,Chr airway obstruct NEC,Convulsions NEC,Crnry athrscl natve vssl,Anemia NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2147-1-4**]     Discharge Date:  [**2147-1-11**]


Service:

HISTORY OF PRESENT ILLNESS:  This is an 80-year-old female
who has a history of coronary artery disease, hypertension,
congestive obstructive pulmonary disease, who presented to an
outside hospital with sudden onset of shortness of breath.
She was found to be in congestive heart failure, treated with
diuretics, nitroglycerin, albuterol.  She has been
transferred to [**Hospital1 69**] for
catheterization which revealed baseline cardiac output of
[**1-25**].  Cardiac index of 1.57 with improvement after milrinone
therapy for a cardiac output of 4.83, cardiac index of 2.34.
Prior her milrinone, her PCW was 37.  After milrinone, PAD
was 22, after milrinone 16 with low of blood pressure.

Left heart catheterization revealed depressed ejection
fraction of 25-30% with inferior basal, anterolateral, and
apical hypokinesis.  Angiography revealed a right dominant
system with LMCA and minor irregularities.  Left anterior
descending artery long and diffuse narrowing with focal 80%
stenotic lesions at the second diagonal left anterior
descending artery filled, right coronary artery and posterior
descending artery by collaterals.  Proximal left circ 40%,
mid right coronary artery 80%, posterior descending artery
was totally occluded.  She was transferred to CCU for further
management.

She reported to have chest pain in the Emergency Department
at the outside hospital, but denies that currently.  She was
not diaphoretic.  Echocardiogram at [**Hospital1 **] revealed an
ejection fraction of 35% with mild inferior wall dysfunction,
atrial enlargement, [**11-24**]+ mitral regurgitation.
Electrocardiogram showed sinus tachycardia with left axis
with nonspecific electrocardiogram changes.  Troponin at
outside hospital also peaked at 1.03.

PAST MEDICAL HISTORY:
1. Coronary artery disease.
2. Hypertension.
3. Diabetes mellitus 2.
4. Congestive heart failure.
5. Stroke.
6. Seizure.
7. Arthritis.

ALLERGIES:  She has no known drug allergies.

MEDICATIONS:
1. Labetalol 200 twice a day.
2. Lipitor 10 once a day.
3. Lasix 20 once a day.
4. Metformin 1,000 mg twice a day.
5. Cardura 40 q hs.
6. Accupril 20 twice a day.
7. Isordil 60 twice a day.
8. Diltiazem 240 once a day.
9. Ranitidine 150.

SOCIAL HISTORY:  She quit smoking six years ago.  Denies
alcohol abuse and lives with her daughter.

FAMILY HISTORY:  Her mom had a myocardial infarction at age
67.  Her son died of a myocardial infarction.

PHYSICAL EXAMINATION:  Temperature 98.0, blood pressure
162/78, pulse 109, respirations 22, and 99% on room air.  She
is a pleasant-obese woman in no acute distress.  She had a
regular, rate, and rhythm with no systolic murmur.  I was
unable to assess JD.  Her neck was supple.  Pulmonary:
Anterior, she is clear to auscultation with no audible
crackles, however, she did have some bibasilar rales.  She
was soft, nontender, nondistended with no hepatosplenomegaly.
She had only trace edema bilaterally.  She did have some end
expiratory wheezing on auscultation.

LABORATORIES ON ADMISSION:  Hematocrit 36.3, platelets 233,
potassium 4, BUN 8, creatinine 1.4.

She was admitted to the CCU for congestive heart failure with
decompensation, much improved after milrinone therapy.  Was
monitored in the CCU for two days with invasive Swan.  Her
numbers did improve on milrinone therapy, and then she was
transferred to the floor, where milrinone was weaned off and
she was continued to diurese with Lasix.

Her Lasix dose was increased originally to 60 [**Hospital1 **] for
adequate diuresis.  Once she was euvolemic, her dose was
decreased to 40 [**Hospital1 **].  Patient also was noted to have a
lengthened QTC.  Electrophysiology was consulted, who thought
this could be secondary to recent ischemia, that she was on
no medications which prolonged her QT.  Therefore, their
recommendation was to be on aldactone 25 mg q day and to
maintain her potassium above 4 and her magnesium above 2.5.

She was monitored on Telemetry for 24 hours.  She had no
event.  She denied symptoms such as palpitations or syncope.
Therefore, she was discharged home in good condition with
Physical Therapy as an outpatient.

DISCHARGE MEDICATIONS:
1. Metformin 1,000 mg po bid.
2. Spironolactone 25 mg po q day.
3. Lasix 40 mg po bid.
4. Ranitidine 150 po q day.
5. Bisacodyl.
6. Colace prn.
7. Lisinopril 20 mg q day.
8. Ipratropium bromide two puffs qid.
9. Labetalol 200 mg [**Hospital1 **].
10. Doxazosin 4 mg po q hs.
11. Atorvastatin 10 mg po q day.
12. Aspirin 325 mg po q day.




                        DR.[**Last Name (STitle) **],[**First Name3 (LF) 251**] 12-191

Dictated By:[**Dictator Info 46398**]

MEDQUIST36

D:  [**2147-1-10**]  16:53
T:  [**2147-1-11**]  06:44
JOB#:  [**Job Number 22531**]


Name:  [**Known lastname 6577**], [**Known firstname 8502**]                        Unit No:  [**Numeric Identifier 8503**]

Admission Date:  [**2147-1-4**]     Discharge Date:  [**2147-1-14**]

Date of Birth:   [**2066-8-14**]     Sex:  F

Service:

ADDENDUM:  This is a slight alteration than previously stated
in the discharge summary.

Electrophysiology was consulted for a lengthened QTC.  She
was watched for several days on telemetry.  However, this did
not resolve.  An AICD was then placed on [**2147-1-14**].  She was
started on Aldactone 37.5 mg with the goal to maintain her
potassium of 4.  She was also started on a standing magnesium
dose to keep her magnesium above 2.5.

She was discharged home in good condition.

DISCHARGE MEDICATIONS:
1.  Metformin 1,000 mg b.i.d.
2.  Spironolactone 37.5 mg p.o. q.d.
3.  Lasix 20 mg q.d.
4.  Ranitidine 150 mg p.o. b.i.d.
5.  Lisinopril 40 mg q.d.
6.  Atrovent two puffs inhalers q.i.d.
7.  Labetalol 300 mg p.o. b.i.d.
8.  Doxazosin 2 mg p.o. q.d.
9.  Atorvostatin 10 mg p.o. q.d.
10. Aspirin 325 mg p.o. q.d.
11. Norvasc 5 mg p.o. q.d.
12. Keflex 500 q.i.d. times two days.

FOLLOW-UP:  She is to follow-up in the Device Clinic in
[**Hospital Ward Name **], the date of which is unknown at the time of this
dictation.




                          [**Name6 (MD) 116**] [**Last Name (NamePattern4) 2879**], M.D.  [**MD Number(1) 5308**]

Dictated By:[**Dictator Info **]

MEDQUIST36

D:  [**2147-1-14**]  11:47
T:  [**2147-1-14**]  12:19
JOB#:  [**Job Number 8504**]
{'Congestive heart failure, unspecified,Primary pulmonary hypertension,Chronic airway obstruction, not elsewhere classified,Other convulsions,Coronary atherosclerosis of native coronary artery,Anemia, 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: This is an 80-year-old female
who has a history of coronary artery disease, hypertension,
congestive obstructive pulmonary disease, who presented to an
outside hospital with sudden onset of shortness of breath.
She was found to be in congestive heart failure, treated with
diuretics, nitroglycerin, albuterol.  She has been
transferred to [**Hospital1 69**] for
catheterization which revealed baseline cardiac output of
[**1-25**].  Cardiac index of 1.57 with improvement after milrinone
therapy for a cardiac output of 4.83, cardiac index of 2.34.
Prior her milrinone, her PCW was 37.  After milrinone, PAD
was 22, after milrinone 16 with low of blood pressure.

MEDICAL HISTORY: 1. Coronary artery disease.
2. Hypertension.
3. Diabetes mellitus 2.
4. Congestive heart failure.
5. Stroke.
6. Seizure.
7. Arthritis.

MEDICATION ON ADMISSION: 

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Her mom had a myocardial infarction at age
67.  Her son died of a myocardial infarction.

SOCIAL HISTORY: She quit smoking six years ago.  Denies
alcohol abuse and lives with her daughter. 

### Response:
{'Congestive heart failure, unspecified,Primary pulmonary hypertension,Chronic airway obstruction, not elsewhere classified,Other convulsions,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
