CHIEF COMPLAINT: Chronic leg edema and shortness or breath

PRESENT ILLNESS: 53 y/o male with h/o constrictive pericarditis with unknown
etiology for approx. 10 years who presented to OSH with leg and
scrotal edema. He is also c/o shortness of breath and PND.
Patient was diursed and underwent cardiac cath which was
consistent with preicardial constriction. He has refused surgery
in the past, but now agrees and was transferred to [**Hospital1 18**] for
surgery.

MEDICAL HISTORY: Constrictive Pericarditis, Diabetes Mellitus, Hypertension,
Obesity, Left Eye blindness

MEDICATION ON ADMISSION: At home: Bumex
At Transfer: Bumex 2mg IV bid, Protonix 40mg qd, Heparin
5000units SC TID, Aspirin 81mg qd, Lisinopril 10mg qd, Novolog
Insulin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 93 26 125/80 5'7" 115kg
Gen: Ill appearing white male
Skin: Bilat. venous stasis LE
HEENT: Poor Dentition, right eye opacity, lef eye fixed pupil
Neck: Supple, FROM, +JVD, -Carotid bruit
Chest: CTAB -w/r/r
Heart: RRR, [**3-31**] murmur
Abd: Soft, NT/ND, +BS, obese
Ext: Warm, 4+ bilat. LE edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Homeless, Quit smoking 2 months ago. 70 pack/yr hx. Denies ETOH.
Constrictive pericarditis,Congestive heart failure, unspecified,Obesity, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lack of housing
Constrictiv pericarditis,CHF NOS,Obesity NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Lack of housing
Admission Date:  [**2105-5-21**]              Discharge Date:   [**2105-6-3**]

Date of Birth:  [**2052-2-1**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chronic leg edema and shortness or breath

Major Surgical or Invasive Procedure:
[**2105-5-22**] Pericardectomy

History of Present Illness:
53 y/o male with h/o constrictive pericarditis with unknown
etiology for approx. 10 years who presented to OSH with leg and
scrotal edema. He is also c/o shortness of breath and PND.
Patient was diursed and underwent cardiac cath which was
consistent with preicardial constriction. He has refused surgery
in the past, but now agrees and was transferred to [**Hospital1 18**] for
surgery.

Past Medical History:
Constrictive Pericarditis, Diabetes Mellitus, Hypertension,
Obesity, Left Eye blindness

Social History:
Homeless, Quit smoking 2 months ago. 70 pack/yr hx. Denies ETOH.

Family History:
Unknown

Physical Exam:
93 26 125/80 5'7" 115kg
Gen: Ill appearing white male
Skin: Bilat. venous stasis LE
HEENT: Poor Dentition, right eye opacity, lef eye fixed pupil
Neck: Supple, FROM, +JVD, -Carotid bruit
Chest: CTAB -w/r/r
Heart: RRR, [**3-31**] murmur
Abd: Soft, NT/ND, +BS, obese
Ext: Warm, 4+ bilat. LE edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2105-5-22**] Echo: The left atrium is moderately dilated. No
spontaneous echo contrast is seen in the body of the left
atrium. Mild spontaneous echo contrast is seen in the body of
the right atrium. No atrial septal defect is seen by 2D or color
Doppler. There is mild symmetric left ventricular hypertrophy.
The left ventricular cavity size is top normal/borderline
dilated. Overall left ventricular systolic function is low
normal (LVEF 50-55%). There appears to be focal left and right
ventricular apical hypokinesis but poor apical windows prevent
complete evaluation. There is abnormal septal motion suggestive
of pericardial constriction. There are simple atheroma in the
aortic arch. There are simple atheroma in the descending
thoracic aorta. There are three aortic valve leaflets. There is
a strand-like echodensity on the left ventricular outflow tract
side of either the left or non-coronary cusp of the aortic valve
that likely represents a degredative process but an aortic valve
vegetation mass cannot be excluded. There is no aortic valve
stenosis. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Trivial mitral regurgitation is
seen. There is a trivial/physiologic pericardial effusion. There
is a very large left pleual effusion as well as a right pleural
effusion and ascites. After stripping of the pericardium there
were no major changes. The pleural effusions were drained.

RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2105-5-27**] 7:04 AM

CHEST (PORTABLE AP)

Reason: r/o ptx. assess effusions

[**Hospital 93**] MEDICAL CONDITION:
53 year old man s/p pericardectomy and ct removal
REASON FOR THIS EXAMINATION:
r/o ptx. assess effusions
AP CHEST [**5-27**], 8:47 A.M.

HISTORY: Pericardiotomy. Chest tube removal.

IMPRESSION: AP chest compared to [**5-22**] and 30:

Left pleural drain has been removed. Small left pleural effusion
and small right pleural effusion are stable. Very small right
apical pneumothorax has decreased. Post-operative
cardiomediastinal silhouette is unremarkable and unchanged. Left
basal atelectasis is improved.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]

[**2105-6-1**] 09:35AM BLOOD WBC-7.7 RBC-3.74* Hgb-12.3* Hct-37.1*
MCV-99* MCH-32.8* MCHC-33.1 RDW-14.2 Plt Ct-684*
[**2105-5-29**] 08:00AM BLOOD PT-13.3* PTT-26.6 INR(PT)-1.2*
[**2105-6-1**] 09:35AM BLOOD Glucose-176* UreaN-16 Creat-0.7 Na-138
K-3.9 Cl-92* HCO3-44* AnGap-6*

Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname **] was transferred to [**Hospital1 18**] for
surgical management. He underwent usual pre-operative lab work
on day of admission. On [**5-22**] he was brought to the operating
room where he underwent a pericardectomy. Please see operative
report for surgical details. Following surgery he was
transferred to the CSRU for invasive monitoring in stable
condition. Within 24 hours he was weaned from sedation, awoke
neurologically intact and extubated. On post-op day one he was
started on beta blockers and diuretics. ID consulted on Mr.
[**Known lastname **] to help determine plan and to determine reason for
constrictive pericarditis (r/o TB as cause). On post-op day one
he appeared to be doing well and was transferred to the
telemetry floor. Over the next several days he worked with
physical therapy for strength and mobility. Chest tubes and
epicardial pacing wires were removed per protocol. He was
diuresed and medically managed during these days and awaited
results of tissue microbiology which were all negative.  He
continued to diurese well.

Medications on Admission:
At home: Bumex
At Transfer: Bumex 2mg IV bid, Protonix 40mg qd, Heparin
5000units SC TID, Aspirin 81mg qd, Lisinopril 10mg qd, Novolog
Insulin

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Diamox Sequels 500 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO twice a day.
6. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours).
7. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 4 weeks.
9. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day
for 7 days: When this dose is complete, decrease to 200 mg PO
daily.
10. Metolazone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Bumex 2 mg Tablet Sig: One (1) Tablet PO twice a day.
12. Insulin Glargine 100 unit/mL Solution Sig: Ten (10) units
Subcutaneous at bedtime.
13. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: One (1)
unit Subcutaneous four times a day: Follow this sliding scale:
BS 109-140  2 units
   141-200  4 units
   201-250  6 units
   251-300  8 units
   301-350 10 units.


Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) 2048**] [**Last Name (NamePattern1) **] House

Discharge Diagnosis:
Constrictive Pericarditis s/p Pericardectomy
PMH: Diabetes Mellitus, Hypertension, Obesity, Left Eye
blindness

Discharge Condition:
Good

Discharge Instructions:
Patient may shower, no baths.
No creams, lotions or ointments to incisions.
No driving for at least one month.
No lifting more than 10 lbs for at least 10 weeks from the date
of surgery.
Monitor wounds for signs of infection.
Please call with any concerns or questions.

Followup Instructions:
Dr. [**First Name (STitle) **] in 4 weeks
Dr. [**First Name (STitle) 1075**] in [**2-28**] weeks
Dr. [**First Name (STitle) **] in [**1-27**] weeks

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2105-6-1**]

Name:  [**Known lastname **],[**Known firstname 12120**]                  Unit No:   [**Numeric Identifier 12121**]

Admission Date:  [**2105-5-21**]              Discharge Date:   [**2105-6-3**]

Date of Birth:  [**2052-2-1**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 265**]
Addendum:
Ready for discharge to rehab with continued monitoring.  He has
been aggressively diuresised and currently zarolyxn
discontinued.  Plan for daily weights and monitoring edema for
diuretic adjustment.

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours).
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 4 weeks.
8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day
for 7 days: When this dose is complete, decrease to 200 mg PO
daily.
9. Bumex 2 mg Tablet Sig: One (1) Tablet PO twice a day.
10. Insulin Glargine 100 unit/mL Solution Sig: Ten (10) units
Subcutaneous at bedtime.
11. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: One (1)
unit Subcutaneous four times a day: Follow this sliding scale:
BS 109-140  2 units
   141-200  4 units
   201-250  6 units
   251-300  8 units
   301-350 10 units.


Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) 302**] [**Last Name (NamePattern1) 5572**] House

Followup Instructions:
Dr. [**First Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 1477**]
Dr. [**First Name (STitle) **] in [**2-28**] weeks
Dr. [**First Name (STitle) 1481**] in [**1-27**] weeks [**Telephone/Fax (1) 12122**]
please call to schedule appointments


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 266**]

Completed by:[**2105-6-3**]

Name:  [**Known lastname **],[**Known firstname 12120**]                  Unit No:   [**Numeric Identifier 12121**]

Admission Date:  [**2105-5-21**]              Discharge Date:   [**2105-6-3**]

Date of Birth:  [**2052-2-1**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 265**]
Addendum:
Of note, Mr. [**Known lastname **] stayed and extra day at the [**Hospital1 8**] as there
was no bed available at the rehab facility on [**2105-6-2**]. He was
thus discharged to rehab on [**2105-6-3**].

Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) 302**] [**Last Name (NamePattern1) 5572**] House

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 266**]

Completed by:[**2105-6-3**]
{'Constrictive pericarditis,Congestive heart failure, unspecified,Obesity, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lack of housing'}


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: Chronic leg edema and shortness or breath

PRESENT ILLNESS: 53 y/o male with h/o constrictive pericarditis with unknown
etiology for approx. 10 years who presented to OSH with leg and
scrotal edema. He is also c/o shortness of breath and PND.
Patient was diursed and underwent cardiac cath which was
consistent with preicardial constriction. He has refused surgery
in the past, but now agrees and was transferred to [**Hospital1 18**] for
surgery.

MEDICAL HISTORY: Constrictive Pericarditis, Diabetes Mellitus, Hypertension,
Obesity, Left Eye blindness

MEDICATION ON ADMISSION: At home: Bumex
At Transfer: Bumex 2mg IV bid, Protonix 40mg qd, Heparin
5000units SC TID, Aspirin 81mg qd, Lisinopril 10mg qd, Novolog
Insulin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 93 26 125/80 5'7" 115kg
Gen: Ill appearing white male
Skin: Bilat. venous stasis LE
HEENT: Poor Dentition, right eye opacity, lef eye fixed pupil
Neck: Supple, FROM, +JVD, -Carotid bruit
Chest: CTAB -w/r/r
Heart: RRR, [**3-31**] murmur
Abd: Soft, NT/ND, +BS, obese
Ext: Warm, 4+ bilat. LE edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Homeless, Quit smoking 2 months ago. 70 pack/yr hx. Denies ETOH. 

### Response:
{'Constrictive pericarditis,Congestive heart failure, unspecified,Obesity, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lack of housing'}
