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CHIEF COMPLAINT: PRESENT ILLNESS: This 60 year old white male has a known murmur since childhood. He is status post inferior myocardial infarction and anteroseptal myocardial infarction in [**2130**] and status post angioplasty at that time. Since [**2140-9-23**] he has had increased dyspnea on exertion and an echocardiogram in [**2140-12-24**], revealed an aortic stenosis with an 80 mm gradient and ejection fraction of 40% with apical akinesis. He had a cardiac catheterization in [**2140-12-24**] which revealed an ejection fraction of 40%, 1+ mitral regurgitation with moderate MAC, left anterior descending is 90% mid 90% lesion, diagonal 1 70% lesion and the right coronary artery had a mid occlusion. He is now admitted for aortic valve replacement and coronary artery bypass graft. MEDICAL HISTORY: Significant for history of skin cancer of the left shoulder, history of hypothyroidism, history of hypercholesterolemia and history of hypertension and history of coronary artery disease, status post angioplasty in [**2130**], status post inferior myocardial infarction and anteroseptal myocardial infarction in [**2130**]. MEDICATION ON ADMISSION: Prozac 20 mg p.o. q. day; Synthroid .125 mEq; Pravachol 80 mg p.o. q. day; Toprol XL 100 mg p.o. q. day; Altace 5 mg p.o. q. day; Aspirin 325 mg p.o. q. day. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Significant for coronary artery disease. SOCIAL HISTORY: He smokes cigars occasionally and drinks alcohol occasionally.

Aortic valve disorders,Congestive heart failure, unspecified,Hyperpotassemia,Cardiac complications, not elsewhere classified,Atrial flutter,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status

Aortic valve disorder,CHF NOS,Hyperpotassemia,Surg compl-heart,Atrial flutter,Crnry athrscl natve vssl,Old myocardial infarct,Status-post ptca

Admission Date: [**2141-3-13**] Discharge Date: [**2141-3-24**] Date of Birth: [**2080-6-12**] Sex: M Service: HISTORY OF PRESENT ILLNESS: This 60 year old white male has a known murmur since childhood. He is status post inferior myocardial infarction and anteroseptal myocardial infarction in [**2130**] and status post angioplasty at that time. Since [**2140-9-23**] he has had increased dyspnea on exertion and an echocardiogram in [**2140-12-24**], revealed an aortic stenosis with an 80 mm gradient and ejection fraction of 40% with apical akinesis. He had a cardiac catheterization in [**2140-12-24**] which revealed an ejection fraction of 40%, 1+ mitral regurgitation with moderate MAC, left anterior descending is 90% mid 90% lesion, diagonal 1 70% lesion and the right coronary artery had a mid occlusion. He is now admitted for aortic valve replacement and coronary artery bypass graft. PAST MEDICAL HISTORY: Significant for history of skin cancer of the left shoulder, history of hypothyroidism, history of hypercholesterolemia and history of hypertension and history of coronary artery disease, status post angioplasty in [**2130**], status post inferior myocardial infarction and anteroseptal myocardial infarction in [**2130**]. MEDICATIONS ON ADMISSION: Prozac 20 mg p.o. q. day; Synthroid .125 mEq; Pravachol 80 mg p.o. q. day; Toprol XL 100 mg p.o. q. day; Altace 5 mg p.o. q. day; Aspirin 325 mg p.o. q. day. ALLERGIES: No known drug allergies. FAMILY HISTORY: Significant for coronary artery disease. SOCIAL HISTORY: He smokes cigars occasionally and drinks alcohol occasionally. REVIEW OF SYSTEMS: Unremarkable. PHYSICAL EXAMINATION: He is a well developed, well nourished male in no apparent distress. Vital signs are stable, afebrile. Head, eyes, ears, nose and throat examination, normocephalic, atraumatic, extraocular movements intact. Oropharynx was benign. Neck supple, full range of motion, no lymphadenopathy or thyromegaly. Carotids 2+ and equal bilaterally without bruits. Lungs, clear to auscultation and percussion. Cardiovascular examination, regular rate and rhythm, III/VI blowing murmur. Abdomen was soft, nontender, with positive bowel sounds, no masses or hepatosplenomegaly. Extremities were without cyanosis, clubbing or edema. Neurological examination was nonfocal. Pulses were 2+ and equal bilaterally throughout. HOSPITAL COURSE: He was admitted to the unit for heart failure workup. He was in stable condition on the unit and on [**2141-3-15**] he underwent aortic valve replacement, 24 mm [**Last Name (un) 3843**]-[**Doctor Last Name **], and coronary artery bypass graft times three with left internal mammary artery to the left anterior descending, reverse saphenous vein graft to obtuse marginal 1 and diagonal. Crossclamp time was 93 minutes, total bypass time 131 minutes. He was transferred to the Cardiothoracic Surgery Recovery Unit in stable condition. He was extubated. He was started on an ACE inhibitor. Chest tubes were discontinued on postoperative day #2. He was transferred to the floor on postoperative day #2. He continued to have a stable postoperative course. He went into rapid atrial fibrillation and had to be anticoagulated and converted back to sinus rhythm. Electrophysiology was following him and wanted him to be seen in follow up on [**4-18**] at 2 PM, Tuesday with Dr. [**Last Name (STitle) **]. He was on Amiodarone and he had an increased TSH to 46 with a decrease T3 and free T4, so he was discontinued from the Amiodarone and his Levoxyl was increased to .150 mg. He needs his pulmonary function tests checked in two to three weeks. So, he was discharged to home on postoperative day #9 in stable condition. His laboratory data on discharge revealed hematocrit 33.1, white count 8,700, platelets 164. Sodium 135, potassium 4.2, chloride 98, carbon dioxide 27, BUN 16, creatinine 0.6 and blood sugar 104. MEDICATIONS ON DISCHARGE: 1. Colace 100 mg p.o. b.i.d. 2. Percocet 1 to 2 p.o. q. 4-6 hours prn pain 3. Ecotrin 81 mg p.o. q. day 4. Coumadin 5 mg p.o. q.h.s. 5. Prozac 20 mg p.o. q. day 6. Levoxyl 150 mcg p.o. q. day 7. Atenolol 25 mg p.o. q. day 8. Altace 5 mg p.o. q. day 9. Lipitor 10 mg p.o. q. day FO[**Last Name (STitle) 996**]P: He will be followed by Dr. [**Last Name (STitle) 46214**] in one to two weeks and Dr. [**Last Name (Prefixes) **] in four weeks and Dr. [**Last Name (STitle) **] on [**4-18**]. Also the visiting nurses will check his coagulation screens on Monday, Wednesday and Friday and call them to Dr. [**Last Name (STitle) 46214**] and he is aware of that. [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D. [**MD Number(1) 414**] Dictated By:[**Last Name (NamePattern1) 11726**] MEDQUIST36 D: [**2141-3-24**] 16:04 T: [**2141-3-24**] 17:02 JOB#: [**Job Number 46215**]

424,428,276,997,427,414,412,V458

{'Aortic valve disorders,Congestive heart failure, unspecified,Hyperpotassemia,Cardiac complications, not elsewhere classified,Atrial flutter,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}

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 60 year old white male has a known murmur since childhood. He is status post inferior myocardial infarction and anteroseptal myocardial infarction in [**2130**] and status post angioplasty at that time. Since [**2140-9-23**] he has had increased dyspnea on exertion and an echocardiogram in [**2140-12-24**], revealed an aortic stenosis with an 80 mm gradient and ejection fraction of 40% with apical akinesis. He had a cardiac catheterization in [**2140-12-24**] which revealed an ejection fraction of 40%, 1+ mitral regurgitation with moderate MAC, left anterior descending is 90% mid 90% lesion, diagonal 1 70% lesion and the right coronary artery had a mid occlusion. He is now admitted for aortic valve replacement and coronary artery bypass graft. MEDICAL HISTORY: Significant for history of skin cancer of the left shoulder, history of hypothyroidism, history of hypercholesterolemia and history of hypertension and history of coronary artery disease, status post angioplasty in [**2130**], status post inferior myocardial infarction and anteroseptal myocardial infarction in [**2130**]. MEDICATION ON ADMISSION: Prozac 20 mg p.o. q. day; Synthroid .125 mEq; Pravachol 80 mg p.o. q. day; Toprol XL 100 mg p.o. q. day; Altace 5 mg p.o. q. day; Aspirin 325 mg p.o. q. day. ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Significant for coronary artery disease. SOCIAL HISTORY: He smokes cigars occasionally and drinks alcohol occasionally. ### Response: {'Aortic valve disorders,Congestive heart failure, unspecified,Hyperpotassemia,Cardiac complications, not elsewhere classified,Atrial flutter,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}

CHIEF COMPLAINT: Substernal Chest Pain PRESENT ILLNESS: 60 year old male with no PMH, non smoker, who presented to [**Hospital6 8283**] [**9-26**] after experiencing SSCP while working excavating and shoveling dirt. States that the pain was sharp and crescendoed to a [**10-11**]. It was initially located on the right side of his chest but then progressed to involve his entire chest, without radiation to his neck, arm, or jaw. It did not subside despite resting. It was associated with diaphoresis, and later on with some nausea. Taken by ambulance to MVH, found to have STs elevation in inferior and precordial leads. Given 4 ASAs, 3 sl nitro sprays, and Medivac'ed to [**Hospital1 18**] for emergent cath. . AT [**Hospital1 18**] ED, given 600 plavix at 1215, heparin bolus of 4000 at 1215, heparin gtt at 800u/hr. At cath, found to have TO of LAD and diag, and 2 BMSs were deployed. . After his first cath he was noted to have AIVR as well as runs of NSVT (8-12 beats), with occasional symptoms such as lightheadedness and diaphoresis. He was started on a lidocaine drip but continued to have NSVT. His BP began to drop and he was started on wide open IVF for a total of approximately 1.5 liters. After this volume resuscitation he desatted to low 90's. He was also started on a dopamine drip but was still hypotensive. Given his symptoms he was taken back to the cath lab when a repeat procedure showed patent stents. A spot film of the groin showed no bleeding. His lidocaine was changed to amiodarone. A right heart cath was performed and he was given 20mg IV lasix for what was felt to be volume overload. . Currently he states his CP remains much improved, approx [**1-11**]. Denies N/V/palpitation/diaphoresis. States that although he has never had CP like this before in his life, he did note a brief episode of self limiting CP last week while at rest. MEDICAL HISTORY: None MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VSL T: 96.9 BP 107/72 P: 97 RR: 21 Sat: 98% 2LNC Gen: WDWN, lying flat in bed, A+Ox3 HEENT: NC/AT, MMM. Slightly flushed. Sclerae anicteric, PERRLA. Orophyarynx with poor dentition and extensive dental work with a broken L lower molar with mild bleeding Neck: supple, no elevation of JVP. No carotid bruits Resp: CTA anteriorly, no accessory muscle use Cor: non-displaced PMI. RR, borderline tachycardia. s1 s2, no m/r/g Abd: S/ND, tender to deep palpation suprapubically. + BS. No palpable masses Ext: WWP, no C/C/E. R Groin site without hematoma. Pulses: Right: Carotid 2+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ FAMILY HISTORY: There is a family history of CAd, as his brother had an MI at 52 and his father had an MI in his 50s-60s. No sudden premature death. SOCIAL HISTORY: Social history is significant for the absence of current or former tobacco use. There is no history of alcohol abuse.

Acute myocardial infarction of other anterior wall, initial episode of care,Acute systolic heart failure,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension

AMI anterior wall, init,Ac systolic hrt failure,Surg compl-heart,Parox ventric tachycard,Crnry athrscl natve vssl,Iatrogenc hypotnsion NEC

Admission Date: [**2102-9-26**] Discharge Date: [**2102-10-2**] Date of Birth: [**2042-5-18**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2387**] Chief Complaint: Substernal Chest Pain Major Surgical or Invasive Procedure: Cardiac catheterization. History of Present Illness: 60 year old male with no PMH, non smoker, who presented to [**Hospital6 8283**] [**9-26**] after experiencing SSCP while working excavating and shoveling dirt. States that the pain was sharp and crescendoed to a [**10-11**]. It was initially located on the right side of his chest but then progressed to involve his entire chest, without radiation to his neck, arm, or jaw. It did not subside despite resting. It was associated with diaphoresis, and later on with some nausea. Taken by ambulance to MVH, found to have STs elevation in inferior and precordial leads. Given 4 ASAs, 3 sl nitro sprays, and Medivac'ed to [**Hospital1 18**] for emergent cath. . AT [**Hospital1 18**] ED, given 600 plavix at 1215, heparin bolus of 4000 at 1215, heparin gtt at 800u/hr. At cath, found to have TO of LAD and diag, and 2 BMSs were deployed. . After his first cath he was noted to have AIVR as well as runs of NSVT (8-12 beats), with occasional symptoms such as lightheadedness and diaphoresis. He was started on a lidocaine drip but continued to have NSVT. His BP began to drop and he was started on wide open IVF for a total of approximately 1.5 liters. After this volume resuscitation he desatted to low 90's. He was also started on a dopamine drip but was still hypotensive. Given his symptoms he was taken back to the cath lab when a repeat procedure showed patent stents. A spot film of the groin showed no bleeding. His lidocaine was changed to amiodarone. A right heart cath was performed and he was given 20mg IV lasix for what was felt to be volume overload. . Currently he states his CP remains much improved, approx [**1-11**]. Denies N/V/palpitation/diaphoresis. States that although he has never had CP like this before in his life, he did note a brief episode of self limiting CP last week while at rest. Past Medical History: None Social History: Social history is significant for the absence of current or former tobacco use. There is no history of alcohol abuse. Family History: There is a family history of CAd, as his brother had an MI at 52 and his father had an MI in his 50s-60s. No sudden premature death. Physical Exam: VSL T: 96.9 BP 107/72 P: 97 RR: 21 Sat: 98% 2LNC Gen: WDWN, lying flat in bed, A+Ox3 HEENT: NC/AT, MMM. Slightly flushed. Sclerae anicteric, PERRLA. Orophyarynx with poor dentition and extensive dental work with a broken L lower molar with mild bleeding Neck: supple, no elevation of JVP. No carotid bruits Resp: CTA anteriorly, no accessory muscle use Cor: non-displaced PMI. RR, borderline tachycardia. s1 s2, no m/r/g Abd: S/ND, tender to deep palpation suprapubically. + BS. No palpable masses Ext: WWP, no C/C/E. R Groin site without hematoma. Pulses: Right: Carotid 2+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ Pertinent Results: EKG demonstrated NSR with extensive Q waves in II, III, aVF, and midline precordial leads, with significant change compared with prior dated [**9-26**], notable resolution of diffuse precordial ST elevations. . TELEMETRY demonstrated: Accelerated Idioventricular Rhythm Occasional runs of VT, Non-sustained, 8-12 beats . CARDIAC CATH performed on [**2102-9-26**] demonstrated: 1. One vessel coronary artery disease. 2. Normal ventricular function. 3. Acute anterior myocardial infarction, managed by acute ptca. 4. Successful PTCA and stenting of the mid LAD with a bare metal stent. 5. Successful PTCA and stenting of the jailed first diagonal with a bare metal stent. . Repeat cardiac cath demonstrated no in-stent thrombosis or change from above. . HEMODYNAMICS FROM 2ND CATH (on dopamine 5-10 mcg/kg): CVP/RA mean: 9 RV 58/5 PA pressure 54/21 mean 37 PCWP: 13 CO: 5.0 CI 2.8 . [**2102-9-26**] CK 3712 -> [**2102-9-27**] 3274 -> 1107* [**2102-9-26**] 09:53PM BLOOD CK-MB-469* MB Indx-12.6* [**2102-9-27**] 05:33AM BLOOD CK-MB-324* MB Indx-9.9* cTropnT-10.7* [**2102-9-28**] 05:45AM BLOOD CK-MB-46* MB Indx-4.2 cTropnT-5.48* [**2102-9-30**] 04:17AM BLOOD CK-MB-7 cTropnT-4.52* Brief Hospital Course: 60M with no cardiac risk factors except +FH who presented with acute STEMI, got PCI with with 2 BMS to LAD and diag, post-cath with resolution of STE's but symptomatic NSVT and hypotension leading to re-cath (no re-thrombosis). Currently stable with 2 runs of asymptomatic VT on tele. . 1) STEMI: patient found to have large anterior MI, cathed with stents to LAD. PAtient was hypotensive immediately after cath with IAVR and many runs of Vtach. He was also very hypotensive. He was recathed and found to have a caged diagnonal, but no stent rethrombosus. He was in integrillin immediately after cath, and heparin, which was bridged to coumadin. He was started on ASA, plavix, metoprolol 12.5 [**Hospital1 **] (unable to tolerate higher doses seconary to hypotension), lisinopril, and a statin. His LDL is 98, his goal is below 70. An ECHO was done and showed EF of 35-40% and apical and anterior wall hypokinesis. Patient showing some sighns of acute systolic heart failure. He is to f/u with his PCP later this week, and with Dr. [**Last Name (STitle) **] within 2 weeks. . 2) Runs of NSVT: Patient had many runs of NSVT immediately after MI, he was started on Lidocaine gtt for the arrythmia, with no change, got 2 grams Mg iv, and was switched to amiodarone gtt. he remained on this for a total of 24 hours. After this he reverted to NSR, bradycardic with 2 runs of NSVT 5 days post MI. He was on amiodoarine PO for several days, but this was dc/ed because his blood pressure did not tolerated it. . 3) Hypotension - Per hemodynamicss in cath lab, patient with signs of mild pulmonary hypertension. Patient put out 2 L in response to 20IV lasix in cathlab, found to be hypotensive post cath. got fluid bolus, and was briefly on dopamine. He has maintained pressure with systolics in high 80s-90s during hospitalization. . 4)abdominal pain. patient described this as gas pains. resolved with simethicone. Medications on Admission: none Discharge Medications: 1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Aspirin 325 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:*2* 3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*2* 4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Acute MI . Secondary Systolic heart failure acute CAD Discharge Condition: stable Discharge Instructions: You were admitted to the hospital with a heart attack. you were started on several medications, which are listed below. You had a cardiac catherization and a stent placed in one of your coronary arteries. You heart has also had an abnormal rhythm both immediately after the heart attack and also few time afterward. You were not sypmtomatic, but it is somethign to be aware of. . Please return to the hospital or your doctor if you have any more chest pain, lightheadedness or shortness of breath. Followup Instructions: You have an appt with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] scheduled for [**2102-10-5**] at 9:30am. . You are to follow up with your cardiologist, Dr. [**Last Name (STitle) **], in 2 weeks in his [**Location (un) **] [**Last Name (un) **] office. They will call you with an appointment. if you do not hear from them by the end of the week, Please call and make an appointment, the office number is [**Telephone/Fax (1) 74956**]. Completed by:[**2102-10-2**]

410,428,997,427,414,458

{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute systolic heart failure,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension'}

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: Substernal Chest Pain PRESENT ILLNESS: 60 year old male with no PMH, non smoker, who presented to [**Hospital6 8283**] [**9-26**] after experiencing SSCP while working excavating and shoveling dirt. States that the pain was sharp and crescendoed to a [**10-11**]. It was initially located on the right side of his chest but then progressed to involve his entire chest, without radiation to his neck, arm, or jaw. It did not subside despite resting. It was associated with diaphoresis, and later on with some nausea. Taken by ambulance to MVH, found to have STs elevation in inferior and precordial leads. Given 4 ASAs, 3 sl nitro sprays, and Medivac'ed to [**Hospital1 18**] for emergent cath. . AT [**Hospital1 18**] ED, given 600 plavix at 1215, heparin bolus of 4000 at 1215, heparin gtt at 800u/hr. At cath, found to have TO of LAD and diag, and 2 BMSs were deployed. . After his first cath he was noted to have AIVR as well as runs of NSVT (8-12 beats), with occasional symptoms such as lightheadedness and diaphoresis. He was started on a lidocaine drip but continued to have NSVT. His BP began to drop and he was started on wide open IVF for a total of approximately 1.5 liters. After this volume resuscitation he desatted to low 90's. He was also started on a dopamine drip but was still hypotensive. Given his symptoms he was taken back to the cath lab when a repeat procedure showed patent stents. A spot film of the groin showed no bleeding. His lidocaine was changed to amiodarone. A right heart cath was performed and he was given 20mg IV lasix for what was felt to be volume overload. . Currently he states his CP remains much improved, approx [**1-11**]. Denies N/V/palpitation/diaphoresis. States that although he has never had CP like this before in his life, he did note a brief episode of self limiting CP last week while at rest. MEDICAL HISTORY: None MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VSL T: 96.9 BP 107/72 P: 97 RR: 21 Sat: 98% 2LNC Gen: WDWN, lying flat in bed, A+Ox3 HEENT: NC/AT, MMM. Slightly flushed. Sclerae anicteric, PERRLA. Orophyarynx with poor dentition and extensive dental work with a broken L lower molar with mild bleeding Neck: supple, no elevation of JVP. No carotid bruits Resp: CTA anteriorly, no accessory muscle use Cor: non-displaced PMI. RR, borderline tachycardia. s1 s2, no m/r/g Abd: S/ND, tender to deep palpation suprapubically. + BS. No palpable masses Ext: WWP, no C/C/E. R Groin site without hematoma. Pulses: Right: Carotid 2+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ FAMILY HISTORY: There is a family history of CAd, as his brother had an MI at 52 and his father had an MI in his 50s-60s. No sudden premature death. SOCIAL HISTORY: Social history is significant for the absence of current or former tobacco use. There is no history of alcohol abuse. ### Response: {'Acute myocardial infarction of other anterior wall, initial episode of care,Acute systolic heart failure,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 58-year-old gentleman, who was going to an outside hospital for preoperative testing for right cataract surgery when his left prosthetic leg slipped and he fell hitting his back. He developed back pain, which persisted. He denied weakness, numbness, or bowel or bladder changes. MEDICAL HISTORY: Fibrosarcoma of the upper back, which was resected in [**2089**]. MEDICATION ON ADMISSION: 1. Metoprolol 100 b.i.d. 2. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 q.d. 3. Metformin 500 b.i.d. 4. Glipizide 10 b.i.d. 5. Actos 15 q.d. 6. Lasix 40 b.i.d. 7. SubQ Heparin 5000 q12. 8. Decadron 4 q.6. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Ankylosing spondylitis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Sprain of thoracic,Fall from other slipping, tripping, or stumbling,Unspecified sleep apnea,Anemia, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled

Ankylosing spondylitis,Hyp kid NOS w cr kid V,Fx dorsal vertebra-close,Sprain thoracic region,Fall from slipping NEC,Sleep apnea NOS,Anemia NOS,DMII neuro nt st uncntrl

Admission Date: [**2115-6-29**] Discharge Date: [**2115-7-10**] Date of Birth: [**2057-1-10**] Sex: M Service: NSU HISTORY OF PRESENT ILLNESS: The patient is a 58-year-old gentleman, who was going to an outside hospital for preoperative testing for right cataract surgery when his left prosthetic leg slipped and he fell hitting his back. He developed back pain, which persisted. He denied weakness, numbness, or bowel or bladder changes. PHYSICAL EXAMINATION: On admission, his temperature was 97.8, heart rate 88, blood pressure 169/68, respiratory rate 14, and sats 96 percent. Patient was examined in the ICU. He was awake, alert, and oriented times three. Speech was fluent. Pupils are equal, round, and reactive to light. He had no nystagmus. Face was symmetric. Tongue was midline. Motor strength: He was [**6-5**] in all muscle groups in his upper and lower extremities. Sensation was intact to light touch throughout. His reflexes are 1 throughout. He has a left below the knee amputation. Lungs were clear to auscultation. Abdomen was obese, soft, nontender, nondistended, positive bowel sounds. His MRI shows disruption of the anterior longitudinal ligament from T8 to T9 with widening of the disk space. No fracture and positive epidural fat. PAST MEDICAL HISTORY: Fibrosarcoma of the upper back, which was resected in [**2089**]. Type 2 diabetes. Hypertension. Left below the knee amputation. Neuropathy. Right cataract. Cellulitis in the right leg in the past. MEDICATIONS ON ADMISSION: 1. Metoprolol 100 b.i.d. 2. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 q.d. 3. Metformin 500 b.i.d. 4. Glipizide 10 b.i.d. 5. Actos 15 q.d. 6. Lasix 40 b.i.d. 7. SubQ Heparin 5000 q12. 8. Decadron 4 q.6. HOSPITAL COURSE: The patient was admitted to the Neurosurgery service. He was evaluated for this T7 to T8. He does have a fracture of the T7-T8 disk in addition to ligamentous injury. He was admitted to the ICU for close neurologic observation. He remained neurologically intact. He was seen by Dr. [**Last Name (STitle) 1906**] for this fracture, and felt at the time he would most likely need surgery to stabilize the back. He was followed by Renal service for his chronic renal insufficiency, but no definitive treatment was initiated, but was just watching his BUN and creatinine. He had an echocardiogram on [**2115-7-2**] that showed an EF of 60 percent with left ventricular hypertrophy and mild A-V sclerosis. He was also seen by the Pulmonary service for his snoring and his sleep apnea for which he is receiving BiPAP. The patient was fitted for a TLSO brace and was out of bed with Physical Therapy. Patient was transferred to the regular floor on [**2115-7-4**] and was seen for a second opinion by Orthopedic Surgery, who recommended surgical stabilization of this fracture in his back. However, Dr. [**Last Name (STitle) 1327**] was also consulted and felt that this particular case, the risk of major of periop morbidity and mortality was extremely high about 75 percent and that surgery would require extensive plastic surgery intervention with flap closure due to his previous fibrosarcoma resection, and that the patient should try conservative treatment at this time using the TLSO brace and be followed closely with serial radiographs. Therefore, the patient was seen by Physical Therapy and Occupational Therapy, and found to require acute rehab. MEDICATIONS ON DISCHARGE: 1. Metoprolol 150 mg p.o. b.i.d. Hold for heart rate less than 60 and systolic blood pressure less than 100. 2. Senna two tablets p.o. b.i.d. 3. Colace 10 mg p.o./p.r. q.d. prn. 4. Pioglitazone 15 mg p.o. q.d. 5. Glipizide 10 mg p.o. b.i.d. 6. Insulin-sliding scale. 7. Hydralazine 50 mg p.o. q.6h. Hold for systolic blood pressure less than 120. 8. Furosemide 40 mg p.o. q.d. 9. Percocet 1-2 tablets p.o. q.4h prn. 10. Heparin 5000 units subQ q.8h. 11. Famotidine 20 mg p.o. q.24h. 12. Colace 100 mg p.o. b.i.d. DISCHARGE CONDITION: The patient's condition was stable. FOLLOW UP: The patient will follow up with Dr. [**Last Name (STitle) 1327**] in two weeks' time with repeat plain films of his thoracic spine. DR.[**Last Name (STitle) **],[**First Name3 (LF) 742**] 14-AAA Dictated By:[**Last Name (NamePattern1) 6583**] MEDQUIST36 D: [**2115-7-9**] 15:46:30 T: [**2115-7-9**] 16:13:52 Job#: [**Job Number 43009**] Name: [**Known lastname **], [**Known firstname 389**] Unit No: [**Numeric Identifier 7806**] Admission Date: [**2115-6-29**] Discharge Date: [**2115-7-12**] Date of Birth: [**2057-1-10**] Sex: M Service: NSU This is a discharge summary addendum for the dates of [**2115-7-10**] to [**2115-7-12**]: The patient continued to do well while under Neurosurgical care during the last three days of his admission. Repeat chemistry laboratories were sent on [**2115-7-11**] revealing an increase in his creatinine from 3.6 one week prior to 4.1. Due to this increase, the Renal team was reconsulted, and the patient was restarted on IV fluids normal saline at 100 for hydration. Renal's re-evaluation was that the patient had some mild prerenal azotemia on top of his chronic renal failure and agreed with our start of IV fluids. Additionally, they recommended at this time to hold the patient's Lasix, to discontinue the patient's hydralazine, and to decrease his metoprolol dose back to 100 b.i.d. as he had been maintaining stable blood pressures. For the patient's chronic anemia, the Renal team also recommended starting him on iron as well as epoietin. The patient continued to do well with good urine output and his Foley was D/C'd on [**7-11**]. On [**7-12**], a repeat check of his creatinine had shown a decrease to 3.8, which is well within the patient's baseline value for his chronic renal failure. He voided well after his Foley was removed, and chemistry values were stable on the morning of discharge with the exception of a potassium that was mildly elevated at 5.3, and to rechecked to be 4.6. The patient was without any further new complaints, and he was discharged back to rehab in stable condition. DISCHARGE DIAGNOSES: Ankylosing spondylosis with ligament disruption of T8-T9. T7-8 fracture. Insulin dependent-diabetes mellitus. Chronic renal failure. Left below the knee amputation. Hypertension. Obstructive-sleep apnea. DISCHARGE CONDITION: Stable. DISCHARGE STATUS: Rehab. DISCHARGE MEDICATIONS: 1. Tylenol 325 1-2 tablets p.o. q.4-6h. prn. 2. Colace 100 mg one capsule p.o. b.i.d. 3. Pepcid 20 mg one tablet p.o. b.i.d. 4. Heparin 5000 units subQ every eight hours. 5. Percocet 1-2 tablets p.o. q.4-6h prn breakthrough pain only. 6. Sliding scale insulin as directed. 7. Albuterol inhaler 1-2 puffs q.6h. prn. 8. Atrovent inhaler two puffs q.4-6h. prn. 9. Glipizide 10 mg p.o. b.i.d. 10. Pioglitazone 15 mg p.o. q.d. 11. Dulcolax 10 mg p.o. q.d. prn. 12. Senna 8.6 mg two tablets p.o. b.i.d. prn. 13. Metoprolol 100 mg p.o. b.i.d. 14. Epoietin alpha 10,000 units one injection a week. The patient received his first dose on [**Last Name (LF) 3032**], [**2115-7-12**]. 15. Iron 325 one tablet p.o. q.d. DISCHARGE INSTRUCTIONS: Diet: Renal/diabetic diet. Activity: Needs acute PT/OT. Patient should be out of bed with a TLSO brace on at all times. He must wear the TLSO brace when sitting up or when he is out of bed. He should renal status closely. He was instructed to call his physician or return to the Emergency Department if there is any fevers/chills, temperature greater than 101.5, redness/swelling/drainage from the surgical site, or if he was unable to eat or drink. FOLLOW UP: The patient will follow up on [**2115-7-23**] with neurosurgeon, Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **]. The patient was instructed to go to the Clinical Center [**Location (un) **] for x-rays at 1 p.m., and then he will see Dr. [**Last Name (STitle) **] at 2 p.m. at [**Hospital Unit Name 7807**] in the [**Hospital **] Medical Building. [**Name6 (MD) **] [**Name8 (MD) **], MD [**MD Number(2) 7808**] Dictated By:[**Last Name (NamePattern1) 7809**] MEDQUIST36 D: [**2115-7-12**] 12:14:45 T: [**2115-7-12**] 12:56:32 Job#: [**Job Number 7810**]

720,403,805,847,E885,780,285,250

{'Ankylosing spondylitis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Sprain of thoracic,Fall from other slipping, tripping, or stumbling,Unspecified sleep apnea,Anemia, unspecified,Diabetes with neurological manifestations, 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 a 58-year-old gentleman, who was going to an outside hospital for preoperative testing for right cataract surgery when his left prosthetic leg slipped and he fell hitting his back. He developed back pain, which persisted. He denied weakness, numbness, or bowel or bladder changes. MEDICAL HISTORY: Fibrosarcoma of the upper back, which was resected in [**2089**]. MEDICATION ON ADMISSION: 1. Metoprolol 100 b.i.d. 2. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 q.d. 3. Metformin 500 b.i.d. 4. Glipizide 10 b.i.d. 5. Actos 15 q.d. 6. Lasix 40 b.i.d. 7. SubQ Heparin 5000 q12. 8. Decadron 4 q.6. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Ankylosing spondylitis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Sprain of thoracic,Fall from other slipping, tripping, or stumbling,Unspecified sleep apnea,Anemia, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a [**Age over 90 **] year old female patient with a history of chronic obstructive pulmonary disease, coronary artery disease, hypertension and cerebrovascular accident who presents with shortness of breath and cough. The patient states that she has no idea why she was brought to the Emergency Department and denies any symptoms. She reports an occasional nonproductive cough that she has had "for years" and feels that she has been experiencing alternating chills and feeling hot. A progress note in the patient's chart from her [**Hospital3 **] facility indicates that the patient has had shortness of breath and cough for one day with chills but no fever. She has been recently evaluated as an outpatient for bradycardia. She was seen by her cardiologist, Dr. [**Last Name (STitle) 27521**] and had a Holter monitor on [**2106-4-2**], that showed first degree AV block with a rate that ranged between 35 to 53 beats per minute. MEDICAL HISTORY: Chronic obstructive pulmonary disease with asthmatic component. MEDICATION ON ADMISSION: 1. Levothyroxine 50 mcg p.o. once daily. 2. Combivent two puffs four times a day. 3. Flovent two puffs four times a day. 4. Protonix 40 mg once daily. 5. Lisinopril 5 mg p.o. once daily. 6. Norvasc 5 mg twice a day. 7. Lasix 40 mg once daily. 8. Senna one once daily. 9. Dulcolax 10 mg once daily p.r.n. 10. TUMS 500 mg twice a day. ALLERGIES: Penicillin, Erythromycin, Valium, Compazine, Demerol, Percodan. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives at [**Location (un) 5481**] in [**Hospital3 **] section. She has a 24 hour caregiver. The patient quit smoking fifty years ago but previously was a heavy smoker, though states that she never inhaled. The patient denies use of alcohol or drugs.

Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Iron deficiency anemia secondary to blood loss (chronic),Other specified cardiac dysrhythmias,First degree atrioventricular block,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Unspecified acquired hypothyroidism

Obs chr bronc w(ac) exac,Pneumonia, organism NOS,Chr blood loss anemia,Cardiac dysrhythmias NEC,Atriovent block-1st degr,Late effect CV dis NEC,Muscskel sympt limb NEC,Hypothyroidism NOS

Admission Date: [**2106-4-14**] Discharge Date: [**2106-4-21**] Service: CME HISTORY OF PRESENT ILLNESS: This is a [**Age over 90 **] year old female patient with a history of chronic obstructive pulmonary disease, coronary artery disease, hypertension and cerebrovascular accident who presents with shortness of breath and cough. The patient states that she has no idea why she was brought to the Emergency Department and denies any symptoms. She reports an occasional nonproductive cough that she has had "for years" and feels that she has been experiencing alternating chills and feeling hot. A progress note in the patient's chart from her [**Hospital3 **] facility indicates that the patient has had shortness of breath and cough for one day with chills but no fever. She has been recently evaluated as an outpatient for bradycardia. She was seen by her cardiologist, Dr. [**Last Name (STitle) 27521**] and had a Holter monitor on [**2106-4-2**], that showed first degree AV block with a rate that ranged between 35 to 53 beats per minute. In the Emergency Department, the patient was given nebulizer treatment, started on antibiotics for presumed chronic obstructive pulmonary disease exacerbation. She was noted to have lateral ST depressions and given Aspirin. She continues to deny chest pain, palpitations, shortness of breath, fevers, nausea, vomiting, abdominal pain, bright red blood per rectum, melena, dysuria, urinary frequency and urgency. PAST MEDICAL HISTORY: Chronic obstructive pulmonary disease with asthmatic component. Hypothyroidism. Gastroenteritis. Anxiety. Insomnia. Hypertension. Osteoporosis. History of cerebrovascular accident with residual right sided weakness. Scoliosis. Coronary artery disease. History of kidney mass. History of lower gastrointestinal bleed. Status post total abdominal hysterectomy, bilateral salpingo- oophorectomy. Left cataract. Bradycardia followed by outpatient cardiologist with a Holter monitor on [**2106-4-2**], with first degree AV block and a heart rate ranging between 35 to 53 beats per minute. ALLERGIES: Penicillin, Erythromycin, Valium, Compazine, Demerol, Percodan. MEDICATIONS ON ADMISSION: 1. Levothyroxine 50 mcg p.o. once daily. 2. Combivent two puffs four times a day. 3. Flovent two puffs four times a day. 4. Protonix 40 mg once daily. 5. Lisinopril 5 mg p.o. once daily. 6. Norvasc 5 mg twice a day. 7. Lasix 40 mg once daily. 8. Senna one once daily. 9. Dulcolax 10 mg once daily p.r.n. 10. TUMS 500 mg twice a day. SOCIAL HISTORY: The patient lives at [**Location (un) 5481**] in [**Hospital3 **] section. She has a 24 hour caregiver. The patient quit smoking fifty years ago but previously was a heavy smoker, though states that she never inhaled. The patient denies use of alcohol or drugs. PHYSICAL EXAMINATION: Temperature 98.1, blood pressure 144/38, heart rate 41, respiratory rate 20, oxygen saturation 94 percent in room air and 96 percent on three liters. In general, a well appearing elderly female in no acute distress. Skin is warm and dry with decreased skin turgor. Head, eyes, ears, nose and throat examination - The pupils are equal, round and reactive to light and accommodation. Extraocular movements are intact. Dry mucous membranes. The oropharynx is clear. Neck is supple, full range of motion, no jugular venous distension or lymphadenopathy. The heart was bradycardic with regular rhythm, no murmurs, rubs or gallops. Lungs - diffuse expiratory wheezes with bibasilar rales, left over right. The abdomen revealed normoactive bowel sounds, soft, nontender, nondistended. Rectal is guaiac positive per Emergency Department. Extremities - no cyanosis or clubbing, one plus bilateral lower extremity edema with right worse than left. Neurologically, the patient is awake, alert and oriented times three. LABORATORY DATA: White blood cell count was 8.5 (80 percent neutrophils, 13 percent lymphocytes), hematocrit 27.4, platelet count 277,000. Sodium 133, potassium 4.8, chloride 94, bicarbonate 24, blood urea nitrogen 39, creatinine 2.0, glucose 111. CK 152, CK MB 3.0, troponin 0.04. INR 1.1. Chest x-ray showed equivocal retrocardiac opacity. Electrocardiogram showed sinus bradycardia at 40 beats per minute. First degree AV block with PR interval 220, left axis deviation, right bundle branch block with a left anterior fascicular block, 0.[**Street Address(2) 11725**] depressions in V4 through V6. HOSPITAL COURSE: Shortness of breath - Though the patient denied shortness of breath on admission, a progress note from [**Location (un) 5481**] nursing facility suggested that the patient had been having shortness of breath and cough for approximately one day with difficulty ambulating, needing to travel in a wheelchair. The patient was afebrile on admission with a normal white blood cell count but had significant wheezing and rales on physical examination with a possible left lower lobe opacity seen on chest x-ray. The etiology of the patient's shortness of breath was considered a likely chronic obstructive pulmonary disease exacerbation and the patient was started on Albuterol and Atrovent nebulizers. The patient was also started on Doxycycline given the concern for pneumonia on chest x-ray. She was also continued on steroids given evidence of severe airway obstruction. The patient's shortness of breath was also considered possibly related to a coronary event and she was admitted for rule out myocardial infarction. The patient's enzymes were cycled and were negative. The patient's electrocardiogram performed on hospital day number two was concerning for 2:1 heart block and the cardiology consult service was contact[**Name (NI) **] for evaluation. The patient was taken to the Coronary Care Unit late on hospital day number two and received a temporary wire. The following day the patient received a permanent dual chamber rate responsive pacemaker. The patient was transferred back to the general medicine service where she continued to exhibit signs of chronic obstructive pulmonary disease exacerbation and nebulizers, steroids and antibiotics were continued. The patient's respiratory status improved throughout the remainder of her hospitalization and oxygen was eventually weaned. Once the patient was transferred out of the Coronary Care Unit, she appeared to have an element of heart failure in addition to her chronic obstructive pulmonary disease. She was given 20 mg of intravenous Lasix with impressive urine output and improvement in her overall fluid status. The patient was eventually restarted on her outpatient dose of Lasix once her renal function improved to baseline and remained hemodynamically stable throughout the remainder of her hospitalization. Heart block - As noted previously, the patient's electrocardiogram was significant for a 2:1 heart block and cardiology consult service was contact[**Name (NI) **] for evaluation. The patient received a temporary pacing wire on the evening of hospital day number two and on hospital day number three received a dual chamber pacemaker. Renal - The patient was admitted with a creatinine of 1.8, considered likely secondary to hypovolemia. Her calculated fractional excretion of sodium was 0.13 percent suggesting a prerenal cause. The patient's creatinine improved to 1.1 with hydration. Once the patient's creatinine had improved to baseline, her Lasix and ace inhibitor were restarted and the patient's creatinine was noted to be stable. Gastrointestinal - The patient was admitted with a history of gastrointestinal bleed with guaiac positive stools on admission. Her hematocrit was noted to trend down after transfusion of one unit of packed red blood cells on admission. Given guaiac positive stools and her history of gastrointestinal bleed in addition to use of steroids for chronic obstructive pulmonary disease exacerbation, the gastroenterology consult service was contact[**Name (NI) **]. The results of that consultation and potential esophagogastroduodenoscopy are pending at the time of dictation. Hypertension - The patient had moderate control of her blood pressure throughout her admission. Her calcium channel blocker and ace inhibitor were continued. Hematology - As noted previously, the patient's hematocrit was noted to drop after transfusion with one unit of packed red blood cells on admission. Given guaiac positive stools and the patient's history of gastrointestinal bleed, gastroenterology consult service was contact[**Name (NI) **] for possible esophagogastroduodenoscopy and/or colonoscopy. The results of this consultation are pending at the time of dictation. The remainder of the [**Hospital 228**] hospital course, discharge diagnoses, medications and follow-up will be dictated at the time of discharge. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(2) 27522**] Dictated By:[**Last Name (NamePattern1) 12325**] MEDQUIST36 D: [**2106-4-19**] 11:24:17 T: [**2106-4-19**] 14:58:16 Job#: [**Job Number 27523**]

491,486,280,427,426,438,729,244

{'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Iron deficiency anemia secondary to blood loss (chronic),Other specified cardiac dysrhythmias,First degree atrioventricular block,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Unspecified acquired hypothyroidism'}

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 a [**Age over 90 **] year old female patient with a history of chronic obstructive pulmonary disease, coronary artery disease, hypertension and cerebrovascular accident who presents with shortness of breath and cough. The patient states that she has no idea why she was brought to the Emergency Department and denies any symptoms. She reports an occasional nonproductive cough that she has had "for years" and feels that she has been experiencing alternating chills and feeling hot. A progress note in the patient's chart from her [**Hospital3 **] facility indicates that the patient has had shortness of breath and cough for one day with chills but no fever. She has been recently evaluated as an outpatient for bradycardia. She was seen by her cardiologist, Dr. [**Last Name (STitle) 27521**] and had a Holter monitor on [**2106-4-2**], that showed first degree AV block with a rate that ranged between 35 to 53 beats per minute. MEDICAL HISTORY: Chronic obstructive pulmonary disease with asthmatic component. MEDICATION ON ADMISSION: 1. Levothyroxine 50 mcg p.o. once daily. 2. Combivent two puffs four times a day. 3. Flovent two puffs four times a day. 4. Protonix 40 mg once daily. 5. Lisinopril 5 mg p.o. once daily. 6. Norvasc 5 mg twice a day. 7. Lasix 40 mg once daily. 8. Senna one once daily. 9. Dulcolax 10 mg once daily p.r.n. 10. TUMS 500 mg twice a day. ALLERGIES: Penicillin, Erythromycin, Valium, Compazine, Demerol, Percodan. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives at [**Location (un) 5481**] in [**Hospital3 **] section. She has a 24 hour caregiver. The patient quit smoking fifty years ago but previously was a heavy smoker, though states that she never inhaled. The patient denies use of alcohol or drugs. ### Response: {'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Iron deficiency anemia secondary to blood loss (chronic),Other specified cardiac dysrhythmias,First degree atrioventricular block,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Unspecified acquired hypothyroidism'}

CHIEF COMPLAINT: s/p rollover MVC with prolonged extrication PRESENT ILLNESS: Mr. [**Known lastname 84125**] presented to the [**Hospital1 18**] on [**2159-2-9**] via [**Location (un) **] transfer after being a driver of a rollover MVC, car vs. tree with prolonged extrication. Patient complained of left arm and leg pain MEDICAL HISTORY: denies medical problems hx substance abuse MEDICATION ON ADMISSION: denies ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon admission FAMILY HISTORY: n/a SOCIAL HISTORY: polysubstance abuse (tob/opiates/amphetamines) Lives with girlfriend Does not work Lives on [**Location (un) 470**] no elevator

Closed fracture of shaft of fibula with tibia,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Contusion of lung without mention of open wound into thorax,Pulmonary collapse,Acute posthemorrhagic anemia,Closed fracture of shaft of ulna (alone),Closed fracture of sternum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Open wound of finger(s), without mention of complication,Hypoxemia,Surgical or other procedure not carried out because of contraindication,Obstructive sleep apnea (adult)(pediatric),Tear of lateral cartilage or meniscus of knee, current

Fx shaft fib w tib-clos,Pneumococcal pneumonia,Lung contusion-closed,Pulmonary collapse,Ac posthemorrhag anemia,Fx ulna shaft-closed,Fracture of sternum-clos,Loss control mv acc-driv,Open wound of finger,Hypoxemia,No proc/contraindication,Obstructive sleep apnea,Tear lat menisc knee-cur

Admission Date: [**2159-2-9**] Discharge Date: [**2159-2-17**] Date of Birth: [**2135-1-19**] Sex: M Service: ORTHOPAEDICS Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 8587**] Chief Complaint: s/p rollover MVC with prolonged extrication Major Surgical or Invasive Procedure: [**2159-2-11**]: I&D Right thumb, ORIF left tibia, and ORIF left ulna History of Present Illness: Mr. [**Known lastname 84125**] presented to the [**Hospital1 18**] on [**2159-2-9**] via [**Location (un) **] transfer after being a driver of a rollover MVC, car vs. tree with prolonged extrication. Patient complained of left arm and leg pain Past Medical History: denies medical problems hx substance abuse Social History: polysubstance abuse (tob/opiates/amphetamines) Lives with girlfriend Does not work Lives on [**Location (un) 470**] no elevator Family History: n/a Physical Exam: Upon admission Alert Cardiac: Regular rate Abdomen: Soft non-tender Extremities: C-collar in place LUE: forearm, abrasion/swelling, +TTP skin intact, SILT, 2+ radial pulse RUE: thumb, laceration with subcutaneous tissue exposed LLE: Knee and calf, +swelling/TTP, +pulses, skin intact, SILT, [**6-6**] AT/[**Last Name (un) 938**]/GS Pertinent Results: [**2159-2-9**] 09:49PM GLUCOSE-122* LACTATE-1.5 [**2159-2-9**] 09:49PM freeCa-1.10* [**2159-2-9**] 05:35AM URINE bnzodzpn-POS barbitrt-NEG opiates-POS cocaine-NEG amphetmn-POS mthdone-NEG [**2159-2-9**] 05:35AM PT-13.4 PTT-24.0 INR(PT)-1.1 [**2159-2-9**] 05:35AM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.028 [**2159-2-9**] 05:35AM URINE BLOOD-LG NITRITE-NEG PROTEIN-25 GLUCOSE-NEG KETONE-15 BILIRUBIN-SM UROBILNGN-NEG PH-6.5 LEUK-NEG [**2159-2-9**] 05:35AM URINE RBC-[**4-6**]* WBC-0-2 BACTERIA-FEW YEAST-NONE EPI-0 [**2159-2-9**] 05:28AM GLUCOSE-181* LACTATE-3.5* NA+-140 K+-3.5 CL--107 TCO2-22 [**2159-2-9**] 05:20AM UREA N-18 CREAT-0.9 [**2159-2-9**] 05:20AM LIPASE-50 [**2159-2-9**] 05:20AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2159-2-9**] 05:20AM WBC-19.3* RBC-4.75 HGB-13.7* HCT-38.3* MCV-81* MCH-28.7 MCHC-35.7* RDW-13.8 [**2159-2-9**] 05:20AM PLT COUNT-249 CT C spine: no fracture or dislocation. normal spine. CT head: no acute abnormality CT C/A/P 1. Minimally displaced manubrial fracture. 2. Multiple pulmonary contusions, most prominent in the right middle lobe. In the right lower lobe, at the level of T6, is a cyst which could represent a lung laceration. 3. Stranding of the fat on the left lateral abdominal wall, incompletely visualized. Recommend clinical evaluation for possible injury to the soft tissues at the site. 4. No evidence for traumatic injury to the aorta, or solid intra- abdominal organs. L Tib/Fib: 1. Comminuted fracture at the lateral aspect of the lateral plateau. 2. Non-displaced fracture through the lateral tibial plateau. 3. Lipohemarthrosis within the knee joint. 4. Possible tiny medial tibial plateau fracture. L forearm: There is fracture of the ulnar shaft. The fracture fragments are transfixed in good anatomic alignment by a slotted plate and six screws. Cortical margins appear otherwise intact. Brief Hospital Course: Mr. [**Known lastname 84125**] presented to the [**Hospital1 18**] on [**2159-2-9**] via [**Hospital **] transfer from the scene. He was evaluated by the orthopaedic and trauma surgery services and found to have Right sided anterior pulmonary contusions, a left proximal tibia shaft fracture with lateral tibial plateau fracture, a left fibula shaft fracture, a left ulnar shaft fracture, and a right thumb palmar laceration which was superficial. He was admitted to the trauma service initially, consented, and prepped for surgery. Later that day he was taken to the operating room. When he was intubated he had immediate desaturation, the ETT was exchanged over a bougie and saturation improved. Chest x-ray revealed a RUL collapse. Surgery was canceled and he was transferred to the T/SICU for further monitoring. On [**2159-2-11**] he was taken to the operating room and underwent an ORIF of his left tibia, ulnar, and an I&D of his right thumb laceration. He tolerated the procedure well and was transferred back to the T/SICU. He was transfused with 2 units of packed red blood cells due to acute blood loss anemia with improvement but required 2 units again on [**2159-2-14**]. He had sputum samples taken in the ICU which revealed strep pneumo so he was started on ceftriaxone. This was changed to levofloxacin for discharge. His pulmonary symptoms had improved at the time of discharge and he was afebrile after [**2-15**]. On the floor he was seen by physical and occupational therapy to improve his strength, mobility, and function. He was also seen by chronic pain service to help with his pain control. He was discharged in stable condition. Medications on Admission: denies Discharge Medications: 1. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) 40mg syringe Subcutaneous DAILY (Daily) for 4 weeks. Disp:*28 syringe* Refills:*0* 2. Wheelchair with elevating and removalbe leg rests Disp # 1 Diagnosis: Left Tibial Fracture 3. 3 & 1 Commode Disp # 1 Diagnosis: Left tibial fracture 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 5. Oxycodone 5 mg Tablet Sig: 2-3 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*120 Tablet(s)* Refills:*0* 6. Baclofen 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 7. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO every six (6) hours. 9. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 10. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day for 7 days. Disp:*7 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: s/p rollover MVC Left tibia fracture Left ulna fracture Right thumb laceration Acute blood loss anemia Discharge Condition: Mental Status:Clear and coherent Level of Consciousness:Alert and interactive Activity Status:Ambulatory - requires assistance or aid (walker or cane) Discharge Instructions: Continue to be non-weight bearing on your left leg and left arm, you may use your platform crutch to ambulate Please take your lovenox injections as instructed for a total of 4 weeks after surgery Please take all your medication as prescribed If you have any chest pain, shortness of breath, increased redness around the wound, drainage from the wound, or swelling of the leg or arm, or if you have a temperature greater than 101.5 please call the office or come to the emergency department You have been prescribed a narcotic pain medication. Please take only as directed and do not drive or operate any machinery while taking this medication. There is a 72 hour (Monday through Friday, 9am to 4pm) response time for prescription refil requests. There will be no prescription refils on Saturdays, Sundays, or holidays. Please plan accordingly. Physical Therapy: TDWB on left leg NWB left arm - may use forearm crutch to ambulate Treatments Frequency: Wound care: daily dressing changes to leg wound Wound eval left arm and leg Followup Instructions: Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP in orthopaedics in 2 weeks, please call [**Telephone/Fax (1) 1228**] to schedule that appointment. Completed by:[**2159-2-17**]

823,481,861,518,285,813,807,E816,883,799,V641,327,836

{'Closed fracture of shaft of fibula with tibia,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Contusion of lung without mention of open wound into thorax,Pulmonary collapse,Acute posthemorrhagic anemia,Closed fracture of shaft of ulna (alone),Closed fracture of sternum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Open wound of finger(s), without mention of complication,Hypoxemia,Surgical or other procedure not carried out because of contraindication,Obstructive sleep apnea (adult)(pediatric),Tear of lateral cartilage or meniscus of knee, current'}

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: s/p rollover MVC with prolonged extrication PRESENT ILLNESS: Mr. [**Known lastname 84125**] presented to the [**Hospital1 18**] on [**2159-2-9**] via [**Location (un) **] transfer after being a driver of a rollover MVC, car vs. tree with prolonged extrication. Patient complained of left arm and leg pain MEDICAL HISTORY: denies medical problems hx substance abuse MEDICATION ON ADMISSION: denies ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Upon admission FAMILY HISTORY: n/a SOCIAL HISTORY: polysubstance abuse (tob/opiates/amphetamines) Lives with girlfriend Does not work Lives on [**Location (un) 470**] no elevator ### Response: {'Closed fracture of shaft of fibula with tibia,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Contusion of lung without mention of open wound into thorax,Pulmonary collapse,Acute posthemorrhagic anemia,Closed fracture of shaft of ulna (alone),Closed fracture of sternum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Open wound of finger(s), without mention of complication,Hypoxemia,Surgical or other procedure not carried out because of contraindication,Obstructive sleep apnea (adult)(pediatric),Tear of lateral cartilage or meniscus of knee, current'}

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: Patient is a 62 year old female with recent admission and drainage of hemorrhagic pericardial effusion with supratherapeutic INR, end-stage renal disease on dialysis, diabetes, and diastolic heart failure who presents from dialysis after developing acute onset of palpitations. She was in her usual state of health and went to HD today. After ~2 hours into the session and ~2.5kg removed, she noted the sudden onset of palpitations in her chest. These were not associated with shortness of breath or chest pain. She stated that she has felt something stuck in her throat since yesterday when she ate grapes. She denies abdominal pain, rash, fevers/chills/sweats or dysuria. . In the ED, her initial vital signs were 98.4 150 139/55 18 98%2L. She received 1 L of NS and 3 doses of 5 mg IV metoprolol with her blood pressure dropped to 100s systolic. She had a bedside TTE that showed no significant pericardial effusion, and preserved biventricular function. A CTA chest was done that was negative for pneumonia or PE but showed only small to moderate left-sided pleural effusions. MEDICAL HISTORY: PAST MEDICAL HISTORY: - hemorrhagic pericardial effusion - Bilateral internal jugular thromboses, restarted on coumadin [**8-24**] - h/o bilateral lower extremity DVT's - ESRD on HD T, Th, Sat - IDDM - Diastolic heart failure - Pulmonary hypertension - Hypercholesterolemia - OSA, noncompliant with CPAP as outpatient - OA - h/o C. Diff - GERD - Depression - Morbid obesity - Fibroid uterus; vaginal bleeding - h/o Osteomyelitis at the T9 Vertebrae [**5-24**]; tx with Vanc - h/o Multiple line infections **[**2135-12-17**]: Providencia, treated with 4 wk course of aztreonam **[**2135-4-17**]: Staph coag positive, sensitive to both vancomycin and gentamicin **[**2136-5-17**]: Staph bacteremia tx with vanc x 6 weeks **[**2136-8-17**]: Proteius mirabilis and MSSA, treated with ceftaz and vanc . PAST SURGICAL HISTORY: - L forearm radial-basilic AV graft, s/p infection, thrombosis and abandonment ([**12-21**]) - Multiple lines in L upper arm with AV graft - 1/07 L femoral PermaCath placed - L upper arm thrombectomy, revision, of LUE AV graft ([**3-23**]) - [**4-23**] Excision of left upper arm infected AV graft; associated MRSA bacteremia treated with 6 weeks vancomycin. - Right upper extremity AV fistula creation [**10-23**] s/p revision - [**2135-12-14**] Right AV fistula repair, Right IJ PermaCath rewiring and IVC filter removed MEDICATION ON ADMISSION: Warfarin 2 mg daily Paroxetine HCl 20 mg daily Ascorbic Acid 500 mg [**Hospital1 **] Docusate Sodium 100 mg [**Hospital1 **] Albuterol Sulfate 2.5 mg /3 mL (0.083 %) q6hrs: Midodrine 10 mg TID Folic Acid 1 mg DAILY Aspirin 81 mg daily Senna 8.6 mg [**Hospital1 **]:prn Bisacodyl 5 mg DAILY Pantoprazole 40 mg PO Q24H Metoclopramide 5 mg q6hours:prn Lantus ALLERGIES: Penicillins / Ceftriaxone PHYSICAL EXAM: Gen: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Unable to assess venous distension due to body habitus. CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. FAMILY HISTORY: Not obtained. SOCIAL HISTORY: Patient denies a tobacco, alcohol or illicit drug use. She lives

Other specified cardiac dysrhythmias,End stage renal disease,Cellulitis and abscess of trunk,Other abscess of vulva,Diastolic heart failure, unspecified,Hyposmolality and/or hyponatremia,Other and unspecified coagulation defects,Primary pulmonary hypertension,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Diabetes with renal manifestations, type I [juvenile type], uncontrolled,Pure hypercholesterolemia,Anemia, unspecified,Other specified disorders of arteries and arterioles,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants

Cardiac dysrhythmias NEC,End stage renal disease,Cellulitis of trunk,Abscess of vulva NEC,Diastolc hrt failure NOS,Hyposmolality,Coagulat defect NEC/NOS,Prim pulm hypertension,MRSA elsewhere/NOS,DMI renal uncntrld,Pure hypercholesterolem,Anemia NOS,Arterial disease NEC,Hx-ven thrombosis/embols,Long-term use anticoagul

Admission Date: [**2136-10-4**] Discharge Date: [**2136-10-23**] Date of Birth: [**2074-2-1**] Sex: F Service: MEDICINE Allergies: Penicillins / Ceftriaxone Attending:[**First Name3 (LF) 1257**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: Intubation and bronchoscopy History of Present Illness: Patient is a 62 year old female with recent admission and drainage of hemorrhagic pericardial effusion with supratherapeutic INR, end-stage renal disease on dialysis, diabetes, and diastolic heart failure who presents from dialysis after developing acute onset of palpitations. She was in her usual state of health and went to HD today. After ~2 hours into the session and ~2.5kg removed, she noted the sudden onset of palpitations in her chest. These were not associated with shortness of breath or chest pain. She stated that she has felt something stuck in her throat since yesterday when she ate grapes. She denies abdominal pain, rash, fevers/chills/sweats or dysuria. . In the ED, her initial vital signs were 98.4 150 139/55 18 98%2L. She received 1 L of NS and 3 doses of 5 mg IV metoprolol with her blood pressure dropped to 100s systolic. She had a bedside TTE that showed no significant pericardial effusion, and preserved biventricular function. A CTA chest was done that was negative for pneumonia or PE but showed only small to moderate left-sided pleural effusions. Past Medical History: PAST MEDICAL HISTORY: - hemorrhagic pericardial effusion - Bilateral internal jugular thromboses, restarted on coumadin [**8-24**] - h/o bilateral lower extremity DVT's - ESRD on HD T, Th, Sat - IDDM - Diastolic heart failure - Pulmonary hypertension - Hypercholesterolemia - OSA, noncompliant with CPAP as outpatient - OA - h/o C. Diff - GERD - Depression - Morbid obesity - Fibroid uterus; vaginal bleeding - h/o Osteomyelitis at the T9 Vertebrae [**5-24**]; tx with Vanc - h/o Multiple line infections **[**2135-12-17**]: Providencia, treated with 4 wk course of aztreonam **[**2135-4-17**]: Staph coag positive, sensitive to both vancomycin and gentamicin **[**2136-5-17**]: Staph bacteremia tx with vanc x 6 weeks **[**2136-8-17**]: Proteius mirabilis and MSSA, treated with ceftaz and vanc . PAST SURGICAL HISTORY: - L forearm radial-basilic AV graft, s/p infection, thrombosis and abandonment ([**12-21**]) - Multiple lines in L upper arm with AV graft - 1/07 L femoral PermaCath placed - L upper arm thrombectomy, revision, of LUE AV graft ([**3-23**]) - [**4-23**] Excision of left upper arm infected AV graft; associated MRSA bacteremia treated with 6 weeks vancomycin. - Right upper extremity AV fistula creation [**10-23**] s/p revision - [**2135-12-14**] Right AV fistula repair, Right IJ PermaCath rewiring and IVC filter removed Social History: Patient denies a tobacco, alcohol or illicit drug use. She lives in a nursing home (?[**Hospital3 2558**]). She is separated from her husband. She has 5 children in [**Location (un) 86**] [**Doctor Last Name **] area. Family History: Not obtained. Physical Exam: Gen: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Unable to assess venous distension due to body habitus. CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. Distant heart sounds due to body habitus. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. Crackles bilateral bases. No wheezes or rhonchi. Abd: Round, soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Ext: No c/c/e. Skin: No stasis dermatitis, ulcers, scars. Pertinent Results: Admission Labs: Trop-T: 0.05 . Na 142 Cl 102 BUN 30 Gluc 150 AGap=13 K 4.3 CO2 27 Cr 4.2 . CK: 12 MB: Notdone Ca: 9.5 P: 4.9 . WBC 5.8 Hb 11.7 Hct 39.2 Plt 468 MCV 103 N:76.3 L:16.2 M:3.8 E:3.1 Bas:0.5 . PT: 21.3 PTT: 30.3 INR: 2.0 . Microbiology: [**2136-10-12**] Abscess swab: MRSA . [**2136-10-4**] EKG: narrow complex tachycardia @ 150. appears sinus mechanism. shortened PR interval compared to priors. no Q waves. old diffuse TW flattening. Imaging: [**2136-10-4**] CXR - Left retrocardiac patchy opacity, which could represent atelectasis but superimposed infection cannot be excluded. [**2136-10-4**] CTA chest: 1. No large, central pulmonary embolus seen. 2. Small-to-moderate left pleural effusion, with related compressive atelectasis. 3. Mediastinal lymph nodes, measuring up to 13 mm in short axis. 4. Endplate changes at T9-10 suggestive of prior infection, corresponding to findings on prior MR [**Name13 (STitle) 23840**] of [**2136-6-12**]. . [**2136-10-7**] Bilateral Femoral Vein US: Bilateral lower extremity DVTs (left greater than right), likely chronic given some re-canalization. Common femoral veins are patent bilaterally. . [**2136-10-7**] Femoral Vascular US: 1. Very small, 10 x 6 mm probable pseudoaneurysm in the right common femoral artery, but with no clear connection to the venous system. 2. High velocities within the right common femoral vein suggesting abnormal communication from the arterial system either via fistula not seen, or small malformation (also not definitively seen). . [**2136-10-9**] CTA Femoral vasculature: 1. Imaging findings are more compatible with diagnosis of arteriovenous malformation rather than arteriovenous fistula. But if patient has had prior procedure in the area, both diagnosis should be considered. 2. Uterine fibroids. Brief Hospital Course: # Superventricular Tachycardia: This was thought to be from ectopic atrial focus, although other causes of SVT remain on the differential. Initially attempted to control tachycardia with esmolol drip without effect. Tachycardia rapidly resolved following a dose of Adenosine 6mg. EP consult was obtained to consider ablation of ectopic atrial focus. Pt agreed to ablation. Coumadin was held in preparation for the procedure. Once INR fell below 2.0 pt was started on heparin gtt. Because of history of manipulation and HD cath placement, the evaluation for her procedure included a femoral vascular ultrasound. The decision was made at this time not to proceed with the procedure and to medically manage her tachycardia. She was started on metoprolol 12.5 [**Hospital1 **]. Pt did not experience any additional episodes of tachycardia after the initial episode in the ICU that was responsive to adenosine. She will follow up with [**Hospital **] clinic. #. R femoral AV malformation/fistula: Ultrasound showed possibility of right femoral artery pseudoaneurysm and distal bilateral femoral vein DVTs which appeared to be chronic. Vascular Surgery was consulted to determine safety of using R femoral vein for the procedure. They recommended CTA of femoral vaculature. This did not show a pseudoaneurysm rather a possible AV fistula or AVM. Pt will follow up with vascular clinic. # Coagulopathy: Unlikely to be a true coagulation disorder. History of bilateral DVTs (also seen on current US) and bilateral IJ clots are more likely attributed to multiple manipulations and foreign bodies related to her dialysis. Upon reviewing old records she was not on Coumadin from [**2136-5-17**] until discovery of IJ occlusion in [**2136-8-17**]. Pt's home coumadin regimen was held for the potential of having the ablation performed. She was started on a heparin drip that was continued until coumadin was restarted and INR returned to therapeutic levels. Pt was not increasing to therapeutic level on 2mg (home regimen), increased dose after 5days to 5mg, and also because pt was started on Rifampin. Pt was therapeutic on discharge, and was d/c on 9mg of coumadin QD. Pt needs close follow up on INR, especially with recent change in bactrim dose. # MRSA Abscesses: On presentation pt had a single self draining abscess on her back. Throughout her hospitalization she developed several other large abscesses on her back. General surgery was consulted and a single large abscess in the central thoracic region was I&D'd. Culture of abscess revealed MRSA. Pt was started on Vancomycin per HD protocol. Levels were monitored daily and adjusted accordingly. Sensitivites came back and pt was switched to Bactrim DS 2 tabs QD and Rifampin 300mg. However the abscesses did not resolve, and it was thought that the pt may have been underdosed. During this time pt developed another smaller abscess at the L upper back. On day of discharge spoke to pharmacy about this issue who agreed and said her correct dose is 6mg/kg (based on trimethoprim) which would put her at Bactrim DS 4 tabs QHD - to take 2 tabs immediatly afterward and the remaining 2 tabs 6hrs later for less gastric irritation. Pt should be kept on this indefinately, since being Diabetic she is at risk for recurrent abscesses. This can be reevaluated in the future. #. Gyn: Pt noticed a small nodule in her vagina - not causing itching or pain. Gyn was consulted and it was determined to be a sebacous cyst. Pt also had a vaginal discharge which was due to Bacterial Vaginosis. They did not recommend treating this since she was asymptomatic. Pt also was found to on [**1-24**] to have 10mm thickening of the endometrium. Pt denied current bleeding, and denied bleeding for 5 years. Pt is scheduled for a pelvic US on [**11-21**] as outpt, and will have follow up with this on [**11-22**] with Gyn. #. Asymtomatic pyuria- Pt has been anuric, but had a sample of urine sent for culture on [**10-21**] by cath and was found to have 100,000 of G(-)rods. Pt was symptomatic at the time, but currently denied any symptoms ([**10-23**]) and denied any suprapubic tenderness. The bacteria is likely due to colonization, and decided not treat. # Hx of hemorrhagic pericarditis: TTE was performed last on [**10-4**], which showed trivial pericardial effusion. No futher evaluation was pursued during this admission. The cultures of periciardial fluid returned negative. # ESRD on HD: While inpatient she was continued on her outpatient HD regimen (T, Th, Sat) and renal diet. #. Diabetes type 2: Glucose was well controlled while inpatient. Pt was continued on home regimen of Glargine 10 Units Subcutaneous at bedtime and Humalog sliding scale. Continue ASA daily and Reglan prn. . # History of orthostatic hypotension: Continued Midodrine 10 mg TID. No episodes of orthostatis during this current admission. Medications on Admission: Warfarin 2 mg daily Paroxetine HCl 20 mg daily Ascorbic Acid 500 mg [**Hospital1 **] Docusate Sodium 100 mg [**Hospital1 **] Albuterol Sulfate 2.5 mg /3 mL (0.083 %) q6hrs: Midodrine 10 mg TID Folic Acid 1 mg DAILY Aspirin 81 mg daily Senna 8.6 mg [**Hospital1 **]:prn Bisacodyl 5 mg DAILY Pantoprazole 40 mg PO Q24H Metoclopramide 5 mg q6hours:prn Lantus Discharge Medications: 1. Paroxetine HCl 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Midodrine 5 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QID (4 times a day) as needed for nausea. 9. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 10. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 11. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 12. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) as needed for itching. 13. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical TID (3 times a day) as needed. 14. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q12H (every 12 hours) as needed. 15. Sevelamer HCl 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 16. Insulin Please continue your home glucose monitoring and insulin regimen. 17. Bactrim DS 160-800 mg Tablet Sig: Four (4) Tablet PO QHD: Dose after HD on dialysis days; take 2 tabs immediately after HD, and take the other 2 tabs 6 hours later that day. Disp:*48 Tablet(s)* Refills:*3* 18. Mupirocin Calcium 2 % Ointment Sig: One (1) Appl Nasal [**Hospital1 **] (2 times a day) for 3 days. Disp:*qs 6* Refills:*0* 19. Chlorhexidine Gluconate 2 % Liquid Sig: One (1) to infected areas Topical daily () as needed for MRSA abscesses: apply to skin daily. Disp:*qs for 1 month supply* Refills:*3* 20. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 21. Warfarin 4 mg Tablet Sig: One (1) Tablet PO once a day: (take total of 9mg QD and titrate to INR [**2-19**]). Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: Atrial tachycardia Diabetes Mellitus End Stage Renal Disease Deep Venous Thrombuses Right Femoral artery AVM vs AVF Discharge Condition: Good; vital signs are stable; pt is tolerating po diet and medication, she does not require supplemental oxygen Discharge Instructions: You were admitted to the hospital for fast heart rate and palpitations. You were evaluated by the cardiology team. Because of your poor venous access the decision was made not to treat your heart rate with a procedure, and to conservatively treat your heart rate with medications. You tolerated the medication well and your increased heart rate did not return during your hospitalization. . During your hospitalization you developed several abscesses on your back. The surgical team was consulted and a single abscess was surgically drained. You were started on antibiotics. You should follow up with your primary care physician to monitor the resolution of the abscesses and the healing of the incision. . The following changes were made to your medications: 1) Added metoprolol 12.5 mg by mouth twice a day. 2) Added Bactrim DS 2 tabs immediately after HD, and then 2 more tablets 6 hours later, indefinitely 3) Mupirocin Calcium 2 % Ointment, apply to nose twice a day for 3 more days 4) Chlorhexidine Gluconate 2 % liquid cream, apply topically to skin daily . Please continue taking all other medications as previously directed. . Please notify your physician or return to the hospital if you experience chest pain, palpitations, shortness or breath, fever, chills or any other symptoms that are concerning to you. Followup Instructions: Follow up with Ob/Gyn, Dr. [**First Name4 (NamePattern1) 7306**] [**Last Name (NamePattern1) **] on [**2136-11-22**] at 9am [**Location (un) **] Clinical building [**Hospital Ward Name **] center [**Telephone/Fax (1) 2664**] Please follow up with vascular surgery in clinic on: Wednesday [**10-24**] at 12:15pm, Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] [**Last Name (un) 2577**] Building [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Hospital Unit Name **] Please follow up with [**Hospital **] clinic for your Atrial Tachycardia Friday 0ct 24th 1:40pm with Dr. [**Last Name (STitle) 23841**] ([**Telephone/Fax (1) 62**]) Please follow up with your primary care provider within the next two weeks. Completed by:[**2136-10-23**]

427,585,682,616,428,276,286,416,041,250,272,285,447,V125,V586

{'Other specified cardiac dysrhythmias,End stage renal disease,Cellulitis and abscess of trunk,Other abscess of vulva,Diastolic heart failure, unspecified,Hyposmolality and/or hyponatremia,Other and unspecified coagulation defects,Primary pulmonary hypertension,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Diabetes with renal manifestations, type I [juvenile type], uncontrolled,Pure hypercholesterolemia,Anemia, unspecified,Other specified disorders of arteries and arterioles,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}

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: Shortness of breath PRESENT ILLNESS: Patient is a 62 year old female with recent admission and drainage of hemorrhagic pericardial effusion with supratherapeutic INR, end-stage renal disease on dialysis, diabetes, and diastolic heart failure who presents from dialysis after developing acute onset of palpitations. She was in her usual state of health and went to HD today. After ~2 hours into the session and ~2.5kg removed, she noted the sudden onset of palpitations in her chest. These were not associated with shortness of breath or chest pain. She stated that she has felt something stuck in her throat since yesterday when she ate grapes. She denies abdominal pain, rash, fevers/chills/sweats or dysuria. . In the ED, her initial vital signs were 98.4 150 139/55 18 98%2L. She received 1 L of NS and 3 doses of 5 mg IV metoprolol with her blood pressure dropped to 100s systolic. She had a bedside TTE that showed no significant pericardial effusion, and preserved biventricular function. A CTA chest was done that was negative for pneumonia or PE but showed only small to moderate left-sided pleural effusions. MEDICAL HISTORY: PAST MEDICAL HISTORY: - hemorrhagic pericardial effusion - Bilateral internal jugular thromboses, restarted on coumadin [**8-24**] - h/o bilateral lower extremity DVT's - ESRD on HD T, Th, Sat - IDDM - Diastolic heart failure - Pulmonary hypertension - Hypercholesterolemia - OSA, noncompliant with CPAP as outpatient - OA - h/o C. Diff - GERD - Depression - Morbid obesity - Fibroid uterus; vaginal bleeding - h/o Osteomyelitis at the T9 Vertebrae [**5-24**]; tx with Vanc - h/o Multiple line infections **[**2135-12-17**]: Providencia, treated with 4 wk course of aztreonam **[**2135-4-17**]: Staph coag positive, sensitive to both vancomycin and gentamicin **[**2136-5-17**]: Staph bacteremia tx with vanc x 6 weeks **[**2136-8-17**]: Proteius mirabilis and MSSA, treated with ceftaz and vanc . PAST SURGICAL HISTORY: - L forearm radial-basilic AV graft, s/p infection, thrombosis and abandonment ([**12-21**]) - Multiple lines in L upper arm with AV graft - 1/07 L femoral PermaCath placed - L upper arm thrombectomy, revision, of LUE AV graft ([**3-23**]) - [**4-23**] Excision of left upper arm infected AV graft; associated MRSA bacteremia treated with 6 weeks vancomycin. - Right upper extremity AV fistula creation [**10-23**] s/p revision - [**2135-12-14**] Right AV fistula repair, Right IJ PermaCath rewiring and IVC filter removed MEDICATION ON ADMISSION: Warfarin 2 mg daily Paroxetine HCl 20 mg daily Ascorbic Acid 500 mg [**Hospital1 **] Docusate Sodium 100 mg [**Hospital1 **] Albuterol Sulfate 2.5 mg /3 mL (0.083 %) q6hrs: Midodrine 10 mg TID Folic Acid 1 mg DAILY Aspirin 81 mg daily Senna 8.6 mg [**Hospital1 **]:prn Bisacodyl 5 mg DAILY Pantoprazole 40 mg PO Q24H Metoclopramide 5 mg q6hours:prn Lantus ALLERGIES: Penicillins / Ceftriaxone PHYSICAL EXAM: Gen: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Unable to assess venous distension due to body habitus. CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. FAMILY HISTORY: Not obtained. SOCIAL HISTORY: Patient denies a tobacco, alcohol or illicit drug use. She lives ### Response: {'Other specified cardiac dysrhythmias,End stage renal disease,Cellulitis and abscess of trunk,Other abscess of vulva,Diastolic heart failure, unspecified,Hyposmolality and/or hyponatremia,Other and unspecified coagulation defects,Primary pulmonary hypertension,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Diabetes with renal manifestations, type I [juvenile type], uncontrolled,Pure hypercholesterolemia,Anemia, unspecified,Other specified disorders of arteries and arterioles,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 80 yo female with hx of CHF (EF 25-30%), HLD, HTN, DMII who presented to OSH with CP and was transferred to [**Hospital1 18**] for PCI after catheterization found 70% LAD lesion and pt refused CABG. Pt states that she has had CP for the last month, however her CP got significantly worse 3 days PTA to OSH, prompting her presentation. She describes it as substernal and radiating to the arms and with associated nausea. Per pt, pain improved with nitroglycerin. Pt denies any associated SOB, vomiting or diaphoresis. On presentation to the OSH, she was ruled out for MI however troponins were mildly elevated to 0.13. She was also found to be hyperkalemic and was therefore given kayexalate, ARF with creatinine to 1.5. She underwent cardiac cath which showed 80% proximal left main stenosis, 70% middle LAD stenosis, 60% proximal circ stenosis and 60% mid-RCA stenosis and was transferred to [**Hospital1 18**] for further management and PCI given pts refusal of CABG. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: At [**Hospital1 1501**]: -Toprol XL 150 mg daily -Aspirin 81 mg -Lisinopril 20 mg -Lipitor 10 mg q day -Ranitidine 150 mg daily -Humulin N insulin, unknown dose -Lasix 40 mg daily -Nitroglycerin 0.4 mg PRN CP -Humulin R insulin to scale, 200 to 250, 6 units subcutaneously; 251 to 300, 8 units subcutaneously; and 301 to 350, 10 units subutaneously . On Transfer: -Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob -Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB -Amlodipine 10 mg PO/NG DAILY -Isosorbide Mononitrate 20 mg PO BID -Aspirin 325 mg PO/NG DAILY -Levothyroxine Sodium 75 mcg PO/NG DAILY -Atorvastatin 10 mg PO/NG DAILY Order -Metoprolol Succinate XL 200 mg PO DAILY -Miconazole Powder 2% 1 Appl TP TID -Furosemide 40 mg PO/NG DAILY Order -Nitroglycerin SL 0.3 mg SL PRN CP -Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol -Pantoprazole 40 mg PO Q24H -Heparin IV -Glargine 8 U at breakfast and bedtime -Novolog before meals, at bedtime and 0300 -Bactroban to nares -ACE I held due to CKD -Epogen 20-40K units q 2-4 wks for Hbg<10 ALLERGIES: Latex / Penicillins PHYSICAL EXAM: VS: T=98.3 BP=118/66 HR=71 RR=26 O2 sat=92% 4L GENERAL: Oriented x3. Mood, affect appropriate. Somewhat uncomfortable and agitated appearing, wanting to sit up in bed. FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Pt worked as a nursing assistant. She has a son in TX and a daughter in [**Name (NI) **], 6 grandchildren. She has been married for 60 yrs. -Tobacco history: No current, quit in [**2152**] -ETOH: none -Illicit drugs: none

Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Intermediate coronary syndrome,Chronic kidney disease, Stage IV (severe),Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atherosclerosis of aorta,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Obesity, unspecified,Unspecified acquired hypothyroidism,Esophageal reflux,Disorder of bone and cartilage, unspecified,Thrombocytopenia, unspecified,Anemia, unspecified,Hypotension, unspecified

Crnry athrscl natve vssl,Ac on chr syst hrt fail,Acute kidney failure NOS,Pneumonia, organism NOS,Intermed coronary synd,Chr kidney dis stage IV,Hyposmolality,DMII wo cmp nt st uncntr,Hy kid NOS w cr kid I-IV,Aortic atherosclerosis,Status cardiac pacemaker,Hyperlipidemia NEC/NOS,Obesity NOS,Hypothyroidism NOS,Esophageal reflux,Bone & cartilage dis NOS,Thrombocytopenia NOS,Anemia NOS,Hypotension NOS

Admission Date: [**2179-12-2**] Discharge Date: [**2179-12-12**] Date of Birth: [**2099-5-12**] Sex: F Service: MEDICINE Allergies: Latex / Penicillins Attending:[**First Name3 (LF) 7055**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: cardiac catheterization [**2179-12-5**] History of Present Illness: 80 yo female with hx of CHF (EF 25-30%), HLD, HTN, DMII who presented to OSH with CP and was transferred to [**Hospital1 18**] for PCI after catheterization found 70% LAD lesion and pt refused CABG. Pt states that she has had CP for the last month, however her CP got significantly worse 3 days PTA to OSH, prompting her presentation. She describes it as substernal and radiating to the arms and with associated nausea. Per pt, pain improved with nitroglycerin. Pt denies any associated SOB, vomiting or diaphoresis. On presentation to the OSH, she was ruled out for MI however troponins were mildly elevated to 0.13. She was also found to be hyperkalemic and was therefore given kayexalate, ARF with creatinine to 1.5. She underwent cardiac cath which showed 80% proximal left main stenosis, 70% middle LAD stenosis, 60% proximal circ stenosis and 60% mid-RCA stenosis and was transferred to [**Hospital1 18**] for further management and PCI given pts refusal of CABG. Pt was transferred to [**Hospital1 18**] on heparin. In the ambulance, pt complained of CP and pressures dropped to 80s systolic however normalized without intervention. On arrival to [**Hospital1 18**], pt required 4L to maintain sats in the 90s, however denied SOB, or CP. Vitals were otherwise stable. She denied further CP or SOB on arrival to the floor. Without complaints however wanting to sit up in bed and somewhat agitated. On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. Cardiac review of systems is notable for absence of chest pain at present, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. She does have trouble lying flat because of SOB. Past Medical History: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: none -PACING/ICD: DDD 60-140 3. OTHER PAST MEDICAL HISTORY: -Anemia -Hx Thrombocytopenia -hypothyroidism -diverticulosis -osteopenia -GERD -bilateral cataract s/p laser surgery and implants -CKD stage III -cholecystectomy -inguinal hernia repair -ventral hernia repair -TAH with bilateral salpingoophorectomy -s/p lysis of small bowel adhesions -s/p R knee surgery Social History: Pt worked as a nursing assistant. She has a son in TX and a daughter in [**Name (NI) **], 6 grandchildren. She has been married for 60 yrs. -Tobacco history: No current, quit in [**2152**] -ETOH: none -Illicit drugs: none Family History: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Physical Exam: VS: T=98.3 BP=118/66 HR=71 RR=26 O2 sat=92% 4L GENERAL: Oriented x3. Mood, affect appropriate. Somewhat uncomfortable and agitated appearing, wanting to sit up in bed. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP of 8 cm. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Breathing appears somewhat labored with use of accessory muscles, pt coughing. Bibasilar crackles, no wheezes or rhonchi. Poor air movement bilaterally. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No calf tenderness. Small painful hematoma on anterior lower leg SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: 2+ carotid bilaterally Pertinent Results: [**2179-12-2**] 07:31PM PT-13.0 PTT-37.3* INR(PT)-1.1 [**2179-12-2**] 07:31PM PLT COUNT-160 [**2179-12-2**] 07:31PM NEUTS-62.1 LYMPHS-26.7 MONOS-10.1 EOS-0.7 BASOS-0.5 [**2179-12-2**] 07:31PM WBC-15.3* RBC-3.02* HGB-8.8* HCT-27.0* MCV-89 MCH-29.2 MCHC-32.6 RDW-15.4 [**2179-12-2**] 07:31PM TRIGLYCER-104 HDL CHOL-46 CHOL/HDL-2.2 LDL(CALC)-34 [**2179-12-2**] 07:31PM CALCIUM-8.7 PHOSPHATE-3.8 MAGNESIUM-1.9 CHOLEST-101 [**2179-12-2**] 07:31PM GLUCOSE-285* UREA N-40* CREAT-1.6* SODIUM-142 POTASSIUM-5.3* CHLORIDE-105 TOTAL CO2-26 ANION GAP-16 TTE [**12-3**]: The left atrium is mildly dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated with severe global hypokinesis (LVEF = 25 %). No masses or thrombi are seen in the left ventricle, but apical images are suboptimal. Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild to moderate ([**1-1**]+) mitral regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Suboptimal image quality. Left ventricular cavity enlargement with severe global hypokinesis. Right ventricular cavity enlargement with free wall hypokinesis. Moderate pulmonary artery systolic hypertension. Mild-moderate mitral regurgitation. CXR [**12-5**]: As compared to the previous radiograph, there is no relevant change. The left basal retrocardiac parenchymal opacities, unchanged in extent and density. The left pectoral pacemaker obliterates the left costophrenic sinus, but an effusion may also be present on the left. The pre-existing right hilar enlargement is slightly less obvious than on the previous examination. The finding should nevertheless be clarified with CT. Unchanged right-sided PICC line, unchanged pacemaker wires. No focal parenchymal opacities have newly occurred. No signs of overhydration. ABI [**12-3**]: Normal lower extremity arterial hemodynamics at rest. Note of noncompressible vessels. Cardiac Catheterization: 1. Three vessel coronary artery disease. 2. Sucecssful stenting of the LMCA into the LCX with two overlapping Cypher DESs 3. Successful placement of TandemHeart assist device during LMCA PCI 4. Successful removal of bilateral arterial sheaths (3 Perclose devices to the RCFA and one 6 F Angioseal to the LCFA). 5. Sucecssful removal of bilateral venous sheaths 6. Mild abdominal aortic plaquing without critical stenosis 7. Limited vagal event following closure of arterial access,successfully treated 8. 2 weeks of 150 mg/d Plavix then 75 mg daily long term 9minimum of 1 year) and ASA indifinitely (325 mg daily x minimum of 1 month then 162 mg daily) 9. Global cardiovascular risk reduction strategies to meet recommended targets Brief Hospital Course: 1. CORONARIES: Mrs [**Known lastname **] was found to have significant 3 vessel disease at the outside hospital and was transferred to [**Hospital1 18**] for PCI. She developed chest pain and hypotension en route to [**Hospital1 **] which resolved without intervention prior to arrival. PCI was initally on hold given pts poor resp status, however resp status improved with lasix and she underwent LMCA stenting with DES using tandem heart support. She was transferred to the CCU after stenting for further montioring, however did well and was quickly transferred to the cardiology floor. She was also maintained on aspirin, Imdur, heparin and high dose statin. Plavix was started after intervention and will be continued at 150 mg for 1 week, then pt will require lifelong treatment of 75 mg/day. High dose aspirin 325mg should be maintained for at least 1 month but thereafter may be down titrated to 162mg daily if necessary. 2. Systolic heart failure/volume overload: Mrs [**Known lastname **] has a baseline EF of 20%, was admitted in significant respiratory distress and crackles on exam. She underwent diuresis with lasix gtt and respiratory status improved with diuresis. She was also continued on metoprolol at a decreased dose (50 mg [**Hospital1 **]) secondary to concern for her hypotension on admission. 3. HYPOTENSION: Pt was hypotensive on transport to the hospital, however pressures stabilized in the low 100s on arrival to the hospital. We also considerd septic physiology given leukocytosis, ? PNA on CXR, 1 positive blood cxs growing gram - staph, and pt was started on vanc/levofloxicin. Vancomycin was discontinued after surveillance cultures remained negative after 48 hrs. Blood pressures stabilized and remained normotensive through duration of hospital stay. 4. LEUKOCYTOSIS: Likely due to PNA, therefore pt was treated for HCAP. While bacteremia was intially considered, vancomycin was dc'd after 48 hrs of negative cultures. She was continued on a 5 day course of levofloxicin for CAP pneumonia. 5. CKD: Worsening renal function during this admission, with FeNa<1 concerning for pre-renal etiology. Initially attributed to aggresive lasix diuresis, given that renal function improved after discontinuation of diuresis, however renal function worsened again after cath, raising concern for contrast-related nephropathy given that the pt received contrast 5 day prior at OSH. 6 DM: sugars were poorly controlled and pt required uptitration of her insulin during this admission. 7. THROMBOCYTOPENIA: Stable, low concern for HIT therefore heparin was continued. 8. ANEMIA: Now WNL s/p transfusion and in the setting of aggressive diuresis. 9. HYPONATREMIA: likely due to aggressive diuresis. Stable. 10. HYPOTHYROIDISM: continue home dose of levothyroxine Medications on Admission: At [**Hospital1 1501**]: -Toprol XL 150 mg daily -Aspirin 81 mg -Lisinopril 20 mg -Lipitor 10 mg q day -Ranitidine 150 mg daily -Humulin N insulin, unknown dose -Lasix 40 mg daily -Nitroglycerin 0.4 mg PRN CP -Humulin R insulin to scale, 200 to 250, 6 units subcutaneously; 251 to 300, 8 units subcutaneously; and 301 to 350, 10 units subutaneously . On Transfer: -Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob -Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB -Amlodipine 10 mg PO/NG DAILY -Isosorbide Mononitrate 20 mg PO BID -Aspirin 325 mg PO/NG DAILY -Levothyroxine Sodium 75 mcg PO/NG DAILY -Atorvastatin 10 mg PO/NG DAILY Order -Metoprolol Succinate XL 200 mg PO DAILY -Miconazole Powder 2% 1 Appl TP TID -Furosemide 40 mg PO/NG DAILY Order -Nitroglycerin SL 0.3 mg SL PRN CP -Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol -Pantoprazole 40 mg PO Q24H -Heparin IV -Glargine 8 U at breakfast and bedtime -Novolog before meals, at bedtime and 0300 -Bactroban to nares -ACE I held due to CKD -Epogen 20-40K units q 2-4 wks for Hbg<10 Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Hospital1 **]:*30 Tablet(s)* Refills:*2* 2. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day): use in groin area and under breasts. [**Hospital1 **]:*1 bottle* Refills:*0* 3. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Hospital1 **]:*30 Tablet(s)* Refills:*2* 4. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for CP: take up to 3 tablets 5 miniutes apart for chest pain or indigestion. Call Dr. [**Last Name (STitle) 84261**] if you take this medicine. [**Last Name (STitle) **]:*30 Tablet, Sublingual(s)* Refills:*0* 5. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. [**Last Name (STitle) **]:*30 Tablet(s)* Refills:*2* 6. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for insomnia. [**Last Name (STitle) **]:*30 Tablet(s)* Refills:*0* 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. [**Last Name (STitle) **]:*60 Capsule(s)* Refills:*2* 8. Clopidogrel 75 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily): take Plavix 150 mg (double dose) until [**12-23**], then decrease to 75 mg daily. [**Month/Year (2) **]:*45 Tablet(s)* Refills:*2* 9. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr Sig: 1.5 Tablet Sustained Release 24 hrs PO once a day. [**Month/Year (2) **]:*45 Tablet Sustained Release 24 hr(s)* Refills:*2* 10. Isosorbide Mononitrate 10 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). [**Month/Year (2) **]:*120 Tablet(s)* Refills:*2* 11. Ranitidine HCl 75 mg Tablet Sig: One (1) Tablet PO twice a day. 12. Outpatient Lab Work Please check chem-7 and monitor renal function. Please fax results to your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 59323**] at [**Telephone/Fax (1) 64799**]. 13. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. [**Telephone/Fax (1) **]:*30 Tablet(s)* Refills:*2* 14. Lantus 100 unit/mL Solution Sig: Seventeen (17) untis Subcutaneous qam and qpm. [**Telephone/Fax (1) **]:*1 vial* Refills:*2* 15. Insulin Lispro 100 unit/mL Solution Sig: according to scale Subcutaneous qac: <100: none, 100-150: 2U, 151-200: 4U, 201-250: 6U, 251-300: 8U, 301-350: 10U, 351-400: 12U, >401 [**Name8 (MD) 138**] MD. [**Last Name (Titles) **]:*1 vial* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) **] regional VNA Discharge Diagnosis: Acute on chronic Renal Failure Acute on chronic Systolic congestive Heart Failure Insulin dependent Diabetes Mellitus coronary artery disease Hyperlipidemia anemia on Fe Discharge Condition: Mental Status:Clear and coherent Level of Consciousness:Alert and interactive Activity Status:Ambulatory - requires assistance or aid (walker or cane) Discharge Instructions: You were admitted from an outside hospital after having presented with chest pain and receiving a cardiac catheterization which showed a very tight blockage in the main artery that feeds blood to your heart. WE placed a drug eluting stent in this artery and you will need to take Plavix 150 mg (double dose) until [**12-23**], then decrease to 75 mg daily. You need to take this every day for the rest of your life. Do not stop taking Plavix unless Dr. [**Last Name (STitle) 11250**] tells you to. Your kidney function deteriorated after the contrast during the catheterization, they are improving now. You will need to have your kidney function checked in a few days with results to Dr. [**Last Name (STitle) 11250**]. Medication changes: 1. Increase Plavix to 150 mg daily until [**12-23**], then decrease to 75 mg daily for life. 2. Stop taking Lisinopril because of your kidney problems, Dr. [**Last Name (STitle) 11250**] will restart this later 3. Increase your cholesterol medicine to 80 mg daily (Simvastatin) 4. Take Imdur twice daily to prevent chest pain or indigestion 5. Continue lasix 40mg daily as previously to prevent excess fluid 6. Your aspirin was increased to 325mg daily 7. Your insulin was changed to Lantus 17U in the morning and at night. You will also follow a sliding scale with humolog insulin for meals. . Check your weight daily before breakfast. Call Dr. [**Last Name (STitle) **] if weight increases more than 3 pounds in 1 day or 6 pounds in 3 days. Followup Instructions: Cardiology: [**Last Name (LF) **],[**First Name3 (LF) **]-[**Doctor First Name 10588**] S. Phone: [**Telephone/Fax (1) 11254**] Office will call [**First Name5 (NamePattern1) 501**] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 84262**]) with an appt.

414,428,584,486,411,585,276,250,403,440,V450,272,278,244,530,733,287,285,458

{'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Intermediate coronary syndrome,Chronic kidney disease, Stage IV (severe),Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atherosclerosis of aorta,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Obesity, unspecified,Unspecified acquired hypothyroidism,Esophageal reflux,Disorder of bone and cartilage, unspecified,Thrombocytopenia, unspecified,Anemia, unspecified,Hypotension, unspecified'}

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: chest pain PRESENT ILLNESS: 80 yo female with hx of CHF (EF 25-30%), HLD, HTN, DMII who presented to OSH with CP and was transferred to [**Hospital1 18**] for PCI after catheterization found 70% LAD lesion and pt refused CABG. Pt states that she has had CP for the last month, however her CP got significantly worse 3 days PTA to OSH, prompting her presentation. She describes it as substernal and radiating to the arms and with associated nausea. Per pt, pain improved with nitroglycerin. Pt denies any associated SOB, vomiting or diaphoresis. On presentation to the OSH, she was ruled out for MI however troponins were mildly elevated to 0.13. She was also found to be hyperkalemic and was therefore given kayexalate, ARF with creatinine to 1.5. She underwent cardiac cath which showed 80% proximal left main stenosis, 70% middle LAD stenosis, 60% proximal circ stenosis and 60% mid-RCA stenosis and was transferred to [**Hospital1 18**] for further management and PCI given pts refusal of CABG. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: At [**Hospital1 1501**]: -Toprol XL 150 mg daily -Aspirin 81 mg -Lisinopril 20 mg -Lipitor 10 mg q day -Ranitidine 150 mg daily -Humulin N insulin, unknown dose -Lasix 40 mg daily -Nitroglycerin 0.4 mg PRN CP -Humulin R insulin to scale, 200 to 250, 6 units subcutaneously; 251 to 300, 8 units subcutaneously; and 301 to 350, 10 units subutaneously . On Transfer: -Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob -Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB -Amlodipine 10 mg PO/NG DAILY -Isosorbide Mononitrate 20 mg PO BID -Aspirin 325 mg PO/NG DAILY -Levothyroxine Sodium 75 mcg PO/NG DAILY -Atorvastatin 10 mg PO/NG DAILY Order -Metoprolol Succinate XL 200 mg PO DAILY -Miconazole Powder 2% 1 Appl TP TID -Furosemide 40 mg PO/NG DAILY Order -Nitroglycerin SL 0.3 mg SL PRN CP -Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol -Pantoprazole 40 mg PO Q24H -Heparin IV -Glargine 8 U at breakfast and bedtime -Novolog before meals, at bedtime and 0300 -Bactroban to nares -ACE I held due to CKD -Epogen 20-40K units q 2-4 wks for Hbg<10 ALLERGIES: Latex / Penicillins PHYSICAL EXAM: VS: T=98.3 BP=118/66 HR=71 RR=26 O2 sat=92% 4L GENERAL: Oriented x3. Mood, affect appropriate. Somewhat uncomfortable and agitated appearing, wanting to sit up in bed. FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Pt worked as a nursing assistant. She has a son in TX and a daughter in [**Name (NI) **], 6 grandchildren. She has been married for 60 yrs. -Tobacco history: No current, quit in [**2152**] -ETOH: none -Illicit drugs: none ### Response: {'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Intermediate coronary syndrome,Chronic kidney disease, Stage IV (severe),Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atherosclerosis of aorta,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Obesity, unspecified,Unspecified acquired hypothyroidism,Esophageal reflux,Disorder of bone and cartilage, unspecified,Thrombocytopenia, unspecified,Anemia, unspecified,Hypotension, unspecified'}

CHIEF COMPLAINT: Altered Mental Status/Hypotension PRESENT ILLNESS: 64 yo with h/o schizophrenia, mental retardation, CVA with residual L sided deficit, and seizure d/o who presents from group home with altered mental status. Per group home, patient is independent with ADLs at baseline and was well all day today until 9:30pm, when she was noted to have upper extremity and head "flinches." Per group home, patient thought that she was having a seizure. Shortly after, she "stopped talking" and became "unresponsive" x ?1h despite being awake. Patient "not herself." Also had more trouble ambulating. Not much information came with patient from group home; history obtained from the case worker who accompanied the patient. Patient denies HA/visual changes/CP/SOB/abd pain and complains of needing to urinate despite having a foley in place. MEDICAL HISTORY: CVA- left side deficit (summer [**2137**]) Hyperparathyroid (PTH 169 [**7-16**]) Seizure disorder CHF- Echo [**2-10**]: mild concentric LVH, LVEF >55%, 1+MR Schizophrenia/Anxiety Mental Retardation Urinary incontinence osteoporosis Glaucoma MEDICATION ON ADMISSION: Buspar 10mg TID Riperidone 2mg q8pm Gabapentin 200mg q8pm Depakote 1000mg [**Hospital1 **] Fosamax qweek Cosopt ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 99 BP 122/60--> 67/37 HR 115-130 --> 80s RR 15 98% RA Gen: very somnolent, but arousable. confused not oriented to time or place. slightly dysarthric HEENT: pupils 3mm reactive bilaterally, MMM, OP clear, L facial droop neck: supple, no LAD; no carotid bruits CTAB CV- tachycardic, III/VI systolic murmur, ?S3 abd- obese, soft, NT/ND ext- no LE edema, 2+ distal pulses, skin warm/dry neuro- difficult to assess due to somnolence and inability to follow commands. R grip weaker than L grip. RLE weaker than LLE. CN 2-12 grossly intact except L facial droop. down-going toe on R, equivocal on L. sensation to light touch grossly intact FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Hospital3 **] (Fairland House), independent ADLs. + history of remote tobacco, no ETOH. Has a son who lives in group home.

Other convulsions,Congestive heart failure, unspecified,Unspecified schizophrenia, unspecified,Unspecified intellectual disabilities,Hyperparathyroidism, unspecified

Convulsions NEC,CHF NOS,Schizophrenia NOS-unspec,Intellect disability NOS,Hyperparathyroidism NOS

Admission Date: [**2139-2-23**] Discharge Date: [**2139-2-25**] Date of Birth: [**2073-12-15**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 23756**] Chief Complaint: Altered Mental Status/Hypotension Major Surgical or Invasive Procedure: n/a History of Present Illness: 64 yo with h/o schizophrenia, mental retardation, CVA with residual L sided deficit, and seizure d/o who presents from group home with altered mental status. Per group home, patient is independent with ADLs at baseline and was well all day today until 9:30pm, when she was noted to have upper extremity and head "flinches." Per group home, patient thought that she was having a seizure. Shortly after, she "stopped talking" and became "unresponsive" x ?1h despite being awake. Patient "not herself." Also had more trouble ambulating. Not much information came with patient from group home; history obtained from the case worker who accompanied the patient. Patient denies HA/visual changes/CP/SOB/abd pain and complains of needing to urinate despite having a foley in place. ED course: Patient initially tachycardic to 130's with BP 122/60. HR to 80s with 500cc fluid bolus. However, pt became hypotensive to 67/37 and dopamine gtt started. Also given Narcan, ASA, Ceftriaxone, and Flagyl. LP performed in ED and was unremarkable. Past Medical History: CVA- left side deficit (summer [**2137**]) Hyperparathyroid (PTH 169 [**7-16**]) Seizure disorder CHF- Echo [**2-10**]: mild concentric LVH, LVEF >55%, 1+MR Schizophrenia/Anxiety Mental Retardation Urinary incontinence osteoporosis Glaucoma Social History: Lives in [**Hospital3 **] (Fairland House), independent ADLs. + history of remote tobacco, no ETOH. Has a son who lives in group home. Family History: Non-contributory Physical Exam: T 99 BP 122/60--> 67/37 HR 115-130 --> 80s RR 15 98% RA Gen: very somnolent, but arousable. confused not oriented to time or place. slightly dysarthric HEENT: pupils 3mm reactive bilaterally, MMM, OP clear, L facial droop neck: supple, no LAD; no carotid bruits CTAB CV- tachycardic, III/VI systolic murmur, ?S3 abd- obese, soft, NT/ND ext- no LE edema, 2+ distal pulses, skin warm/dry neuro- difficult to assess due to somnolence and inability to follow commands. R grip weaker than L grip. RLE weaker than LLE. CN 2-12 grossly intact except L facial droop. down-going toe on R, equivocal on L. sensation to light touch grossly intact Pertinent Results: [**2139-2-22**] 11:51PM WBC-4.1 HGB-11.8* HCT-35.9* MCV-90 PLT COUNT-136* NEUTS-48.9* LYMPHS-35.4 MONOS-14.7* EOS-0.8 BASOS-0.4 PT-12.8 PTT-30.1 INR(PT)-1.0 SODIUM-145 POTASSIUM-3.3 CHLORIDE-108 TOTAL CO2-28 UREA N-12 CREAT-0.8 GLUCOSE-113* ANION GAP-9 CALCIUM-10.1 MAGNESIUM-2.0 PHOSPHATE-3.2 AST(SGOT)-14 ALT(SGPT)-12 ALK PHOS-51 TOT BILI-0.2 LD(LDH)-148 AMYLASE-47 ALBUMIN-4.1 CK(CPK)-53 CK-MB-NotDone cTropnT-<0.01 [**2139-2-23**] 03:00AM CEREBROSPINAL FLUID (CSF) WBC-0 RBC-489* POLYS-33 LYMPHS-67 MONOS-0 (tube 1) WBC-0 RBC-42* POLYS-50 LYMPHS-50 MONOS-0 (tube 4) PROTEIN-35 GLUCOSE-70 URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG EKG: ST @133, nl intervals, nl axis, ST depression I,aVL, V3-6 Head CT: Study limited by patient motion. No intracranial hemorrhage or mass effect. CXR:1. Stable appearance of retrocardiac opacity that was imaged on the recent chest CT, which may represent sequestration, sequela of prior granulomatous infection, however a neoplastic process cannot be fully excluded. 2. Stable calcified mediastinal and hilar lymph nodes. 3. No congestive heart failure or new focal consolidations. Brief Hospital Course: 64 yo f w/ h/o MR, sz d/o on depakote, CVA who p/w altered MS in setting of questionable sz episode, initially normotensive in ED, w/ subsequent hypotension requiring dopamine gtt. In [**Name (NI) **] pt rec'd only 500ml NS, underwent head ct and LP both of which were negative and was covered w/ ceftriaxone, flagyl (?), and started on dopamine drip, eventually requiring up to 18 mics. Admitted to MICU, titrated off dopamine gtt over several hours and subsequently remained normotensive, w/ MAPs>70, but tachycardic in the 110s to 120s. Tachycardia resolved with additional 2L IVF. . 1) Altered Mental Status- CVA vs seizure vs infection vs toxic/metabolic (h/o hyperparathyroid, although calcium not very elevated). Depakote level nl, so sz less likely but by no means ruled out given the compelling story. No ongoing evidence of infxn: ruled out for meningitis (completely aseptic), nl wbcc, afebrile. Urine and blood cultures negative. CXR clr. On discharge PTH level still pending (although calcium normal). Unclear etiology of this episode. Felt likely related to previous seizure prior to arival in hospital w/ prolonged postictal period. Patient scheduled for outpatient Neurology follow up. . 2. [**Name (NI) **] unclear etiology. Pt with h/o hyperparathyroid. Other possibilities included hypovolemia, sepsis, cardiogenic etiology. No obvious source of infection to support sepsis since blood and urine culture remained negative. TTE nl, [**Last Name (un) 104**] stim was appropriate. Felt likely related to hypovolemia given response to fluid administration. . 3. Dynamic EKG changes- EKG with demand ischemia. No history of CAD/MI. Ruled out for MI. TTE without significant abnormalities. Started on aspirin while in house. . 4. prophylaxis- continued on pneumoboots, bowel regimen while in house. . Medications on Admission: Buspar 10mg TID Riperidone 2mg q8pm Gabapentin 200mg q8pm Depakote 1000mg [**Hospital1 **] Fosamax qweek Cosopt Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 4. Buspirone HCl 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 5. Risperidone 2 mg Tablet Sig: One (1) Tablet PO tid. 6. Gabapentin 100 mg Capsule Sig: Two (2) Capsule PO TID (3 times a day). 7. Divalproex Sodium 500 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO BID (2 times a day). 8. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop Ophthalmic QDAY (). Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: 1) hypovolemia 2) presumed seizure Discharge Condition: Good, VSS. BP stable. Discharge Instructions: 1) Please take your medications as directed. 2) Please attend your follow up appointments. 3) Return to medical care if you develop fevers, headaches, or shortness of breath. 4) Continue taking your fosamax as you were previously. Followup Instructions: 1) Provider: [**Name Initial (NameIs) **]/[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Where: [**Hospital6 29**] NEUROLOGY Phone:[**Telephone/Fax (1) 8302**] Date/Time:[**2139-3-18**] 1:00 . 2) Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] ([**Telephone/Fax (1) **]) [**2144-3-11**]:45am

780,428,295,319,252

{'Other convulsions,Congestive heart failure, unspecified,Unspecified schizophrenia, unspecified,Unspecified intellectual disabilities,Hyperparathyroidism, unspecified'}

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: Altered Mental Status/Hypotension PRESENT ILLNESS: 64 yo with h/o schizophrenia, mental retardation, CVA with residual L sided deficit, and seizure d/o who presents from group home with altered mental status. Per group home, patient is independent with ADLs at baseline and was well all day today until 9:30pm, when she was noted to have upper extremity and head "flinches." Per group home, patient thought that she was having a seizure. Shortly after, she "stopped talking" and became "unresponsive" x ?1h despite being awake. Patient "not herself." Also had more trouble ambulating. Not much information came with patient from group home; history obtained from the case worker who accompanied the patient. Patient denies HA/visual changes/CP/SOB/abd pain and complains of needing to urinate despite having a foley in place. MEDICAL HISTORY: CVA- left side deficit (summer [**2137**]) Hyperparathyroid (PTH 169 [**7-16**]) Seizure disorder CHF- Echo [**2-10**]: mild concentric LVH, LVEF >55%, 1+MR Schizophrenia/Anxiety Mental Retardation Urinary incontinence osteoporosis Glaucoma MEDICATION ON ADMISSION: Buspar 10mg TID Riperidone 2mg q8pm Gabapentin 200mg q8pm Depakote 1000mg [**Hospital1 **] Fosamax qweek Cosopt ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 99 BP 122/60--> 67/37 HR 115-130 --> 80s RR 15 98% RA Gen: very somnolent, but arousable. confused not oriented to time or place. slightly dysarthric HEENT: pupils 3mm reactive bilaterally, MMM, OP clear, L facial droop neck: supple, no LAD; no carotid bruits CTAB CV- tachycardic, III/VI systolic murmur, ?S3 abd- obese, soft, NT/ND ext- no LE edema, 2+ distal pulses, skin warm/dry neuro- difficult to assess due to somnolence and inability to follow commands. R grip weaker than L grip. RLE weaker than LLE. CN 2-12 grossly intact except L facial droop. down-going toe on R, equivocal on L. sensation to light touch grossly intact FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Hospital3 **] (Fairland House), independent ADLs. + history of remote tobacco, no ETOH. Has a son who lives in group home. ### Response: {'Other convulsions,Congestive heart failure, unspecified,Unspecified schizophrenia, unspecified,Unspecified intellectual disabilities,Hyperparathyroidism, unspecified'}

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: 66 year old female with h/o severe COPD on home 2LO2 who presents with shortness of breath. MEDICAL HISTORY: - Severe COPD on home O2 (2L). PFTs [**9-4**]: FVC 54%pred, FEV1 24%pred, FEV1/FVC 45%pred. Last admission for COPD exac [**8-4**]. - Depression - Incontinence x 33 years MEDICATION ON ADMISSION: Prednisone 20mg po daily Alprazolam 0.5mg po bid, 0.75mg po qhs Risperidone 2mg po qhs Combivent 18mcg-103mcg 2 puffs inh q4h prn SOB Fluticasone 220mcg 2 puffs [**Hospital1 **] Formoterol 12 mcg Capsule, w/Inhalation Device Spiriva 18mcg 1 puff inh daily Docusate 100mg po bid Senna 1 tab po bid Alprazolam 1mg po bid prn Paroxetine 60mg po daily Vitamin D 800units po daily Calcium 1000mg po daily ALLERGIES: Diphenhydramine / Penicillins / Fluoxetine / Trimethoprim PHYSICAL EXAM: VS: Tm=99.0, Tc=96.8, 122/86, 80, 22, 100%2L NC GEN: Elderly female, sitting up in bed, tremulous (baseline), no apparent respiratory distress HEENT: PERRL, EOMI, sclerae anicteric, MM dry, OP without lesions, no supraclavicular or cervical lymphadenopathy, JVP low FAMILY HISTORY: [**Name (NI) **] mother died of severe COPD. SOCIAL HISTORY: Patient lives in [**Hospital3 **]. Previously had difficulty with medication administration and meals. Still smoking 1/2ppd - states that she quit on the morning of admission. Denies alcohol or illicit drug use. Has 3 children, [**Doctor First Name **] is closest to the patient.

Obstructive chronic bronchitis with (acute) exacerbation,Alkalosis,Hypoxemia,Dysthymic disorder,Tobacco use disorder

Obs chr bronc w(ac) exac,Alkalosis,Hypoxemia,Dysthymic disorder,Tobacco use disorder

Admission Date: [**2159-10-13**] Discharge Date: [**2159-10-16**] Date of Birth: [**2092-10-15**] Sex: F Service: MEDICINE Allergies: Diphenhydramine / Penicillins / Fluoxetine / Trimethoprim Attending:[**First Name3 (LF) 689**] Chief Complaint: shortness of breath Major Surgical or Invasive Procedure: None. History of Present Illness: 66 year old female with h/o severe COPD on home 2LO2 who presents with shortness of breath. She states that 1.5 weeks ago she began to have cold symptoms consisting of a cough and congestion. She wasn't treated for the first few days but then began to feel more SOB and saw her PCP [**Last Name (NamePattern4) **] [**2159-10-7**]. She was reportedly given levaquin and a prednisone taper (starting at 40mg, presently at 20mg). She reports increasing cough productive of yellow sputum and worsening dyspnea over the last week. She reports that she has also been smoking more than usual over the last several weeks, but quit on the morning of admission. She became very SOB and called EMS due to respiratory distress. She was found to have O2 sat 43% on RA. In the ED, initial vitals were T 98.4 HR 100 BP 160/70 RR 20 O2 Sat 100%2L. She then dropped her O2 sats to mid to high 80's and low 90's on a NRB. Received 125mg IV solumedrol, 3 treatments with atrovent, and 500mg po azithromycin. She was weaned to 50% facemask with O2 sat of 90% with some improvement but persistent dyspnea. Vitals on transfer HR 95 BP 141/76 RR 22 O2 Sat 90% 50%FM. Review of systems: Negative for fever, chills, night sweats, chest pain, abdominal pain, nausea, vomiting, diarrhea. Does have some constipation. Past Medical History: - Severe COPD on home O2 (2L). PFTs [**9-4**]: FVC 54%pred, FEV1 24%pred, FEV1/FVC 45%pred. Last admission for COPD exac [**8-4**]. - Depression - Incontinence x 33 years Social History: Patient lives in [**Hospital3 **]. Previously had difficulty with medication administration and meals. Still smoking 1/2ppd - states that she quit on the morning of admission. Denies alcohol or illicit drug use. Has 3 children, [**Doctor First Name **] is closest to the patient. Family History: [**Name (NI) **] mother died of severe COPD. Physical Exam: VS: Tm=99.0, Tc=96.8, 122/86, 80, 22, 100%2L NC GEN: Elderly female, sitting up in bed, tremulous (baseline), no apparent respiratory distress HEENT: PERRL, EOMI, sclerae anicteric, MM dry, OP without lesions, no supraclavicular or cervical lymphadenopathy, JVP low RESP: Diffuse coarse wheezing and slightly decreased breath sounds throughout, improved. CV: RRR without MRG ABD: Soft, NT/ND, BS+, no rebound or guarding EXT: No cyanosis, clubbing, or edema. Left shin ulcer bandaged. SKIN: White skin discoloration lesions, appearing like vitiligo, noted on her upper back and arms. Multiple ecchymoses arms and back as well. NEURO: AAOx3. CN II-XII intact. 5/5 strength throughout. No sensory deficits to light touch appreciated. Patient is noticeably tremulous from head to toe. Pertinent Results: ADMISSION LABS: [**2159-10-13**] 07:15PM WBC-11.0 RBC-4.64 HGB-14.0 HCT-43.9 MCV-95 MCH-30.2 MCHC-31.9 RDW-14.9 [**2159-10-13**] 07:15PM NEUTS-85.2* LYMPHS-8.6* MONOS-4.9 EOS-0.6 BASOS-0.8 [**2159-10-13**] 07:15PM PLT COUNT-359 [**2159-10-13**] 07:15PM PT-11.8 PTT-25.9 INR(PT)-1.0 [**2159-10-13**] 07:15PM cTropnT-<0.01 [**2159-10-13**] 07:15PM GLUCOSE-202* UREA N-13 CREAT-0.7 SODIUM-135 POTASSIUM-5.1 CHLORIDE-89* TOTAL CO2-42* ANION GAP-9 [**2159-10-13**] 07:29PM LACTATE-1.7 [**2159-10-13**] 07:15PM BLOOD proBNP-427* DISCHARGE LABS: [**2159-10-16**] 06:00AM BLOOD WBC-9.7 RBC-4.19* Hgb-12.7 Hct-38.2 MCV-91 MCH-30.4 MCHC-33.4 RDW-15.1 Plt Ct-276 [**2159-10-16**] 06:00AM BLOOD Glucose-85 UreaN-11 Creat-0.5 Na-137 K-4.1 Cl-95* HCO3-39* AnGap-7* [**2159-10-16**] 06:00AM BLOOD Albumin-3.8 Calcium-9.5 Phos-2.3* Mg-2.4 IMAGING: CHEST (PA & LAT) Study Date of [**2159-10-13**] 8:13 PM IMPRESSION: COPD without definite sign of superimposed pneumonia or CHF. MICROBIOLOGY: - [**2159-10-13**] 7:00 pm BLOOD CULTURE: pending on discharge - [**2159-10-14**] 2:05 am MRSA SCREEN Source: Nasal swab. MRSA SCREEN (Final [**2159-10-15**]): POSITIVE FOR METHICILLIN RESISTANT STAPH AUREUS. - [**2159-10-14**] 4:07 pm SPUTUM Site: EXPECTORATED GRAM STAIN (Final [**2159-10-15**]): >25 PMNs and <10 epithelial cells/100X field. 4+ (>10 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS, CHAINS, AND CLUSTERS. 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). SMEAR REVIEWED; RESULTS CONFIRMED. RESPIRATORY CULTURE (Final [**2159-10-16**]): HEAVY GROWTH Commensal Respiratory Flora. YEAST. MODERATE GROWTH. Brief Hospital Course: 66 yo F with PMH of severe COPD on 2L home O2 and severe anxiety who presented [**10-13**] to [**Hospital1 18**] and was admitted to the MICU for shortness of breath related to a COPD exacerbation, then transferred to the medical floor for further management. # COPD exacerbation: The patient described an increased productive cough and worsening dyspnea in the setting of a recent viral syndrome and increased smoking. She has a significantly reduced FEV1 of 24% predicted and has severe COPD on baseline home O2 of 2L NC. Patient afebrile with no evidence of pneumonia on CXR. Received azithromycin 250mg PO x 5 days (last dose 9/22). Also received one 100mg dose of doxycycline to cover MRSA; this was stopped when the final sputum culture came back. She was treated with methylprednisolone 60mg IV q6h on admission, then switched to PO prednisone 60mg on [**10-14**]. She will be discharged on a prednisone taper. She received scheduled albuterol nebs q4h and was written for ipratropium nebs q6h which she refused. On the floor, her O2 requirement was weaned back to her baseline of 2L O2 via nasal cannula; her sats were maintained 88-92%. On the day of discharge (after receiving a nebulizer treatment), rest saturation was 93% on 2L, then ambulatory saturation was down to 88% on 2L. She was counseled about smoking cessation. # Elevated bicarbonate: Has chronically elevated bicarbonate, likely related to CO2 retention from COPD. # Anxiety/Depression: The patient has a noteable tremor on exam which she attributes to recently decreased dose xanax. She was continued on her home dose and encouraged to speak to her psychiatrist about possibly increasing the dose if she is not able to tolerate the lower dose. Risperdal and paroxetine were also continued. # Prophylaxis: Patient received heparin products during this admission. # Code status: Full code Medications on Admission: Prednisone 20mg po daily Alprazolam 0.5mg po bid, 0.75mg po qhs Risperidone 2mg po qhs Combivent 18mcg-103mcg 2 puffs inh q4h prn SOB Fluticasone 220mcg 2 puffs [**Hospital1 **] Formoterol 12 mcg Capsule, w/Inhalation Device Spiriva 18mcg 1 puff inh daily Docusate 100mg po bid Senna 1 tab po bid Alprazolam 1mg po bid prn Paroxetine 60mg po daily Vitamin D 800units po daily Calcium 1000mg po daily Discharge Medications: 1. Alprazolam 0.25 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 2. Alprazolam 0.25 mg Tablet Sig: Three (3) Tablet PO QHS (once a day (at bedtime)). 3. Risperidone 2 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 4. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation every four (4) hours as needed for shortness of breath or wheezing. 5. Fluticasone 220 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation twice a day. 6. Formoterol Fumarate 12 mcg Capsule, w/Inhalation Device Sig: One (1) inhalation Inhalation every twelve (12) hours. 7. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device Sig: One (1) puff Inhalation once a day. 8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. Paroxetine HCl 20 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 11. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 12. Calcium Carbonate 200 mg (500 mg) Tablet, Chewable Sig: Two (2) Tablet, Chewable PO DAILY (Daily). 13. Azithromycin 250 mg Tablet Sig: One (1) Tablet PO once a day for 1 doses: last dose 9/22. Disp:*1 Tablet(s)* Refills:*0* 14. Prednisone 10 mg Tablet Sig: As directed Tablet PO AS DIRECTED for 11 days: 40mg (four tabs) x 2 days ([**2072-10-15**]), THEN 30mg (three tabs) x 3 days ([**Date range (1) 50299**]), THEN 20mg (two tabs) x 3 days ([**2078-10-21**]), THEN 10mg (one tab) x 3 days ([**Date range (1) 8258**]). Disp:*26 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Primary Diagnosis: 1. Chronic obstructive pulmonary disease exacerbation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: 1. You were admitted to the hospital for shortness of breath and found to have an exacerbation of your chronic obstructive pulmonary disease, also known as COPD. This was likely caused by the cold you experienced last week. 2. You were started on a 5-day course of azithromycin (last dose on [**10-17**]). You were also started on a prednisone taper: 40mg x 2 days ([**2072-10-15**]) 30mg x 3 days ([**Date range (1) 50299**]) 20mg x 3 days ([**2078-10-21**]) 10mg x 3 days ([**Date range (1) 8258**]) 3. We observed that your oxygen saturation dropped while you were walking with the physical therapists and nurses, therefore, you should use 3L O2 while you walk for the next 1 week and then have the physical therapists re-evaluate your ambulatory oxygen saturation. Otherwise, you can use your baseline of 2L O2 at rest. 4. Your respiratory symptoms are made much worse by smoking. You should discuss options for smoking cessation with your PCP. 5. It is important that you take all of your medications as prescribed. 6. It is important that you keep all of your follow up appointments. Followup Instructions: Department: PULMONARY FUNCTION LAB When: THURSDAY [**2159-10-18**] at 3:10 PM With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: MEDICAL SPECIALTIES When: THURSDAY [**2159-10-18**] at 3:30 PM With: DR. [**Last Name (STitle) 11071**] / DR. [**Last Name (STitle) **] [**Telephone/Fax (1) 612**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage **You should schedule a follow up appointment with your PCP (Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1266**] [**Telephone/Fax (1) 608**]) within the next 1 week. Completed by:[**2159-10-18**]

491,276,799,300,305

{'Obstructive chronic bronchitis with (acute) exacerbation,Alkalosis,Hypoxemia,Dysthymic disorder,Tobacco use disorder'}

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: shortness of breath PRESENT ILLNESS: 66 year old female with h/o severe COPD on home 2LO2 who presents with shortness of breath. MEDICAL HISTORY: - Severe COPD on home O2 (2L). PFTs [**9-4**]: FVC 54%pred, FEV1 24%pred, FEV1/FVC 45%pred. Last admission for COPD exac [**8-4**]. - Depression - Incontinence x 33 years MEDICATION ON ADMISSION: Prednisone 20mg po daily Alprazolam 0.5mg po bid, 0.75mg po qhs Risperidone 2mg po qhs Combivent 18mcg-103mcg 2 puffs inh q4h prn SOB Fluticasone 220mcg 2 puffs [**Hospital1 **] Formoterol 12 mcg Capsule, w/Inhalation Device Spiriva 18mcg 1 puff inh daily Docusate 100mg po bid Senna 1 tab po bid Alprazolam 1mg po bid prn Paroxetine 60mg po daily Vitamin D 800units po daily Calcium 1000mg po daily ALLERGIES: Diphenhydramine / Penicillins / Fluoxetine / Trimethoprim PHYSICAL EXAM: VS: Tm=99.0, Tc=96.8, 122/86, 80, 22, 100%2L NC GEN: Elderly female, sitting up in bed, tremulous (baseline), no apparent respiratory distress HEENT: PERRL, EOMI, sclerae anicteric, MM dry, OP without lesions, no supraclavicular or cervical lymphadenopathy, JVP low FAMILY HISTORY: [**Name (NI) **] mother died of severe COPD. SOCIAL HISTORY: Patient lives in [**Hospital3 **]. Previously had difficulty with medication administration and meals. Still smoking 1/2ppd - states that she quit on the morning of admission. Denies alcohol or illicit drug use. Has 3 children, [**Doctor First Name **] is closest to the patient. ### Response: {'Obstructive chronic bronchitis with (acute) exacerbation,Alkalosis,Hypoxemia,Dysthymic disorder,Tobacco use disorder'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 80 year-old male who was found down at home under his car after missing for three days most likely the patient rolled off the road and the patient was initially admitted to [**Hospital6 10443**], intubated and transferred here. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Closed fracture of multiple ribs, unspecified,Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Calculus of ureter,Hydronephrosis,Closed fracture of clavicle, unspecified part,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle

Fx mult ribs NOS-closed,Pneumonia, organism NOS,Acute respiratry failure,Acidosis,Calculus of ureter,Hydronephrosis,Fx clavicle NOS-closed,Loss control mv acc-driv

Admission Date: [**2146-9-22**] Discharge Date: [**2146-10-12**] Service: TRAUMA SURGERY HISTORY OF PRESENT ILLNESS: The patient is an 80 year-old male who was found down at home under his car after missing for three days most likely the patient rolled off the road and the patient was initially admitted to [**Hospital6 10443**], intubated and transferred here. The patient's past medical history is significant for prostate cancer and upon admission to the Emergency Room the patient's examination, pupils were sluggish, tongue was midline and no blood in the nare or the ears. Chest was clear and heart was regular rate and rhythm on admission. The patient also had some right shoulder bruises. Bilateral distal pulses are palpable. The patient's rectal examination was guaiac negative. At the time of admission the patient underwent a CT scan of the head, which was negative and CT C spine, which was negative and abdominal CT was negative. The only significant for a right ureteral stone and TLS spine films were all negative. Chest x-ray was negative for pneumothorax and the patient was subsequently admitted to the Trauma Surgery Service for further evaluation and management. Patient had an x-ray of the right shoulder, which showed right clavicular distal fracture and with apparent loss of corticoclavicular ligament and orthopedic surgery was called to see the patient and it appeared the clavicular fracture was stable and they recommended nonoperative management of the fracture. The patient was also placed on C spine precaution, although CT of the C spine was negative, however, due to altered mental status we were not able to clear the C spine and urology was consulted for an obstructing right kidney stone. Urology decided not to place a percutaneous nephrostomy tube and would just follow his renal stone. The patient was continued to be monitored in the Intensive Care Unit subsequently and a right radial artery A line was then placed on hospital day number two and also a right subclavian central line was also placed. On chest x-ray the patient has a lot of secretions and the patient underwent a bronchoscopy on hospital day number two, which cleared a lot of secretions, but no other abnormality finding was found on the bronchoscopy. The patient also had an epidural placed for pain control. On the CT scan done at admission the final read also showed that the patient had some old left frontal infarct and basal ganglion and calcification, but no acute bleed or acute infarct was seen. On hospital day number three the patient was extubated, however, due to increased secretion and worsening metabolic acidosis the patient required reintubation on the same day. On hospital day number four the patient was started on tube feeds and appeared to be tolerating tube feed well and Zosyn was then started for some left lower lobe infiltrate, which was seen on the chest x-ray. The patient was started on Fluconazole per ID recommendation on the [**4-29**] for some yeast, which was growing from urine. Three days of Fluconazole was given until the yeast was cleared. On [**10-1**] his subclavian catheter was changed over the wire due to fear of 38.1, however, the patient's white count is only 14. The antibiotics were continued and repeat chest x-ray subsequently showed the patient continued to have left lower lobe infiltrate. There was a question of pneumonia versus aspiration event and the patient was failed to extubate continuously, although the patient appeared to be doing well on pressure support ventilation. The patient underwent another bronchoscopy on [**10-6**], which showed left lower collapse and large amount of purulent secretion was washed out. The patient was continued on the Zosyn and Fluconazole. His respiratory condition appeared to be improved and respiratory culture grew out gram negative rods and staph aureus, which is pan sensitive and also a _________________. The patient was continued on the current course of antibiotics. Due to the patient's repeat failure of extubation it was decided the patient would require a trach and PEG. The procedure was performed on [**10-11**] by Dr. [**Last Name (STitle) 519**]. The trach and PEG was performed without any incidents and post procedure chest x-ray showed trach in good position and will begin giving the patient po medication via his PEG, which appeared to be tolerating that fine and the patient was deemed ready for discharge on [**2146-10-12**]. Prior to discharge the patient was afebrile, vital signs were stable and he was responsive and follows commands, although mental status wise he is still appeared to be somewhat confused and is not quite appropriate. His chest was clear to auscultation except for some mild basal rales on the left side. The patient's belly was soft, nontender, nondistended. The PEG site was clean and trach site appeared to be clean. DISCHARGE DIAGNOSES: 1. Status post motor vehicle accident found down under his car. 2. Old left frontal infarct and basal ganglia and calcifications. 3. Right shoulder distal clavicular fracture, which required nonoperative management. 4. Right renal stone, which urology recommended follow up and nonoperative management. 5. Failure to wean off ventilator. 6. Status post trach and PEG. 7. History of prostate cancer. DISCHARGE MEDICATIONS: 1. Regular insulin sliding scale. 2. Heparin subq 5000 units b.i.d. 3. Lopressor 25 mg po b.i.d. 4. Zantac 150 mg po b.i.d. 5. Levaquin 500 mg po q day for another seven days. The antibiotics will end on [**2146-10-19**]. 6. Nystatin ointment prn. 7. Atrovent nebulizers one to two puffs q 4 hours prn. FOLLOW UP INSTRUCTIONS: The patient is to follow up in the Trauma Clinic in approximately seven to eight weeks and the patient is to follow up with urology in three to four weeks after discharge and the patient is also to follow up with the [**Hospital **] Clinic in four to five weeks after discharge for his distal clavicular fracture. Meanwhile, due to his altered mental status we are unable to clear his C spine, although radiological studies has shown no fracture. The patient is to remain on Aspen collar for about eight weeks from the day of discharge and the patient is to remain on trach collar. The patient can be weaned off vent as tolerated. The patient will be getting Impact with fiber tube feeds starting at 10 cc an hour and tube feeds can be advanced as tolerated to a goal of 70 cc per hour. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D. [**MD Number(1) 521**] Dictated By:[**Last Name (STitle) 46794**] MEDQUIST36 D: [**2146-10-12**] 12:38 T: [**2146-10-12**] 13:00 JOB#: [**Job Number 50133**]

807,486,518,276,592,591,810,E816

{'Closed fracture of multiple ribs, unspecified,Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Calculus of ureter,Hydronephrosis,Closed fracture of clavicle, unspecified part,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle'}

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 80 year-old male who was found down at home under his car after missing for three days most likely the patient rolled off the road and the patient was initially admitted to [**Hospital6 10443**], intubated and transferred here. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Closed fracture of multiple ribs, unspecified,Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Calculus of ureter,Hydronephrosis,Closed fracture of clavicle, unspecified part,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle'}

CHIEF COMPLAINT: Lethargy and Dizziness PRESENT ILLNESS: Mr. [**Known lastname 58995**] is a 76 year old gentleman status post AVR/CABGx3 [**2176-12-31**] by Dr. [**Last Name (Prefixes) **]. He was discharged home on [**2177-1-6**] on coumadin for atrial fibrillation. He was also on plavix and amiodarone. Roughly a day after discharge, Mr, [**Known lastname 58995**] began to feel progressively tired. He denies any chest pain, syncope or palpitations however did experience dysnea with laying flat. On [**2177-1-10**], he noticed that he passed bloody urine. Incidently he had fallen on his rightside two days prior. He presented to an outside emergency room where a CT scan of his pelvis and kidneys was unremarkable. His INR was 6.4 and a chest x-ray revealed cardiomegally with a left sided pleural effusion. He was diuresed and claims to have felt better. The urology service saw him and was planning lithotripsy as an outpatient for nephrolithiasis given his past history. Mr. [**Known lastname 58995**] was subsequently transferred back to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1675**] [**Last Name (NamePattern1) **] Medical Center given his hematuria, congestive heart failure, anemia and supratherapeutic INR. MEDICAL HISTORY: CABGx3/AVR [**2176-12-31**] Atrial Fibrillation Nephrolithiasis s/p stent Skin cancer Gout Knee arthroscopy Hyperlipidemia MEDICATION ON ADMISSION: MEDS ON TRANSFER: Lopressor 12.5mg twice daily Lasix 40mg twice daily Protonix 40mg once daily Alopurinol 150mg once daily 2% nitropaste Pravachol 20mg once daily Cephalexin 250mg four time daily Iron and folic acid Coumadin(on hold) ALLERGIES: Penicillins PHYSICAL EXAM: Gen: Well developed man in no acute distress VS: 116/58 64 SR Afebrile HEENT: Anicteric sclera, PERRL, EOMI, Oropharynx benign NECK: Supple LUNGS: Few scattered rales CARDIAC: RRR, III/VI systolic murmur ABDOMEN: Soft, nontender, nondistended EXT: 2+ lower extremity edema DERM: small rash on back NEURO: Nonfocal FAMILY HISTORY: Father died of CAD at age 56 Mother died of lung cancer SOCIAL HISTORY: 18 pack years of smoking, past alcohol abuse. Lives with wife.

Hemopericardium,Congestive heart failure, unspecified,Atrial fibrillation,Other and unspecified coagulation defects,Heart valve replaced by transplant,Aortocoronary bypass status,Calculus of kidney,Gout, unspecified,Pure hypercholesterolemia

Hemopericardium,CHF NOS,Atrial fibrillation,Coagulat defect NEC/NOS,Heart valve transplant,Aortocoronary bypass,Calculus of kidney,Gout NOS,Pure hypercholesterolem

Admission Date: [**2177-1-13**] Discharge Date: [**2177-1-19**] Date of Birth: [**2100-8-16**] Sex: M Service: CARDIOTHORACIC Allergies: Penicillins Attending:[**First Name3 (LF) 1283**] Chief Complaint: Lethargy and Dizziness Major Surgical or Invasive Procedure: [**2176-1-14**] Drainage of pericardial effusion [**Last Name (NamePattern4) 15255**] of Present Illness: Mr. [**Known lastname 58995**] is a 76 year old gentleman status post AVR/CABGx3 [**2176-12-31**] by Dr. [**Last Name (Prefixes) **]. He was discharged home on [**2177-1-6**] on coumadin for atrial fibrillation. He was also on plavix and amiodarone. Roughly a day after discharge, Mr, [**Known lastname 58995**] began to feel progressively tired. He denies any chest pain, syncope or palpitations however did experience dysnea with laying flat. On [**2177-1-10**], he noticed that he passed bloody urine. Incidently he had fallen on his rightside two days prior. He presented to an outside emergency room where a CT scan of his pelvis and kidneys was unremarkable. His INR was 6.4 and a chest x-ray revealed cardiomegally with a left sided pleural effusion. He was diuresed and claims to have felt better. The urology service saw him and was planning lithotripsy as an outpatient for nephrolithiasis given his past history. Mr. [**Known lastname 58995**] was subsequently transferred back to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1675**] [**Last Name (NamePattern1) **] Medical Center given his hematuria, congestive heart failure, anemia and supratherapeutic INR. Past Medical History: CABGx3/AVR [**2176-12-31**] Atrial Fibrillation Nephrolithiasis s/p stent Skin cancer Gout Knee arthroscopy Hyperlipidemia Social History: 18 pack years of smoking, past alcohol abuse. Lives with wife. Family History: Father died of CAD at age 56 Mother died of lung cancer Physical Exam: Gen: Well developed man in no acute distress VS: 116/58 64 SR Afebrile HEENT: Anicteric sclera, PERRL, EOMI, Oropharynx benign NECK: Supple LUNGS: Few scattered rales CARDIAC: RRR, III/VI systolic murmur ABDOMEN: Soft, nontender, nondistended EXT: 2+ lower extremity edema DERM: small rash on back NEURO: Nonfocal Pertinent Results: [**2177-1-13**] 10:04PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.015 [**2177-1-13**] 10:04PM URINE BLOOD-LGE NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG [**2177-1-13**] 10:04PM URINE RBC-97* WBC-3 BACTERIA-NONE YEAST-NONE EPI-<1 [**2177-1-13**] 10:04PM URINE MUCOUS-RARE [**2177-1-13**] - CXR Status post CABG/AVR. There is cardiomegaly but no evidence for CHF. There are small bilateral pleural effusions with associated atelectasis in the left lower lobe. No pneumothorax. [**2177-1-13**] - EKG Sinus bradycardia. Left atrial abnormality. Modest non-specific intraventricular conduction delay. Diffuse ST-T wave abnormalities with prolonged QTc interval. Clinical correlation is suggested for metabolic/drug effect. Since the previous tracing of [**2176-12-31**] sinus bradycardia rate has increased. No pacer activity is seen and further ST-T wave changes are present [**2177-1-14**] ECHO 1. The left atrium is mildly dilated. 2. The left ventricular cavity size is normal. Overall left ventricular systolic function cannot be reliably assessed. 3. The aortic root is mildly dilated. 4. A prosthetic aortic valve is present. 5. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. 6. There is a moderate sized (1-2 cm) pericardial effusion with fibrin deposits on the surface of the heart. Right ventricular compression is present, which suggests the presence of some tamponade. 7. Compared with the findings of the prior study (tape reviewed) of [**2176-12-24**], the pericardial effusion is new. [**2177-1-15**] CYTOLOGY Blood and rare reactive mesothelial cells [**2177-1-15**] ECHO The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). Segmental wall motion was not fully assessed. Right ventricular chamber size is normal. There is a small pericardial effusion. There are no echocardiographic signs of tamponade. Compared with the prior study (tape reviewed) of [**2177-1-14**], the pericardial effusion is now much smaller. [**2177-1-14**] PERICARDIOCENTESIS Right Heart Catheterization: was performed by percutaneous entry of the right femoral vein, using a 6 French pulmonary wedge pressure catheter, advanced to the PCW position through a 8 French introducing sheath. Cardiac output was measured by the Fick method. Pericardiocentesis: was performed via the subxyphoid approach, using an 18 gauge thin-wall needle, a guide wire, and a drainage catheter. Right femoral artery was accessed with a 4 French catheter from arterial hemodynamic monitoring. [**Last Name (NamePattern4) 4125**]ospital Course: Mr. [**Known lastname 58995**] was admitted to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1675**] [**Last Name (NamePattern1) **] Medical Center on [**2177-1-13**] for further management of his hematuria and congestive heart failure. An echocardiogram was performed which noted signs of tamponade. Given his elevated INR, fresh frozen plasma and vitamin K were given for reversal. On [**2177-1-14**], Mr. [**Known lastname 58995**] was taken to the cardiac catheterization lab where he underwent pericardiocentesis with drainage of 350cc's of blood fluid. He was transferred to the cardiac surgical intensive care unit for monitoring. The urology service was consulted for hematuria however as Mr. [**Known lastname 58995**] was already under the care of an outside urologist, he elected to have follow-up with his outpatient urologist. Hie foley catheter drianage cleared from pink to yellow. On [**2177-1-16**], his pericardial drain was removed without issue. A repeat echocardiogram showed a significant improvement in his pericardial effusion. Anticoagulation was resumed for his paroxysmal atrial fibrillation. Mr. [**Known lastname **] was transferred to the cardiac surgical step down unit for further recovery. Gentle diuresis continued. The electrophysiology service was consulted for assistance with his atrial fibrillation. His amiodarone dose was decreased and it was elected to wait one week prior to resuming his coumadin. On [**2177-1-17**], Mr. [**Known lastname 58995**] was discharged home. He will follow-up with Dr. [**Last Name (Prefixes) **], his cardiologist and his primary care physician as instructed. Medications on Admission: MEDS ON TRANSFER: Lopressor 12.5mg twice daily Lasix 40mg twice daily Protonix 40mg once daily Alopurinol 150mg once daily 2% nitropaste Pravachol 20mg once daily Cephalexin 250mg four time daily Iron and folic acid Coumadin(on hold) Discharge Medications: 1. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H (every 12 hours) for 7 days. Disp:*14 Packet(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 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:*2* 4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 6. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 7. Pravastatin Sodium 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Allopurinol 300 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7 days. Disp:*14 Tablet(s)* Refills:*0* 10. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO once a day: RESTART ON TUESDAY. Disp:*30 Tablet(s)* Refills:*2* 1. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H (every 12 hours) for 7 days. Disp:*14 Packet(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 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:*2* 4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 6. Multivitamin Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 7. Pravastatin Sodium 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Allopurinol 300 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7 days. Disp:*14 Tablet(s)* Refills:*0* 10. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO once a day: RESTART ON TUESDAY. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: vna of [**Location (un) **] Discharge Diagnosis: pericardial effusion AFib Discharge Condition: good Discharge Instructions: no lifting > 10 # for 1 month no creams or lotions to incisions may shower, no bathing or swimming for 1 month [**Last Name (NamePattern4) 2138**]p Instructions: with Dr. [**Last Name (STitle) **] in [**12-15**] weeks with Dr. [**Last Name (Prefixes) **] in [**2-14**] weeks with Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 22784**] in [**2-14**] weeks Completed by:[**2177-2-7**]

423,428,427,286,V422,V458,592,274,272

{'Hemopericardium,Congestive heart failure, unspecified,Atrial fibrillation,Other and unspecified coagulation defects,Heart valve replaced by transplant,Aortocoronary bypass status,Calculus of kidney,Gout, unspecified,Pure hypercholesterolemia'}

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: Lethargy and Dizziness PRESENT ILLNESS: Mr. [**Known lastname 58995**] is a 76 year old gentleman status post AVR/CABGx3 [**2176-12-31**] by Dr. [**Last Name (Prefixes) **]. He was discharged home on [**2177-1-6**] on coumadin for atrial fibrillation. He was also on plavix and amiodarone. Roughly a day after discharge, Mr, [**Known lastname 58995**] began to feel progressively tired. He denies any chest pain, syncope or palpitations however did experience dysnea with laying flat. On [**2177-1-10**], he noticed that he passed bloody urine. Incidently he had fallen on his rightside two days prior. He presented to an outside emergency room where a CT scan of his pelvis and kidneys was unremarkable. His INR was 6.4 and a chest x-ray revealed cardiomegally with a left sided pleural effusion. He was diuresed and claims to have felt better. The urology service saw him and was planning lithotripsy as an outpatient for nephrolithiasis given his past history. Mr. [**Known lastname 58995**] was subsequently transferred back to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1675**] [**Last Name (NamePattern1) **] Medical Center given his hematuria, congestive heart failure, anemia and supratherapeutic INR. MEDICAL HISTORY: CABGx3/AVR [**2176-12-31**] Atrial Fibrillation Nephrolithiasis s/p stent Skin cancer Gout Knee arthroscopy Hyperlipidemia MEDICATION ON ADMISSION: MEDS ON TRANSFER: Lopressor 12.5mg twice daily Lasix 40mg twice daily Protonix 40mg once daily Alopurinol 150mg once daily 2% nitropaste Pravachol 20mg once daily Cephalexin 250mg four time daily Iron and folic acid Coumadin(on hold) ALLERGIES: Penicillins PHYSICAL EXAM: Gen: Well developed man in no acute distress VS: 116/58 64 SR Afebrile HEENT: Anicteric sclera, PERRL, EOMI, Oropharynx benign NECK: Supple LUNGS: Few scattered rales CARDIAC: RRR, III/VI systolic murmur ABDOMEN: Soft, nontender, nondistended EXT: 2+ lower extremity edema DERM: small rash on back NEURO: Nonfocal FAMILY HISTORY: Father died of CAD at age 56 Mother died of lung cancer SOCIAL HISTORY: 18 pack years of smoking, past alcohol abuse. Lives with wife. ### Response: {'Hemopericardium,Congestive heart failure, unspecified,Atrial fibrillation,Other and unspecified coagulation defects,Heart valve replaced by transplant,Aortocoronary bypass status,Calculus of kidney,Gout, unspecified,Pure hypercholesterolemia'}

CHIEF COMPLAINT: Presented with respiratory distress to outside hospital. Transferred to [**Hospital1 18**] intubated with left lower lobe pneumonia and positive cardiac biomarkers. PRESENT ILLNESS: 72yo male with EtOH abuse, HTN, Afib, TIA/Stroke, pulmonary HTN, and [**Hospital 2182**] transferred from [**Location (un) 620**] Hopsital with LLL PNA and +biomarkers. Presented to outside hospital on [**2183-1-6**]. He complained of cough, congestion, fever, sweats, and fatigue with worsening SOB prior to admission. In the OSH ED, initial vitals on [**2183-1-6**] were HR78, RR 20, BP 155/78, 97% on RA, Temp 102.2. At OSH WBC 6.7, Hgb 11.1, Plt 134, 96.6% PMNs. LLL PNA on CXray. Intubated for respiratory tiring on morning of [**1-7**]. PNA treated with azithromycin/ceftriaxone. Resp distress treated with duoneb Q4, methylprednisolone, fluticasone, furosemide. Cardiac biomarkers noted to be positive. Started heparin drip and gave 81mg ASA. Transferred to [**Hospital1 18**] intubated with CMV of 16, FiO2 of 100%, tidal volume of 550, PEEP 5.0. HR of 49. On transfer MAPs <65 and patient received norepinephrine, hypotension resolved prior to arrival at [**Hospital1 18**]. MEDICAL HISTORY: PAST MEDICAL HISTORY: (per OSH notes, patient intubated) 1. CARDIAC RISK FACTORS: Hypertension 2. CARDIAC HISTORY: -CARDIAC DYSRHYTHMIAS NEC, -ATRIAL FIBRILLATION 3. OTHER PAST MEDICAL HISTORY: TIA [**2172**] Lacunar infarct on imaging (left external capsule) Mucus retention cyst in right maxillary sinus Arachnoid cysts in left temporal fossa on imaging Shingles [**2182-9-29**]. GERD Prostate CA s/p radiation Peripheral neuropathy Macular degeneration Retinal artery occlusion in left eye Cardiomyopathy ?EtOH related EOSINOPHILIC ESOPHAGITIS Schatzki's ring (ESOPHAGEAL STRICTURE) FOREIGN BODY ESOPHAGUS GLAUCOMA ?COPD (AIRWAY OBSTRUCTIVE/RESTRICTIVE DISEASE)and EMPHYSEMATOUS BLEB Pulmonary hypertension. DIVERTICULOSIS COLON (W/O MENT OF HEMORRHAGE) +[**Doctor First Name **] (1:1280) MEDICATION ON ADMISSION: Home medications: Tylenol Metoprolol ER 25mg QD Neurontin 100mg TID Symbicort inhaler Flonase Timolol eye drops [**Hospital1 **] ASA 325mg QD Lumigan one drop QD Zyrtec Vitamin B12 ALLERGIES: Lisinopril / Amlodipine PHYSICAL EXAM: PHYSICAL EXAMINATION: at admission VS: BP=101/62...HR=54 (AFib)...RR=13...O2 sat=97% intubation 50% FiO2, CMV/AS, minTV 600mL (824 observed) GENERAL: Intubated. HEENT: NCAT. Sclera anicteric. Pupils 3mm->2mm reactive to light. No xanthalesma. Dry MM without visible lesions on tongue/lips. NECK: Supple without visible JVP. CARDIAC: PMI not palpated. Slow rate normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Coarse breath sounds bilaterally at anterior and lateral axillary fields. ABDOMEN: Soft, ND. Abd aorta not enlarged by palpation. Normal BS. No abdominial bruits. EXTREMITIES: No clubbing, cyanosis, edema. Cool [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]/l. SKIN: Skin demonstrates diffuse/coalescing maculopapular erythematous rash with plaques/erosions on extremities and torso. PULSES: Weak 1 DP pules, 2 radial pulses b/l. FAMILY HISTORY: 2 daughters and son healthy. Father died of heart attack and CVA at 80yo. Mother had dementia and expired at age [**Age over 90 **]. Brother and older sister are healthy. SOCIAL HISTORY: Past autobody worker. Lives with wife of 50yrs in [**Location (un) 13588**]. -Tobacco history: quit 30 yrs ago, 40pkyr history. -ETOH: Alcohol abuse 7-8drinks/day, last drink [**1-5**]. Independent with ADLs

Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Lupus erythematosus,Unspecified essential hypertension,Other chronic pulmonary heart diseases,Chronic airway obstruction, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Other late effects of cerebrovascular disease,Long QT syndrome,Personal history of malignant neoplasm of prostate,Other and unspecified alcohol dependence, unspecified

Subendo infarct, initial,Pneumonia, organism NOS,Hyposmolality,Prim cardiomyopathy NEC,Crnry athrscl natve vssl,Atrial fibrillation,Lupus erythematosus,Hypertension NOS,Chr pulmon heart dis NEC,Chr airway obstruct NEC,Idio periph neurpthy NOS,Late effect CV dis NEC,Long QT syndrome,Hx-prostatic malignancy,Alcoh dep NEC/NOS-unspec

Admission Date: [**2183-1-7**] Discharge Date: [**2183-1-13**] Date of Birth: [**2110-12-14**] Sex: M Service: MEDICINE Allergies: Lisinopril / Amlodipine Attending:[**First Name3 (LF) 443**] Chief Complaint: Presented with respiratory distress to outside hospital. Transferred to [**Hospital1 18**] intubated with left lower lobe pneumonia and positive cardiac biomarkers. Major Surgical or Invasive Procedure: Percutaneous Coronary Intervention with Bare Metal Stent to LAD. History of Present Illness: 72yo male with EtOH abuse, HTN, Afib, TIA/Stroke, pulmonary HTN, and [**Hospital 2182**] transferred from [**Location (un) 620**] Hopsital with LLL PNA and +biomarkers. Presented to outside hospital on [**2183-1-6**]. He complained of cough, congestion, fever, sweats, and fatigue with worsening SOB prior to admission. In the OSH ED, initial vitals on [**2183-1-6**] were HR78, RR 20, BP 155/78, 97% on RA, Temp 102.2. At OSH WBC 6.7, Hgb 11.1, Plt 134, 96.6% PMNs. LLL PNA on CXray. Intubated for respiratory tiring on morning of [**1-7**]. PNA treated with azithromycin/ceftriaxone. Resp distress treated with duoneb Q4, methylprednisolone, fluticasone, furosemide. Cardiac biomarkers noted to be positive. Started heparin drip and gave 81mg ASA. Transferred to [**Hospital1 18**] intubated with CMV of 16, FiO2 of 100%, tidal volume of 550, PEEP 5.0. HR of 49. On transfer MAPs <65 and patient received norepinephrine, hypotension resolved prior to arrival at [**Hospital1 18**]. Past Medical History: PAST MEDICAL HISTORY: (per OSH notes, patient intubated) 1. CARDIAC RISK FACTORS: Hypertension 2. CARDIAC HISTORY: -CARDIAC DYSRHYTHMIAS NEC, -ATRIAL FIBRILLATION 3. OTHER PAST MEDICAL HISTORY: TIA [**2172**] Lacunar infarct on imaging (left external capsule) Mucus retention cyst in right maxillary sinus Arachnoid cysts in left temporal fossa on imaging Shingles [**2182-9-29**]. GERD Prostate CA s/p radiation Peripheral neuropathy Macular degeneration Retinal artery occlusion in left eye Cardiomyopathy ?EtOH related EOSINOPHILIC ESOPHAGITIS Schatzki's ring (ESOPHAGEAL STRICTURE) FOREIGN BODY ESOPHAGUS GLAUCOMA ?COPD (AIRWAY OBSTRUCTIVE/RESTRICTIVE DISEASE)and EMPHYSEMATOUS BLEB Pulmonary hypertension. DIVERTICULOSIS COLON (W/O MENT OF HEMORRHAGE) +[**Doctor First Name **] (1:1280) Social History: Past autobody worker. Lives with wife of 50yrs in [**Location (un) 13588**]. -Tobacco history: quit 30 yrs ago, 40pkyr history. -ETOH: Alcohol abuse 7-8drinks/day, last drink [**1-5**]. Independent with ADLs Family History: 2 daughters and son healthy. Father died of heart attack and CVA at 80yo. Mother had dementia and expired at age [**Age over 90 **]. Brother and older sister are healthy. Physical Exam: PHYSICAL EXAMINATION: at admission VS: BP=101/62...HR=54 (AFib)...RR=13...O2 sat=97% intubation 50% FiO2, CMV/AS, minTV 600mL (824 observed) GENERAL: Intubated. HEENT: NCAT. Sclera anicteric. Pupils 3mm->2mm reactive to light. No xanthalesma. Dry MM without visible lesions on tongue/lips. NECK: Supple without visible JVP. CARDIAC: PMI not palpated. Slow rate normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Coarse breath sounds bilaterally at anterior and lateral axillary fields. ABDOMEN: Soft, ND. Abd aorta not enlarged by palpation. Normal BS. No abdominial bruits. EXTREMITIES: No clubbing, cyanosis, edema. Cool [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]/l. SKIN: Skin demonstrates diffuse/coalescing maculopapular erythematous rash with plaques/erosions on extremities and torso. PULSES: Weak 1 DP pules, 2 radial pulses b/l. Pertinent Results: [**2183-1-7**] Echo: 30-35% EF with moderately dilated RA, mild LVH, RV cavity, moderate regional left ventricular systolic dysfunction w/ akinesis of mid-distal septum and apex. . Admission Labs [**2183-1-7**]: 07:11PM CBC WBC-3.2* RBC-3.01* Hgb-9.7* Hct-28.8* MCV-96 MCH-32.3* MCHC-33.8 RDW-12.8 Plt Ct-136* 07:11PM BLOOD PT-11.8 PTT-78.0* INR(PT)-1.0 07:11PM BLOOD Glucose-162* UreaN-26* Creat-1.2 Na-132* K-4.2 Cl-100 HCO3-22 AnGap-14 07:11PM Calcium-7.7* Phos-4.6* Mg-2.0 . Other labs: 07:11PM BLOOD TSH-0.23* [**2183-1-9**] 02:55AM BLOOD [**Doctor First Name **]-POSITIVE * Titer-1:1280, Anti-Histone pending. Anti-Ro pending. Anti-[**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]. [**2183-1-8**] 04:22AM BLOOD Type-ART Temp-36.2 pO2-166* pCO2-37 pH-7.37 calTCO2-22 Base XS--3 [**2183-1-7**] 03:59AM ALT-16 AST-35 CK(CPK)-77 AlkPhos-58 TotBili-0.3 . Cardiac Biomarkers: [**2183-1-7**] 07:11PM BLOOD CK-MB-10 MB Indx-9.8 cTropnT-0.51* [**2183-1-8**] 03:59AM BLOOD cTropnT-0.33* . Microbiology: -VARICELLA-ZOSTER CULTURE (Preliminary): No Virus isolated so far. -DIRECT INFLUENZA A ANTIGEN TEST (Final [**2183-1-8**]):Negative for Influenza A. -DIRECT INFLUENZA B ANTIGEN TEST (Final [**2183-1-8**]):Negative for Influenza B. -Legionella Urinary Antigen (Final [**2183-1-8**]): NEGATIVE FOR LEGIONELLA SEROGROUP 1 ANTIGEN. -[**2183-1-8**] 4:00 am SPUTUM Endotracheal. **FINAL REPORT [**2183-1-10**]** --GRAM STAIN (Final [**2183-1-8**]): >25 PMNs and <10 epithelial cells/100X field. NO MICROORGANISMS SEEN. --RESPIRATORY CULTURE (Final [**2183-1-10**]): Commensal Respiratory Flora Absent. YEAST. RARE GROWTH. -URINE CULTURE (Final [**2183-1-9**]): NO GROWTH. -[**2183-1-8**] 4:00 am BLOOD CULTURE Blood Culture, Routine (Pending) -[**2183-1-8**] 3:59 am BLOOD CULTURE Blood Culture, Routine (Pending) -MRSA SCREEN (Final [**2183-1-10**]): No MRSA isolated. . Discharge Labs: [**2183-1-13**] 07:15AM BLOOD WBC-3.9* RBC-2.94* Hgb-9.3* Hct-27.6* MCV-94 MCH-31.6 MCHC-33.7 RDW-13.0 Plt Ct-189 [**2183-1-13**] 07:15AM BLOOD PT-14.0* PTT-25.6 INR(PT)-1.2* [**2183-1-13**] 07:15AM BLOOD Glucose-93 UreaN-18 Creat-0.8 Na-140 K-4.0 Cl-108 HCO3-24 AnGap-12 . Cardiology Report Cardiac Cath Study Date of [**2183-1-10**] COMMENTS: 1. Selective coronary angiography in this right dominant system demonstrated single vessel disease. The LMCA, LCx and RCA were normal. The LAD had an 80% calcified stenosis after S1. 2. Resting hemodynamics revealed elevated right and left sided filling pressures with RVEDP of 16 mm Hg and LVEDP of 16 mm Hg. There was moderate pulmonary artery systolic hypertension with PASP of 49 mm Hg. The cardiac index was preserved at 3.1 l/min/m2. There was moderate systemic arterial hypertension with SBP of 146 mm Hg and DBP of 73 mm Hg. 3. Left ventriculography revealed no mitral regurgitation. The LVEF was calculated to be 60% with anteroapical hypokinesis. 4. Successful PTCA, rotational atherectomy, and placement of a 2.75x15mm Vision bare-metal stent in the mid RCA were performed. Final angiography showed normal flow, no apparent dissection, and a 5% residual stenosis. (See PTCA comments.) 5. The right common femoral arteriotomy was successfully closed using a 6 Fr Angioseal VIP device. FINAL DIAGNOSIS: 1. One vessel coronary artery disease. 2. Placement of a bare metal stent in the mid LAD. . Cardiology Report ECG Study Date of [**2183-1-7**] 6:32:36 PM Atrial fibrillation with slow ventricular response. Prolonged QTc interval. Anterolateral ST-T wave changes suggestive of myocardial ischemia. Low QRS voltages in the limb leads. No previous tracing available for comparison. Clinical correlation is suggested. Read by: [**Last Name (LF) **],[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10592**] Intervals Axes Rate PR QRS QT/QTc P QRS T 46 0 100 560/535 0 43 107 . . Cardiology Report ECG Study Date of [**2183-1-8**] 12:31:40 PM Atrial fibrillation with slow ventricular response. Compared to the previous tracing of [**2183-1-7**] there is further evolution of acute anterolateral and apical myocardial infarction and continued Q-T interval prolongation. Clinical correlation is suggested. Intervals Axes Rate PR QRS QT/QTc P QRS T 47 0 106 566/543 0 21 174 . . Radiology Report CHEST (PORTABLE AP) Study Date of [**2183-1-7**] 7:27 PM Heart is moderately enlarged, mediastinal veins are engorged suggesting elevated central venous pressure. Large area of heterogeneous opacification in the left perihilar and lower lung is most likely pneumonia or large region of pulmonary hemorrhage. Suggestion of lucencies raises questions about cavitation or preexisting cavitated nodules. Right lung is grossly clear, but anatomic detail is obscured by respiratory motion. Right subclavian line tip projects over the junction of the brachiocephalic veins. No pneumothorax or appreciable pleural effusion. Brief Hospital Course: Mr. [**Name14 (STitle) 86613**] is a 72 year-old male who presented intubated from an outside hospital with positive cardiac biomarkers and LLL PNA. #Type 2 Myocardial Infarction: Patient was transferred from outside hospital on heparin drip with concern for NSTEMI. After admission cardiac biomarkers trended down. Troponin T at OSH was 0.758 and repeated values at [**Hospital1 18**] were 0.51 to 0.33. CKMB at [**Hospital1 18**] was within normal limits. Patient did not complain of chest pain since extubation on [**1-8**]. Ischemic disease thought to have been precipitated by infection. Patient was initially loaded on clopidogrel and continued on 75mg daily. Patient underwent Cardiac Catheterization [**1-10**] which demonstrated mid-distal anterolateral hypokinesis and one vessel disease in the mid LAD, 80% stenosis. After insufficient expansion with angioplasty, cutting balloon rotablade was employed and then an 2.75x15mm BMS was placed with good angio result noted afterwards. LVEDP 15-20. Patient will need to continue on plavix for one year, not to be stopped unless approved by his cardiologist. He will follow up with a cardiologist at [**Hospital1 **] in one month. Patient will need a repeat echocardiogram 4-6 weeks. #Pneumonia: Patient was transferred to [**Hospital1 18**] on [**1-7**] intubated on ceftriaxone and azithromycin for pneumonia. Chest x-ray confirmed left lower lobe opacity consistent with pneumonia. Patient was successfully extubated on [**1-8**] and required supplemental oxygen for several days. Patient's pneumonia was treated with antibiotics for 7 days. Initial ceftriaxone/azithromycin treatment from OSH was changed to vancomycin/cefepime/azithromicin at [**Hospital1 18**] out of concern for hospital acquired pneumonia. Azithromycin was stopped on [**1-9**] due to prolonged QTc and low suspicion for atypical infection. Negative blood cultures and rapid improvement caused team to discontinue vancomycin and transition back from cefepime to ceftriaxone, which was last given on [**2183-1-13**]. [**Last Name (un) **] Legionella, varicella, flu, blood cultures, and urine cultures were negative throughout admission. Sputum culture revealed only normal flora; patient had already started antibiotic treatment at outside hospital prior to sputum sample. #Atrial Fibrillation. Per patient's daughter, he is always bradycardic. He does not take any nodal agents at home. CHADS2 score of 4 (CHF, HTN, TIA, age) concerning for stoke risk, but patient is chronic alcoholic and a fall risk which may be why he was not anticoagulated on coumadin. Patient was in atrial fibrillation with slow ventricular response throughout admission. He was transitioned from the heparin drip to coumadin. Patient had presumably not been on coumadin in the past due to alcohol abuse and fall risk, so PCP may decide to discontinue long-term anticoagulation. PCP will follow up within several days of discharge. Visiting nursing services have been arranged to check INR and evaluate for safety as well as drug compliance. TSH was low during admission and should be rechecked as outpatient once acute illness has resolved. #Rash. Dermatology was consulted at outside hospital for diffuse rash; biopsy suggested focal interface change consistent with drug eruption or drug-induced lupus erythematosis. Drug-induced lupus more likely given subsequently positive [**Doctor First Name **]. Dermatology suggested amlodipine or lisinopril as possible culprits. Lisinopril had previously been discontinued on [**2183-1-1**] and amlodipine was stopped [**2183-1-6**] at OSH admission. Rash began 1 month ago as vesicles which coalesced. Rash was intermittently pruritic and painful. [**Hospital1 18**] Dermatolgy consult stated that Drug Induced Lupus may persist for days/months following discontinuation of offending [**Doctor Last Name 360**]. Negative anti-histone antibody makes drug-induced SLE less likely and sub-acute cutaneous lupus (SCLE) more likely. Anti-Ro and -[**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 32545**] are pending and will help support diagnosis of SCLE. Patient was treated with 0.1% triamcinolone cream during admission with some improvement in rash noted throughout hospitalization. #COPD. Patient was treated for COPD throughout stay with albuterol and ipratropium nebulizers as needed and twice daily fluticasone/salmeterol. #Blood pressure. Patient was initially hypotensive on admission. Patient has chronic hypertensive history, but his lisinopril and amlodipine have been stopped out of concern for rash effect. Patient was discharged on valsartan 80mg and hydrochlorothiazide 12.5mg after becoming hypertensive the day prior to discharge. # Prolonged QTc. Likely medication side-effect. We also considered contribution of ischemic heart disease. Azithromycin was stopped for long QTc and this resolved. #Hyponatremia Presented with mild hyponatremia to 132, likely due to volume loss. Sodium normalized during hospitalization. #EtOH abuse. Patient reportedly was having alcohol withdrawal symptoms at outside hospital. Patient did not require diazepam for CIWA scale at [**Hospital1 18**] after sedative midazolam was stopped post extubation. Patient was placed on folate and thiamine supplementation. # Glaucoma. Patient was treated on Latanoprost throughout admission and discharged back to home bimatoprost/timolol regimen. Medications on Admission: Home medications: Tylenol Metoprolol ER 25mg QD Neurontin 100mg TID Symbicort inhaler Flonase Timolol eye drops [**Hospital1 **] ASA 325mg QD Lumigan one drop QD Zyrtec Vitamin B12 Discharge Medications: 1. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). [**Hospital1 **]:*60 Tablet(s)* Refills:*2* 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Hospital1 **]:*30 Tablet(s)* Refills:*2* 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Hospital1 **]:*30 Tablet(s)* Refills:*2* 4. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Hospital1 **]:*30 Tablet(s)* Refills:*2* 5. Triamcinolone Acetonide 0.1 % Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). [**Hospital1 **]:*1 tube* Refills:*5* 6. Diovan HCT 80-12.5 mg Tablet Sig: One (1) Tablet PO once a day. [**Hospital1 **]:*30 Tablet(s)* Refills:*2* 7. Bimatoprost 0.03 % Drops Sig: One (1) drop Ophthalmic once a day. 8. Symbicort 80-4.5 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) puffs Inhalation twice a day. 9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day. 10. Warfarin 2.5 mg Tablet Sig: Two (2) Tablet PO once a day: Please take medication at 4pm, you will need to get your INR checked and this medication will be adjusted by your primary care physician. [**Name Initial (NameIs) **]:*60 Tablet(s)* Refills:*2* 11. Timolol Ophthalmic 12. Flonase 50 mcg/Actuation Spray, Suspension Sig: Two (2) Nasal twice a day. 13. Zyrtec Oral 14. Vitamin B-12 Oral 15. Outpatient Lab Work Please have your INR drawn on [**2183-1-16**] and have the results faxed to Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 36518**]. Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Primary Diagnosis: Left Lower Lobe Pneumonia Type II Myocardial Infarction Secondary Diagnoses: Atrial Fibrillation with Slow Ventricular Response Hypertension Rash Glaucoma Chronic Obstructive Pulmonary Disease Discharge Condition: Stable, chest pain free. Alert and Oriented. Ambulatory with Walker. Discharge Instructions: Dear Mr. [**Known lastname 86614**], You were admitted to the hospital because you were found to have a Left sided pneumonia and had some heart injury. You were transferred from [**Hospital1 **] with a mechanical ventilator, which was successfully removed. You were treated for the pneumonia with antibiotics. You underwent a Cardiac Catheterization and stenting procedure to improve blood supply to your heart. The following changes have been made to your medications: New Medications: -Warfarin 5mg (2 tablets of 2.5 mg) every day at 4pm. -Clopidogrel 75mg every day. -Simvastatin 80mg every day. -Diovan (80mg valsartan and 12.5mg hydrochlorothiazide) every day. -Triamcinolone 0.1% ointment applied to rash twice a day. -Folic acid 1mg every day. -Thiamine 100mg every day. Continue the following medications as previously: -Aspirin 325mg every day. -Symbicort -Timolol -Bimatoprost(Lumigan) -Flonase -Zyrtec -Vitamin B12 Stop taking following medications: -Metoprolol -Neurontin -Lisinopril -Amlodipine (Norvasc) Please be sure to keep all of your followup appointments. Please seek medical attention if you experience any symptoms concerning to you. Followup Instructions: Please be sure to make and keep all of your followup appointments: -Appointment with your PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 450**] [**Last Name (NamePattern1) **] or covering physician([**Telephone/Fax (1) 6163**]) this week, preferably Wednesday. You will need to discuss your warfarin treatment with her. -Schedule a cardiology appointment with [**Location (un) 620**] Cardiology ([**Telephone/Fax (1) 4105**]) in approximately 1 month. You will need an echocardiogram 4-6 weeks.

410,486,276,425,414,427,695,401,416,496,356,438,426,V104,303

{'Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Lupus erythematosus,Unspecified essential hypertension,Other chronic pulmonary heart diseases,Chronic airway obstruction, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Other late effects of cerebrovascular disease,Long QT syndrome,Personal history of malignant neoplasm of prostate,Other and unspecified alcohol dependence, unspecified'}

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: Presented with respiratory distress to outside hospital. Transferred to [**Hospital1 18**] intubated with left lower lobe pneumonia and positive cardiac biomarkers. PRESENT ILLNESS: 72yo male with EtOH abuse, HTN, Afib, TIA/Stroke, pulmonary HTN, and [**Hospital 2182**] transferred from [**Location (un) 620**] Hopsital with LLL PNA and +biomarkers. Presented to outside hospital on [**2183-1-6**]. He complained of cough, congestion, fever, sweats, and fatigue with worsening SOB prior to admission. In the OSH ED, initial vitals on [**2183-1-6**] were HR78, RR 20, BP 155/78, 97% on RA, Temp 102.2. At OSH WBC 6.7, Hgb 11.1, Plt 134, 96.6% PMNs. LLL PNA on CXray. Intubated for respiratory tiring on morning of [**1-7**]. PNA treated with azithromycin/ceftriaxone. Resp distress treated with duoneb Q4, methylprednisolone, fluticasone, furosemide. Cardiac biomarkers noted to be positive. Started heparin drip and gave 81mg ASA. Transferred to [**Hospital1 18**] intubated with CMV of 16, FiO2 of 100%, tidal volume of 550, PEEP 5.0. HR of 49. On transfer MAPs <65 and patient received norepinephrine, hypotension resolved prior to arrival at [**Hospital1 18**]. MEDICAL HISTORY: PAST MEDICAL HISTORY: (per OSH notes, patient intubated) 1. CARDIAC RISK FACTORS: Hypertension 2. CARDIAC HISTORY: -CARDIAC DYSRHYTHMIAS NEC, -ATRIAL FIBRILLATION 3. OTHER PAST MEDICAL HISTORY: TIA [**2172**] Lacunar infarct on imaging (left external capsule) Mucus retention cyst in right maxillary sinus Arachnoid cysts in left temporal fossa on imaging Shingles [**2182-9-29**]. GERD Prostate CA s/p radiation Peripheral neuropathy Macular degeneration Retinal artery occlusion in left eye Cardiomyopathy ?EtOH related EOSINOPHILIC ESOPHAGITIS Schatzki's ring (ESOPHAGEAL STRICTURE) FOREIGN BODY ESOPHAGUS GLAUCOMA ?COPD (AIRWAY OBSTRUCTIVE/RESTRICTIVE DISEASE)and EMPHYSEMATOUS BLEB Pulmonary hypertension. DIVERTICULOSIS COLON (W/O MENT OF HEMORRHAGE) +[**Doctor First Name **] (1:1280) MEDICATION ON ADMISSION: Home medications: Tylenol Metoprolol ER 25mg QD Neurontin 100mg TID Symbicort inhaler Flonase Timolol eye drops [**Hospital1 **] ASA 325mg QD Lumigan one drop QD Zyrtec Vitamin B12 ALLERGIES: Lisinopril / Amlodipine PHYSICAL EXAM: PHYSICAL EXAMINATION: at admission VS: BP=101/62...HR=54 (AFib)...RR=13...O2 sat=97% intubation 50% FiO2, CMV/AS, minTV 600mL (824 observed) GENERAL: Intubated. HEENT: NCAT. Sclera anicteric. Pupils 3mm->2mm reactive to light. No xanthalesma. Dry MM without visible lesions on tongue/lips. NECK: Supple without visible JVP. CARDIAC: PMI not palpated. Slow rate normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Coarse breath sounds bilaterally at anterior and lateral axillary fields. ABDOMEN: Soft, ND. Abd aorta not enlarged by palpation. Normal BS. No abdominial bruits. EXTREMITIES: No clubbing, cyanosis, edema. Cool [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]/l. SKIN: Skin demonstrates diffuse/coalescing maculopapular erythematous rash with plaques/erosions on extremities and torso. PULSES: Weak 1 DP pules, 2 radial pulses b/l. FAMILY HISTORY: 2 daughters and son healthy. Father died of heart attack and CVA at 80yo. Mother had dementia and expired at age [**Age over 90 **]. Brother and older sister are healthy. SOCIAL HISTORY: Past autobody worker. Lives with wife of 50yrs in [**Location (un) 13588**]. -Tobacco history: quit 30 yrs ago, 40pkyr history. -ETOH: Alcohol abuse 7-8drinks/day, last drink [**1-5**]. Independent with ADLs ### Response: {'Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Lupus erythematosus,Unspecified essential hypertension,Other chronic pulmonary heart diseases,Chronic airway obstruction, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Other late effects of cerebrovascular disease,Long QT syndrome,Personal history of malignant neoplasm of prostate,Other and unspecified alcohol dependence, unspecified'}