CHIEF COMPLAINT: Chest pain and hypoxia.

PRESENT ILLNESS: 63 F with pmhx of p/w acute SOB, chest tightness under breasts
with no radiation for 2 days, initially noted it while
ambulating with walker to bathroom. She otherwise had noted
bilateral swelling in her lower extremities over 1 week, and
with bluish discoloration of the RLE, she denies air travel,
smoking, however has been relatively immobile since last year
after being hosp for bacteremia.

MEDICAL HISTORY: 1. Cervical and lumbar spondylosis.
   - Anterior cervical corpectomy and fusion at C3 to C7 in
[**2173-11-23**].
   - C7 through T1 laminectomies and partial laminectomy of C6
and T2 on [**2176-4-23**]
   - L4-L4 laminectomy in [**2166**].
   - L2-S1 spinal fusion in [**2169**].
   - L1 stimulator ? in [**2170**].
2. Osteoarthritis, status post bilateral shoulder surgery.
3. Hypertension
4. Hypercholesterolemia
5. Hypothyroidism
6. MSSA infections associated with hardware- on suppressive doxy

MEDICATION ON ADMISSION: 1. Alendronate 70 mg qweek
2. Amitriptyline 100 mg daily
3. Aspirin 325 mg daily
4. Atenolol 25 mg daily
5. Calcium 600 mg [**Hospital1 **]
6. Celebrex *NF* 200 mg Oral [**Hospital1 **]
7. Docusate Sodium 100 mg PO BID
8. Doxycycline Hyclate 100 mg PO Q12H
9. Furosemide 40 mg [**Hospital1 **]
10. Glucosamine/chondroitin by mouth [**Hospital1 **]
11. Levothyroxine Sodium 150 mcg PO DAILY
12. Omeprazole 20 mg daily
13. Percocet 5/325 mg [**Hospital1 **]
14. Senna 1 TAB PO BID:PRN
15. Simvastatin 20 mg PO DAILY
16. Spironolactone 50 mg daily
17. Valsartan 20 mg daily

ALLERGIES: E-Mycin / Flagyl

PHYSICAL EXAM: Tm P 115 121/68 92 RR 20 98% NRB
Gen: NAD, speaking in full sentences
HEENT: PERRL, EOMI, dry MM, JVD flat,
Lungs: CTA b/l
CV: s1/s2, rrr no mrg nondisplaced PMI
ABD: +BS nt/nd no organomegaly
ext: no c/c, hands ulnar deviation, b/l 1+ pitting edema
dp 2+
neuro: aaox3, cnii-cnxii intact, no focal deficits

FAMILY HISTORY: She had a father with a transient ischemic attack. Both parents
have hypertension. There is no family history of coronary artery
disease or diabetes.

SOCIAL HISTORY: The patient has not smoked for the past 30 years. She has never
had alcohol. Denies any history of illicit drug use.
Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Unspecified acquired hypothyroidism,Long-term (current) use of antibiotics
Pulm embol/infarct NEC,Pneumonia, organism NOS,Acute kidney failure NOS,CHF NOS,Pure hypercholesterolem,Hypertension NOS,Loc osteoarth NOS-shlder,Hypothyroidism NOS,Long-term use antibiotic
Admission Date:  [**2179-3-25**]              Discharge Date:   [**2179-4-2**]

Date of Birth:  [**2115-4-1**]             Sex:   F

Service: MEDICINE

Allergies:
E-Mycin / Flagyl

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Chest pain and hypoxia.

Major Surgical or Invasive Procedure:
1. IVC filter placement ([**2179-3-26**]).


History of Present Illness:
63 F with pmhx of p/w acute SOB, chest tightness under breasts
with no radiation for 2 days, initially noted it while
ambulating with walker to bathroom. She otherwise had noted
bilateral swelling in her lower extremities over 1 week, and
with bluish discoloration of the RLE, she denies air travel,
smoking, however has been relatively immobile since last year
after being hosp for bacteremia.

She does have a hx of DVTs 2 yrs ago during her neck surgies and
was on 1 yr of coumadin anticoagulation, but no hx of PEs

She was brought in by the EMS after noting hypoxia of 80%RA,
then 90%NRB. In the ED, HR 109, 142/68 30 89RA, then 96% 4L,
given ntg, aspirin, levo 750, and heparin.

ROS: She denied n/v, cough, hemoptysis, diarrhea, brbpr, melena,
hematuria,


Past Medical History:
1. Cervical and lumbar spondylosis.
   - Anterior cervical corpectomy and fusion at C3 to C7 in
[**2173-11-23**].
   - C7 through T1 laminectomies and partial laminectomy of C6
and T2 on [**2176-4-23**]
   - L4-L4 laminectomy in [**2166**].
   - L2-S1 spinal fusion in [**2169**].
   - L1 stimulator ? in [**2170**].
2. Osteoarthritis, status post bilateral shoulder surgery.
3. Hypertension
4. Hypercholesterolemia
5. Hypothyroidism
6. MSSA infections associated with hardware- on suppressive doxy



Social History:
The patient has not smoked for the past 30 years. She has never
had alcohol. Denies any history of illicit drug use.


Family History:
She had a father with a transient ischemic attack. Both parents
have hypertension. There is no family history of coronary artery
disease or diabetes.

Physical Exam:
Tm P 115 121/68 92 RR 20 98% NRB
Gen: NAD, speaking in full sentences
HEENT: PERRL, EOMI, dry MM, JVD flat,
Lungs: CTA b/l
CV: s1/s2, rrr no mrg nondisplaced PMI
ABD: +BS nt/nd no organomegaly
ext: no c/c, hands ulnar deviation, b/l 1+ pitting edema
dp 2+
neuro: aaox3, cnii-cnxii intact, no focal deficits


Pertinent Results:
ADMIT LABS:
[**2179-3-25**] 02:40PM   WBC-17.9*# RBC-4.48 HGB-13.8 HCT-41.4 MCV-93
MCH-30.9 MCHC-33.4 RDW-14.8
[**2179-3-25**] 02:40PM   PLT SMR-NORMAL PLT COUNT-317
[**2179-3-25**] 02:40PM   PT-12.2 PTT-23.1 INR(PT)-1.0
[**2179-3-25**] 02:40PM   GLUCOSE-125* UREA N-45* CREAT-1.3* SODIUM-135
POTASSIUM-7.4* CHLORIDE-99 TOTAL CO2-25 ANION GAP-18
[**2179-3-25**] 02:40PM   ALT(SGPT)-31 AST(SGOT)-76* CK(CPK)-140 ALK
PHOS-75 AMYLASE-115* TOT BILI-0.3
[**2179-3-25**] 02:40PM   CK-MB-6 proBNP-[**Numeric Identifier 45061**]*
[**2179-3-25**] 02:40PM   cTropnT-0.09*

CTA CHEST W&W/O C&RECONS, NON-CORONARY  ([**2179-3-25**])
IMPRESSION: Large "saddle" embolus within the main pulmonary
artery with extension into both main pulmonary arteries and
their subsegmental branches. There is associated ground-glass
opacity in the left upper lobe that most likely represents an
acute infarction. There is also CT evidence of right ventricular
strain as demonstrated by right ventricular dilatation. The main
pulmonary artery size is in the upper limit of normal range.

ECHO ([**2179-3-26**])
The left atrium is normal in size. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded.  Overall left ventricular
systolic function is normal (LVEF>55%). Tissue Doppler imaging
suggests a normal left ventricularn filling pressure
(PCWP<12mmHg). The right ventricular cavity is markedly dilated.
There is severe global right ventricular free wall hypokinesis.
There is abnormal septal motion/position consistent with right
ventricular pressure/volume overload. The aortic valve leaflets
(3) are mildly  thickened. There is no aortic valve stenosis. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. The tricuspid valve leaflets are mildly
thickened. There is severe pulmonary artery systolic
hypertension. There is no pericardial effusion.

CHEST (PORTABLE AP)  [**2179-3-28**]
A previously reported confluent left perihilar opacity shows
slight interval improvement with residual hazy opacity
remaining. Remainder of the lungs are clear, and there are no
pleural effusions.

Brief Hospital Course:
1.  Pulmonary embolism:
Patient presented with a large saddle PE involving the main
pulmonary artery extending into both pulmonary arteries and
their subsegmental branches.  An echo was performed which showed
evidence of right heart strain.  An IVC filter was placed on
[**2179-3-26**].  She was started on a heparin gtt with coumadin.  The
patient's INR was followed and the heparing gtt was stopped when
an INR was elevated at 6.6.  She should continue on warfarin for
at least 6months.  INR was 3.2 on the day of discharge.
Warfarin should be held [**4-2**] and resumed [**2179-4-3**] at 2mg QHS.

She initially required high-flow mask to maintain O2 sats; this
was weaned over her stay - she was mid 90s on 5 liters via nasal
cannula at the time of discharge.  Blood pressures were stable
throughout with a persistent tachycardia present.
It was felt that the PE was secondary to immobilization from her
many prior surgeries.

2. Pneumonia:
Fevers, leukocytosis on admission. CXR/CT were consistent with
pneumonia.  She was treated with levofloxacin for seven days.

3. Hypertension:
Initially, her atenolol and valsartan were held in the setting
of acute PE.  The beta-blocker was restarted slowly (as
metoprolol [**Hospital1 **]) as the patient remained tachycardic (possibly
from rebound).  She was discharged on atenolol 25mg daily.  The
valsartan was held throughout with the possibility of restarting
upon discharge.

4. Hypercholesterolemia:
Continued statin.

5. Hypothyroidism:
Continued synthroid.

6. Osteooarthritis:
Continued fosamax, calcium, celebrex, oxycodone PRN.

7. Peripheral edema:
Patient presented on Lasix/Spironolactone for chronic lower
extremity edema.  In the setting of possible RV dysfunction from
PE, these medications were held.  Stockings were used to help
mobilize some of the fluid.

Medications on Admission:
1. Alendronate 70 mg qweek
2. Amitriptyline 100 mg daily
3. Aspirin 325 mg daily
4. Atenolol 25 mg daily
5. Calcium 600 mg [**Hospital1 **]
6. Celebrex *NF* 200 mg Oral [**Hospital1 **]
7. Docusate Sodium 100 mg PO BID
8. Doxycycline Hyclate 100 mg PO Q12H
9. Furosemide 40 mg [**Hospital1 **]
10. Glucosamine/chondroitin by mouth [**Hospital1 **]
11. Levothyroxine Sodium 150 mcg PO DAILY
12. Omeprazole 20 mg daily
13. Percocet 5/325 mg [**Hospital1 **]
14. Senna 1 TAB PO BID:PRN
15. Simvastatin 20 mg PO DAILY
16. Spironolactone 50 mg daily
17. Valsartan 20 mg daily


Discharge Medications:
1. Levothyroxine 100 mcg Tablet Sig: 1.5 Tablets PO DAILY
(Daily).
2. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
3. Amitriptyline 50 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
4. Doxycycline Hyclate 100 mg Capsule Sig: One (1) Capsule PO
Q12H (every 12 hours).
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
7. Calcium Carbonate 600 mg Tablet Sig: One (1) Tablet PO twice
a day.
8. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
9. Celecoxib 200 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
10. Alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week:
Every Sunday.
11. Glucosamine  Oral
12. Chondroitin Sulfate  Oral
13. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day.
15. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
16. Amitriptyline 100 mg Tablet Sig: One (1) Tablet PO once a
day.
17. Percocet 5-325 mg Tablet Sig: One (1) Tablet PO twice a day
as needed for pain.
18. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
19. Warfarin 2 mg Tablet Sig: One (1) Tablet PO at bedtime:
please Hold on [**2179-4-2**] and resume [**2179-4-3**]. Tablet(s)


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Primary:
1. Pulmonary embolism
2. Pneumonia
.
Secondary:
1. Hypertension
2. Hyperlipidemia
3. Hypothyroidism


Discharge Condition:
Hemodynamically stable, satting mid 90s on 5 liters NC.


Discharge Instructions:
You were admitted and fount to have a large pulmonary embolism.
Please be sure to continue taking all you medications as
prescribed.  It will be particuarularly important that you take
coumadin for at least six month (possibly longer); while taking
this, you will need to have blood work drawn to monitor your
coumadin level (INR).

Continue to take coumadin every day. Your levels need to be
monitored regularly for a goal INR of [**12-26**].

Work with your primary care physician to keep up with you pap
smear, mammogram, and colonoscopy since sometimes blood clots
can be related to cancer.  You should also discuss having a
"hypercoagulable work-up" with your doctor.  This may be
indicated after you complete the course of warfarin as you have
had repeated blood clots.

Followup Instructions:
You have the following appointment scheduled:

[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 16881**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2179-7-1**] 11:30

Please follow-up with Dr. [**Last Name (STitle) 1968**], your primary care doctor,
within the next two weeks to discuss your hospitalization.
Phone number: [**Telephone/Fax (1) 3329**]
{'Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Unspecified acquired hypothyroidism,Long-term (current) use of antibiotics'}


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 and hypoxia.

PRESENT ILLNESS: 63 F with pmhx of p/w acute SOB, chest tightness under breasts
with no radiation for 2 days, initially noted it while
ambulating with walker to bathroom. She otherwise had noted
bilateral swelling in her lower extremities over 1 week, and
with bluish discoloration of the RLE, she denies air travel,
smoking, however has been relatively immobile since last year
after being hosp for bacteremia.

MEDICAL HISTORY: 1. Cervical and lumbar spondylosis.
   - Anterior cervical corpectomy and fusion at C3 to C7 in
[**2173-11-23**].
   - C7 through T1 laminectomies and partial laminectomy of C6
and T2 on [**2176-4-23**]
   - L4-L4 laminectomy in [**2166**].
   - L2-S1 spinal fusion in [**2169**].
   - L1 stimulator ? in [**2170**].
2. Osteoarthritis, status post bilateral shoulder surgery.
3. Hypertension
4. Hypercholesterolemia
5. Hypothyroidism
6. MSSA infections associated with hardware- on suppressive doxy

MEDICATION ON ADMISSION: 1. Alendronate 70 mg qweek
2. Amitriptyline 100 mg daily
3. Aspirin 325 mg daily
4. Atenolol 25 mg daily
5. Calcium 600 mg [**Hospital1 **]
6. Celebrex *NF* 200 mg Oral [**Hospital1 **]
7. Docusate Sodium 100 mg PO BID
8. Doxycycline Hyclate 100 mg PO Q12H
9. Furosemide 40 mg [**Hospital1 **]
10. Glucosamine/chondroitin by mouth [**Hospital1 **]
11. Levothyroxine Sodium 150 mcg PO DAILY
12. Omeprazole 20 mg daily
13. Percocet 5/325 mg [**Hospital1 **]
14. Senna 1 TAB PO BID:PRN
15. Simvastatin 20 mg PO DAILY
16. Spironolactone 50 mg daily
17. Valsartan 20 mg daily

ALLERGIES: E-Mycin / Flagyl

PHYSICAL EXAM: Tm P 115 121/68 92 RR 20 98% NRB
Gen: NAD, speaking in full sentences
HEENT: PERRL, EOMI, dry MM, JVD flat,
Lungs: CTA b/l
CV: s1/s2, rrr no mrg nondisplaced PMI
ABD: +BS nt/nd no organomegaly
ext: no c/c, hands ulnar deviation, b/l 1+ pitting edema
dp 2+
neuro: aaox3, cnii-cnxii intact, no focal deficits

FAMILY HISTORY: She had a father with a transient ischemic attack. Both parents
have hypertension. There is no family history of coronary artery
disease or diabetes.

SOCIAL HISTORY: The patient has not smoked for the past 30 years. She has never
had alcohol. Denies any history of illicit drug use. 

### Response:
{'Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Unspecified acquired hypothyroidism,Long-term (current) use of antibiotics'}
