CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 42-year-old Hispanic
male with a past medical history of hypertension, not
currently on treatment who presented to the clinic with
increasing shortness of breath, orthopnea and lower extremity
edema for 4-5 days.  He notes a history of sleeping with 2-3
pillows for the recent past.  He has never had symptoms of
orthopnea until this past week.  He has noticed a 10 lb
weight gain over the past month and lower extremity edema
over the past 4-5 days.  He denies fevers, chills, cough,
nausea or vomiting.  He had a headache several days ago that
was not severe and responded to NSAIDs.  He denies paroxysmal
episodes of sweating or palpitations.  He denies urinary
symptoms or changes in urine color.  He denies Cocaine or
crack use.

MEDICAL HISTORY: Hypertension diagnosed approximately 5
years ago, initially treated with Accupril but self
discontinued medications about four years ago.  Has not seen
a doctor in [**3-21**] years.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His mother and father both have essential
hypertension.  His father has diabetes mellitus.  He has a
brother who died of an MI in his late 30's.

SOCIAL HISTORY: The patient is an electrician who lives in
[**Location 686**] with his girlfriend, [**Name (NI) 23190**] and their two
children, ages 14 and 5.  He denies tobacco use ever.  He
drinks at least a six pack on the weekends and denies drug
use.  He is originally from [**Country 3587**].
Atherosclerosis of renal artery,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Retinal hemorrhage
Renal artery atheroscler,Mal hyp ht/kd stg V w hf,Retinal hemorrhage
Admission Date:  [**2104-1-2**]     Discharge Date:  [**2104-1-9**]

Date of Birth:   [**2061-1-7**]     Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  This is a 42-year-old Hispanic
male with a past medical history of hypertension, not
currently on treatment who presented to the clinic with
increasing shortness of breath, orthopnea and lower extremity
edema for 4-5 days.  He notes a history of sleeping with 2-3
pillows for the recent past.  He has never had symptoms of
orthopnea until this past week.  He has noticed a 10 lb
weight gain over the past month and lower extremity edema
over the past 4-5 days.  He denies fevers, chills, cough,
nausea or vomiting.  He had a headache several days ago that
was not severe and responded to NSAIDs.  He denies paroxysmal
episodes of sweating or palpitations.  He denies urinary
symptoms or changes in urine color.  He denies Cocaine or
crack use.

He presented to the clinic with his symptoms and was found to
have a systolic blood pressure of 260.  He was referred to
the Emergency Room.  In the Emergency Room he was felt to be
in biventricular heart failure with evidence of end organ
damage.  He was given 20 mg of IV Lasix and diuresed 1.5
liters.  He was started on IV Nitroglycerin and then IV
Nitroprusside and admitted to the CCU for further management.

PAST MEDICAL HISTORY:  Hypertension diagnosed approximately 5
years ago, initially treated with Accupril but self
discontinued medications about four years ago.  Has not seen
a doctor in [**3-21**] years.

MEDICATIONS:  None.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient is an electrician who lives in
[**Location 686**] with his girlfriend, [**Name (NI) 23190**] and their two
children, ages 14 and 5.  He denies tobacco use ever.  He
drinks at least a six pack on the weekends and denies drug
use.  He is originally from [**Country 3587**].

FAMILY HISTORY:  His mother and father both have essential
hypertension.  His father has diabetes mellitus.  He has a
brother who died of an MI in his late 30's.

PHYSICAL EXAMINATION:  This is a well appearing man in no
acute distress with a blood pressure of 208/115.  It was
initially 260/160 in clinic.  Heart rate is 108, respiratory
rate 22 and oxygen saturation 98% on two liters nasal
cannula.  His HEENT exam reveals moist mucus membranes.  His
fundi reveal no papilledema but bilateral hemorrhages with
moderate arteriosclerosis.  Neck is supple with no bruits but
he has a JVP of about 10 cm.  His lungs are clear to
auscultation with no wheezes or rales.  He has mildly
decreased breath sounds at the bases bilaterally.  His heart
is tachycardic with a normal S1 and S2.  He also has S3 and
S4 gallops.  There are no murmurs.  His abdomen is soft,
nontender, non distended and with good bowel sounds.  He has
no renal bruits.  His extremities have 2+ pitting edema to
the thigh.  He has 2+ dorsalis pedis and radial pulses
bilaterally.  His neurological exam is non focal.  He is
awake and oriented times three with intact cranial nerves and
V/V strength bilaterally.  He has no sensory deficits.

LABORATORY DATA:  Revealed a white count of 7.5 with a normal
differential.  Hematocrit was 39.  Platelet count 317,000.
Coagulation profile was within normal limits.  His Chem 7
revealed sodium of 140, potassium 3.3, chloride 104, CO2 21,
BUN 29 and creatinine 2.6.  Glucose 137.  We have no records
of earlier creatinine.  His LFTs were within normal limits,
namely his AST was 24, ALT 30, total bilirubin 0.7 and
alkaline phosphatase 90.  His CK was 182 with an MB of 5 and
a negative troponin of less than .3.  His amylase was 72,
lipase 15.  His calcium, magnesium and phosphorus were within
normal limits.  His albumin was 3.6.  His TSH was 1.2.
Urinalysis revealed moderate blood and greater than 300
protein.  He had 0-2 red, 0-1 white and 0-2 epi with rare
bacteria.

An EKG revealed sinus tachycardia at 115 beats per minute
with a normal axis and normal intervals.  He demonstrated a
left atrial abnormality as well as a left ventricular
hypertrophy with strain pattern.

Chest x-ray showed questionable cardiomegaly with mild CHF.
He had some bilateral pleural effusions and evidence of
pulmonary edema at the bases.

HOSPITAL COURSE:  Mr. [**Known lastname 23191**] was admitted and placed on a
Nipride drip and slowly changed to po Labetalol.  His
systolic blood pressure was initially dropped to the 160-180
range and then 140-160 on the second hospital day.  Initial
dose of Lasix that he received in the Emergency Room led to a
diuresis of 4 liters.  His dyspnea also resolved.  An
echocardiogram was done to evaluate his cardiac function.  It
revealed an EF of 30% with bilateral atrial dilatation and
moderate symmetric LVH.  His TR gradient was 33 mmHg.  He had
mild LV dilatation and moderate global LV hypokinesis.  He
also had right ventricular hypertrophy with moderate global
right ventricular hypokinesis.  He had 1+ MR and 1+ TR.  He
had mild pulmonary hypertension.

Given his presentation and family history, it was felt that
he was most likely suffering from essential hypertension that
was poorly controlled.  However, as he was a relatively young
man, a work-up for secondary causes of hypertension was
performed.  His urine was bland with no RBC cast to suggest
glomerulonephritis.  An MRI/MRA of his abdomen was also
performed which showed no adrenal mass but did reveal a tight
proximal right renal artery high grade stenosis.  A renal
ultrasound was done to evaluate for resistant indices, as
well as renal atrophy.  His ultrasound revealed no stones and
no hydronephrosis but bilateral small kidneys with a right
measuring 9 cm and a left measuring 9.3 cm.  Both renal
arteries demonstrated indices of 0.5 with slow systolic
upstroke suggestive of bilateral renal artery stenosis.
Other tests that were performed included a plasma aldosterone
that was within normal limits as well as a 24 hour urine
collection to look for VMA and other signs of
pheochromocytoma.  These were all negative.  He had a normal
TSH.  He did mention alcohol use, but it was not felt that
this was significant enough to be causing his hypertension,
although he was advised that excessive alcohol use could
exacerbate hypertension.

His creatinine clearance was about 40 and his creatinine
remained between 2.5 and 3 during his entire stay.  A renal
consultation was obtained to see if stenting of his right
renal artery stenosis would be of any benefit with regards to
preserving renal function or in terms of blood pressure
control.  The renal team determined that it was possible that
a stent could allow him to have a few more years off of
dialysis, especially given concerns for non compliance and
poor follow-up in this patient.  Thus, he was hydrated and
given Mucomyst and then underwent catheterization which
revealed a 99% proximal right renal artery stenosis status
post stent with distal protection with a 0% residual stenosis
and no measurable gradient after and no evidence of embolism.
 He had a completely patent left renal artery.  His groin was
closed with angiocele and there were no groin complications
during his stay.

It became clear during his admission that finding appropriate
medicine that he would be willing to take and that would be
within his economic reach would be slightly difficult given
that he has to pay for his own prescription meds.  His
hypertension was eventually well controlled on Atenolol 150
mg q day and Nifedipine 60 mg q day.  His blood pressures by
the time of discharge were running in the 120/70 range.  His
creatinine remained stable after the procedure and on
discharge was 2.6.

He was discharged home to follow-up with Dr. [**Last Name (STitle) 8499**] who
will become his primary care physician on [**Name9 (PRE) 2974**] or Monday,
to have a creatinine checked and a blood pressure check.  He
will also need to follow-up with nephrology clinic in [**12-19**]
weeks.

With regards to his heart, given his history of hypertension
and positive family history, an outpatient stress test is
recommended in the near future.  A cholesterol panel was
checked while he was within the hospital and was within
normal limits.

CONDITION ON DISCHARGE:  Improved.

DISCHARGE STATUS:  To home to follow-up with Dr. [**Last Name (STitle) 8499**]
in [**1-21**] days and nephrology clinic in [**12-19**] weeks.  He will also
need to follow-up with Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **] in [**3-22**] weeks with
regards to his renal stent.

DISCHARGE DIAGNOSIS:
1.  Hypertension complicated by chronic renal insufficiency.
2.  Right renal artery stenosis status post stent placement.

DISCHARGE MEDICATIONS:  Aspirin 325 mg po q day, Atenolol 150
mg po q day, Nifedipine 60 mg po q day, Plavix 75 mg po q day
times 30 days.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Name8 (MD) 1552**]

MEDQUIST36

D:  [**2104-1-16**]  19:27
T:  [**2104-1-18**]  15:27
JOB#:  [**Job Number 23192**]

cc:[**Last Name (NamePattern4) **]
{'Atherosclerosis of renal artery,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Retinal hemorrhage'}


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 42-year-old Hispanic
male with a past medical history of hypertension, not
currently on treatment who presented to the clinic with
increasing shortness of breath, orthopnea and lower extremity
edema for 4-5 days.  He notes a history of sleeping with 2-3
pillows for the recent past.  He has never had symptoms of
orthopnea until this past week.  He has noticed a 10 lb
weight gain over the past month and lower extremity edema
over the past 4-5 days.  He denies fevers, chills, cough,
nausea or vomiting.  He had a headache several days ago that
was not severe and responded to NSAIDs.  He denies paroxysmal
episodes of sweating or palpitations.  He denies urinary
symptoms or changes in urine color.  He denies Cocaine or
crack use.

MEDICAL HISTORY: Hypertension diagnosed approximately 5
years ago, initially treated with Accupril but self
discontinued medications about four years ago.  Has not seen
a doctor in [**3-21**] years.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His mother and father both have essential
hypertension.  His father has diabetes mellitus.  He has a
brother who died of an MI in his late 30's.

SOCIAL HISTORY: The patient is an electrician who lives in
[**Location 686**] with his girlfriend, [**Name (NI) 23190**] and their two
children, ages 14 and 5.  He denies tobacco use ever.  He
drinks at least a six pack on the weekends and denies drug
use.  He is originally from [**Country 3587**]. 

### Response:
{'Atherosclerosis of renal artery,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease,Retinal hemorrhage'}
