CHIEF COMPLAINT: Hypertensive Emergency

PRESENT ILLNESS: Pt is a 53 yo W with no significant PMH who presented to her PCP
yesterday with 2 week hx of DOE. Pt was concerned she had
pneumonia but denied fever, chill, productive cough or URI
symptoms. VS at PCP's office were BP 180/104, HR 104, 97% RA. Pt
was sent home with metoprolol 25mg [**Hospital1 **] and plan for stress ECHO
the following day.

MEDICAL HISTORY: No prior history of HTN, last recorded BP was several months ago
and normal per pt
Bilateral shoulder pain
Headaches

MEDICATION ON ADMISSION: ASA 81mg daily
Ibuprofen PRN
Centrum silver
Calcium

ALLERGIES: Penicillins / Erythromycin Base

PHYSICAL EXAM: VS: T=97.3 BP= 138/84 HR= 69 RR= 14 O2 sat= 96% 2L
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: Patient is married. Pt denies tobacco or alcohol abuse.
Unspecified hypertensive heart disease with heart failure,Hypopotassemia,Congestive heart failure, unspecified,Dizziness and giddiness
Hyp ht dis NOS w ht fail,Hypopotassemia,CHF NOS,Dizziness and giddiness
Admission Date:  [**2143-11-12**]              Discharge Date:   [**2143-11-16**]

Date of Birth:  [**2090-8-5**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Erythromycin Base

Attending:[**First Name3 (LF) 7651**]
Chief Complaint:
Hypertensive Emergency

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Pt is a 53 yo W with no significant PMH who presented to her PCP
yesterday with 2 week hx of DOE. Pt was concerned she had
pneumonia but denied fever, chill, productive cough or URI
symptoms. VS at PCP's office were BP 180/104, HR 104, 97% RA. Pt
was sent home with metoprolol 25mg [**Hospital1 **] and plan for stress ECHO
the following day.

Upon arrival to stress lab, pt's BP was elevated to systolic
230. She was sent directly to the ED for further evaluation.
There she complained of HA and nausea. She denied visual
changes, chest pain, palpitations, back pain, abdominal. She did
report diaphoresis.

Initial VS's were: T98.9, HR110, 239/139, RR16 97 . Patient was
started on nitro gtt with no improvement in BP despite max dose
of nitro. She was then switched to labetalol gtt with
improvement in BP to 159/97. Pt developed progressive
respiratory distress with exam notable for crackles [**1-9**] way up
posteriorly. Patient received lasix 40mg IV x1 and was started
on BIPAP, which was d/c'd after patient vomited into the mask.
She was then placed on NRB. She also received zofran, ativan.
Initial labs notable for BUN/Cr 27/1.2, proBNP of 10,933, CK
104, MB 4, Tn-T 0.02. She was transferred to the CCU for further
management.

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,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.


Past Medical History:
No prior history of HTN, last recorded BP was several months ago
and normal per pt
Bilateral shoulder pain
Headaches


Social History:
Patient is married. Pt denies tobacco or alcohol abuse.

Family History:
No family history of early MI, otherwise non-contributory.

Physical Exam:
VS: T=97.3 BP= 138/84 HR= 69 RR= 14 O2 sat= 96% 2L
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
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. III/VI systolic murmur at LUSB,
nonradiating. No thrills, lifts. No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Crackles at bilateral
bases with decreased BS.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits. No radial femoral
delay.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
[**2143-11-12**] 12:50PM   CK(CPK)-104
[**2143-11-12**] 12:50PM   cTropnT-0.02*
[**2143-11-12**] 12:50PM   CK-MB-4 proBNP-[**Numeric Identifier 9053**]*
[**2143-11-12**] 12:50PM   TSH-2.2
[**2143-11-12**] 12:50PM   T4-10.5
[**2143-11-11**] 12:15PM   WBC-8.1 RBC-4.43 HGB-13.3 HCT-38.3 MCV-86
MCH-30.1 MCHC-34.8 RDW-14.7
[**2143-11-12**] 12:50PM   GLUCOSE-106* UREA N-27* CREAT-1.2* SODIUM-140
POTASSIUM-3.9 CHLORIDE-101 TOTAL CO2-29 ANION GAP-14
[**2143-11-12**] 05:01PM URINE  HOURS-RANDOM CREAT-60 TOT PROT-18
PROT/CREA-0.3*

Renin-pending
Aldosterone-pending
Plasma metanephrines-pending

Imaging:
Prelim MRI/MRA abdomen: No evidence of pheochromocytoma/
paraganglioma or renal artery stenosis.
CT Head:
1. Patent major intracranial arteries, without flow limiting
stenosis,
occlusion, or aneurysm.

2. White matter hypodense areas can be better evaluated with MR
[**Name13 (STitle) 430**] without and with IV contrast as these are less likely to
relate to chronic small vessel occlusive disease given the
patient's age.

3. Prominent plexus of veins in the region of the left pterygoid
muscles, with one of the tributaries having a varicose
appearance with a maximum dimension of 6mm but patent. Consult
with Interventional neuroradiologist would be helpful to assess
the significance of this findings and if any further work up is
necessary.


Brief Hospital Course:
53 yo W with no significant PMH presents with hypertensive
emergency and acute pulmonary edema

CV/HTN:
- Pt initially had evidence of cardiomegaly and pulmonary edema
on physical exam and cxr as well as LVH on EKG. Cr was elevated
at 1.1-1.3. TTE showed moderate symmetric left ventricular
hypertrophy with normal global and regional biventricular
systolic function, mild mitral regurgitation, elevated left
ventricular filling pressures. Pt's BP was initially controlled
on labetolol drip and switched to PO labetolol. Control of BP
with PO meds required labetolol 800mg TID and lisinopril 10mg
daily. Workup for causes of secondary hypertension, including
MRI/MRA abdomen (preliminarily negative for RAS, Pheo, other
tumors), plasma metanephrines and renin/[**Male First Name (un) 2083**] levels was negative
or pending at time of discharge. Urine studies showed Urine
protein of 18, CR of 60 for an elevated Up/cr ratio of .3.

Neuro:
- Pt complained of vertigo, nausea and vomiting shortly after
admission (immediately after begining CPAP), associated with any
movement. Physical exam was negative for any cerebellar,
vestibular or proprioceptive signs. CT head showed white matter
hypodensities and prominent venous plexus in the pterygoid
muscle, and follow up MRI showed no infarct, moderate small
vessel disease, and no signs of hypertensive encephalopathy; MRA
normal. Neuro consult found no neurologic cause for vertigo.

Medications on Admission:
ASA 81mg daily
Ibuprofen PRN
Centrum silver
Calcium


Discharge Disposition:
Home

Discharge Diagnosis:
Hypertensive Emergency
Vertigo (etiology unclear)
[**Name2 (NI) 2325**] ventricular hypertrophy


Discharge Condition:
stable


Discharge Instructions:
[**Doctor Last Name **] had very high blood pressure with vomiting and a headache.
The high blood pressure is unclear in etiology.  We treated you
with labetolol three times a day to lower the blood pressure.
You should have a blood pressure cuff at home to monitor your
pressure. Please check it every day at different times of the
day and keep a log for Dr. [**Last Name (STitle) 6481**]. Please take your medicines
exactly as directed. You also have vertigo.
New medicines:
1. Labetolol: a beta blocker that lowers your blood pressure and
heart rate.
2. Aspirin: as a mild blood thinner to protect your heart.
3. Ibuprofen: a non steroidal medicine to treat your headache.
.
Please call Dr. [**Last Name (STitle) 6481**] or come to the emergency room if you
have develop a severe headache, nausea or vomiting. Please check
your blood pressure at that time also.
.
Please also call Dr. [**Last Name (STitle) 6481**] for any other symptom such as
worsening dizziness, trouble walking, nauseea,

Followup Instructions:
See primary care physician for follow up of renin/aldosterone,
plasma metanephrine levels.

Primary Care:
Provider: [**Name10 (NameIs) 9054**] [**Name11 (NameIs) 6481**], MD Phone: [**Telephone/Fax (1) 4775**]  Date/time:
Wednesday [**11-20**] at 1:30pm.
.
Cardiology:
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD Phone: [**Telephone/Fax (1) 62**] Friday [**11-22**] at 3:20pm.



Completed by:[**2143-11-18**]
{'Unspecified hypertensive heart disease with heart failure,Hypopotassemia,Congestive heart failure, unspecified,Dizziness and giddiness'}


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: Hypertensive Emergency

PRESENT ILLNESS: Pt is a 53 yo W with no significant PMH who presented to her PCP
yesterday with 2 week hx of DOE. Pt was concerned she had
pneumonia but denied fever, chill, productive cough or URI
symptoms. VS at PCP's office were BP 180/104, HR 104, 97% RA. Pt
was sent home with metoprolol 25mg [**Hospital1 **] and plan for stress ECHO
the following day.

MEDICAL HISTORY: No prior history of HTN, last recorded BP was several months ago
and normal per pt
Bilateral shoulder pain
Headaches

MEDICATION ON ADMISSION: ASA 81mg daily
Ibuprofen PRN
Centrum silver
Calcium

ALLERGIES: Penicillins / Erythromycin Base

PHYSICAL EXAM: VS: T=97.3 BP= 138/84 HR= 69 RR= 14 O2 sat= 96% 2L
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: Patient is married. Pt denies tobacco or alcohol abuse. 

### Response:
{'Unspecified hypertensive heart disease with heart failure,Hypopotassemia,Congestive heart failure, unspecified,Dizziness and giddiness'}
