CHIEF COMPLAINT: Hypertension and right eye pain.

PRESENT ILLNESS: The patient is a 62 year old
male, status post cadaveric renal transplant times two, last
in [**2146**], history of polycystic kidney disease, history of CMV
colitis/hepatitis, and history of atrial fibrillation, who
presents with headache over the right frontal region as well
as right eye pain, as well as nausea and vomiting in the
setting of high blood pressure.  The patient notes that the
symptoms came on this morning and are like symptoms he has
had in the past when he has been hospitalized secondary to
hypertension.  In the past, workups have been negative
including head CT and lumbar puncture.

MEDICAL HISTORY: 1.  Polycystic kidney disease, status post cadaveric renal
transplant in [**2140**], and [**2146**], baseline creatinine 1.5.
2.  History of intracranial hemorrhage, status post aneurysm
clipping in [**2116**].
3.  Atrial fibrillation.
4.  Posttransplant erythrocytosis.
5.  Diverticulosis.
6.  History of gastrointestinal bleed.
7.  Bilateral cataracts.
8.  History of migraine headache.
9.  Hypertension.
10. CMV colitis and hepatitis.

MEDICATION ON ADMISSION: 1.  Valacyclovir.
2.  Coumadin.
3.  Reglan.
4.  Prograf 4 mg p.o. b.i.d.
5.  Toprol XL 50 mg p.o. q.d.
6.  Bactrim one tablet p.o. q.d.
7.  Calcitrel 0.25 mg p.o. q.d.
8.  Prednisone 20 mg p.o. q.d.
9.  Motilium 10 mg one to two tablets p.o. before meals.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Two brothers and one sister with polycystic
kidney disease and children with polycystic kidney disease.
He denies any coronary artery disease.

SOCIAL HISTORY: The patient denies tobacco use at present,
quit approximately twenty years ago.  The patient lives with
family, wife and daughter.
Malignant essential hypertension,Kidney replaced by transplant,Atrial fibrillation,Other primary cardiomyopathies,Polycythemia vera
Malignant hypertension,Kidney transplant status,Atrial fibrillation,Prim cardiomyopathy NEC,Polycythemia vera
Admission Date:  [**2148-4-18**]     Discharge Date:  [**2148-4-21**]

Date of Birth:   [**2086-1-4**]     Sex:  M

Service:  CCU

CHIEF COMPLAINT:  Hypertension and right eye pain.

HISTORY OF PRESENT ILLNESS:  The patient is a 62 year old
male, status post cadaveric renal transplant times two, last
in [**2146**], history of polycystic kidney disease, history of CMV
colitis/hepatitis, and history of atrial fibrillation, who
presents with headache over the right frontal region as well
as right eye pain, as well as nausea and vomiting in the
setting of high blood pressure.  The patient notes that the
symptoms came on this morning and are like symptoms he has
had in the past when he has been hospitalized secondary to
hypertension.  In the past, workups have been negative
including head CT and lumbar puncture.

In the Emergency Department, the patient noted to have a
blood pressure of 204/100 which subsequently went as high as
240/120 with heart rate in the 140s in atrial fibrillation.
The patient responded to intravenous Nipride and was changed
to Nitroglycerin drip so that the patient could be admitted
to the floor, however, blood pressure rebounded to 220
systolic despite 100 mcg of Nitroglycerin, Hydralazine
intravenously, as well as Lopressor.  The patient continued
to experience headache and nausea and the Nipride was
restarted with pressures dropping to as low as 60 systolic.
The patient denied any associated chest pain or shortness of
breath.  No visual changes.  The patient was seen by
neurology in the Emergency Department and head CT performed
at that time was negative.

PAST MEDICAL HISTORY:
1.  Polycystic kidney disease, status post cadaveric renal
transplant in [**2140**], and [**2146**], baseline creatinine 1.5.
2.  History of intracranial hemorrhage, status post aneurysm
clipping in [**2116**].
3.  Atrial fibrillation.
4.  Posttransplant erythrocytosis.
5.  Diverticulosis.
6.  History of gastrointestinal bleed.
7.  Bilateral cataracts.
8.  History of migraine headache.
9.  Hypertension.
10. CMV colitis and hepatitis.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Valacyclovir.
2.  Coumadin.
3.  Reglan.
4.  Prograf 4 mg p.o. b.i.d.
5.  Toprol XL 50 mg p.o. q.d.
6.  Bactrim one tablet p.o. q.d.
7.  Calcitrel 0.25 mg p.o. q.d.
8.  Prednisone 20 mg p.o. q.d.
9.  Motilium 10 mg one to two tablets p.o. before meals.

SOCIAL HISTORY:  The patient denies tobacco use at present,
quit approximately twenty years ago.  The patient lives with
family, wife and daughter.

FAMILY HISTORY:  Two brothers and one sister with polycystic
kidney disease and children with polycystic kidney disease.
He denies any coronary artery disease.

PHYSICAL EXAMINATION  Heart rate 80 to 108, blood pressure
160/90, respiratory rate 12, oxygen saturation 98% in room
air.  In general, the patient is a middle age male lying in
bed somnolent but arousible and in no apparent distress.
Head, eyes, ears, nose and throat examination is
normocephalic and atraumatic.  The pupils are equal, round,
and reactive to light and accommodation.  Extraocular
movements are intact.  Mucous membranes are dry.  Sclera
injected bilaterally.  The neck is soft, supple, no jugular
venous distention.  The heart is irregularly irregular
rhythm, no murmurs, rubs or gallops.  The lungs reveal
bilateral crackles at the base.  The abdomen is soft,
nontender, nondistended, normoactive bowel sounds.  Graft
nontender.  Extremities no cyanosis, clubbing or edema, 2+
dorsalis pedis and posterior tibial pulses.  Skin -
erythematous papules over the face and chest.  Positive
blanching.  Neurologically, the patient is oriented times
three, grossly nonfocal examination.  Motor is [**6-2**]
bilaterally.  Sensory is intact by light touch.  Funduscopic
examination revealed sharp disks.  Deep tendon reflexes are
2+ and symmetric.

LABORATORY DATA:  White blood count 11.1, hematocrit 57.2,
platelets 201,000.  Sodium 138, potassium 4.1, chloride 100,
bicarbonate 25, blood urea nitrogen 23, creatinine 1.5,
glucose 124.  Prothrombin time 25.8, partial thromboplastin
time 41.7, INR 4.6.  Urinalysis shows trace blood, 100
mg/deciliter protein, no red blood cells, no white blood
cells.  ALT 34, AST 34, alkaline phosphatase 124, amylase 70,
total bilirubin 0.8.

Electrocardiogram showed atrial fibrillation in the 90s,
leftward axis, poor R wave progression in the precordium.  Q
waves in aVF and III noted to be old compared to previous
electrocardiogram in [**2147-1-30**].  No acute ST-T wave
changes.

Chest x-ray showed no infiltrate, poor inspiratory effort.
No failure.  Questionable mild cardiomegaly. Head CT from the
Emergency Department showed no cerebrovascular accident and
old lacunar stroke.

IMPRESSION:  A 62 year old male, with history of
hypertension, polycystic kidney disease, status post
cadaveric renal transplant times two, chronic atrial
fibrillation times twenty years, presents to the Emergency
Department with nausea, vomiting, right frontal headache and
right eye pain in the setting of elevated blood pressure.

HOSPITAL COURSE:
1.  Cardiovascular - Ischemia - The patient with no known
coronary artery disease.  The patient was ruled out for a
myocardial infarction with cardiac enzymes negative times
three.  Because suspicion for underlying coronary artery
disease was low, no further workup was performed at this
time.

Pump - The patient with a previous echocardiogram showing an
ejection fraction of 55% in [**2147-9-30**].  The patient did
not manifest any symptoms of congestive heart failure despite
the elevated blood pressure and diuresis was deferred.

Rhythm - The patient was noted to be in atrial fibrillation
with adequate rate control.  The patient's Coumadin was
initially held while INR was elevated.  Once INR dropped down
to low 2.0 range, the patient's Coumadin was restarted.  In
addition, the team discussed the possibility of cardioversion
or the addition of antiarrhythmic drugs, however, the patient
reportedly had several attempts at cardioversion with only
temporary return to sinus rhythm.

Hypertension - In light of the patient's elevated blood
pressure, secondary causes of hypertension were explored
including renal artery stenosis and pheochromocytoma.  Renal
ultrasound was performed on [**2148-4-19**], and showed no
son[**Name (NI) 493**] evidence for renal artery stenosis.  In addition,
24 hour urine collection for catecholamines as well as
catechol metabolites was performed with sample three
submitted to the patient's outpatient primary care physician
for analysis.  The patient was maintained on the intravenous
Nipride drip during the initial part of his hospital stay
while doses of his Toprol as well as newly added ace
inhibitor were titrated upward.  The patient was subsequently
taken off the Nipride drip as the blood pressure was able to
be controlled with p.o. medication.  The patient's symptoms
resolved completely by hospital day number two with the
concomitant control of his blood pressure.

2.  Hematology - The patient with posttransplant
erythrocytosis with a baseline hematocrit approximately high
40s to low 50s.  On admission, the patient was noted to have
a hematocrit of 57.0 which subsequently dropped to 52.0 on
hospital day number two.  It was the feeling of the primary
team that the patient's elevated hematocrit may be
contributing to his symptoms and decision was to phlebotomize
one unit of blood from the patient.  The patient's hematocrit
remained stable in the high 40s for the remainder of his
hospital course.

3.  Renal - The patient as above is status post two renal
transplants.  The patient's creatinine remained stable at his
baseline throughout the hospital course.  The patient's
Prograf level was checked and was noted to be low and
decision was made to increase the patient's Prograf to 5 mg
p.o. b.i.d.  In addition, after discussions with the renal
team, it was deemed appropriate to start up an ace inhibitor
at low dose.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  The patient is to be discharged to home.

DISCHARGE DIAGNOSES:
1.  Hypertensive urgency.
2.  Polycystic kidney disease, status post cadaveric renal
transplant times two.
3.  Atrial fibrillation.
4.  Posttransplant erythrocytosis.
5.  History of intracranial hemorrhage.

MEDICATIONS ON DISCHARGE:
1.  Valacyclovir.
2.  Coumadin.
3.  Reglan.
4.  Prograf 5 mg p.o. b.i.d.
5.  Toprol XL 200 mg p.o. q.d.
6.  Bactrim one tablet p.o. q.d.
7.  Calcitrel 0.25 mg p.o. q.d.
8.  Prednisone 20 mg p.o. q.d.
9.  Motilium 10 mg one to two tablets p.o. before meals.
10. Zestril 5 mg p.o. q.d.

FOLLOW-UP:  Appointments include:
1.  Primary care physician, [**Last Name (NamePattern4) **]. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **], within two
to three days.
2.  Transplant nephrologist as per regularly scheduled
appointment.
3.  The patient is to have Prograf level checked on [**2148-4-25**],
as well as prothrombin time and INR as per regular
monitoring.
4.  In addition, 24 hour urine to be analyzed as per primary
care physician for catecholamines as well as catechol
metabolites.
5.  Evaluation of intracranial vessel to be performed as an
outpatient for any signs of aneurysm.  The patient was
initially to undergo MRA in the hospital, however, this
procedure was contraindicated secondary to metal hardware in
the patient.




                          [**Last Name (LF) **],[**First Name3 (LF) **] 12.675

Dictated By:[**Name8 (MD) 2054**]

MEDQUIST36

D:  [**2148-4-26**]  22:8
T:  [**2148-4-27**]  20:08
JOB#:  [**Job Number 29722**]
{'Malignant essential hypertension,Kidney replaced by transplant,Atrial fibrillation,Other primary cardiomyopathies,Polycythemia vera'}


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: Hypertension and right eye pain.

PRESENT ILLNESS: The patient is a 62 year old
male, status post cadaveric renal transplant times two, last
in [**2146**], history of polycystic kidney disease, history of CMV
colitis/hepatitis, and history of atrial fibrillation, who
presents with headache over the right frontal region as well
as right eye pain, as well as nausea and vomiting in the
setting of high blood pressure.  The patient notes that the
symptoms came on this morning and are like symptoms he has
had in the past when he has been hospitalized secondary to
hypertension.  In the past, workups have been negative
including head CT and lumbar puncture.

MEDICAL HISTORY: 1.  Polycystic kidney disease, status post cadaveric renal
transplant in [**2140**], and [**2146**], baseline creatinine 1.5.
2.  History of intracranial hemorrhage, status post aneurysm
clipping in [**2116**].
3.  Atrial fibrillation.
4.  Posttransplant erythrocytosis.
5.  Diverticulosis.
6.  History of gastrointestinal bleed.
7.  Bilateral cataracts.
8.  History of migraine headache.
9.  Hypertension.
10. CMV colitis and hepatitis.

MEDICATION ON ADMISSION: 1.  Valacyclovir.
2.  Coumadin.
3.  Reglan.
4.  Prograf 4 mg p.o. b.i.d.
5.  Toprol XL 50 mg p.o. q.d.
6.  Bactrim one tablet p.o. q.d.
7.  Calcitrel 0.25 mg p.o. q.d.
8.  Prednisone 20 mg p.o. q.d.
9.  Motilium 10 mg one to two tablets p.o. before meals.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Two brothers and one sister with polycystic
kidney disease and children with polycystic kidney disease.
He denies any coronary artery disease.

SOCIAL HISTORY: The patient denies tobacco use at present,
quit approximately twenty years ago.  The patient lives with
family, wife and daughter. 

### Response:
{'Malignant essential hypertension,Kidney replaced by transplant,Atrial fibrillation,Other primary cardiomyopathies,Polycythemia vera'}
