CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 79-year-old
female with a history of hypertension.  Her hypertension
workup has included renal artery angiogram in [**Month (only) 547**] which
revealed bilateral 90% renal artery stenoses.  In [**Month (only) 116**], the
patient underwent bilateral renal artery percutaneous
transluminal coronary angioplasty and stenting.

MEDICAL HISTORY: (The patient's past medical history
is as follows)
1.  Hypertension.
2.  Peripheral vascular disease with bilateral renal artery
stenoses, status post percutaneous transluminal coronary
angioplasty and stenting in [**2187-4-11**].
3.  Hiatal hernia/gastroesophageal reflux disease.
4.  Schatzki's ring.
5.  Hypercholesterolemia.
6.  Abdominal aortic aneurysm (3 cm in size).

MEDICATION ON ADMISSION: (The patient's medications are as
follows on admission).
1.  Atenolol 50 mg p.o. q.d.
2.  Unithyroid 125 mcg p.o. q.d.
3.  Lipitor 20 mg p.o. q.d.
4.  Premarin 0.625 mg p.o. q.d.
5.  Ambien 5 mg p.o. q.h.s. as needed.
6.  Enteric-coated aspirin.

ALLERGIES: The patient gives questionable allergies to
LABETALOL (scalp discomfort) and HYDRALAZINE (unclear what
the nature of this allergy was).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant renovascular hypertension,Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene
Mal renovasc hypertens,Hypothyroidism NOS,Diaphragmatic hernia
Admission Date:  [**2187-7-2**]     Discharge Date:  [**2187-7-3**]


Service:  Medicine

HISTORY OF PRESENT ILLNESS:  The patient is a 79-year-old
female with a history of hypertension.  Her hypertension
workup has included renal artery angiogram in [**Month (only) 547**] which
revealed bilateral 90% renal artery stenoses.  In [**Month (only) 116**], the
patient underwent bilateral renal artery percutaneous
transluminal coronary angioplasty and stenting.

Subsequent to this, in the middle of [**Month (only) **], the patient was
admitted to the [**Hospital 26200**] Hospital with confusion,
headache, and a blood pressure of 180/110.  At that time, she
was diagnosed with malignant hypertension and was treated
with a Nipride drip which was then changed to oral labetalol;
on which she was discharged.

Subsequent to that hospitalization, she was started on
atenolol 50 mg p.o. q.d. and the labetalol was discontinued
as an outpatient.

In early [**Month (only) 205**], she saw her cardiologist (Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **])
in follow up of her renal artery stenting, and she was noted
to still have a high systolic blood pressure of 190 over a
diastolic blood pressure of 80.

Her recent history is notable for presenting to the
[**Hospital 26200**] Hospital on [**7-1**] with left scapula
burning pain.  Her blood pressure was noted to be elevated at
220/110.  She was then transferred to the [**Hospital1 346**] for further management of what was
felt to be a hypertensive emergency.

PAST MEDICAL HISTORY:   (The patient's past medical history
is as follows)
1.  Hypertension.
2.  Peripheral vascular disease with bilateral renal artery
stenoses, status post percutaneous transluminal coronary
angioplasty and stenting in [**2187-4-11**].
3.  Hiatal hernia/gastroesophageal reflux disease.
4.  Schatzki's ring.
5.  Hypercholesterolemia.
6.  Abdominal aortic aneurysm (3 cm in size).

MEDICATIONS ON ADMISSION:  (The patient's medications are as
follows on admission).
1.  Atenolol 50 mg p.o. q.d.
2.  Unithyroid 125 mcg p.o. q.d.
3.  Lipitor 20 mg p.o. q.d.
4.  Premarin 0.625 mg p.o. q.d.
5.  Ambien 5 mg p.o. q.h.s. as needed.
6.  Enteric-coated aspirin.

ALLERGIES:  The patient gives questionable allergies to
LABETALOL (scalp discomfort) and HYDRALAZINE (unclear what
the nature of this allergy was).

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
revealed the patient's vital signs were a temperature
of 97.3, heart rate was 65, blood pressure was 220/110 at the
outside hospital (down to 178/68 here), respiratory rate
was 20, and an oxygen saturation of 100%.  In general, the
patient was pleasant and in no apparent distress.  The
patient's head, eyes, ears, nose, and throat examination
revealed a normocephalic and atraumatic head.  Pupils were
equal, round, and reactive to light, and mucous membranes
were dry.  The patient's neck was supple, and the thyroid was
diffusely enlarged.  The patient's cardiovascular examination
revealed a regular pulse, normal first heart sound and second
heart sound, and soft blowing systolic murmur at the sternal
border.  The patient's lung examination revealed essentially
clear lungs with trace crackles at the bases.  The patient's
abdominal examination revealed a soft, nontender, and
nondistended abdomen.  Bilateral renal and femoral bruits
were noted.  The patient's extremity examination revealed 2+
lower extremity edema and normal distal pulses.

PERTINENT LABORATORY DATA ON PRESENTATION:  Laboratory data
on admission revealed a white blood cell count of 10.4,
hematocrit was 33, platelet count was 242.  The PT was 12.4,
and the INR was 1.1.  The sodium was 133, the potassium
was 3.8, the chloride was 100, the bicarbonate was 24, the
blood urea nitrogen was 15, the creatinine was 0.9, and the
blood glucose was 121.  The magnesium level was 1.6.
Thyroid-stimulating hormone was 0.15, and free T4 was 1.3.

RADIOLOGY/IMAGING:   A chest CT scan was performed to rule
out an aortic dissection.  Here, the chest CT revealed no
evidence of aortic dissection.  There were dependent
ground-glass opacities bilaterally.  There was a small liver
lesion with low attenuation; consistent with a hemangioma or
cysts.

The patient's electrocardiogram revealed a sinus bradycardia
at 55 beats per minute.  There was an intraventricular
conduction delay and repolarization ST changes in leads V1
through V3.

HOSPITAL COURSE:  The patient was admitted to the Surgical
Intensive Care Unit for hypertensive emergency.

The patient had been started on nitroprusside in the
Emergency Department for an elevated blood pressure.  The
patient's blood pressure was well controlled on
nitroprusside.

Overnight on the first hospital night, the patient's
nitroprusside was weaned down.  By the afternoon of the first
hospital day, the patient's nitroprusside had been
discontinued, and the patient was transitioned to oral
medications.  The patient was started on captopril 12.5 mg
t.i.d. and Norvasc 5 mg q.d.   The captopril was titrated
upward to 25 mg p.o. t.i.d., and the Norvasc was also
titrated upward to 10 mg p.o. q.d.

With control of the patient's blood pressure, the patient's
left scapular pain resolved.  Cardiac enzymes were obtained
and were negative for ischemia.

On the second hospital day, the patient's blood pressures
were stable on the oral regimen of captopril and Norvasc with
blood pressures ranging from the 130s to 170s/40s to 60s.
The patient's left scapular pain never returned with control
of her blood pressure.

Please note that the patient's thyroid medication was
decreased to 100 mcg p.o. q.d. due to her low
thyroid-stimulating hormone.

DISCHARGE STATUS:  On the second hospital day, it was decided
to discharge the patient home as her blood pressure was well
controlled.

CONDITION AT DISCHARGE:  She was discharged to home in good
condition.

DISCHARGE DIAGNOSES:  (The patient's discharge diagnoses were
as follows)
1.  Malignant hypertension with hypertensive emergency.
2.  Peripheral vascular disease with renal artery stenoses;
status post stenting.
3.  Hypothyroidism.
4.  Gastroesophageal reflux disease.

MEDICATIONS ON DISCHARGE:  (The patient's discharged
medications were as follows)
1.  Captopril 25 mg p.o. t.i.d.
2.  Norvasc 10 mg p.o. q.d.
3.  Aspirin 325 mg p.o. q.d.
4.  Lipitor 20 mg p.o. q.h.s.
5.  Unithyroid 100 mcg p.o. q.d.
6.  Ambien 5 mg p.o. q.h.s. as needed.

DISCHARGE DIET:  The patient's discharge diet was a
low-sodium diet.




                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 292**]

Dictated By:[**Last Name (NamePattern1) 30366**]

MEDQUIST36

D:  [**2187-7-3**]  14:21
T:  [**2187-7-7**]  05:36
JOB#:  [**Job Number 41230**]
{'Malignant renovascular hypertension,Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene'}


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 79-year-old
female with a history of hypertension.  Her hypertension
workup has included renal artery angiogram in [**Month (only) 547**] which
revealed bilateral 90% renal artery stenoses.  In [**Month (only) 116**], the
patient underwent bilateral renal artery percutaneous
transluminal coronary angioplasty and stenting.

MEDICAL HISTORY: (The patient's past medical history
is as follows)
1.  Hypertension.
2.  Peripheral vascular disease with bilateral renal artery
stenoses, status post percutaneous transluminal coronary
angioplasty and stenting in [**2187-4-11**].
3.  Hiatal hernia/gastroesophageal reflux disease.
4.  Schatzki's ring.
5.  Hypercholesterolemia.
6.  Abdominal aortic aneurysm (3 cm in size).

MEDICATION ON ADMISSION: (The patient's medications are as
follows on admission).
1.  Atenolol 50 mg p.o. q.d.
2.  Unithyroid 125 mcg p.o. q.d.
3.  Lipitor 20 mg p.o. q.d.
4.  Premarin 0.625 mg p.o. q.d.
5.  Ambien 5 mg p.o. q.h.s. as needed.
6.  Enteric-coated aspirin.

ALLERGIES: The patient gives questionable allergies to
LABETALOL (scalp discomfort) and HYDRALAZINE (unclear what
the nature of this allergy was).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant renovascular hypertension,Unspecified acquired hypothyroidism,Diaphragmatic hernia without mention of obstruction or gangrene'}
