CHIEF COMPLAINT: 

PRESENT ILLNESS: This 31-year-old
African-American female has a history of Hodgkin's lymphoma,
depression, anxiety, hypothyroidism, gastroesophageal reflux
disease and presented with acute onset of shortness of breath
and dizziness.  She was at work and was walking up steps when
she began to feel short of breath.  She denies chest pain,
hemoptysis, cough or visual changes.  She has been on oral
contraceptive pills since the [**2123**]'s for menorrhagia
secondary to fibroids.  She denied smoking or history of
blood clotting in the family.  She walks regularly and is
obese.  She has complaint of right lower extremity swelling
and pain one month ago and she had a right lower extremity
_______________ at that time which was negative.  She was
given naproxen and the pain resolved in a week.  She has not
been on any plane flights to travel.  She was treated with
radiation and chemotherapy for her Hodgkin's disease and is
currently in remission.  She was seen in the clinic and was
tachycardic and hypoxic with a room air saturation of 88 and
was admitted.

MEDICAL HISTORY: Significant for:
1.  History of Hodgkin's lymphoma for five years.
2.  History of depression.
3.  History of anxiety.
4.  History of hypothyroidism.
5.  History of gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  [**Doctor First Name **] 60 mg p.o. b.i.d. p.r.n.
2.  Dyazide 1 mg q. day p.r.n.
3.  Flonase t.i.d.
4.  Unithroid 150 mcg p.o. q. day.
5.  Zoloft 200 mg p.o. b.i.d.
6.  Prilosec 20 mg p.o. q. day.
7.  OCP q. day.
8.  Naprosyn 500 mg p.o. b.i.d.
9.  Topamax 50 mg p.o. q. day.

ALLERGIES: She is allergic to sulfa, clindamycin and
penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for diabetes.

SOCIAL HISTORY: She lives with her mother.  Does not drink
alcohol, does not smoke cigarettes.
Other specified forms of chronic ischemic heart disease,Other pulmonary embolism and infarction,Hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites,Certain sequelae of myocardial infarction, not elsewhere classified, other,Tricuspid valve disorders, specified as nonrheumatic,Esophageal reflux,Unspecified acquired hypothyroidism,Morbid obesity,Depressive disorder, not elsewhere classified
Chr ischemic hrt dis NEC,Pulm embol/infarct NEC,Hdgk dis unsp xtrndl org,Other sequelae of MI NEC,Nonrheum tricusp val dis,Esophageal reflux,Hypothyroidism NOS,Morbid obesity,Depressive disorder NEC
Name:  [**Known lastname 15908**], [**Known firstname 1197**]                     Unit No:  [**Numeric Identifier 15909**]

Admission Date:  [**2146-11-29**]       Discharge Date: [**2146-12-13**]

Date of Birth:   [**2115-8-12**]       Sex:  F

Service:

ADDENDUM:  This is a continuation of the Discharge Summary
for Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **].

CONCISE SUMMARY OF HOSPITAL COURSE (CONTINUED):  The patient
was admitted and started on a heparin drip and was started on
Coumadin.  She was seen by Cardiology.  She had a cardiac
echocardiogram which revealed mild right atrial enlargement,
1+ tricuspid regurgitation, and a 2-cm X 3-cm echogenic mass
attached to the lateral wall of the tricuspid annulus near
the coronary sinus with a mild mobile component.

She also had a transesophageal echocardiogram which revealed
right atrial dilatation and a 2-cm X 2.5-cm heterogenous and
echogenic mass which was broad based and attached to the
tricuspid annulus with mobile components.

Cardiac Surgery was consulted.  She remained on
anticoagulation.  Her Coumadin was stopped.  They also wanted
to perform a positron emission tomography scan, but this was
not done prior to surgery.

On [**12-6**], the patient underwent an excision of a right
atrial mass.  Complete bypass time was 63 minutes.  She
tolerated the procedure well and was transferred to the
Cardiothoracic Intensive Care Unit on Neo-Synephrine and
propofol.  She was extubated that night.  She was restarted
on anticoagulation on postoperative day one and had her chest
tube discontinued.  The patient was transferred to the floor
in stable condition.  The pathology from her mass revealed a
calcified thrombus.  She continued to be anticoagulated on
heparin and Coumadin.

A Hematology consultation was obtained, and they recommended
discontinuing oral contraceptive pills, and they are going to
do a complete workup in two months as they could not perform
protein C and protein S assays for antithrombin III assays
because she was on heparin.  She continued to improve.

DISCHARGE DISPOSITION:  On postoperative day seven she was
discharged to home.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

PERTINENT LABORATORY VALUES ON DISCHARGE:  Her laboratories
on discharge revealed her hematocrit was 26.5, her white
blood cell count was 11,600, and her platelets were 465,000.
Her sodium was 135, potassium was 4.2, chloride was 104,
bicarbonate was 27, blood urea nitrogen was 11, creatinine
was 0.7, and blood glucose was 97.  Her INR was 1.9.

MEDICATIONS ON DISCHARGE:  (Her medications on discharge
included)
 1.  Potassium chloride 20 mEq by mouth twice per day (times
seven days).
 2.  Colace 100 mg by mouth twice per day.
 3.  Percocet one to two tablets by mouth q.4-6h. as needed
(for pain).
 4.  Topiramate 50 mg by mouth once per day.
 5.  Zoloft 200 mg by mouth once per day.
 6.  Levoxyl 150 mcg by mouth once per day.
 7.  Atenolol 25 mg by mouth once per day.
 8.  Lasix 20 mg by mouth twice per day (for seven days).
 9.  Prilosec 20 mg by mouth once per day.
10.  Coumadin 7.5 mg by mouth at night and as directed by Dr.
[**First Name (STitle) **] with an INR goal of 2 to 2.5.
11.  Flonase one twice per day.

DI[**Last Name (STitle) 1390**]E INSTRUCTIONS/FOLLOWUP:
1.  The patient will be followed by Dr. [**First Name (STitle) **] and her
prothrombin time and INR drawn in the morning and followed by
him as well.
2.  The patient was to follow up with Dr. [**Last Name (Prefixes) **] in four
weeks.
3.  The patient was to follow up with [**Hospital 10445**] Clinic in
two months.





                            [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Last Name (NamePattern1) 736**]
MEDQUIST36

D:  [**2146-12-13**]  18:24
T:  [**2146-12-13**]  18:29
JOB#:  [**Job Number 15910**]


Admission Date:  [**2146-11-29**]     Discharge Date:  [**2146-12-13**]

Date of Birth:   [**2115-8-12**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  This 31-year-old
African-American female has a history of Hodgkin's lymphoma,
depression, anxiety, hypothyroidism, gastroesophageal reflux
disease and presented with acute onset of shortness of breath
and dizziness.  She was at work and was walking up steps when
she began to feel short of breath.  She denies chest pain,
hemoptysis, cough or visual changes.  She has been on oral
contraceptive pills since the [**2123**]'s for menorrhagia
secondary to fibroids.  She denied smoking or history of
blood clotting in the family.  She walks regularly and is
obese.  She has complaint of right lower extremity swelling
and pain one month ago and she had a right lower extremity
_______________ at that time which was negative.  She was
given naproxen and the pain resolved in a week.  She has not
been on any plane flights to travel.  She was treated with
radiation and chemotherapy for her Hodgkin's disease and is
currently in remission.  She was seen in the clinic and was
tachycardic and hypoxic with a room air saturation of 88 and
was admitted.

PAST MEDICAL HISTORY:  Significant for:
1.  History of Hodgkin's lymphoma for five years.
2.  History of depression.
3.  History of anxiety.
4.  History of hypothyroidism.
5.  History of gastroesophageal reflux disease.

ALLERGIES:  She is allergic to sulfa, clindamycin and
penicillin.

MEDICATIONS ON ADMISSION:
1.  [**Doctor First Name **] 60 mg p.o. b.i.d. p.r.n.
2.  Dyazide 1 mg q. day p.r.n.
3.  Flonase t.i.d.
4.  Unithroid 150 mcg p.o. q. day.
5.  Zoloft 200 mg p.o. b.i.d.
6.  Prilosec 20 mg p.o. q. day.
7.  OCP q. day.
8.  Naprosyn 500 mg p.o. b.i.d.
9.  Topamax 50 mg p.o. q. day.

SOCIAL HISTORY:  She lives with her mother.  Does not drink
alcohol, does not smoke cigarettes.

FAMILY HISTORY:  Significant for diabetes.

REVIEW OF SYSTEMS:  As above.

PHYSICAL EXAMINATION:  She is a well-developed
African-American female in no apparent distress.  Vital
signs:  Temperature 97.8, heart rate 120, blood pressure
121/79, respirations 26, 99% sat on two liters.  HEENT
examination:  Normocephalic, atraumatic.  Extraocular
movements intact.  Oropharynx benign.  Neck supple with full
range of motion.  No lymphadenopathy or thyromegaly.
Carotids 2+ and equal bilaterally without bruits.  Lungs
clear to auscultation and percussion.  Cardiovascular
examination:  Regular rate and rhythm, normal S1, S2 with no
murmurs, rubs or gallops.  Abdomen soft and obese,
non-tender, with positive bowel sounds.  No masses or
hepatosplenomegaly.  Extremities were without clubbing,
cyanosis or edema.

RADIOLOGY:  She had a CTA of the chest which revealed
bilateral pulmonary embolisms distal to the left and right
pulmonary arteries.  Right was greater than left and the main
pulmonary artery was prominent with several prominent
prevascular and mediastinal nodes.  The largest was 18 x 9
mm.




                          [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern1) 13867**]

MEDQUIST36

D:  [**2146-12-13**]  17:20
T:  [**2146-12-13**]  17:36
JOB#:  [**Job Number 99348**]
{"Other specified forms of chronic ischemic heart disease,Other pulmonary embolism and infarction,Hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites,Certain sequelae of myocardial infarction, not elsewhere classified, other,Tricuspid valve disorders, specified as nonrheumatic,Esophageal reflux,Unspecified acquired hypothyroidism,Morbid obesity,Depressive disorder, not elsewhere classified"}


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 31-year-old
African-American female has a history of Hodgkin's lymphoma,
depression, anxiety, hypothyroidism, gastroesophageal reflux
disease and presented with acute onset of shortness of breath
and dizziness.  She was at work and was walking up steps when
she began to feel short of breath.  She denies chest pain,
hemoptysis, cough or visual changes.  She has been on oral
contraceptive pills since the [**2123**]'s for menorrhagia
secondary to fibroids.  She denied smoking or history of
blood clotting in the family.  She walks regularly and is
obese.  She has complaint of right lower extremity swelling
and pain one month ago and she had a right lower extremity
_______________ at that time which was negative.  She was
given naproxen and the pain resolved in a week.  She has not
been on any plane flights to travel.  She was treated with
radiation and chemotherapy for her Hodgkin's disease and is
currently in remission.  She was seen in the clinic and was
tachycardic and hypoxic with a room air saturation of 88 and
was admitted.

MEDICAL HISTORY: Significant for:
1.  History of Hodgkin's lymphoma for five years.
2.  History of depression.
3.  History of anxiety.
4.  History of hypothyroidism.
5.  History of gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  [**Doctor First Name **] 60 mg p.o. b.i.d. p.r.n.
2.  Dyazide 1 mg q. day p.r.n.
3.  Flonase t.i.d.
4.  Unithroid 150 mcg p.o. q. day.
5.  Zoloft 200 mg p.o. b.i.d.
6.  Prilosec 20 mg p.o. q. day.
7.  OCP q. day.
8.  Naprosyn 500 mg p.o. b.i.d.
9.  Topamax 50 mg p.o. q. day.

ALLERGIES: She is allergic to sulfa, clindamycin and
penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for diabetes.

SOCIAL HISTORY: She lives with her mother.  Does not drink
alcohol, does not smoke cigarettes. 

### Response:
{"Other specified forms of chronic ischemic heart disease,Other pulmonary embolism and infarction,Hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites,Certain sequelae of myocardial infarction, not elsewhere classified, other,Tricuspid valve disorders, specified as nonrheumatic,Esophageal reflux,Unspecified acquired hypothyroidism,Morbid obesity,Depressive disorder, not elsewhere classified"}
