CHIEF COMPLAINT: chest pain, headache

PRESENT ILLNESS: 41F with recent IUFD @31 wks s/p induction and vaginal delivery
presented to the hospital with substernal CP and sob, found to
have bilateral PEs, now with HTN concerning for pre-eclampsia.
The pt had a previous diagnosis of htn having taken HCTZ though
not for a few years, and was initiated on Labetalol 200mg [**Hospital1 **]
during her pregnancy. She had a 24h urine in mid [**Month (only) **] which
did not show evidence of proteinuria. During her admission
[**Date range (1) 8258**] for IUFD she had elevated blood pressures which were
treated by increasing Labetalol to 400mg [**Hospital1 **]. Yesterday she
developed a headache which she described as a constant pressure,
and subsequent SOB worse with exertion and substernal, pleuritic
CP.
.
In the ED the pt was found to have an elevated d-dimer, and CTA
revealed bilateral PEs and pt was started on a heparin gtt and
labetalol 200mg PO. Vitals upon transfer to CC7: T97.8, HR 73,
BP 193/94, HR 20, sat 100% on RA.
.
Today the pt had SBPs up to 210, and a headache worse with
elevated BPs. She had pr/cr neg (0.2). OB was consulted and
noted a few beats of clonus bilaterally. The pt was given hydral
IV 10mg x2 followed by 20mg x1, and hydral 25mg PO and labetalol
200mg PO. Given concern for preeclampsia the pt was transferred
to the MICU. By arrival to the MICU the pt had SBPs in the
150s-160s and noted that her HA and decreased. She was given a
mag bolus of 4g over 20min and continued on a mag infusion 2g/h
over 24h.
.
Of note, the pt denies recent long travel, h/o CA,
immobilization, hormone replacement or personal h/o blood clots.
The pt does have an aunt who just finised 6m of coumadin for a
blood clot.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.

MEDICAL HISTORY: PNC
*) Dating [**Last Name (un) **] [**2110-12-15**]
*) Labs: A pos/Ab neg/3rd tri labs and 2 hr GTT wnl
*) FFS:two echogenic foci in LV, outflows are reassuring, Face:
nose abnormal. shortened nasal bone.
*) ERA: DS risk of 1:5 and T18 risk of 1:28, fetal echo normal
per pt, no report in OMR. AFP normal. declines amnio.
issues
1. cHTN- labetalol 200 mg po BID
2. AMA/high risk ERA and SS: SS DS risk 1:5, T18 risk 1:28 with
FFS suggestive of DS (2 LV echogenic intracardiac foci and a
shortened nasal bone.) Patient declined amniocentesis.
- Fetal ECHO done at CHB on [**9-4**]. Normal per pt report. Still
awaiting report.

MEDICATION ON ADMISSION: - PNV
- Labetalol 400 [**Hospital1 **]
- Ibuprofen

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: MICU Admission exam:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Denies tobacco, alcohol, and drugs.
Obstetrical blood-clot embolism, postpartum condition or complication,Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, postpartum condition or complication,Asthma, unspecified type, unspecified,Polyarticular juvenile rheumatoid arthritis, chronic or unspecified,Allergic urticaria
Pulm embol NOS-postpart,Tox w old hyper-postpart,Asthma NOS,Juv rheum arthritis NOS,Allergic urticaria
Admission Date:  [**2110-10-22**]              Discharge Date:   [**2110-10-25**]

Date of Birth:  [**2069-6-9**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 8257**]
Chief Complaint:
chest pain, headache

Major Surgical or Invasive Procedure:
none

History of Present Illness:
41F with recent IUFD @31 wks s/p induction and vaginal delivery
presented to the hospital with substernal CP and sob, found to
have bilateral PEs, now with HTN concerning for pre-eclampsia.
The pt had a previous diagnosis of htn having taken HCTZ though
not for a few years, and was initiated on Labetalol 200mg [**Hospital1 **]
during her pregnancy. She had a 24h urine in mid [**Month (only) **] which
did not show evidence of proteinuria. During her admission
[**Date range (1) 8258**] for IUFD she had elevated blood pressures which were
treated by increasing Labetalol to 400mg [**Hospital1 **]. Yesterday she
developed a headache which she described as a constant pressure,
and subsequent SOB worse with exertion and substernal, pleuritic
CP.
.
In the ED the pt was found to have an elevated d-dimer, and CTA
revealed bilateral PEs and pt was started on a heparin gtt and
labetalol 200mg PO. Vitals upon transfer to CC7: T97.8, HR 73,
BP 193/94, HR 20, sat 100% on RA.
.
Today the pt had SBPs up to 210, and a headache worse with
elevated BPs. She had pr/cr neg (0.2). OB was consulted and
noted a few beats of clonus bilaterally. The pt was given hydral
IV 10mg x2 followed by 20mg x1, and hydral 25mg PO and labetalol
200mg PO. Given concern for preeclampsia the pt was transferred
to the MICU. By arrival to the MICU the pt had SBPs in the
150s-160s and noted that her HA and decreased. She was given a
mag bolus of 4g over 20min and continued on a mag infusion 2g/h
over 24h.
.
Of note, the pt denies recent long travel, h/o CA,
immobilization, hormone replacement or personal h/o blood clots.
The pt does have an aunt who just finised 6m of coumadin for a
blood clot.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.


Past Medical History:
PNC
*) Dating [**Last Name (un) **] [**2110-12-15**]
*) Labs: A pos/Ab neg/3rd tri labs and 2 hr GTT wnl
*) FFS:two echogenic foci in LV, outflows are reassuring, Face:
nose abnormal. shortened nasal bone.
*) ERA: DS risk of 1:5 and T18 risk of 1:28, fetal echo normal
per pt, no report in OMR. AFP normal. declines amnio.
issues
1. cHTN- labetalol 200 mg po BID
2. AMA/high risk ERA and SS: SS DS risk 1:5, T18 risk 1:28 with
FFS suggestive of DS (2 LV echogenic intracardiac foci and a
shortened nasal bone.) Patient declined amniocentesis.
- Fetal ECHO done at CHB on [**9-4**]. Normal per pt report. Still
awaiting report.

OBHx [**2094**] SVD at term
GYNHx LMP
      denies abn pap/STI's
PMH -asthma exercised induced, has an albuterol inhalor, last
used one month ago, never been intubated.
    -[**Male First Name (un) **] rheumatoid arthritis diagnosed as a young child.no
medication.
    -migraine HA
    -cHTN on Labetalol 200 mg [**Hospital1 **]
    - question of an enlarged thyroid, no medication.
[**Doctor First Name **] denies


Social History:
Denies tobacco, alcohol, and drugs.


Family History:
Non-contributory.

Physical Exam:
MICU Admission exam:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
Imaging:
CTA OF THE CHEST:
There is no pneumomediastinum and no mediastinal hemorrhage. No
acute aortic syndrome.
There are bilateral pulmonary emboli involving the left upper
lobe pulmonary artery (series 3, image 35), left superior
lingular artery and the posterobasal segmental artery (series 3,
image 47).
On the right side, there are pulmonary emboli involving the
lateral segment of the right middle lobe (series 3, image 47)
and the apical segment of the right
upper lobe. There is no evidence of pulmonary infarct or right
heart strain. There are prominent bilateral axillary lymph
nodes.
The partially visualized upper abdomen is normal. No suspicious
lytic or
sclerotic bony lesions are seen
IMPRESSION:
1. Bilateral pulmonary emboli.
2. No pulmonary infarct and no right heart strain.
3. Prominent axillary lymph nodes. Follow-up with physical exams
is
recommended.

MRI/MRV/MRA
Normal MRI and MRV of the head, specifically without evidence of
sinus vein thrombosis.



Brief Hospital Course:
41F with recent IUFD @31 wks s/p induction and vaginal delivery
presented to the hospital with substernal CP and sob, found to
have bilateral PEs, now with HTN concerning for pre-eclampsia.
.
# Hypertensive urgency: Pt presented to MICU due to HTN to the
190s elevated to 210s on the floor with associated headache.
This was not resolved with her home dose of Labetalol 400mg PO
BID. Given recent pregnancy, this picture was concerning for
pre-eclampsia. Therefore pt was transferred to the MICU and
started on a 24h magnesium gtt. Patient maintained on PO
labetalol 200mg PO BID with SBPs predominantly in 140s-150s.
While on mg ggt, [**Doctor First Name 8259**] monitored [**Name2 (NI) 8259**] closely.
.
# Bilateral PEs: Pt hemodynamically stable, satting on RA,
currently anticoagulated on heparin gtt. Transition to Lovenox
on HD2.
.
# HA: MRI/MRA/MRV prelim wnl
- f/u final read
.
# Urticaria: Unclear etiology. [**Month (only) 116**] have been associated with
hydral or heparinl; though likely hydralazine. Improved with
anti-histamines.
.
Ms. [**Known lastname 8251**] was transferred to 12 [**Hospital Ward Name 1827**] after a brief stay in
the ICU.
.
# Hypertensive Urgency: In the ICU, she had been treated with IV
and PO hydralazine and also PO labetalol. Her blood pressures
continued to run as high as 170s/80s while on the postparum
floor. She had P/C ratio done on [**10-22**], which was 0.2. She was
treated with magnesium for 21 hours given the severity of her
elevated blood pressures and her high risk for preeclampsia
given IUFD. She did have an MRA/MRV, which did rule out a sinus
vein thromobosis. Her labetalol was also titrated up until she
reached a maximum dose of 600mg TID prior to discharge.
.
# Bilateral pulmonary embolism: Ms [**Known lastname 8251**] was transitioned from
a heparin drip to lovenox 100mg [**Hospital1 **] on [**10-23**]. She was
hemodynamically stable and had normal oxygen saturations for the
rest of her hospitalization.
.
# IUFD: Ms. [**Known lastname 8251**] was followed by social work during this
hospitalization for her IUFD. All torch labs came back negative.
She did have [**First Name8 (NamePattern2) **] [**Doctor First Name **] of 1:40, which was considered a variant of
normal. Fetal hemoglobin was zero and ACA antibody negative.

Medications on Admission:
- PNV
- Labetalol 400 [**Hospital1 **]
- Ibuprofen


Discharge Medications:
1. enoxaparin 100 mg/mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours).
Disp:*60 syringes* Refills:*2*
2. labetalol 200 mg Tablet Sig: Three (3) Tablet PO three times
a day.
Disp:*270 Tablet(s)* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Pre-eclampsia
Hypertensive urgency
bilateral pulmonary embolisms


Discharge Condition:
stable


Discharge Instructions:
-Please follow-up at [**Hospital1 **] for a blood pressure check on
Tuesday.
-Please take your Labetalol as directed (500mg three times per
day)
-Please take your Lovenox (blood thinner) as directed (twice
daily)
-An appointment with a PCP has been made for you at [**Hospital1 **]: Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 8260**], on [**2110-10-30**] @ 1 pm
-Please call us if you have any shortness of breath, chest pain,
heavy vaginal bleeding, abdominal pain or a headache that does
not respond to tylenol or medication.

Followup Instructions:
-OBGYN: [**Hospital1 **] for blood pressure check on Tuesday at 8:30 or
9am.
-PCP [**Last Name (NamePattern4) **].[**Name (NI) 8261**] office at [**Hospital1 **]: Thursday [**10-30**] 1pm



Completed by:[**2110-10-27**]
{'Obstetrical blood-clot embolism, postpartum condition or complication,Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, postpartum condition or complication,Asthma, unspecified type, unspecified,Polyarticular juvenile rheumatoid arthritis, chronic or unspecified,Allergic urticaria'}


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: chest pain, headache

PRESENT ILLNESS: 41F with recent IUFD @31 wks s/p induction and vaginal delivery
presented to the hospital with substernal CP and sob, found to
have bilateral PEs, now with HTN concerning for pre-eclampsia.
The pt had a previous diagnosis of htn having taken HCTZ though
not for a few years, and was initiated on Labetalol 200mg [**Hospital1 **]
during her pregnancy. She had a 24h urine in mid [**Month (only) **] which
did not show evidence of proteinuria. During her admission
[**Date range (1) 8258**] for IUFD she had elevated blood pressures which were
treated by increasing Labetalol to 400mg [**Hospital1 **]. Yesterday she
developed a headache which she described as a constant pressure,
and subsequent SOB worse with exertion and substernal, pleuritic
CP.
.
In the ED the pt was found to have an elevated d-dimer, and CTA
revealed bilateral PEs and pt was started on a heparin gtt and
labetalol 200mg PO. Vitals upon transfer to CC7: T97.8, HR 73,
BP 193/94, HR 20, sat 100% on RA.
.
Today the pt had SBPs up to 210, and a headache worse with
elevated BPs. She had pr/cr neg (0.2). OB was consulted and
noted a few beats of clonus bilaterally. The pt was given hydral
IV 10mg x2 followed by 20mg x1, and hydral 25mg PO and labetalol
200mg PO. Given concern for preeclampsia the pt was transferred
to the MICU. By arrival to the MICU the pt had SBPs in the
150s-160s and noted that her HA and decreased. She was given a
mag bolus of 4g over 20min and continued on a mag infusion 2g/h
over 24h.
.
Of note, the pt denies recent long travel, h/o CA,
immobilization, hormone replacement or personal h/o blood clots.
The pt does have an aunt who just finised 6m of coumadin for a
blood clot.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.

MEDICAL HISTORY: PNC
*) Dating [**Last Name (un) **] [**2110-12-15**]
*) Labs: A pos/Ab neg/3rd tri labs and 2 hr GTT wnl
*) FFS:two echogenic foci in LV, outflows are reassuring, Face:
nose abnormal. shortened nasal bone.
*) ERA: DS risk of 1:5 and T18 risk of 1:28, fetal echo normal
per pt, no report in OMR. AFP normal. declines amnio.
issues
1. cHTN- labetalol 200 mg po BID
2. AMA/high risk ERA and SS: SS DS risk 1:5, T18 risk 1:28 with
FFS suggestive of DS (2 LV echogenic intracardiac foci and a
shortened nasal bone.) Patient declined amniocentesis.
- Fetal ECHO done at CHB on [**9-4**]. Normal per pt report. Still
awaiting report.

MEDICATION ON ADMISSION: - PNV
- Labetalol 400 [**Hospital1 **]
- Ibuprofen

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: MICU Admission exam:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Denies tobacco, alcohol, and drugs. 

### Response:
{'Obstetrical blood-clot embolism, postpartum condition or complication,Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, postpartum condition or complication,Asthma, unspecified type, unspecified,Polyarticular juvenile rheumatoid arthritis, chronic or unspecified,Allergic urticaria'}
