CHIEF COMPLAINT: Dyspnea.

PRESENT ILLNESS: This is a 43-year-old female
with a past medical history remarkable for primary pulmonary
hypertension diagnosed in [**2167**] now with dyspnea.  The patient
was well until she developed a herniated disk in [**3-8**], had
conservative therapy including physical therapy but then
noticed shortness of breath with exertion.  Over the next
month, these symptoms got worse.  She found it progressively
harder to walk up any incline and one to two flights of
stairs which made her extremely short of breath.  As she was
diagnosed with asthma 14 years ago, she was treated with beta
agonists and corticosteroids without improvement in her
symptoms.  She quit smoking on [**11-5**] after 28 year history of
one pack per day.  She gained 16 pounds and felt palpitations
that she at that time attributed to her smoking cessation.
The symptoms did not get any better and she developed
heaviness in her chest, so she was referred to Cardiology in
[**2167-2-4**].  EKG at that time showed a sinus tachycardia in
the 120s with evidence of right ventricular hypertrophy.  A
Holter monitor showed no arrhythmias.  A chest echocardiogram was
performed. The patient was only able to go 4 minutes, 8 seconds
without signs of ischemia.  TTE showed normal LVEF and ejection
fraction of 60%, but dilated hypertrophied RV, and Doppler
showed pulmonary hypertension with RVSP of 60.  Bubble study
suggested a small amount of bubbles crossing to the left
heart consistent with ASD or PFO.

MEDICAL HISTORY: 1.  Primary pulmonary hypertension, as described in the HPI.
2.  Asthma.
3.  Herniated disk at L4-5 in [**3-8**].
4.  Rosacea.
5.  Status post exploratory laparoscopy two years ago to
evaluate abdominal pain.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to penicillin which
causes hives.

PHYSICAL EXAM: 

FAMILY HISTORY: Not significant for any history of primary
pulmonary hypertension or lung disease.  Her father died at
the age of 75 after pneumonia and Alzheimer's disease.  The
patient's mother is still living and well.

SOCIAL HISTORY: She lives with her husband and has two
children.  She is a nurse [**First Name (Titles) **] [**Hospital3 **].  She smoked
times 28 years, one pack per day; quit smoking in the fall of
[**2166**].  Occasional alcohol use.  No IV drug use.
Primary pulmonary hypertension,Asthma, unspecified type, unspecified,Displacement of lumbar intervertebral disc without myelopathy,Personal history of tobacco use
Prim pulm hypertension,Asthma NOS,Lumbar disc displacement,History of tobacco use
Admission Date:  [**2167-7-20**]       Discharge Date:  [**2167-7-24**]

Date of Birth:   [**2123-12-7**]       Sex:  F

Service:  MEDICINE

CHIEF COMPLAINT:  Dyspnea.

HISTORY OF THE PRESENT ILLNESS:  This is a 43-year-old female
with a past medical history remarkable for primary pulmonary
hypertension diagnosed in [**2167**] now with dyspnea.  The patient
was well until she developed a herniated disk in [**3-8**], had
conservative therapy including physical therapy but then
noticed shortness of breath with exertion.  Over the next
month, these symptoms got worse.  She found it progressively
harder to walk up any incline and one to two flights of
stairs which made her extremely short of breath.  As she was
diagnosed with asthma 14 years ago, she was treated with beta
agonists and corticosteroids without improvement in her
symptoms.  She quit smoking on [**11-5**] after 28 year history of
one pack per day.  She gained 16 pounds and felt palpitations
that she at that time attributed to her smoking cessation.
The symptoms did not get any better and she developed
heaviness in her chest, so she was referred to Cardiology in
[**2167-2-4**].  EKG at that time showed a sinus tachycardia in
the 120s with evidence of right ventricular hypertrophy.  A
Holter monitor showed no arrhythmias.  A chest echocardiogram was
performed. The patient was only able to go 4 minutes, 8 seconds
without signs of ischemia.  TTE showed normal LVEF and ejection
fraction of 60%, but dilated hypertrophied RV, and Doppler
showed pulmonary hypertension with RVSP of 60.  Bubble study
suggested a small amount of bubbles crossing to the left
heart consistent with ASD or PFO.

Cardiac catheterization was notable for primary hypertension
with PA of 71/33 and mean of 50, PCWP of 8, heart rate 110,
cardiac index of 2.55 liters per minute per metered square.
No shunting was noted.  Pulmonary function tests and chest CT
showed no evidence of underlying disease.  On a six minute
walk test, the patient had a desat down to 83%.  She was
started on Bosentan, oxygen, Coumadin, and Lasix.  She had
some elevated LFTs on Bosentan as well as incomplete
resolution of her symptoms.  She has been following with
physicians at [**Hospital6 1708**] for lung
transplant.

She now comes in with progressing shortness of breath, worse
with exertion, left-sided chest heaviness and palpitations
that are present and yet worse on exertion.  This is an
elective admission for starting intravenous Flolan therapy
and placement of a permanent catheter.  At this point, she is
on 4 liters of oxygen with regular exertion and 6 liters with
maximal exertion.

PAST MEDICAL HISTORY:
1.  Primary pulmonary hypertension, as described in the HPI.
2.  Asthma.
3.  Herniated disk at L4-5 in [**3-8**].
4.  Rosacea.
5.  Status post exploratory laparoscopy two years ago to
evaluate abdominal pain.

ADMISSION MEDICATIONS:
1.  Bosentan 125 b.i.d.
2.  Coumadin 10 q.h.s.
3.  Lasix 40 b.i.d.
4.  Elavil 50 q.h.s.

ALLERGIES:   The patient is allergic to penicillin which
causes hives.

SOCIAL HISTORY:  She lives with her husband and has two
children.  She is a nurse [**First Name (Titles) **] [**Hospital3 **].  She smoked
times 28 years, one pack per day; quit smoking in the fall of
[**2166**].  Occasional alcohol use.  No IV drug use.

FAMILY HISTORY:  Not significant for any history of primary
pulmonary hypertension or lung disease.  Her father died at
the age of 75 after pneumonia and Alzheimer's disease.  The
patient's mother is still living and well.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Temperature
afebrile, heart rate 120s, blood pressure 115/73, respiratory
rate 32, saturating 96% on 4 liters nasal cannula.  General:
This is a 43-year-old female in no acute distress.  HEENT:
Normocephalic, atraumatic.  The extraocular muscles were
intact.  Neck:  Supple.  JVD 10 cm.  Lungs:  Clear.  Cardiac:
Normal S1, pronounced S2, regular rate.  Abdomen:  Soft,
nontender, nondistended.  Extremities:  She has positive
clubbing and 1+ edema bilaterally.  Neurologic:  Alert and
oriented.  She has some left-sided cheek erythema consistent
with rosacea.

LABORATORY/RADIOLOGIC DATA:  White blood cell count 10.2,
hematocrit 37.1, platelets 244,000, INR 1.0.  Sodium 140,
potassium 3.9, chloride 107, bicarbonate 19, BUN 19,
creatinine 0.9, glucose 87, total bilirubin 0.2, AST 17, ALT
18, alkaline phosphatase 70.  Calcium 9.2, magnesium 2.3,
phosphorus 3.0.  PFTs showed normal spirometry and lung
volumes but decreased DLCO.

HOSPITAL COURSE:  The patient was admitted to the Intensive
Care Unit in order to have a Swan-Ganz catheter placed in
order to measure wedge pressures and began Flolan
administration.  The patient tolerated the Swan-Ganz
placement without any complication.  She was started on the
Flolan, had some flushing and nausea with advancement of
dose, was titrated back.  She was started on Compazine as
well as Tylenol for her symptoms.  She was noted to be mildly
hypotensive but asymptomatic.  This is apparently her
baseline.  It was felt that she was stable for transfer to
the floor.  A Hickman catheter was placed by the Surgical
Service without any complication.

The patient was titrated up to 6 nanograms per kilogram per
minute of Flolan.  Her Coumadin was restarted.  She was
monitored while ambulating on 6 liters of oxygen without any
dyspnea.  She had Flolan teaching in order to educate the
patient on administration at home.  At this point, it was
felt that the patient was stable for discharge with follow-up
with Dr. [**First Name (STitle) **].

DISCHARGE DIAGNOSIS:
1.  Primary pulmonary hypertension.
2.  Status post Hickman catheter placement.

DISCHARGE MEDICATIONS:
1.  Flolan.
2.  Coumadin 10 mg q.h.s., adjust as per INR.
3.  Lasix 80 mg p.o. b.i.d.
4.  Compazine 10 mg p.o. q. six hours p.r.n.
5.  Acetaminophen 325 mg p.o. q. four to six hours p.r.n.
6.  Amitriptyline 50 mg p.o. q.h.s.

CONDITION ON DISCHARGE:  Good.




                            [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7585**]

Dictated By:[**Last Name (NamePattern1) 9296**]
MEDQUIST36

D:  [**2167-7-25**]  12:54
T:  [**2167-7-25**]  13:11
JOB#:  [**Job Number 45781**]
{'Primary pulmonary hypertension,Asthma, unspecified type, unspecified,Displacement of lumbar intervertebral disc without myelopathy,Personal history of tobacco use'}


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: Dyspnea.

PRESENT ILLNESS: This is a 43-year-old female
with a past medical history remarkable for primary pulmonary
hypertension diagnosed in [**2167**] now with dyspnea.  The patient
was well until she developed a herniated disk in [**3-8**], had
conservative therapy including physical therapy but then
noticed shortness of breath with exertion.  Over the next
month, these symptoms got worse.  She found it progressively
harder to walk up any incline and one to two flights of
stairs which made her extremely short of breath.  As she was
diagnosed with asthma 14 years ago, she was treated with beta
agonists and corticosteroids without improvement in her
symptoms.  She quit smoking on [**11-5**] after 28 year history of
one pack per day.  She gained 16 pounds and felt palpitations
that she at that time attributed to her smoking cessation.
The symptoms did not get any better and she developed
heaviness in her chest, so she was referred to Cardiology in
[**2167-2-4**].  EKG at that time showed a sinus tachycardia in
the 120s with evidence of right ventricular hypertrophy.  A
Holter monitor showed no arrhythmias.  A chest echocardiogram was
performed. The patient was only able to go 4 minutes, 8 seconds
without signs of ischemia.  TTE showed normal LVEF and ejection
fraction of 60%, but dilated hypertrophied RV, and Doppler
showed pulmonary hypertension with RVSP of 60.  Bubble study
suggested a small amount of bubbles crossing to the left
heart consistent with ASD or PFO.

MEDICAL HISTORY: 1.  Primary pulmonary hypertension, as described in the HPI.
2.  Asthma.
3.  Herniated disk at L4-5 in [**3-8**].
4.  Rosacea.
5.  Status post exploratory laparoscopy two years ago to
evaluate abdominal pain.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to penicillin which
causes hives.

PHYSICAL EXAM: 

FAMILY HISTORY: Not significant for any history of primary
pulmonary hypertension or lung disease.  Her father died at
the age of 75 after pneumonia and Alzheimer's disease.  The
patient's mother is still living and well.

SOCIAL HISTORY: She lives with her husband and has two
children.  She is a nurse [**First Name (Titles) **] [**Hospital3 **].  She smoked
times 28 years, one pack per day; quit smoking in the fall of
[**2166**].  Occasional alcohol use.  No IV drug use. 

### Response:
{'Primary pulmonary hypertension,Asthma, unspecified type, unspecified,Displacement of lumbar intervertebral disc without myelopathy,Personal history of tobacco use'}
