CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 24-year-old male with
past medical history significant for bilateral PE with
bilateral pleural effusions and pericardial effusions in [**2118-6-3**] requiring extensive MICU stay and prolonged
hospitalization.  Since discharge, the patient had been
reasonably well, however, over the week prior to admission he
developed onset of pleuritic right sided anterior chest pain
associated with exertional dyspnea.  Emergency Room
evaluation done at that time revealed no new clot by CTA but
revealed a right atrial abnormality.  Follow-up echo showed
echo dense space intimately associated with either the
pericardium or the pleural space.  The patient was
hemodynamically stable without pulses paradoxus or tamponade.
Repeat echo 7 days later was done with stability in the
patient's symptoms.  Echo at this time showed increased size
of the right sided loculated pericardial effusion with
diastolic compression of the RV.  Chest x-ray showed increase
in heart size.  In clinic on the day of admission the patient
was hemodynamically stable.  EKG showed ST elevations in 2,
3, and AVF with PR depressions in 3 and a pulsus paradoxus of
10.  The patient was sent to the Emergency Room for
admission.

MEDICAL HISTORY: Pericardial effusion status post
drainage with pigtail catheter in [**2118-6-3**] with negative
rheumatologic malignant and infectious work-up.  Bilateral
pleural effusion status post pigtail drainage of the right
with negative work-up as well for rheumatologic infectious
disease and malignancy, bilateral pulmonary emboli diagnosed
in [**2118-6-3**], treated with Heparin initially and currently
anticoagulated on Coumadin, history of heterozygosity for
factor [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 12843**] mutation.

MEDICATION ON ADMISSION: 

ALLERGIES: None known.

PHYSICAL EXAM: 

FAMILY HISTORY: Grandfather had [**Name2 (NI) 499**] cancer and also a
grandparent with lung cancer.

SOCIAL HISTORY: He is a heterosexual male in a monogamous
relationship.  He denies tobacco, denies drug use, used
alcohol in the past prior to his [**Month (only) **] hospitalization of
greater than 30 beers per week.  He is from Great [**Last Name (un) 35668**]
and is a sailor.
Malignant neoplasm of heart,Iatrogenic pneumothorax,Acute posthemorrhagic anemia,Other specified complications of procedures not elsewhere classified,Congenital deficiency of other clotting factors,Personal history of venous thrombosis and embolism
Malignant neopl heart,Iatrogenic pneumothorax,Ac posthemorrhag anemia,Oth spcf cmplc procd NEC,Cong def clot factor NEC,Hx-ven thrombosis/embols
Admission Date:  [**2118-8-5**]     Discharge Date:  [**2118-8-25**]

Date of Birth:   [**2094-5-3**]     Sex:  M

Service:  Medicine

HISTORY OF PRESENT ILLNESS:  This is a 24-year-old male with
past medical history significant for bilateral PE with
bilateral pleural effusions and pericardial effusions in [**2118-6-3**] requiring extensive MICU stay and prolonged
hospitalization.  Since discharge, the patient had been
reasonably well, however, over the week prior to admission he
developed onset of pleuritic right sided anterior chest pain
associated with exertional dyspnea.  Emergency Room
evaluation done at that time revealed no new clot by CTA but
revealed a right atrial abnormality.  Follow-up echo showed
echo dense space intimately associated with either the
pericardium or the pleural space.  The patient was
hemodynamically stable without pulses paradoxus or tamponade.
Repeat echo 7 days later was done with stability in the
patient's symptoms.  Echo at this time showed increased size
of the right sided loculated pericardial effusion with
diastolic compression of the RV.  Chest x-ray showed increase
in heart size.  In clinic on the day of admission the patient
was hemodynamically stable.  EKG showed ST elevations in 2,
3, and AVF with PR depressions in 3 and a pulsus paradoxus of
10.  The patient was sent to the Emergency Room for
admission.

PAST MEDICAL HISTORY:  Pericardial effusion status post
drainage with pigtail catheter in [**2118-6-3**] with negative
rheumatologic malignant and infectious work-up.  Bilateral
pleural effusion status post pigtail drainage of the right
with negative work-up as well for rheumatologic infectious
disease and malignancy, bilateral pulmonary emboli diagnosed
in [**2118-6-3**], treated with Heparin initially and currently
anticoagulated on Coumadin, history of heterozygosity for
factor [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 12843**] mutation.

MEDICATIONS:  Coumadin 8 mg q day, Tylenol 650 mg prn.

ALLERGIES:  None known.

SOCIAL HISTORY:  He is a heterosexual male in a monogamous
relationship.  He denies tobacco, denies drug use, used
alcohol in the past prior to his [**Month (only) **] hospitalization of
greater than 30 beers per week.  He is from Great [**Last Name (un) 35668**]
and is a sailor.

FAMILY HISTORY:  Grandfather had [**Name2 (NI) 499**] cancer and also a
grandparent with lung cancer.

PHYSICAL EXAMINATION:  Temperature 99.0, heart rate 90-106,
blood pressure 128/76, respirations 12, satting 99% on room
air.  In general, in no apparent distress sitting in bed.
HEENT:  Pupils equally round and reactive to light, moist
mucus membranes, JVD approximately 4-5 cm above the right
atrium.  Cardiovascular, regular rate and rhythm, no murmurs,
rubs, gallops.  Respirations clear to auscultation
bilaterally.  Abdomen soft, nontender, normoactive bowel
sounds.  Extremities, no clubbing, cyanosis or edema.
Neurologically alert and oriented times three, grossly non
focal.

LABORATORY DATA:  On admission, white count 6.3, neutrophils
58, 0 bands, 33 lymphs, 7 monos, 2 eos, hematocrit of 34.1,
platelet count 270,000, sodium 141, potassium 4.6, chloride
105, CO2 21, BUN 12, creatinine 0.9, glucose 93. Chest x-ray
as dictated in the HPI.  EKG showed normal sinus rhythm, left
and right atrial abnormalities, 1-2 mm ST segment elevations
in leads 2, 3, and F, PR depression in 2.  ST elevations were
new compared to EKG from [**6-3**].

HOSPITAL COURSE:  The patient was admitted initially to the
medicine service where cardiothoracic consultation was
obtained for his pericardial effusion.  Initially this was
thought secondary to recurrent pericarditis.  Plans were made
for going to the OR for pericardial window.  On [**2118-8-9**] the
patient was taken to the operating room by cardiothoracic
surgery for pericardial window.  At the time of surgery,
transesophageal echocardiogram was performed and showed
abnormality in the right atrium consistent with perforation
with overlying clots and fluid loculated on pericardial
effusion.  At this time plans were suspended for pericardial
window with plans for medial sternotomy in [**1-4**] days for
repair of right atrial abnormality.  The patient was
transferred to the Coronary Care Unit overnight where he
remained hemodynamically stable.  He was taken to the
operating room again on [**2118-8-11**] where the patient underwent
median sternotomy with exploration of his cardiac anatomy.
At the time of surgery multiple tumor nodules were noted
within the pericardium and eroding into the right atrium.
Major debulking occurred at the time.  The right atrium was
closed and pericardial partial stripping was performed.
Hemostasis was achieved. The patient was transferred in
stable condition from the OR to the cardiac surgery Intensive
Care Unit where he remained intubated for 24 hours.  He was
extubated on [**2118-8-12**] without complication.  His postoperative
course was complicated by significant blood loss requiring a
number of blood transfusions to maintain a hematocrit between
25 and 30.  His chest tubes and mediastinal tubes were
removed without complication on postoperative day #3.  On
postoperative day #4 anticoagulation for history of bilateral
pulmonary emboli was reinitiated with IV unfractionated
Heparin without a bolus.  Within 8-10 hours of reinstitution
of anticoagulation the patient became tachypneic, tachycardic
and hypoxic.  At that time it was noted to have a large
re-accumulation of fluid in his right hemithorax on chest
x-ray as well as a small pneumothorax.  Cardiothoracic
surgery inserted 32 French chest tube at the bedside without
complication.  Drainage of 2 liters of bloody fluid was
yielded.  Patient's anticoagulation was stopped and reversed
with Protamine at that time.  The patient obtained
hemodynamic stability and his chest tubes were discontinued
without complications on postoperative day #7.  Follow-up
chest x-ray throughout the remainder of the hospital course
showed resolution of the patient's pneumothorax and stability
in a small right sided pleural effusion.  Follow-up CAT scan
revealed abnormality consistent with tumor and postoperative
changes along the right cardiac border with bilateral
atelectasis.  No pulmonary metastases.  Follow-up staging
abdominal CT was performed during this hospitalization which
revealed no evidence of metastases, showed a small right
inguinal seroma.

Infectious Disease:  The patient began spiking fevers on
postoperative day #1, up to 104 degrees.  Multiple cultures
were obtained which remained negative.  Infectious disease
was consulted initially.  The patient was placed briefly on
Vancomycin and Ceftaz but after pan CT revealed no evidence
of fluid collection or infectious etiology, these antibiotics
were discontinued.  The patient's fever curve trended down
throughout his admission without any evidence of bacterial
etiology to his fevers.  The thought was the fevers were
secondary to tumor fever.  Upon discharge the patient's fever
curve had been trending down with occasional low grade
temperatures.

Heme:  The patient's anticoagulation was initially restarted
but after re-complication with hemopneumothorax, was
discontinued and not restarted.  The risks and benefits of
anticoagulation were weighed.  Given the remainder of tumor
still involved in the cardiac tissue and the risk of bleed,
it was decided not to re-anticoagulate the patient for
several weeks, if ever.  The patient required several blood
transfusions, platelet transfusions, FFP and cryoprecipitates
during his surgery and occasionally after to maintain
hematocrit between 25-30.  Upon discharge the patient's
hematocrit was stable for 4-5 days at 26??????.  He had no signs
of bleeding.  He will avoid non steroidals as they may
increase his risk of bleeding.

Cardiovascular:  As above.  The patient developed a new
pericardial friction rub during this admission after his
operative course.  Echocardiogram was performed on [**8-21**] to
evaluate this pericardial friction rub which revealed no
pericardial effusion, stable LV and RV function.  The patient
had some tachycardia that resolved by discharge.

Pain:  The patient had significant chest discomfort during
this hospitalization which initially required PCA.  He was
transitioned to OxyContin with Percocet for breakthrough and
was discharged on 30 mg q a.m., 20 mg of OxyContin q p.m. and
Percocet for breakthrough.

Renal:  The patient's kidney function remained stable
throughout this hospitalization.

Pulmonary:  The patient had to rule out the possibility of
DVT leading to PE secondary to concerns over his chest pain.
This was negative on [**2118-8-24**].  The patient will not be
re-anticoagulated secondary to concerns of his bleed.  The
patient's oxygen saturation was maintained between 94 and 95%
on room air at the time of discharge.

Fluids, Electrolytes & Nutrition:  The patient was tolerating
full diet on discharge.  He required intermittent
electrolytes repletion during his hospitalization.

Heme/Onc:  Patient's tumor at resection was sent to
pathology.  Pathologic diagnosis revealed angiosarcoma of low
grade type.  Heme/Onc was consulted immediately
postoperatively.  Plans were made for chemotherapy as an
outpatient vs transfer back to the United Kingdom for
treatment there.  The patient will follow-up with Dr. [**First Name8 (NamePattern2) 189**]
[**Last Name (NamePattern1) **] on [**2118-9-2**] for arrangement of his chemotherapy at a
time when he is fully healed from his cardiothoracic surgery.

Social Work:  The patient was seen extensively by social work
and case management during this hospitalization.  Plans were
made for living situation upon discharge as the patient is
from Great [**Last Name (un) 35668**].  [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 35669**] was instrumental in
arranging this.  Patient was discharged on [**2118-8-25**] to home.

DISCHARGE STATUS:  Stable.

DISCHARGE DIAGNOSIS:
1.  Angiosarcoma of cardiac origin.
2.  Right atrial perforation secondary to tumor.
3.  Pericardial effusion causing tamponade physiology.
4.  Anemia secondary to blood loss as a complication of
cardiothoracic surgery.
5.  History of bilateral pulmonary embolus.
6.  Status post hemopneumothorax.
7.  Postoperative chest pain.

DISCHARGE MEDICATIONS:  OxyContin 30 mg q a.m., 20 mg q p.m.,
Percocet 5/325 1-2 tablets po q 4-6 hours prn for
breakthrough pain, Colace 100 mg [**Hospital1 **], Zantac 150 mg [**Hospital1 **] and
Bacitracin topically to affected areas tid.

FOLLOW-UP:  He will follow-up with his primary care
physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 2048**] [**Last Name (NamePattern1) 3640**] on [**2118-9-9**] at 3:30 p.m. in the
clinical center, [**Hospital Ward Name 23**] Bldg., [**Location (un) **].  He will also
follow-up with Dr. [**First Name8 (NamePattern2) 189**] [**Last Name (NamePattern1) **] on [**2118-9-2**] in the
clinical center, [**Location (un) **].




                          [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**], M.D.  [**MD Number(1) 736**]

Dictated By:[**Last Name (NamePattern1) 35670**]

MEDQUIST36

D:  [**2118-8-26**]  10:00
T:  [**2118-8-30**]  16:07
JOB#:  [**Job Number **]
{'Malignant neoplasm of heart,Iatrogenic pneumothorax,Acute posthemorrhagic anemia,Other specified complications of procedures not elsewhere classified,Congenital deficiency of other clotting factors,Personal history of venous thrombosis and embolism'}


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 is a 24-year-old male with
past medical history significant for bilateral PE with
bilateral pleural effusions and pericardial effusions in [**2118-6-3**] requiring extensive MICU stay and prolonged
hospitalization.  Since discharge, the patient had been
reasonably well, however, over the week prior to admission he
developed onset of pleuritic right sided anterior chest pain
associated with exertional dyspnea.  Emergency Room
evaluation done at that time revealed no new clot by CTA but
revealed a right atrial abnormality.  Follow-up echo showed
echo dense space intimately associated with either the
pericardium or the pleural space.  The patient was
hemodynamically stable without pulses paradoxus or tamponade.
Repeat echo 7 days later was done with stability in the
patient's symptoms.  Echo at this time showed increased size
of the right sided loculated pericardial effusion with
diastolic compression of the RV.  Chest x-ray showed increase
in heart size.  In clinic on the day of admission the patient
was hemodynamically stable.  EKG showed ST elevations in 2,
3, and AVF with PR depressions in 3 and a pulsus paradoxus of
10.  The patient was sent to the Emergency Room for
admission.

MEDICAL HISTORY: Pericardial effusion status post
drainage with pigtail catheter in [**2118-6-3**] with negative
rheumatologic malignant and infectious work-up.  Bilateral
pleural effusion status post pigtail drainage of the right
with negative work-up as well for rheumatologic infectious
disease and malignancy, bilateral pulmonary emboli diagnosed
in [**2118-6-3**], treated with Heparin initially and currently
anticoagulated on Coumadin, history of heterozygosity for
factor [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 12843**] mutation.

MEDICATION ON ADMISSION: 

ALLERGIES: None known.

PHYSICAL EXAM: 

FAMILY HISTORY: Grandfather had [**Name2 (NI) 499**] cancer and also a
grandparent with lung cancer.

SOCIAL HISTORY: He is a heterosexual male in a monogamous
relationship.  He denies tobacco, denies drug use, used
alcohol in the past prior to his [**Month (only) **] hospitalization of
greater than 30 beers per week.  He is from Great [**Last Name (un) 35668**]
and is a sailor. 

### Response:
{'Malignant neoplasm of heart,Iatrogenic pneumothorax,Acute posthemorrhagic anemia,Other specified complications of procedures not elsewhere classified,Congenital deficiency of other clotting factors,Personal history of venous thrombosis and embolism'}
