CHIEF COMPLAINT: dizziness, vomiting, hypertension

PRESENT ILLNESS: 62yo F w/ a PMH of afib, CAD, and CHF (diastolic dysfunction)
now admitted with nausea and dizziness in the setting of afib w/
RVR. Pt states that she first had symptoms of dizziness [**1-21**]
weeks ago in the setting of what she thought was a cold. She
took Sudafed for several days and the symptoms seemed to
improve. Her cold then seemed to settle into her chest, with a
sore throat predominating. She had 24hrs of diarrhea but then
felt well up until last night. During dinner last night, she
began to feel dizzy again. She describes her dizziness as a
sensation of a "heaviness" in her head. She denies any spinning
sensation, of either herself or the room. She denies any vision
changes. She states that she came home from dinner and went to
bed, but then got up in the middle of the night and had
difficulty walking to the bathroom and had to hold on to the
walls as she walked. She then decided to come to the ER for
further evaluation.
.
The dizziness is associated with a mild headache and nausea.
She's had emesis or more specifically, dry heaves x2. She denies
any presyncope, LH, falls or LOC. She denies any URI sx,
including cough, rhinorrhea or sinus tenderness. She denies any
SOB, CP or palpitations. She has had minimal PO's since the
start of these sx, but previously denied any weight loss, night
sweats, diarrhea. No urinary sx. No leg swelling, numbness,
tingling or weakness in her arms or legs.
.
In the ER, VS were T 97.5, BP 236/106, HR 120-130s, RR 16, sats
of 99% on RA.

MEDICAL HISTORY: Afib
- On [**Month/Day (3) 197**]/Coreg
- S/P cardioversion [**6-24**]
CAD
- cath in [**2169**]: The LMCA was angiographically normal. The LAD
had a 40-50% stenosis in the mid portion. The D2 branch had an
ostial/proximal 70% stenosis. The LCX had proximal mild luminal

MEDICATION ON ADMISSION: Aspirin 81mg PO QD
Coreg 50mg PO BID
[**Year (4 digits) 197**] 5mg PO QHS
Cyanocobalamin 1000mcg PO QD
Co Q-10 100mg PO BID
Diovan 40mg PO QD
Lasix 40mg PO QD
Ibuprofen 800mg PO TID
Levoxyl 200mcg PO QD
Lisinopril 40mg PO QD
MVI 1tab PO QD
Simvastatin 80mg PO QD

ALLERGIES: Adalat Cc

PHYSICAL EXAM: VS: T - 97.6, BP - 140/57, HR - 77, RR - 16, O2 - 97% on RA
Gen: Fatigued, intermittently dry heaving, but awake, alert and
oriented x 3 in NAD
HEENT: NC/AT; PERRLA, EOMI; OP clear, nonerythematous with mildy
dry mucous membranes
CV: S1, S2 nl, no m/r/g appreciated
Lungs: CTAB
Abd: Soft, obese, NT, ND, +BS
Ext: No c/c/e
Neuro: CN II - XII intact; sensation intact; strength 5/5 in UEs
and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 6816**], reflexes 2+ in biceps, triceps,
brachioradialis bilaterally; downgoing toes bilaterally;
finger-to-nose intact, no dysdiadokokinesia; gait not assessed,
[**Last Name (un) **]-Hallpike deferred given patient's nausea

FAMILY HISTORY: M died of lung cancer at age 56; F died of pna at 72, but also
had stomach cancer. Brother is 58 and healthy, other than HTN.

SOCIAL HISTORY: Patient has a remote history of tobacco use for approximately 5
years, up to 1 ppd. She reports being a social alcohol drinker
and denies any illicit drug use.
Unspecified essential hypertension,Atrial fibrillation,Chronic diastolic heart failure,Coronary atherosclerosis of native coronary artery,Long-term (current) use of anticoagulants,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, other specified sites,Personal history of malignant neoplasm of thyroid,Labyrinthitis, unspecified
Hypertension NOS,Atrial fibrillation,Chr diastolic hrt fail,Crnry athrscl natve vssl,Long-term use anticoagul,Obesity NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Osteoarthro NOS-oth site,Hx of thyroid malignancy,Labyrinthitis NOS
Admission Date:  [**2175-9-11**]              Discharge Date:   [**2175-9-14**]

Date of Birth:  [**2113-6-17**]             Sex:   F

Service: MEDICINE

Allergies:
Adalat Cc

Attending:[**First Name3 (LF) 2817**]
Chief Complaint:
dizziness, vomiting, hypertension

Major Surgical or Invasive Procedure:
none

History of Present Illness:
62yo F w/ a PMH of afib, CAD, and CHF (diastolic dysfunction)
now admitted with nausea and dizziness in the setting of afib w/
RVR. Pt states that she first had symptoms of dizziness [**1-21**]
weeks ago in the setting of what she thought was a cold. She
took Sudafed for several days and the symptoms seemed to
improve. Her cold then seemed to settle into her chest, with a
sore throat predominating. She had 24hrs of diarrhea but then
felt well up until last night. During dinner last night, she
began to feel dizzy again. She describes her dizziness as a
sensation of a "heaviness" in her head. She denies any spinning
sensation, of either herself or the room. She denies any vision
changes. She states that she came home from dinner and went to
bed, but then got up in the middle of the night and had
difficulty walking to the bathroom and had to hold on to the
walls as she walked. She then decided to come to the ER for
further evaluation.
.
The dizziness is associated with a mild headache and nausea.
She's had emesis or more specifically, dry heaves x2. She denies
any presyncope, LH, falls or LOC. She denies any URI sx,
including cough, rhinorrhea or sinus tenderness. She denies any
SOB, CP or palpitations. She has had minimal PO's since the
start of these sx, but previously denied any weight loss, night
sweats, diarrhea. No urinary sx. No leg swelling, numbness,
tingling or weakness in her arms or legs.
.
In the ER, VS were T 97.5, BP 236/106, HR 120-130s, RR 16, sats
of 99% on RA.


Past Medical History:
Afib
- On [**Month/Day (3) 197**]/Coreg
- S/P cardioversion [**6-24**]
CAD
- cath in [**2169**]: The LMCA was angiographically normal. The LAD
had a 40-50% stenosis in the mid portion. The D2 branch had an
ostial/proximal 70% stenosis. The LCX had proximal mild luminal

irregularities. The RCA had a 30% mid stenosis. The R-PDA had a

70-80% proximal stenosis involving its takeoff.
Papillary thyroid cancer - Diagnosed in the summer of [**2173**], s/p
total thyroidectomy and radiation, on synthroid
Obesity
- S/P gastric bypass in [**12-22**]
HTN
CHF
- Diastolic Dysfunction, EF of 55%, LVH
DM type II
Hypercholesterolemia
TTP
OA


Social History:
Patient has a remote history of tobacco use for approximately 5
years, up to 1 ppd. She reports being a social alcohol drinker
and denies any illicit drug use.

Family History:
M died of lung cancer at age 56; F died of pna at 72, but also
had stomach cancer. Brother is 58 and healthy, other than HTN.

Physical Exam:
VS: T - 97.6, BP - 140/57, HR - 77, RR - 16, O2 - 97% on RA
Gen: Fatigued, intermittently dry heaving, but awake, alert and
oriented x 3 in NAD
HEENT: NC/AT; PERRLA, EOMI; OP clear, nonerythematous with mildy
dry mucous membranes
CV: S1, S2 nl, no m/r/g appreciated
Lungs: CTAB
Abd: Soft, obese, NT, ND, +BS
Ext: No c/c/e
Neuro: CN II - XII intact; sensation intact; strength 5/5 in UEs
and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 6816**], reflexes 2+ in biceps, triceps,
brachioradialis bilaterally; downgoing toes bilaterally;
finger-to-nose intact, no dysdiadokokinesia; gait not assessed,
[**Last Name (un) **]-Hallpike deferred given patient's nausea


Pertinent Results:
WBC-10.7 RBC-4.97 HGB-12.7 HCT-39.9 MCV-80 MCH-25.6 MCHC-31.9
RDW-17.7
TSH 0.053, T4 10.2
CALCIUM-8.7 PHOSPHATE-2.8 MAGNESIUM-2.2
GLUCOSE-193* UREA N-21* CREAT-0.7 SODIUM-139 POTASSIUM-3.5
CHLORIDE-101 TOTAL CO2-31 ANION GAP-11
URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-100 KETONE-NEG
BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG
CK-MB-3 cTropnT-<0.01 CK(CPK)-54
.
Studies:
CT Head with contrast:
There is no hemorrhage, mass effect, shift of normally midline
structures or hydrocephalus.  Tiny hypodensity is seen in the
right centrum semiovale, unchanged from the prior study,
consistent with microangiopathic change.  No air- fluid levels
are seen in the paranasal sinuses. The mastoid air cells are
clear. The soft tissues appear unremarkable.
.
EKG: Baseline artifact. Regular supraventricular rhythm. There
is a late
transition which is probably normal. Compared to the prior
tracing regular
supraventricular tachycardia is now present.
.
MRI/A Brain: Multiple T2 and FLAIR hyperintense signals seen in
the periventricular and subcortical white matter, consistent
with chronic
microangiopathic changes.  No evidence of acute hemorrhage or
stroke.


Brief Hospital Course:
A/P: 62 y.o. female with PMHx of A fib, s/p cardioversion, HTN,
CHF who presents with complaints of N/V and dizziness in the
setting of a. fib with RVR and hypertensive urgency.
.
# Nausea/Dizziness: Initial differential included vertigo, acute
MI, posterior CVA, labrynthitis with recent URI. ACS ruled out
by CEs x 2, 12 hours apart and has no ischemic changes on EKG,
making MI less likely. Posterior CVA assessed by MRI/MRA without
evidence of thrombosis or new CVA.  Patient was followed by
neurology during stay and gave input concerning symptom
management.  On the third day of admission, symptoms had
completely resolved, which is consistent with vertigo associated
with labrynthitis following her recent URI.  Upon discharge
denies any further symptoms of nausea, vomiting or vertigo.
.
# HTN: Poorly controlled upon arrival to the ED at 236/106. OMR
notes demonstrate BP range of 120s-150s, though given 3
antihypertensive agents, suspected that patient likely has
chronically elevated blood pressure. Cause of acute elevation
was unclear, but likely related to poorly tolerating po
medications. Patient does report compliance with her medications
prior to hospitalization. Acute cardiac event was ruled out as
detailed above. Initially on ICU admit BP was being controlled
on Labetalol gtt. She denied HA and UA shows no evidence of
end-organ damage. Labetalol gtt was discontinued and she was
briefly hypotensive to low 100s. She continued to have labile
BP, with averages to 170s but had much improvement with addition
of home lasix dosing.  Electrophysiology was consulted
concerning her afib despite prior cardioconversion and suggested
adding verapamil 80mg [**Hospital1 **].  This medication was only given once
while inpatient as she persistently had heart rates in the
mid-60s.  She was not discharged on this medication, but sent
home on her prior antihypertensive medications with a VNA to
visit and perform BP checks.
.
# Atrial Fibrillation: S/P cardioversion in [**Month (only) 205**] on admit found
to be in atrial fibrillation again. Patient denied chest pain or
palpitations on presentation which might suggest asymptomatic a.
fib, thus making it difficult to tell if she has been in sinus
since her conversion. Underlying etiologies include
hyperthyroidism or infection. TSH suppressed, not hyperthyroid
on labs. Patient is afebrile now with no signs of infection, but
had a recent URI. Again, MI has been ruled out as above.  HR
labile the evening of admit with swings from HR 120s to 65s
indicative of possible Afib vs autonomic dysfuntion. EP
consulted and thought she likely had atrial tachycardia and
recommended verapamil, maximum dosing of carvediol/lisinopril
and lasix.  Verapamil held as above.  Discharged with
instruction to decrease [**Month (only) 197**] dosing for next three days,
given elevated INR of 3.6.  Should follow-up with [**Hospital 197**]
Clinic next week for INR check and dose adjustment.
.
# CAD: History of two vessel CAD with no intervention. Admitted
on ASA, BB and statin at outpatient dosing. No evidence of MI on
admit. Continue all outpatient meds.
.
# CHF: Preserved EF with LVH and elevated left-sided filling
pressures on echo in [**2173**] with overall greater evidence of
diastolic dysfunction, compared to previous echo in [**2169**].
Patient is followed by Dr. [**First Name (STitle) 437**] as an outpatient and took Lasix
PRN. On admit was hypovolemic given recent nausea and vomiting.
Given IVF and tolerated po on discharge, sent home on outpatient
medications.
.
# S/P Thyroidectomy: On suppressive therapy with Synthroid,
recently decreased. TSH is very suppresed at 0.053 despite
recent decrease in Synthroid from 225 mcg to 200 mcg. Patient is
followed by Dr. [**Last Name (STitle) **] in endocrine and per a conversation with
her yesterday, patient could benefit from decrease in Synthroid
to 175 mcg.  On discharge was instructed to continue Synthroid
at 175 mcg and follow-up with her endocrinologist as outpatient.

.
# DM: Patient has a history of DM2, reportedly controlled with
diet and improved since gastric bypass. Most recent HbA1C is 6.5
in 4/[**2174**]. Patient is not on standing diabetic medications as an
outpatient.   Was monitored with QID fingersticks and did
require a low dose ISS while inpatient.  Instructed to follow-up
with PCP on this issue and continue to monitor her fingersticks
as an outpatient.
.
# TTP: Stable. Platelets are normal though slightly lower than
baseline approximately one year ago. Currently no signs of
bleeding. Patient also has no fever and hematocrit and
creatinine are normal. No active issues during hospital stay.


Medications on Admission:
Aspirin 81mg PO QD
Coreg 50mg PO BID
[**Year (4 digits) 197**] 5mg PO QHS
Cyanocobalamin 1000mcg PO QD
Co Q-10 100mg PO BID
Diovan 40mg PO QD
Lasix 40mg PO QD
Ibuprofen 800mg PO TID
Levoxyl 200mcg PO QD
Lisinopril 40mg PO QD
MVI 1tab PO QD
Simvastatin 80mg PO QD


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Primary: Hypertension, vertigo
Secondary: DM, coronary artery disease, congestive heart
failure, history of papillary thyroid cancer, atrial
fibrillation.


Discharge Condition:
Hemodynamically stable, tolerating oral intake and afebrile.


Discharge Instructions:
You have been admitted for hypertensive urgency, nausea and
dizziness.  You were treated symptomatically with medicine for
nausea and your blood pressure.  You were additionally evaluated
with CT Scan and MRI of  your head, which did not reveal new
abnormalities concerning of recent stroke or bleeding.  Once
your symptoms had resolved, you were discharged home with
continued services to help you during your recovery period.

While in the hospital, your medications were continued.  The
only medication change we advise on discharge is that you hold
your [**First Name3 (LF) 197**] dose tonight, and then take only 3mg daily for the
following two days.  After that you should resume your regular
dosing and follow-up with your [**Hospital 197**] Clinic in the next [**6-27**]
days for monitoring of your INR.

Additionally, you have required insulin while inpatient to
control your blood sugar.  You should continue checking your
blood sugar four times daily and follow-up with your PCP in the
next 1-2 weeks to discuss your diabetic management.

Please return to the ED or contact Dr. [**Last Name (STitle) **] should your
symptoms return or should you become nauseated and unable to
tolerate oral intake.

Followup Instructions:
Provider: [**Name10 (NameIs) **] CLINIC  [**Telephone/Fax (1) 10413**]  Call to schedule
appointment

Please call your Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 250**] to schedule and
appointment in the next 1-2 weeks to discuss your hypertension
and diabetes management further.
{'Unspecified essential hypertension,Atrial fibrillation,Chronic diastolic heart failure,Coronary atherosclerosis of native coronary artery,Long-term (current) use of anticoagulants,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, other specified sites,Personal history of malignant neoplasm of thyroid,Labyrinthitis, unspecified'}


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: dizziness, vomiting, hypertension

PRESENT ILLNESS: 62yo F w/ a PMH of afib, CAD, and CHF (diastolic dysfunction)
now admitted with nausea and dizziness in the setting of afib w/
RVR. Pt states that she first had symptoms of dizziness [**1-21**]
weeks ago in the setting of what she thought was a cold. She
took Sudafed for several days and the symptoms seemed to
improve. Her cold then seemed to settle into her chest, with a
sore throat predominating. She had 24hrs of diarrhea but then
felt well up until last night. During dinner last night, she
began to feel dizzy again. She describes her dizziness as a
sensation of a "heaviness" in her head. She denies any spinning
sensation, of either herself or the room. She denies any vision
changes. She states that she came home from dinner and went to
bed, but then got up in the middle of the night and had
difficulty walking to the bathroom and had to hold on to the
walls as she walked. She then decided to come to the ER for
further evaluation.
.
The dizziness is associated with a mild headache and nausea.
She's had emesis or more specifically, dry heaves x2. She denies
any presyncope, LH, falls or LOC. She denies any URI sx,
including cough, rhinorrhea or sinus tenderness. She denies any
SOB, CP or palpitations. She has had minimal PO's since the
start of these sx, but previously denied any weight loss, night
sweats, diarrhea. No urinary sx. No leg swelling, numbness,
tingling or weakness in her arms or legs.
.
In the ER, VS were T 97.5, BP 236/106, HR 120-130s, RR 16, sats
of 99% on RA.

MEDICAL HISTORY: Afib
- On [**Month/Day (3) 197**]/Coreg
- S/P cardioversion [**6-24**]
CAD
- cath in [**2169**]: The LMCA was angiographically normal. The LAD
had a 40-50% stenosis in the mid portion. The D2 branch had an
ostial/proximal 70% stenosis. The LCX had proximal mild luminal

MEDICATION ON ADMISSION: Aspirin 81mg PO QD
Coreg 50mg PO BID
[**Year (4 digits) 197**] 5mg PO QHS
Cyanocobalamin 1000mcg PO QD
Co Q-10 100mg PO BID
Diovan 40mg PO QD
Lasix 40mg PO QD
Ibuprofen 800mg PO TID
Levoxyl 200mcg PO QD
Lisinopril 40mg PO QD
MVI 1tab PO QD
Simvastatin 80mg PO QD

ALLERGIES: Adalat Cc

PHYSICAL EXAM: VS: T - 97.6, BP - 140/57, HR - 77, RR - 16, O2 - 97% on RA
Gen: Fatigued, intermittently dry heaving, but awake, alert and
oriented x 3 in NAD
HEENT: NC/AT; PERRLA, EOMI; OP clear, nonerythematous with mildy
dry mucous membranes
CV: S1, S2 nl, no m/r/g appreciated
Lungs: CTAB
Abd: Soft, obese, NT, ND, +BS
Ext: No c/c/e
Neuro: CN II - XII intact; sensation intact; strength 5/5 in UEs
and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 6816**], reflexes 2+ in biceps, triceps,
brachioradialis bilaterally; downgoing toes bilaterally;
finger-to-nose intact, no dysdiadokokinesia; gait not assessed,
[**Last Name (un) **]-Hallpike deferred given patient's nausea

FAMILY HISTORY: M died of lung cancer at age 56; F died of pna at 72, but also
had stomach cancer. Brother is 58 and healthy, other than HTN.

SOCIAL HISTORY: Patient has a remote history of tobacco use for approximately 5
years, up to 1 ppd. She reports being a social alcohol drinker
and denies any illicit drug use. 

### Response:
{'Unspecified essential hypertension,Atrial fibrillation,Chronic diastolic heart failure,Coronary atherosclerosis of native coronary artery,Long-term (current) use of anticoagulants,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, other specified sites,Personal history of malignant neoplasm of thyroid,Labyrinthitis, unspecified'}
