CHIEF COMPLAINT: Shortness of breath.

PRESENT ILLNESS: This is a 23-year-old male with
a history of past left lower extremity edema who presents
with sudden onset of dyspnea, vomiting, shortness of breath,
When he presented to the Emergency Department, he was sating
80% on room air.  He did have visual changes and lightheadedness
that resolved with oxygen supplementation.   Electrocardiogram
showed tachycardia and was consistent with right heart strain.
Patient had an emergent CTA which showed mass of bilateral
pulmonary emboli in the left upper lobe, pulmonary artery, and in
the right main, and right upper lobe pulmonary arteries.
The patient was hemodynamically stable.  He was thought to have a
pulmonary embolus secondary to hypercoagulable state.  He was
started immediately on Heparin and transferred to the Intensive
Care Unit.  Transthoracic echocardiogram showed mild RV dilation,
mild pulmonary hypertension, below normal RV function, and an
ejection fraction of 55%.

MEDICAL HISTORY: 1. Head trauma in [**2137**], CT scan negative.
2. Right shoulder injury status post fall in [**2141-3-13**].
3. Superficial thrombophlebitis of the right basilar vein in
[**2141-4-12**], two weeks after lacrosse injury to the arm.
4. Chronic left leg swelling x1 year, last in summer of [**2140**],
diagnosed with chronic compartment syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Patient denies any family history of
clotting problems.

SOCIAL HISTORY: Patient is a student at [**University/College 5130**]
[**Location (un) **].  He denies any current or past tobacco, alcohol,
or IV drug use.
Other pulmonary embolism and infarction,Primary pulmonary hypertension,Ostium secundum type atrial septal defect
Pulm embol/infarct NEC,Prim pulm hypertension,Secundum atrial sept def
Admission Date:  [**2141-12-18**]     Discharge Date:  [**2141-12-23**]

Date of Birth:   [**2118-11-17**]     Sex:  M

Service:
CHIEF COMPLAINT:  Shortness of breath.

HISTORY OF PRESENT ILLNESS:  This is a 23-year-old male with
a history of past left lower extremity edema who presents
with sudden onset of dyspnea, vomiting, shortness of breath,
When he presented to the Emergency Department, he was sating
80% on room air.  He did have visual changes and lightheadedness
that resolved with oxygen supplementation.   Electrocardiogram
showed tachycardia and was consistent with right heart strain.
Patient had an emergent CTA which showed mass of bilateral
pulmonary emboli in the left upper lobe, pulmonary artery, and in
the right main, and right upper lobe pulmonary arteries.
The patient was hemodynamically stable.  He was thought to have a
pulmonary embolus secondary to hypercoagulable state.  He was
started immediately on Heparin and transferred to the Intensive
Care Unit.  Transthoracic echocardiogram showed mild RV dilation,
mild pulmonary hypertension, below normal RV function, and an
ejection fraction of 55%.

The patient was seen by Hematology, who was called upon to
rule out hypercoagulopathic states.  Of note, patient has a
history of a superficial thrombophlebitis in his right
basilar vein, which developed in [**2141-4-12**], two weeks after
a lacrosse injury to the same arm.  He also has a history of
chronic left lower extremity swelling that he last had in the
summer of [**2140**].  He had been given the diagnosis of chronic
compartment syndrome.

Patient went onto have a transthoracic echocardiogram with a
bubble test, which elucidated a large patent foramen ovale,
and showed large right to left shunt.  While still in the
Intensive Care Unit, on [**2141-12-19**], patient received TPA
without complications.  This was in order to recanalize the
obstructive pulmonary arteries.  After the TPA, patient was
oxygenating better, and feeling significantly less short of
breath.  His right-sided heart pressures were significantly
reduced on repeat echocardiogram and as a result there was less
of a right to left shunt through the PFO.

The patient had upper extremity noninvasive ultrasound, which
showed a nonocclusive right basilar clots.

Patient was transferred to the floor on [**2141-12-20**].  Patient
remained hemodynamically stable.  At this time, patient
denies any chest pain, shortness of breath, or pleuritic
pain.  He has only a minimal cough.

PAST MEDICAL HISTORY:
1. Head trauma in [**2137**], CT scan negative.
2. Right shoulder injury status post fall in [**2141-3-13**].
3. Superficial thrombophlebitis of the right basilar vein in
[**2141-4-12**], two weeks after lacrosse injury to the arm.
4. Chronic left leg swelling x1 year, last in summer of [**2140**],
diagnosed with chronic compartment syndrome.

MEDICATIONS ON TRANSFER:
1. Heparin drip.
2. Coumadin 5 mg po q day.
3. Tylenol prn.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Patient is a student at [**University/College 5130**]
[**Location (un) **].  He denies any current or past tobacco, alcohol,
or IV drug use.

FAMILY HISTORY:  Patient denies any family history of
clotting problems.

Vitals:  Temperature 97.7, pulse 77, blood pressure 139/76,
respiratory rate 16, and O2 sat is 96% on room air.  In
general, the patient is in no apparent distress.  HEENT:
Mucous membranes moist.  Pupils are equal, round, and
reactive to light and accommodation.  Oropharynx is clear.
Lungs are clear to auscultation bilaterally.  Cardiovascular:
Regular, rate, and rhythm, no murmurs, rubs, or gallops, no
heaves.  Abdomen is soft, nontender, nondistended,
normoactive bowel sounds, no hepatosplenomegaly.
Extremities:  No clubbing, cyanosis, or edema, although the
left leg appears slightly larger in terms of musculature in
comparison to the right leg, there is no right basilar vein
protrusion or tenderness.

LABORATORIES FROM [**2141-12-20**]:  White count 11.5, hematocrit
40.4, platelets 169.  PT 15.3, PTT 87.9, INR 1.5.  Potassium
3.7, magnesium 1.6.  Protein-C 116, normal is 67-123.
Homocystine 9.5, normal is 4.5-12.4.

HOSPITAL COURSE:  In short, this is a 23-year-old male with a
history of superficial thrombophlebitis and past left lower
extremity swelling with possible chronic compartment
syndrome, who presents with acute shortness of breath,
pleuritic chest pain, cough, found to have submassive
bilateral pulmonary emboli.  Patient was also found to have
significantly large patent foramen ovale with right to left
shunt.  He was treated with Heparin, and then given TPA with
marked improvement of symptoms.

1. Heme:  As already noted, the patient was seen by
Hematology.  He had a full set of hypercoagulability panels
sent.  When he first came in, patient's only risk factors for
pulmonary emboli were the superficial thrombophlebitis in his
right basilar vein, and the chronic left lower extremity
swelling that was diagnosed as chronic compartment syndrome.

At the time of this dictation, patient's anticardiolipin IgM
came back as 34.2.  The normal is 0-12.5.  Otherwise, the
patient had normal protein-C, protein-S, and homocystine
levels.  His PT gene mutation and factor-[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 12843**] mutation are
pending at this time.  Nevertheless, his hypercoagulable
state may be attributed to the antiphospholipid syndrome
associated with anticardiolipin antibody.  For this reason,
this patient will likely need anticoagulation for life.

Patient was started on both Heparin and Coumadin while
in-house.  Patient's INR on [**2141-12-23**], the date of discharge,
was only 1.3.  The patient was taught how to use Lovenox.  He
was sent with therapeutic dose of 100 mg subQ [**Hospital1 **] of Lovenox
until his INR becomes therapeutic.  Patient will also need to
followup with Hematology in the future.

2. Cardiovascular:  Patient's original transthoracic
echocardiogram on [**2141-12-18**] showed large PFO, right to left
shunt, left ventricular size and function normal, ejection
fraction of greater than 55%, RV moderately dilated, right
ventricular systolic function depressed, and moderate
pulmonary artery hypertension.  There was a question of
whether or not patient has always had this PFO, or if it was
exacerbated with the increasing right sided pressures
secondary to right sided strain.

The patient had a repeat transthoracic echocardiogram on
[**2141-12-22**].  This showed improved RV free wall motion, and only
demonstrated right to left shunt with maneuvers.  Patient may
need a repeat bubble scan for further evaluation as an
outpatient.

3. Pulmonary:  As already noted, the patient remains
hemodynamically stable, oxygenating well on room air after
the administration of TPA on [**2141-12-19**].

4. Patient has given various accounts of history when he
developed this acute shortness of breath.  He stated that he
lost vision in the upper zone of his visual field.  Given the
fact that the patient demonstrated large PFO with right to
left shunt, there was concern that the patient may be
throwing paradoxical emboli.  The patient demonstrated no
focal neurological signs while in-house.  This was true also
after receiving TPA.  Patient had a MRI on [**2141-12-22**].  This
demonstrated no presence of infarct.

CONDITION ON DISCHARGE:  Good.

DISCHARGE MEDICATIONS:
1. Coumadin 5 mg po q day.
2. Lovenox 100 mg subQ [**Hospital1 **] until Coumadin is therapeutic with
an INR of 2.5-3.5.
3. Tylenol prn.

DISCHARGE INSTRUCTIONS:  Patient has a follow-up appointment
with Dr. [**First Name (STitle) **] on Monday, [**2141-12-25**] at 3:20 pm on the [**Location (un) 25799**] of the [**Doctor Last Name 780**] Building.  At this time, he will need to
have his INR checked and Coumadin dose readjusted.  From
there, the patient will follow up with Dr. [**Last Name (STitle) **] as his
primary PCP.  [**Name10 (NameIs) **] will also need to followup with
Cardiology with Dr. [**Last Name (STitle) **].  Patient will also need to followup
with Hematology.

DISCHARGE DIAGNOSES:
1. Submassive bilateral pulmonary emboli.
2. Anticardiolipin antibody positive.




                          [**First Name11 (Name Pattern1) 2515**] [**Last Name (NamePattern4) 4517**], M.D.  [**MD Number(1) 4521**]

Dictated By:[**Name8 (MD) 4990**]

MEDQUIST36

D:  [**2141-12-26**]  23:14
T:  [**2141-12-29**]  07:47
JOB#:  [**Job Number 21387**]
{'Other pulmonary embolism and infarction,Primary pulmonary hypertension,Ostium secundum type atrial septal defect'}


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: Shortness of breath.

PRESENT ILLNESS: This is a 23-year-old male with
a history of past left lower extremity edema who presents
with sudden onset of dyspnea, vomiting, shortness of breath,
When he presented to the Emergency Department, he was sating
80% on room air.  He did have visual changes and lightheadedness
that resolved with oxygen supplementation.   Electrocardiogram
showed tachycardia and was consistent with right heart strain.
Patient had an emergent CTA which showed mass of bilateral
pulmonary emboli in the left upper lobe, pulmonary artery, and in
the right main, and right upper lobe pulmonary arteries.
The patient was hemodynamically stable.  He was thought to have a
pulmonary embolus secondary to hypercoagulable state.  He was
started immediately on Heparin and transferred to the Intensive
Care Unit.  Transthoracic echocardiogram showed mild RV dilation,
mild pulmonary hypertension, below normal RV function, and an
ejection fraction of 55%.

MEDICAL HISTORY: 1. Head trauma in [**2137**], CT scan negative.
2. Right shoulder injury status post fall in [**2141-3-13**].
3. Superficial thrombophlebitis of the right basilar vein in
[**2141-4-12**], two weeks after lacrosse injury to the arm.
4. Chronic left leg swelling x1 year, last in summer of [**2140**],
diagnosed with chronic compartment syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Patient denies any family history of
clotting problems.

SOCIAL HISTORY: Patient is a student at [**University/College 5130**]
[**Location (un) **].  He denies any current or past tobacco, alcohol,
or IV drug use. 

### Response:
{'Other pulmonary embolism and infarction,Primary pulmonary hypertension,Ostium secundum type atrial septal defect'}
