CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 75yo F with h/o R breast cancer s/p resection/XRT (dx last
year), DMII, HTN, and recent travel to [**Location (un) 9012**] [**6-30**] (2.5 plane
ride) p/w a sudden acute onset of anterior L sided chest pain x
12 hours prior to presentation to the ED. It was [**2128-5-17**]
nonradiating pain associated with SOB but otherwise no
diaphoresis, palpitations, n/v, LH. She usually has SOB with
exertion at baseline after walking [**2-13**] blocks, however, over the
last 2 days, pt has been having SOB at rest. She was supposed to
go see her PCP today for chest pain, but instead came to the ED.
Per her daughter, pt is usually not physically active at
baseline due to her low back pain and R knee pain. She
previously never had any chest pain. Her BPs usually runs
120-160s on meds. Didn't take any meds today. While en route to
the [**Name (NI) **], pt received lasix and sl nitro. Her chest pain relieved
only in ED after med administration, however. Currently, denies
any chest pain and shortness of breath improved.
.
In ED, at presentation VS 98.1, 99, 132/92, 22 93% on RA. pt
received ASA 325mg, Tyelno 1gm, and mophine 4mg and heparing
bolus and gtt. Because heparin pump malfunctioned and pt
recieved approx 12,000U heparin and drip stopped and coags
rechecked.
.
Of note, s/p recent mechanical fall without any head trauma or
LOC and panscan negative for traumatic injury prior to starting
heparin.
.
ROS: Denies recent weight gain, exertional chest pain, PND,
orthopnea, constipation, n/v, abdominal pain, diarrhea, melena,
hematochezia, URI symptoms, cough, fevers/chills.

MEDICAL HISTORY: R breast cancer s/p resection and XRT- dx last year followed at
[**Hospital3 328**]
DM II
HTN
No prior PUD or CVA
s/p total R knee replacement [**7-/2119**]
? RLE DVT- had sxs but u/s negative, never been placed on
coumadin.

MEDICATION ON ADMISSION: Glyburide 5mg TID
Avandia 2mg qday
Toprol XL 100 qam and 50mg qpm
Nateglinide (Starlix) 125mg? [**Hospital1 **]
Hyzaar 100/25 daily
Vytorin [**12-1**] qday
furosemide 20mg qday
ASA 81- stopped 1 mo ago due to easy bruising

ALLERGIES: Penicillins

PHYSICAL EXAM: BP 118/43 HR 87 Resp 14 O2 sat 96% 3L
Gen: obese woman, lying flat in bed, NAD
HEENT: anicteric, OP moist.
Neck: JVP to earlobe lying at 30 deg, supple
CV: RRR without m/r/g, distant heart sounds
Resp: clear to auscutation anteriorly, no wheezing/rhonchi.
Abd: Obese, nontender throughout, BS+
Ext: 2+ pitting edema to above the knee b/l, tender to firm
touch throughout, no erythema, mass, fluctance, rash.  Large
ecchymoses over right knee.
Neuro: AO x 3, CN II to XII wnl. normal sensation to light
touch. moving all 4 extremities.

FAMILY HISTORY: No PE/DVT, DM or CAD

SOCIAL HISTORY: Used to be an accountant. Originally from [**Location (un) 3156**]. In the US for
the last 13 years. No smoking or ETOH or IVDA. Lives alone and
has a homemaker who comes to clean. Independent ADLs but not
physically active. Cooks for herself.  She has children who live
in the [**Location (un) 86**] area. She is Russian speaking only.
Other pulmonary embolism and infarction,Chronic diastolic heart failure,Personal history of malignant neoplasm of breast,Anemia, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Pulm embol/infarct NEC,Chr diastolic hrt fail,Hx of breast malignancy,Anemia NOS,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2125-7-12**]              Discharge Date:   [**2125-7-18**]

Date of Birth:  [**2049-8-15**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
None


History of Present Illness:
75yo F with h/o R breast cancer s/p resection/XRT (dx last
year), DMII, HTN, and recent travel to [**Location (un) 9012**] [**6-30**] (2.5 plane
ride) p/w a sudden acute onset of anterior L sided chest pain x
12 hours prior to presentation to the ED. It was [**2128-5-17**]
nonradiating pain associated with SOB but otherwise no
diaphoresis, palpitations, n/v, LH. She usually has SOB with
exertion at baseline after walking [**2-13**] blocks, however, over the
last 2 days, pt has been having SOB at rest. She was supposed to
go see her PCP today for chest pain, but instead came to the ED.
Per her daughter, pt is usually not physically active at
baseline due to her low back pain and R knee pain. She
previously never had any chest pain. Her BPs usually runs
120-160s on meds. Didn't take any meds today. While en route to
the [**Name (NI) **], pt received lasix and sl nitro. Her chest pain relieved
only in ED after med administration, however. Currently, denies
any chest pain and shortness of breath improved.
.
In ED, at presentation VS 98.1, 99, 132/92, 22 93% on RA. pt
received ASA 325mg, Tyelno 1gm, and mophine 4mg and heparing
bolus and gtt. Because heparin pump malfunctioned and pt
recieved approx 12,000U heparin and drip stopped and coags
rechecked.
.
Of note, s/p recent mechanical fall without any head trauma or
LOC and panscan negative for traumatic injury prior to starting
heparin.
.
ROS: Denies recent weight gain, exertional chest pain, PND,
orthopnea, constipation, n/v, abdominal pain, diarrhea, melena,
hematochezia, URI symptoms, cough, fevers/chills.


Past Medical History:
R breast cancer s/p resection and XRT- dx last year followed at
[**Hospital3 328**]
DM II
HTN
No prior PUD or CVA
s/p total R knee replacement [**7-/2119**]
? RLE DVT- had sxs but u/s negative, never been placed on
coumadin.


Social History:
Used to be an accountant. Originally from [**Location (un) 3156**]. In the US for
the last 13 years. No smoking or ETOH or IVDA. Lives alone and
has a homemaker who comes to clean. Independent ADLs but not
physically active. Cooks for herself.  She has children who live
in the [**Location (un) 86**] area. She is Russian speaking only.

Family History:
No PE/DVT, DM or CAD

Physical Exam:
BP 118/43 HR 87 Resp 14 O2 sat 96% 3L
Gen: obese woman, lying flat in bed, NAD
HEENT: anicteric, OP moist.
Neck: JVP to earlobe lying at 30 deg, supple
CV: RRR without m/r/g, distant heart sounds
Resp: clear to auscutation anteriorly, no wheezing/rhonchi.
Abd: Obese, nontender throughout, BS+
Ext: 2+ pitting edema to above the knee b/l, tender to firm
touch throughout, no erythema, mass, fluctance, rash.  Large
ecchymoses over right knee.
Neuro: AO x 3, CN II to XII wnl. normal sensation to light
touch. moving all 4 extremities.


Pertinent Results:
R knee x-ray [**7-12**]:  Two views of the right knee demonstrate the
patient to be status post total right knee arthroplasty in
overall anatomic alignment. There is no periprosthetic lucency
to suggest loosening. There is no evidence of fracture. Vascular
calcifications are again noted. Minimal joint effusion.
IMPRESSION: No evidence of fracture. Minimal joint effusion.
.
CXR [**7-12**]: No previous studies for comparison. There is
cardiomegaly and tortuosity of the thoracic aorta but no
definite CHF/pulmonary edema in this single frontal view and no
obvious pleural effusions or pulmonary consolidation. Slight
shift to the right of the tracheal air column at the thoracic
inlet is likely related to tortuous vasculature.
IMPRESSION: Cardiomegaly but no definite CHF or evidence for
pneumonia.
.
CT head [**2125-7-12**]:
IMPRESSION: No acute intracranial process.
.
CTA chest/CT abd/pelvis: [**7-12**]
1. Massive acute pulmonary embolism involving both main
pulmonary arteries, extending into the lobar branches with
relative regional oligemia.
2. No definite CT evidence of pulmonary infarction or acute
right heart strain.
3. No evidence of acute traumatic injury to the chest, abdomen
or pelvis.
4. Multilevel, degenerative lumbar spinal stenosis.
5. Multifibroid uterus.
.
ECHO [**2125-7-12**]:  The left atrium is normal in size. There is
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF>55%). The right ventricular cavity is
dilated although free wall motion appears preserved. The aortic
valve leaflets (3) are mildly thickened. There is no aortic
valve stenosis. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Physiologic mitral
regurgitation is seen (within normal limits). The left
ventricular inflow pattern suggests impaired relaxation. The
tricuspid valve leaflets are mildly thickened. There is moderate
pulmonary artery systolic hypertension. There is no pericardial
effusion. There is an anterior space which most likely
represents a fat pad.
.
B/l LE U/S [**7-13**]: The right common femoral vein, right
saphenofemoral junction, upper and mid portions of the right
superficial femoral vein are normal to  compression and
augmentation. The distal right superficial femoral vein does not
compress well. However the right popliteal vein is normal to
compression and augmentation. The left common femoral vein, left
superficial femoral vein, left popliteal veins are all normal to
compression and augmentation with no evidence of DVT. A fluid
collection is identified in the left popliteal fossa measuring 4
cm x
2 cm x 2 cm. The appearances may be consistent with a previous
[**Hospital Ward Name 4675**] cyst.
IMPRESSION:
1. Poor compression of distal right superficial femoral vein
which may be secondary to old thrombus, although the chronicity
of this is uncertain.
2. Incidental note is made of small fluid collection in the left
popliteal fossa measuring 4 cm x 2 cm x 2 cm. This may represent
[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 4675**] cyst.


Brief Hospital Course:
Ms. [**Known lastname 23959**] is a 75 yo Russian speaking female with h/o breast
CA s/p lumpectomy/XRT, DM, HTN, immobility presents with
submassive PE
.
# PE: Patient presented with acute thrombus impacted in central
right and left main pulmonary arteries and was admitted to the
medical ICU on a heparin drip.  Unclear precipitant however
numerous risk factors including recent travel, underlying
malignancy, immobility, possilble h/o DVT in the past. U/S of LE
showing old clot in R superficial femoral vein. Echo showing RV
dilatation and mod pulm htn but preserved RV systolic function
as well as known diastolic dysfunction.  She remained
hemodynamically stable in the ICU and was subsequently
transferred to the medical service.  Given the preference for
chronic anticoagulation in the setting of malignancy, patient
was transitioned to Lovenox injections at 1 mg/kg [**Hospital1 **] dosing.
Given the relative contraindication of her obesisty, a Factor Xa
level was checked 4 hours following her third dose to
demonstrate therapeutic dosing. Patient underwent Lovenox
teaching with the assistance of a Russian translator and
expressed a good understanding of the correct administration of
this medication.  Prior to discharge, she was weaned off
supplemental oxygen with SpO2 of 95-96% at rest and 94-95% with
ambulation.
.
# HTN: restarted beta blocker and lasix in ICU today, SBP
remained stable.
.
# Hyperlipidemia: continue Vytorin
.
# DM: restarted oral agents, including Avandia, Glyburide, and
Nateglinide.
.
# Diastolic CHF: EF >55% but LVH with impaired relaxation.  She
was diuresed gently and restarted on home beta-blocker.  Low
sodium diet was selected.


Medications on Admission:
Glyburide 5mg TID
Avandia 2mg qday
Toprol XL 100 qam and 50mg qpm
Nateglinide (Starlix) 125mg? [**Hospital1 **]
Hyzaar 100/25 daily
Vytorin [**12-1**] qday
furosemide 20mg qday
ASA 81- stopped 1 mo ago due to easy bruising


Discharge Medications:
1. Vytorin [**12-1**] 10-20 mg Tablet Sig: One (1) Tablet PO at
bedtime.
2. Rosiglitazone 2 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Nateglinide 120 mg Tablet Sig: One (1) Tablet PO 3x daily
with meals.
5. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. HYZAAR 100-25 mg Tablet Sig: One (1) Tablet PO once a day.
7. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
8. Lovenox 100 mg/mL Syringe Sig: One (1) syringe Subcutaneous
twice a day.
Disp:*60 syringes* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] Family & [**Hospital1 1926**] Services

Discharge Diagnosis:
Pulmonary embolism
Hypertension
Type II diabetes mellitus
Breast cancer


Discharge Condition:
SpO2 95% on room air, 94-96% with ambulation.


Discharge Instructions:
You were admitted to the hospital with the finding of a large
blood clot in your lungs.  You were started on an
anti-coagulation medication called Lovenox to prevent the
formation of future blood clots.  This medication will require
you to self-administer injections every 12 hours.  Please take
this medication exactly as directly; stopping it could be
life-threatening.
.
Please resume taking all of your other medications.
.
You should seek immediate medical attention if you are
experiencing shortness of breath, chest pain, palpitations, or
other concerning symptoms.

Followup Instructions:
Please call your primary care physician [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Name (STitle) 5102**] to
schedule a follow-up appointment in the next 7-10 days.
[**Telephone/Fax (1) 5105**].
.
Please call your oncologist to schedule a follow-up appointment.
{'Other pulmonary embolism and infarction,Chronic diastolic heart failure,Personal history of malignant neoplasm of breast,Anemia, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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

PRESENT ILLNESS: 75yo F with h/o R breast cancer s/p resection/XRT (dx last
year), DMII, HTN, and recent travel to [**Location (un) 9012**] [**6-30**] (2.5 plane
ride) p/w a sudden acute onset of anterior L sided chest pain x
12 hours prior to presentation to the ED. It was [**2128-5-17**]
nonradiating pain associated with SOB but otherwise no
diaphoresis, palpitations, n/v, LH. She usually has SOB with
exertion at baseline after walking [**2-13**] blocks, however, over the
last 2 days, pt has been having SOB at rest. She was supposed to
go see her PCP today for chest pain, but instead came to the ED.
Per her daughter, pt is usually not physically active at
baseline due to her low back pain and R knee pain. She
previously never had any chest pain. Her BPs usually runs
120-160s on meds. Didn't take any meds today. While en route to
the [**Name (NI) **], pt received lasix and sl nitro. Her chest pain relieved
only in ED after med administration, however. Currently, denies
any chest pain and shortness of breath improved.
.
In ED, at presentation VS 98.1, 99, 132/92, 22 93% on RA. pt
received ASA 325mg, Tyelno 1gm, and mophine 4mg and heparing
bolus and gtt. Because heparin pump malfunctioned and pt
recieved approx 12,000U heparin and drip stopped and coags
rechecked.
.
Of note, s/p recent mechanical fall without any head trauma or
LOC and panscan negative for traumatic injury prior to starting
heparin.
.
ROS: Denies recent weight gain, exertional chest pain, PND,
orthopnea, constipation, n/v, abdominal pain, diarrhea, melena,
hematochezia, URI symptoms, cough, fevers/chills.

MEDICAL HISTORY: R breast cancer s/p resection and XRT- dx last year followed at
[**Hospital3 328**]
DM II
HTN
No prior PUD or CVA
s/p total R knee replacement [**7-/2119**]
? RLE DVT- had sxs but u/s negative, never been placed on
coumadin.

MEDICATION ON ADMISSION: Glyburide 5mg TID
Avandia 2mg qday
Toprol XL 100 qam and 50mg qpm
Nateglinide (Starlix) 125mg? [**Hospital1 **]
Hyzaar 100/25 daily
Vytorin [**12-1**] qday
furosemide 20mg qday
ASA 81- stopped 1 mo ago due to easy bruising

ALLERGIES: Penicillins

PHYSICAL EXAM: BP 118/43 HR 87 Resp 14 O2 sat 96% 3L
Gen: obese woman, lying flat in bed, NAD
HEENT: anicteric, OP moist.
Neck: JVP to earlobe lying at 30 deg, supple
CV: RRR without m/r/g, distant heart sounds
Resp: clear to auscutation anteriorly, no wheezing/rhonchi.
Abd: Obese, nontender throughout, BS+
Ext: 2+ pitting edema to above the knee b/l, tender to firm
touch throughout, no erythema, mass, fluctance, rash.  Large
ecchymoses over right knee.
Neuro: AO x 3, CN II to XII wnl. normal sensation to light
touch. moving all 4 extremities.

FAMILY HISTORY: No PE/DVT, DM or CAD

SOCIAL HISTORY: Used to be an accountant. Originally from [**Location (un) 3156**]. In the US for
the last 13 years. No smoking or ETOH or IVDA. Lives alone and
has a homemaker who comes to clean. Independent ADLs but not
physically active. Cooks for herself.  She has children who live
in the [**Location (un) 86**] area. She is Russian speaking only. 

### Response:
{'Other pulmonary embolism and infarction,Chronic diastolic heart failure,Personal history of malignant neoplasm of breast,Anemia, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
