CHIEF COMPLAINT: Rash and agitation.

PRESENT ILLNESS: The patient is an 88 year old
woman with a past medical history of hypertension,
hypercholesterolemia, paroxysmal atrial fibrillation, peptic
ulcer disease, who had a recent total hip replacement at
[**Hospital6 1129**] and recent discharge to
[**Hospital3 **] Center on [**2119-8-22**], who was in her
usual state of health until [**2119-9-5**], at which time she
developed an urticarial rash in her pelvic area which spread
to her chest and legs.  On [**2119-9-8**], the rash had spread to
her face and palms.  She did not have any shortness of breath
at the time or any oral involvement, any chest pain, nausea
or vomiting.  She was started on Benadryl and Claritin in
addition to Hydrocortisone cream with little improvement.
She had recently been started on Captopril at the
rehabilitation center and this reaction was thought to be due
to the Captopril.  At approximately 8:00 p.m. on [**2119-9-8**],
the patient reported being diaphoretic and short of breath.
Her oxygen saturation fell to 84% with heart rate elevated to
160 beats per minute and her blood pressure was 250/158.  The
patient was noted to be very agitated and confused.
Electrocardiogram was checked which showed sinus rhythm which
was tachycardic.  There were no acute ischemic changes.  Her
oxygen saturation improved to 97% on four liters nasal
cannula.  The patient was brought to the [**Hospital1 346**] Emergency Department where she was
found to be normotensive with a normal electrocardiogram.
Her potassium was found to be elevated at 6.0 for which she
was given Kayexalate and after being on the bed pan became
hypertensive again.  Electrocardiogram at that time showed
high T waves with anterolateral ST elevations in V2 through
V6, I, II and aVF.  Cardiology was called and the patient was
started on Lopressor intravenously, Nitroglycerin, Heparin
drip as well as Integrilin.  Her ST elevations decreased
slightly and she became normotensive.  She was admitted from
there to the CCU.

MEDICAL HISTORY: 1.  Status post left total hip replacement for displaced
femoral fracture.
2.  Osteoporosis.
3.  Peptic ulcer disease.
4.  Hypercholesterolemia.
5.  Coronary artery disease.
6.  Paroxysmal atrial fibrillation.
7.  Hypertension.
8.  Anxiety.
9.  Macular degeneration.
10. Peripheral vascular disease.
11. Status post right carotid endarterectomy.

MEDICATION ON ADMISSION: 1.  Celexa 20 mg once daily.
2.  Zocor 40 mg once daily.
3.  Aspirin 81 mg once daily.
4.  Protonix.
5.  Lasix.
6.  Lopressor 50 mg p.o. three times a day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant essential hypertension,Acute myocardial infarction of unspecified site, initial episode of care,Hyperpotassemia,Thrombocytopenia, unspecified,Pneumonia, organism unspecified,Dermatitis due to drugs and medicines taken internally
Malignant hypertension,AMI NOS, initial,Hyperpotassemia,Thrombocytopenia NOS,Pneumonia, organism NOS,Drug dermatitis NOS
Admission Date:  [**2119-9-9**]     Discharge Date:  [**2119-9-12**]


Service:  [**Doctor Last Name 1181**]

CHIEF COMPLAINT:  Rash and agitation.

HISTORY OF PRESENT ILLNESS:  The patient is an 88 year old
woman with a past medical history of hypertension,
hypercholesterolemia, paroxysmal atrial fibrillation, peptic
ulcer disease, who had a recent total hip replacement at
[**Hospital6 1129**] and recent discharge to
[**Hospital3 **] Center on [**2119-8-22**], who was in her
usual state of health until [**2119-9-5**], at which time she
developed an urticarial rash in her pelvic area which spread
to her chest and legs.  On [**2119-9-8**], the rash had spread to
her face and palms.  She did not have any shortness of breath
at the time or any oral involvement, any chest pain, nausea
or vomiting.  She was started on Benadryl and Claritin in
addition to Hydrocortisone cream with little improvement.
She had recently been started on Captopril at the
rehabilitation center and this reaction was thought to be due
to the Captopril.  At approximately 8:00 p.m. on [**2119-9-8**],
the patient reported being diaphoretic and short of breath.
Her oxygen saturation fell to 84% with heart rate elevated to
160 beats per minute and her blood pressure was 250/158.  The
patient was noted to be very agitated and confused.
Electrocardiogram was checked which showed sinus rhythm which
was tachycardic.  There were no acute ischemic changes.  Her
oxygen saturation improved to 97% on four liters nasal
cannula.  The patient was brought to the [**Hospital1 346**] Emergency Department where she was
found to be normotensive with a normal electrocardiogram.
Her potassium was found to be elevated at 6.0 for which she
was given Kayexalate and after being on the bed pan became
hypertensive again.  Electrocardiogram at that time showed
high T waves with anterolateral ST elevations in V2 through
V6, I, II and aVF.  Cardiology was called and the patient was
started on Lopressor intravenously, Nitroglycerin, Heparin
drip as well as Integrilin.  Her ST elevations decreased
slightly and she became normotensive.  She was admitted from
there to the CCU.

PAST MEDICAL HISTORY:
1.  Status post left total hip replacement for displaced
femoral fracture.
2.  Osteoporosis.
3.  Peptic ulcer disease.
4.  Hypercholesterolemia.
5.  Coronary artery disease.
6.  Paroxysmal atrial fibrillation.
7.  Hypertension.
8.  Anxiety.
9.  Macular degeneration.
10. Peripheral vascular disease.
11. Status post right carotid endarterectomy.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Celexa 20 mg once daily.
2.  Zocor 40 mg once daily.
3.  Aspirin 81 mg once daily.
4.  Protonix.
5.  Lasix.
6.  Lopressor 50 mg p.o. three times a day.

HOSPITAL COURSE:
1.  Cardiovascular - The patient was admitted to the
Intensive Care Unit and found to rule in for myocardial
infarction with cardiac enzymes and troponin greater than 50.
Cardiology fellow at that time had a long discussion with the
patient's family who related the patient's wishes which were
that she wanted no life prolonging care. These were wishes
that she had had for a long time since her husband had died
years before and the patient had said repeatedly that she
wanted nothing to prolong her life, that she wanted no
medical care whatsoever.  The patient and family refused
cardiac catheterization and the patient was made comfort
measures only status.  At that time, she was transferred out
of the CCU to the medical floor to the [**Doctor Last Name **] service where
her comfort only status was upheld with no intravenous
fluids, no laboratory checks, no radiology studies and only
medications to make her comfortable which included Morphine,
Ativan and occasional respiratory treatments.

She was initially responsive to verbal stimuli but appeared
to be uncomfortable.  She was started on a Morphine drip at
which time she became less arousible and on [**2119-9-12**], was
found to have expired.  She was examined by the covering
physician at the time who noted that her pupils were fixed
and dilated.  She had no heart sounds or lung sounds.  No
palpable pulse or corneal reflex.  Time of death was 10:00
p.m.  Dr. [**First Name (STitle) 1022**] was notified and the family was ask about an
autopsy and declined.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4122**], M.D.

Dictated By:[**Name8 (MD) 3491**]

MEDQUIST36

D:  [**2119-10-10**]  15:16
T:  [**2119-10-10**]  20:40
JOB#:  [**Job Number 45576**]
{'Malignant essential hypertension,Acute myocardial infarction of unspecified site, initial episode of care,Hyperpotassemia,Thrombocytopenia, unspecified,Pneumonia, organism unspecified,Dermatitis due to drugs and medicines taken internally'}


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: Rash and agitation.

PRESENT ILLNESS: The patient is an 88 year old
woman with a past medical history of hypertension,
hypercholesterolemia, paroxysmal atrial fibrillation, peptic
ulcer disease, who had a recent total hip replacement at
[**Hospital6 1129**] and recent discharge to
[**Hospital3 **] Center on [**2119-8-22**], who was in her
usual state of health until [**2119-9-5**], at which time she
developed an urticarial rash in her pelvic area which spread
to her chest and legs.  On [**2119-9-8**], the rash had spread to
her face and palms.  She did not have any shortness of breath
at the time or any oral involvement, any chest pain, nausea
or vomiting.  She was started on Benadryl and Claritin in
addition to Hydrocortisone cream with little improvement.
She had recently been started on Captopril at the
rehabilitation center and this reaction was thought to be due
to the Captopril.  At approximately 8:00 p.m. on [**2119-9-8**],
the patient reported being diaphoretic and short of breath.
Her oxygen saturation fell to 84% with heart rate elevated to
160 beats per minute and her blood pressure was 250/158.  The
patient was noted to be very agitated and confused.
Electrocardiogram was checked which showed sinus rhythm which
was tachycardic.  There were no acute ischemic changes.  Her
oxygen saturation improved to 97% on four liters nasal
cannula.  The patient was brought to the [**Hospital1 346**] Emergency Department where she was
found to be normotensive with a normal electrocardiogram.
Her potassium was found to be elevated at 6.0 for which she
was given Kayexalate and after being on the bed pan became
hypertensive again.  Electrocardiogram at that time showed
high T waves with anterolateral ST elevations in V2 through
V6, I, II and aVF.  Cardiology was called and the patient was
started on Lopressor intravenously, Nitroglycerin, Heparin
drip as well as Integrilin.  Her ST elevations decreased
slightly and she became normotensive.  She was admitted from
there to the CCU.

MEDICAL HISTORY: 1.  Status post left total hip replacement for displaced
femoral fracture.
2.  Osteoporosis.
3.  Peptic ulcer disease.
4.  Hypercholesterolemia.
5.  Coronary artery disease.
6.  Paroxysmal atrial fibrillation.
7.  Hypertension.
8.  Anxiety.
9.  Macular degeneration.
10. Peripheral vascular disease.
11. Status post right carotid endarterectomy.

MEDICATION ON ADMISSION: 1.  Celexa 20 mg once daily.
2.  Zocor 40 mg once daily.
3.  Aspirin 81 mg once daily.
4.  Protonix.
5.  Lasix.
6.  Lopressor 50 mg p.o. three times a day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant essential hypertension,Acute myocardial infarction of unspecified site, initial episode of care,Hyperpotassemia,Thrombocytopenia, unspecified,Pneumonia, organism unspecified,Dermatitis due to drugs and medicines taken internally'}
