CHIEF COMPLAINT: chest pain, shortness of breath, back pain

PRESENT ILLNESS: The patient is a 70-year-old
female with history of HIV, end-stage renal disease, three
vessel disease status post stent to left circumflex on [**2154-6-4**], history of congestive heart failure with ejection
fraction of 25 percent who was recently discharged from the
[**Hospital1 69**] status post non-ST
elevation myocardial infarction, status post left circumflex
stent, who experienced left sternal chest pain, back pain and
dyspnea at 6:00 a.m. on the day of presentation while getting
out of bed to go to the bathroom.  The patient remained
symptomatic and was taken to the [**Hospital1 190**] by EMS where she was found to have a systolic
blood pressure of 210.  She was given aspirin, Lopressor 5 IV
times three, Lasix 40 IV times one and was started on
intravenous nitroglycerin drip with resolution of all
symptoms.  The patient also has undergone a CT angiogram that
showed no evidence of dissection.  The patient had a chest x-
ray that showed right costophrenic angle opacity.  The
patient's CT showed signs of left ventricular strain.  By the
time she was seen by the Coronary Care Unit team, her
systolic blood pressure was in the 180's and she was symptom
free.

MEDICAL HISTORY: Coronary artery disease, three vessel
disease status post non-ST elevation myocardial infarction in
[**2154-6-4**], status post taxis down to left circumflex in
[**2154-6-4**].

MEDICATION ON ADMISSION: 

ALLERGIES: Colchicine, allopurinol, ethambutol.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: No smoking, no alcohol, no drug use.
Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Diastolic heart failure, unspecified,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Human immuno virus dis,Pneumonia, organism NOS,Mal hyp kid w cr kid V,Diastolc hrt failure NOS,Nephritis NOS,Crnry athrscl natve vssl,Status-post ptca
Admission Date: [**2154-6-24**]        Discharge Date: [**2154-6-25**]

Date of Birth:  [**2083-8-18**]        Sex:  F

Service:  CME


HISTORY OF PRESENT ILLNESS:  The patient is a 70-year-old
female with history of HIV, end-stage renal disease, three
vessel disease status post stent to left circumflex on [**2154-6-4**], history of congestive heart failure with ejection
fraction of 25 percent who was recently discharged from the
[**Hospital1 69**] status post non-ST
elevation myocardial infarction, status post left circumflex
stent, who experienced left sternal chest pain, back pain and
dyspnea at 6:00 a.m. on the day of presentation while getting
out of bed to go to the bathroom.  The patient remained
symptomatic and was taken to the [**Hospital1 190**] by EMS where she was found to have a systolic
blood pressure of 210.  She was given aspirin, Lopressor 5 IV
times three, Lasix 40 IV times one and was started on
intravenous nitroglycerin drip with resolution of all
symptoms.  The patient also has undergone a CT angiogram that
showed no evidence of dissection.  The patient had a chest x-
ray that showed right costophrenic angle opacity.  The
patient's CT showed signs of left ventricular strain.  By the
time she was seen by the Coronary Care Unit team, her
systolic blood pressure was in the 180's and she was symptom
free.

ALLERGIES:  Colchicine, allopurinol, ethambutol.

PAST MEDICAL HISTORY:  Coronary artery disease, three vessel
disease status post non-ST elevation myocardial infarction in
[**2154-6-4**], status post taxis down to left circumflex in
[**2154-6-4**].

Congestive heart failure.  Ejection fraction 25-30 percent.

History of malignant hypertension.

Status post intubation for flush pulmonary edema on [**2154-6-3**], complicated by laryngeal edema.

History of human immunodeficiency virus, CD4 count 74, viral
load less than 60 on [**2154-3-4**], on HAART therapy.

End-stage renal disease on hemodialysis, HIV nephropathy.

Type 2 diabetes, diet controlled.

Spinal tuberculosis.

Hypercholesterolemia.

Hepatitis C viral infection.

Gout.

Anemia.

SOCIAL HISTORY:  No smoking, no alcohol, no drug use.

FAMILY HISTORY:  Noncontributory.

OUTPATIENT MEDICATIONS:  Lipitor 10, Bactrim 160/800 mg p.o.
q. day, aspirin 325 mg p.o. q. day, Imdur 30 mg p.o. q. day,
calcium acetate three tablets t.i.d. with meals, Colace,
vitamin B complex, Sevelamer, Plavix 75 mg p.o. q. day,
lisinopril 40 mg p.o. q. day, _______ XL 150 mg p.o. q. day,
Protonix 40 mg p.o. q. day, Neviratin 200 mg p.o. b.i.d.,
zidovudine 120  mg p.o. b.i.d., lamivudine 100 mg p.o. q.
day.

PHYSICAL EXAMINATION:  Temperature 98.5, heart rate 80, blood
pressure 180/100, respirations 23, 97 percent on four liters.
General:  Thin, cachectic African-American female in no
apparent distress.  HEENT:  Moist mucus membranes.  Poor
dentition.  Neck:  Jugular venous distention 10 cm.  Normal
carotid upstrokes.  Pulmonary:  Crackles one-third up, right
greater than left.  Cardiovascular:  Regular rate and rhythm,
normal S1, S2.  Murmur of mitral regurgitation.  No rubs or
gallops.  Abdomen:  Positive bowel sounds, soft, non-tender,
non-distended.  Extremities:  No clubbing, cyanosis or edema.
Left arteriovenous fistula.

LABORATORY ON ADMISSION:  White count 4.8, hematocrit 37.8,
platelet count 269,000, INR 1.0, PTT 28.7.  Sodium 139,
potassium 4.3, chloride 100, bicarb 27, BUN 83, creatinine
6.4, glucose 145, calcium 9.4, phosphorus 6.1, magnesium 1.9,
troponin-I 0.49.

ELECTROCARDIOGRAM:  Normal sinus rhythm at 81 beats per
minute.  Left axis deviation.  Positive left ventricular
hypertrophy with strain pattern.  T-wave inversions 1, aVL,
V5, V6.  This EKG is similar to [**2154-6-4**].

HOSPITAL COURSE:  Hypertensive urgency:  When evaluated by
Coronary Care Unit team the patient's systolic blood pressure
was in the 180's.  The patient had no symptoms of chest pain
or shortness of breath.  Nitroglycerin drip was weaned off
and labetalol drip was started with a goal diastolic blood
pressure of less than 100 and decrease of systolic blood
pressure by 25 percent within the first three to six hours
with goal systolic blood pressure 150's to 160's.  This goal
was reached in two hours.  The patient has undergone
hemodialysis with removal of three liters of fluid after
which patient's systolic blood pressure was in the 120's.
Labetalol drip was stopped and patient remained asymptomatic
with a blood pressure goal in the 140's to 150's.  The
patient's lisinopril was continued at the present dose but
changed to 20 mg p.o. b.i.d. to achieve better blood pressure
control and less blood pressure fluctuation.  It was thought
that the event that led to patient's admission was
hypertensive urgency with fluid overload which was likely
exacerbated by receiving a dye load required for CT
angiogram.

Coronary artery disease:  The patient has known three vessel
disease.  She is status post left circumflex stent on [**2154-6-4**].  The patient had no signs of ongoing ischemia.  The
patient's chronically elevated troponin-I was likely due to
chronic subendocardial ischemia in patient with end-stage
renal disease.  The patient was continued on aspirin, Plavix,
Lipitor.  Enzymes were cycled and were negative.  The
patient's Lopressor was changed to labetalol to ensure better
blood pressure control which the patient tolerated well.

Congestive heart failure:  The patient was maintained on
outpatient hemodialysis schedule.  This went uneventfully.

Human immunodeficiency virus:  The patient was continued on
outpatient HAART medications.

Diabetes:  Fingersticks were stable and patient was covered
with regular insulin sliding scale.

The rest of the discharge summary is to be dictated in an
addendum by another physician who is taking over care for
this patient.

INCOMPLETE DICTATION



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], MD [**MD Number(2) 12421**]

Dictated By:[**Last Name (NamePattern1) 6602**]
MEDQUIST36
D:  [**2154-6-25**] 13:53:38
T:  [**2154-6-25**] 14:37:29
Job#:  [**Job Number 12422**]


Name:  [**Known lastname 1839**],[**Known firstname 1840**]                     Unit No:   [**Numeric Identifier 1841**]

Admission Date:  [**2154-6-24**]              Discharge Date:   [**2154-6-26**]

Date of Birth:  [**2083-8-18**]             Sex:   F

Service: [**Hospital Unit Name 319**]

Allergies:
Allopurinol / Ethambutol / Colchicine / Efavirenz

Attending:[**First Name3 (LF) 1845**]
Chief Complaint:
chest pain, shortness of breath, back pain

Major Surgical or Invasive Procedure:
Hemodialysis

History of Present Illness:
As per discharge summary.

Past Medical History:
As per discharge summary.

Brief Hospital Course:
On [**2154-6-25**], Toprol XL was discontinued and the patient was
switched to labetalol 200 mg [**Hospital1 **] for better blood pressure
control. Patient received hemodialysis on [**2154-6-26**] and tolerated
it well. Renagel was increased on [**2153-6-25**] to 1600 mg TID before
discharge. Blood pressure well controlled and ready for
discharge on [**2154-6-26**].

Discharge Medications:
1. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
2. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO QD (once a day).
3. Nevirapine 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
4. Aspirin, Buffered 325 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
5. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO QD (once a day).
6. Calcium Acetate (Phos Binder) 667 mg Tablet Sig: One (1)
Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
7. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
8. Zidovudine 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Lamivudine 100 mg Tablet Sig: 0.5 Tablet PO QD (once a day).

10. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q48H
(every 48 hours) for 4 doses.
Disp:*4 Tablet(s)* Refills:*0*
11. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24
hours).
12. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
13. Labetalol HCl 200 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
14. Sevelamer HCl 800 mg Tablet Sig: Two (2) Tablet PO three
times a day.
Disp:*180 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 42**] VNA

Discharge Diagnosis:
Hypertensive urgency
HIV nephropathy
Hep C
CAD s/p stent to LCX


Discharge Condition:
Good.

Discharge Instructions:
Return to the ER or call your primary physician if you
experience any chest pain, shortness of breath, lightheadedness,
dizziness, nausea or vomiting. Remember to take new blood
pressure medications: labetalol and lisinopril twice a day. Stop
taking Toprol XL.

Followup Instructions:
1. Call Dr. [**Last Name (STitle) **] for appointment in [**1-4**] weeks.

2. Please follow up Provider: [**First Name8 (NamePattern2) 77**] [**Last Name (NamePattern1) 1846**], [**Name Initial (NameIs) **].D. Where: LM
[**Hospital Unit Name 1847**] (ENT) Phone:[**Telephone/Fax (1) 1848**]
Date/Time:[**2154-6-27**] 8:15

3. Provider: [**First Name8 (NamePattern2) 77**] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Where: [**Hospital6 189**] CARDIAC
SERVICES Phone:[**Telephone/Fax (1) 1849**] Date/Time:[**2154-7-2**] 2:00

4. Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Where: LM [**Hospital Unit Name 495**] DISEASE Phone:[**Telephone/Fax (1) 496**] Date/Time:[**2154-7-9**] 1:30

5. Hemodialysis on [**2154-6-28**] or as per Dr. [**First Name (STitle) **]


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1850**] MD [**MD Number(2) 1851**]

Completed by:[**2154-6-26**]
{'Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Diastolic heart failure, unspecified,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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, shortness of breath, back pain

PRESENT ILLNESS: The patient is a 70-year-old
female with history of HIV, end-stage renal disease, three
vessel disease status post stent to left circumflex on [**2154-6-4**], history of congestive heart failure with ejection
fraction of 25 percent who was recently discharged from the
[**Hospital1 69**] status post non-ST
elevation myocardial infarction, status post left circumflex
stent, who experienced left sternal chest pain, back pain and
dyspnea at 6:00 a.m. on the day of presentation while getting
out of bed to go to the bathroom.  The patient remained
symptomatic and was taken to the [**Hospital1 190**] by EMS where she was found to have a systolic
blood pressure of 210.  She was given aspirin, Lopressor 5 IV
times three, Lasix 40 IV times one and was started on
intravenous nitroglycerin drip with resolution of all
symptoms.  The patient also has undergone a CT angiogram that
showed no evidence of dissection.  The patient had a chest x-
ray that showed right costophrenic angle opacity.  The
patient's CT showed signs of left ventricular strain.  By the
time she was seen by the Coronary Care Unit team, her
systolic blood pressure was in the 180's and she was symptom
free.

MEDICAL HISTORY: Coronary artery disease, three vessel
disease status post non-ST elevation myocardial infarction in
[**2154-6-4**], status post taxis down to left circumflex in
[**2154-6-4**].

MEDICATION ON ADMISSION: 

ALLERGIES: Colchicine, allopurinol, ethambutol.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: No smoking, no alcohol, no drug use. 

### Response:
{'Human immunodeficiency virus [HIV] disease,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Diastolic heart failure, unspecified,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
