CHIEF COMPLAINT: Hypertensive urgency

PRESENT ILLNESS: Pt is a 48 yo M with PMHx sig. for hypertension, hepatitis C who
presents from PCP's office with asymptomatic hypertension. Blood
pressure at PCP's office was 210/134. He was there for a refill
of his lisinopril as he has currently been off of lisinopril for
1 week.
.
He denies any fever, chills, changes in weight, headache,
lightheadedness, syncope, numbness/tingling, muscle weakness,
vision changes, chest pain, palpitations, shortness of breath,
N/V, abdominal pain, constipation, diarrhea, BRBPR, melena,
pedal edema. No PND, orthopnea. No snoring, daytime somnolence.
Awakes feeling refreshed. He may be more stressed with wedding
planning.
.
In the ED, initial VS were: 98.5 69 185/123 19 98. EKG showed
biphasic T waves in V4-V6. Cardiology reviewed the EKG, felt it
was c/w hypertrophic cardiomyopathy and recommended
echocardiogram. Nicardipine gtt was started and titrated up to
1.5. Pt also received ASA 325 mg. His current vital signs are
97, 210/107, 17, 100RA.

MEDICAL HISTORY: Hypertension, diagnosed 2 years ago
Hepatitis C, followed by Dr. [**Name (NI) **], liver biopsy from [**4-10**]
showed grade 1 inflammation, stage 1 fibrosis
Gastric ulcer s/p cauterization in 91
s/p appy [**2122**]

MEDICATION ON ADMISSION: Lisinopril 40 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  T 97.7, BP 186/94, HR 86, RR 19, 94% on RA
GEN:  pleasant man in no acute distress
HEENT:  PERRL, no papilladema
Neck:  supple without LAD, no carotid bruits, no JVD
CV:  RRR, no murmurs
Pulm:  CTAB
Abd:  +BS, soft, NT, ND
Ext:  no edema, 2+ DP pulses
Neuro:  CNs II-XII grossly intact, muscule strength intact,
finger to nose intact, no gross sensory deficits, DTRs 2+/4 in
BUEs and BLEs.

FAMILY HISTORY: There is a family history of both diabetes and ischemic heart
disease. No family history of sudden cardiac death, strokes.
Mother with HTN and MI at 49yrs s/p ICD. Father healthy.

SOCIAL HISTORY: He is single with six children. He works as a custodian in
[**Location (un) 86**] Public School. He quit smoking, drinking alcohol 22 years
ago. He was previously a heavy drinker. He also has a history of
IVDA, marijuana use, also quit 22 years ago.
Unspecified essential hypertension,Other primary cardiomyopathies,Unspecified viral hepatitis C without hepatic coma,Personal history of noncompliance with medical treatment, presenting hazards to health,Nonspecific abnormal electrocardiogram [ECG] [EKG]
Hypertension NOS,Prim cardiomyopathy NEC,Hpt C w/o hepat coma NOS,Hx of past noncompliance,Abnorm electrocardiogram
Admission Date:  [**2126-4-10**]              Discharge Date:   [**2126-4-11**]

Date of Birth:  [**2077-8-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Hypertensive urgency

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Pt is a 48 yo M with PMHx sig. for hypertension, hepatitis C who
presents from PCP's office with asymptomatic hypertension. Blood
pressure at PCP's office was 210/134. He was there for a refill
of his lisinopril as he has currently been off of lisinopril for
1 week.
.
He denies any fever, chills, changes in weight, headache,
lightheadedness, syncope, numbness/tingling, muscle weakness,
vision changes, chest pain, palpitations, shortness of breath,
N/V, abdominal pain, constipation, diarrhea, BRBPR, melena,
pedal edema. No PND, orthopnea. No snoring, daytime somnolence.
Awakes feeling refreshed. He may be more stressed with wedding
planning.
.
In the ED, initial VS were: 98.5 69 185/123 19 98. EKG showed
biphasic T waves in V4-V6. Cardiology reviewed the EKG, felt it
was c/w hypertrophic cardiomyopathy and recommended
echocardiogram. Nicardipine gtt was started and titrated up to
1.5. Pt also received ASA 325 mg. His current vital signs are
97, 210/107, 17, 100RA.


Past Medical History:
Hypertension, diagnosed 2 years ago
Hepatitis C, followed by Dr. [**Name (NI) **], liver biopsy from [**4-10**]
showed grade 1 inflammation, stage 1 fibrosis
Gastric ulcer s/p cauterization in 91
s/p appy [**2122**]


Social History:
He is single with six children. He works as a custodian in
[**Location (un) 86**] Public School. He quit smoking, drinking alcohol 22 years
ago. He was previously a heavy drinker. He also has a history of
IVDA, marijuana use, also quit 22 years ago.

Family History:
There is a family history of both diabetes and ischemic heart
disease. No family history of sudden cardiac death, strokes.
Mother with HTN and MI at 49yrs s/p ICD. Father healthy.

Physical Exam:
VS:  T 97.7, BP 186/94, HR 86, RR 19, 94% on RA
GEN:  pleasant man in no acute distress
HEENT:  PERRL, no papilladema
Neck:  supple without LAD, no carotid bruits, no JVD
CV:  RRR, no murmurs
Pulm:  CTAB
Abd:  +BS, soft, NT, ND
Ext:  no edema, 2+ DP pulses
Neuro:  CNs II-XII grossly intact, muscule strength intact,
finger to nose intact, no gross sensory deficits, DTRs 2+/4 in
BUEs and BLEs.

Pertinent Results:
Admission labs:
[**2126-4-10**] 04:40PM   WBC-4.5 RBC-5.94 HGB-13.7* HCT-43.2 MCV-73*
MCH-23.1* MCHC-31.8 RDW-15.5
[**2126-4-10**] 04:40PM   NEUTS-46.6* LYMPHS-47.1* MONOS-3.9 EOS-1.7
BASOS-0.7
[**2126-4-10**] 04:40PM   PLT COUNT-155
[**2126-4-10**] 04:40PM   GLUCOSE-88 UREA N-16 CREAT-0.9 SODIUM-138
POTASSIUM-4.0 CHLORIDE-105 TOTAL CO2-27 ANION GAP-10
[**2126-4-10**] 04:40PM   CALCIUM-9.7 PHOSPHATE-3.9 MAGNESIUM-2.0
[**2126-4-10**] 04:40PM   TSH-0.76
.
ECHO:
The left atrium and right atrium are normal in cavity size. The
estimated right atrial pressure is 0-5 mmHg. There is severe
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Regional left ventricular wall motion is
normal. Left ventricular systolic function is hyperdynamic
(EF>75%). There is no left ventricular outflow obstruction at
rest or with Valsalva. These findings are consistent with
hypertrophic non-obstructive cardiomyopathy (HCM). An apical
intracavitary gradient is identified. Right ventricular chamber
size and free wall motion are normal. The aortic root is mildly
dilated at the sinus level. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Trivial mitral
regurgitation is seen. The pulmonary artery systolic pressure
could not be determined. There is a trivial/physiologic
pericardial effusion.

IMPRESSION: Hypertrophic non-obstructive cardiomyopathy with
hyperdynamic systolic function.

Brief Hospital Course:
48 yo M with hypertensive urgency.

1. Hypertensive urgency:  Pt had no signs of end-organ damage,
include neg. cardiac enzymes, no s/sxs of CHF, baseline
creatinine, neg U/A, and normal neuro exam. Hypertension is
likely essential, off home lisinopril x 1 week.  Utox neg. for
cocaine.  Pt was transferred from ED on nicardipine gtt.  Pt's
SBP came down to 120-140 on home dose of lisinopril and addition
of metoprolol 25 mg [**Hospital1 **].

2. Abnormal EKG:  Upon review by cardiology, there was concern
for hypertrophic cardiomyopathy.  An echocardiogram showed
hypertrophic non-obstructive cardiomyopathy with hyperdynamic
systolic function.  A follow-up appointment with cardiology was
made.

3. Hepatitis C: No stigmata of chronic liver disease. Recent
biopsy with grade 1 inflammation, stage 1 fibrosis.


Medications on Admission:
Lisinopril 40 mg daily

Discharge Medications:
1. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Hypertensive Urgency


Discharge Condition:
Stable with BP at 120-140/80s


Discharge Instructions:
You were admitted for high blood pressure.  Your blood pressure
normalized back on your lisinopril in ADDITION to a new blood
pressure medication metoprolol.  PLEASE be sure to take your
blood pressure pills every day.
.
You also had an echocardiogram (ultrasound of the heart), which
showed that you have a large, muscular heart due to your high
blood pressure.
.
Please follow up with your primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1789**]
within 2 weeks.  The clinic number is [**Telephone/Fax (1) 1792**].
.
If you develop chest pain, palpitations, shortness of breath,
dizziness, or any other concerning symptoms, please call Dr.
[**Last Name (STitle) 1789**] or go to the Emergency Department.

Followup Instructions:
Please follow up with your primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1789**]
within 2 weeks.  The clinic number is [**Telephone/Fax (1) 1792**].
.
We have scheduled you to followup with our heart specialists,
Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) 5543**], on Thursday, [**4-18**] at 2:40 on
the [**Location (un) 436**] of the [**Hospital Ward Name 23**] building.  Please call [**Telephone/Fax (1) 62**]
if you need to reschedule for any reason.  PLEASE ALSO CALL
[**Telephone/Fax (1) 10676**] PRIOR TO YOUR APPOINTMENT TO COMPLETE REGISTRATION
WITHIN THE [**Hospital1 18**] SYSTEM.
{'Unspecified essential hypertension,Other primary cardiomyopathies,Unspecified viral hepatitis C without hepatic coma,Personal history of noncompliance with medical treatment, presenting hazards to health,Nonspecific abnormal electrocardiogram [ECG] [EKG]'}


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: Hypertensive urgency

PRESENT ILLNESS: Pt is a 48 yo M with PMHx sig. for hypertension, hepatitis C who
presents from PCP's office with asymptomatic hypertension. Blood
pressure at PCP's office was 210/134. He was there for a refill
of his lisinopril as he has currently been off of lisinopril for
1 week.
.
He denies any fever, chills, changes in weight, headache,
lightheadedness, syncope, numbness/tingling, muscle weakness,
vision changes, chest pain, palpitations, shortness of breath,
N/V, abdominal pain, constipation, diarrhea, BRBPR, melena,
pedal edema. No PND, orthopnea. No snoring, daytime somnolence.
Awakes feeling refreshed. He may be more stressed with wedding
planning.
.
In the ED, initial VS were: 98.5 69 185/123 19 98. EKG showed
biphasic T waves in V4-V6. Cardiology reviewed the EKG, felt it
was c/w hypertrophic cardiomyopathy and recommended
echocardiogram. Nicardipine gtt was started and titrated up to
1.5. Pt also received ASA 325 mg. His current vital signs are
97, 210/107, 17, 100RA.

MEDICAL HISTORY: Hypertension, diagnosed 2 years ago
Hepatitis C, followed by Dr. [**Name (NI) **], liver biopsy from [**4-10**]
showed grade 1 inflammation, stage 1 fibrosis
Gastric ulcer s/p cauterization in 91
s/p appy [**2122**]

MEDICATION ON ADMISSION: Lisinopril 40 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  T 97.7, BP 186/94, HR 86, RR 19, 94% on RA
GEN:  pleasant man in no acute distress
HEENT:  PERRL, no papilladema
Neck:  supple without LAD, no carotid bruits, no JVD
CV:  RRR, no murmurs
Pulm:  CTAB
Abd:  +BS, soft, NT, ND
Ext:  no edema, 2+ DP pulses
Neuro:  CNs II-XII grossly intact, muscule strength intact,
finger to nose intact, no gross sensory deficits, DTRs 2+/4 in
BUEs and BLEs.

FAMILY HISTORY: There is a family history of both diabetes and ischemic heart
disease. No family history of sudden cardiac death, strokes.
Mother with HTN and MI at 49yrs s/p ICD. Father healthy.

SOCIAL HISTORY: He is single with six children. He works as a custodian in
[**Location (un) 86**] Public School. He quit smoking, drinking alcohol 22 years
ago. He was previously a heavy drinker. He also has a history of
IVDA, marijuana use, also quit 22 years ago. 

### Response:
{'Unspecified essential hypertension,Other primary cardiomyopathies,Unspecified viral hepatitis C without hepatic coma,Personal history of noncompliance with medical treatment, presenting hazards to health,Nonspecific abnormal electrocardiogram [ECG] [EKG]'}
