CHIEF COMPLAINT: Hypoxia, status post right middle lobe
wedge resection.

PRESENT ILLNESS: This is a 44-year-old female,
with a history of primary pulmonary hypertension diagnosed in
[**2167**], presenting with progressive dyspnea on exertion over
the past year.  The patient states that the dyspnea has
worsened since [**2167-3-7**], for which she was admitted four
months later with a diagnosis of dyspnea.  She was initially
treated with Flolan, given her diagnosis of primary pulmonary
hypertension.  Echo and cardiac catheterization were notable
for increased pulmonary artery hypertension.  At that time,
the patient also had a normal wedge pressure, normal LV
function, normal biventricular diastolic function, and a
normal ejection fraction.

MEDICAL HISTORY: 1. Primary pulmonary hypertension.
2. Herniated disk at L4-L5 diagnosed in [**2166-3-7**].
3. Rosacea.
4. Status post ex. lap 2 years ago to evaluate abdominal
pain.
5. History of negative Holter evaluation.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes hives.

PHYSICAL EXAM: 

FAMILY HISTORY: Negative for any pulmonary processes.
Father is deceased from Alzheimer's disease and pneumonia.
Mother is alive and well.  There is a family history of
coronary artery disease.

SOCIAL HISTORY: The patient is an ex-tobacco user of
approximately 28-pack year.  She quit in [**2166-11-4**].  She
works as a registered nurse [**First Name (Titles) **] [**Hospital3 **].  She lives
with her children and husband.  She reports occasional
alcohol use, but denies IV drug abuse.  At baseline, the
patient is on 4 liters nasal cannula at home.  Her code
status is full.
Primary pulmonary hypertension,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Hemangioma of other sites,Long-term (current) use of anticoagulants,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Prim pulm hypertension,Hemorrhage complic proc,CHF NOS,Ac posthemorrhag anemia,Hemangioma NEC,Long-term use anticoagul,Abn react-surg proc NEC
Admission Date:  [**2167-12-22**]       Discharge Date: [**2167-12-30**]

Date of Birth:   [**2123-12-7**]       Sex:  F

Service:  MICU GREEN TEAM

CHIEF COMPLAINT:  Hypoxia, status post right middle lobe
wedge resection.

HISTORY OF PRESENT ILLNESS:  This is a 44-year-old female,
with a history of primary pulmonary hypertension diagnosed in
[**2167**], presenting with progressive dyspnea on exertion over
the past year.  The patient states that the dyspnea has
worsened since [**2167-3-7**], for which she was admitted four
months later with a diagnosis of dyspnea.  She was initially
treated with Flolan, given her diagnosis of primary pulmonary
hypertension.  Echo and cardiac catheterization were notable
for increased pulmonary artery hypertension.  At that time,
the patient also had a normal wedge pressure, normal LV
function, normal biventricular diastolic function, and a
normal ejection fraction.

The patient was admitted primarily for work-up of new chest
x-ray and chest CAT scan findings which were diffuse
bilateral ground glass opacities, bibasilar thickening of the
interlobar septa with honeycombing.  The concern was that the
patient may have had a secondary diagnosis in addition to her
primary pulmonary hypertension.  Therefore, the patient was
admitted to have a right lobe wedge resection performed for
pathologic studies.  The differential at the time of this
surgery primarily included pulmonary [**Last Name (un) **]-occlusive disease
versus pulmonary capillary hemangiomatosis.  At the time of
admission, the patient was status post chest tube removal.
She complained of pleuritic right-sided chest and back
discomfort.  She also noted feeling short of breath.  She was
persistently nauseated, and she had vomited bilious emesis x
1 on the day of transfer to the MICU.  The patient also noted
a cough productive of dark blood 2-3 times a day.
Additionally, the patient felt orthopneic.  Chest x-ray upon
transfer to the MICU was notable for a new right lower lobe
infiltrate consistent with air space disease, most likely
lung injury.

PAST MEDICAL HISTORY:
1. Primary pulmonary hypertension.
2. Herniated disk at L4-L5 diagnosed in [**2166-3-7**].
3. Rosacea.
4. Status post ex. lap 2 years ago to evaluate abdominal
pain.
5. History of negative Holter evaluation.

ALLERGIES:  Penicillin causes hives.

MEDICATIONS ON TRANSFER:
1. Flolan continuous infusion.
2. Potassium chloride 60 mEq qd.
3. Lasix 240 mg po qd.
4. Vitamin D 800 U qd.
5. Digoxin 0.125 po qd.
6. Elavil 50 mg po q hs.
7. Coumadin had been discontinued as of [**2167-12-9**].

SOCIAL HISTORY:  The patient is an ex-tobacco user of
approximately 28-pack year.  She quit in [**2166-11-4**].  She
works as a registered nurse [**First Name (Titles) **] [**Hospital3 **].  She lives
with her children and husband.  She reports occasional
alcohol use, but denies IV drug abuse.  At baseline, the
patient is on 4 liters nasal cannula at home.  Her code
status is full.

FAMILY HISTORY:  Negative for any pulmonary processes.
Father is deceased from Alzheimer's disease and pneumonia.
Mother is alive and well.  There is a family history of
coronary artery disease.

PHYSICAL EXAM ON TRANSFER TO MICU:  Notable for vital signs -
T-max 99.8??????F, blood pressure ranged systolic 84-123/45-91,
heart rate range 103-140, respiratory rate 24, 89-95% on 4 L
nasal cannula and shovel mask.  Her intake and output history
upon transfer:  She had 2,050 ml/3,425 ml.  Exam was notable
for anicteric sclerae.  Her oropharynx was clear.  Her neck
exam - JVP approximately 10 cm at 45??????, no bruits.  Pulmonary
exam - decreased breath sounds at bases, no crackles, no
wheezes.  Cardiac exam - regular, tachycardia, S1, S2, II/VI
systolic murmur at the left sternal border.  Abdominal exam
benign.  Extremity exam -  1+ pretibial edema, 2+ dorsalis
pedis bilaterally, positive clubbing of the upper digits, no
calf tenderness, no swelling.  Neurologic exam grossly
intact.

STUDIES [**2167-10-5**]:  Echocardiogram - ejection fraction
55-60%, right ventricular dilatation, moderate global right
ventricular hypokinesis, moderate pulmonary systolic
hypertension.

[**2167-11-4**] CARDIAC CATHETERIZATION:  Right ventricular
filling pressures 55/7, pulmonary artery pressure 55/26, with
a mean of 39, mean wedge 6, left ventricular pressure 81/10,
cardiac output 4.9, cardiac index 2.8, pulmonary vascular
resistance 536.

RADIOGRAPHIC STUDIES:  As mentioned, CAT scan notable for
ground glass opacities bibasilar.  Chest x-ray notable for a
new right lower lobe infiltrate.

HOSPITAL COURSE BY PROBLEM - 1) PRIMARY PULMONARY
HYPERTENSION, STATUS POST RIGHT LOWER LOBE WEDGE RESECTION
FOR WORK-UP OF NEW RADIOGRAPHIC LUNG FINDINGS AND PROGRESSIVE
DYSPNEA ON EXERTION:  The patient was initially treated with
Flolan with a short course of inhaled nitric oxide treatment
in the setting of her acute dyspnea.  Symptomatically, the
patient improved and was able to be weaned off nitric oxide
after a 48-hour course.  The patient's pathology was notable
for evidence of pulmonary capillary hemangiomatosis.  Given
the overall poor prognosis in this diagnosis, the patient was
maintained on supportive regimen including Flolan,
doxycycline for its presumed effects on decreased
metalloproteinase activity, and lasix to further reduce
preload in the setting of increased filling pressures on the
right side.  The patient's chest x-ray did not change
remarkably.  However, symptomatically she improved.  Her
cough became dry without any evidence of hemoptysis.  The
patient's hematocrit was stable.  Her oxygen saturation
improved while weaning her O2 requirement.  Additionally, the
patient's exercise tolerance increased during her hospital
course, and upon transfer to the regular floor, the patient
was able to ambulate without feeling short of breath.

2) CARDIAC:  From an ischemia standpoint, the patient did not
have any active issues.  She, however, did remain tachycardic
throughout her hospital course, but denied any symptoms of
chest discomfort, and did not have any evidence of ischemia
on her EKG.  The patient did have a recent cardiac
catheterization from [**2167-11-4**] which did not reveal any
evidence of critical stenoses in her coronary arteries.

From a pump perspective, the patient's ejection fraction was
55-60%.  She did have evidence of increased right ventricular
filling pressures and moderate right ventricular hypokinesis.
The patient was maintained on lasix with very impressive
diuresis.  She was maintained on her PO regimen and was
approximately negative 10 liters for her length of stay in
the ICU.  The patient was continued on her digoxin with her
dig level at 0.6 on transfer to the MICU.  Follow-up level is
pending.

From a rhythm perspective, the patient was persistently sinus
tachycardic.  This was presumed to be in relation to
diuresis, as well as her Flolan treatment which is a common
side-effect.  The patient was asymptomatic, however.
Therefore, she was not aggressively treated for this, and her
EKG did not reveal any abnormalities.  For this reason, the
patient was maintained on tele.

3) HEMATOLOGIC:  The patient initially was on Coumadin for
her primary pulmonary hypertension.  However, in the setting
of an acute bleed in the right lung, her Coumadin was held
and continues to be held upon transfer to the floor.  Her
hematocrit remained stable, and her chest x-ray did not
change in appearance.

4) GI:  The patient did not have any active issues.  She was
maintained on a bowel regimen with normal bowel movements
which were reportedly guaiac negative.

5) POSTOPERATIVE PAIN AND BACK PAIN:  The patient, at
baseline, has back pain in relation to her disk disease for
which she takes amitriptyline.  In the setting of having had
her chest surgery, she was given morphine sulfate on a prn
basis, as well as po percocet, to which the patient reported
adequate pain control.  Thereafter, the patient was
maintained on Tylenol treatment prn for her pain.

6) PROPHYLAXIS:  The patient was maintained on a proton pump
inhibitor, as well as heparin subcu tid.

DISPOSITION:  To the floor with follow-up with Dr. [**Last Name (STitle) **]
for potential treatment of her primary pulmonary hypertension
and pulmonary capillary hemangiomatosis.  Additionally, the
patient is on the lung transplant waiting list.  Addendum to
follow with the team on service.




                            [**First Name8 (NamePattern2) 1176**] [**Name8 (MD) 1177**], M.D.  [**MD Number(1) 1178**]

Dictated By:[**Last Name (NamePattern1) 1600**]
MEDQUIST36

D:  [**2167-12-30**]  10:56
T:  [**2167-12-30**]  12:01
JOB#:  [**Job Number 45782**]


Name:  [**Known lastname 8417**], [**Known firstname **]                       Unit No:  [**Numeric Identifier 8418**]

Admission Date:  [**2167-12-22**]     Discharge Date:  [**2168-1-2**]

Date of Birth:   [**2123-12-7**]     Sex:  F

Service:  [**Location (un) 571**]

ADDENDUM:  [**2167-12-30**], through [**2158-1-2**].

The patient was transferred from the Medical Intensive Care
Unit to the general medical floor and remained in stable
condition.  She was weaned from her oxygen 50% face mask and
nasal cannula to four liters nasal cannula.  The patient was
able to ambulate well on four liters nasal cannula with
oxygen saturation above 90%.  The patient was also continued
on her home Flolan dose as well as the Doxycycline for
pulmonary capillary hemangiomatosis.  For further diuresis,
the patient was placed on her home dose of Lasix 120 mg twice
a day as well as her potassium repletion of 30 meq twice a
day.  Given the patient's improvement in her oxygen
requirement, the patient was stable for discharge on
[**2168-1-2**]. She will be discharged with her home oxygen
requirement of four liters nasal cannula.

CONDITION ON DISCHARGE:  Stable to home requiring four liters
of oxygen nasal cannula on exertion.

DISCHARGE STATUS:  To home with VNA services for Flolan and
home oxygen.

DISCHARGE DIAGNOSES:
1.  Pulmonary hypertension.
2.  Congestive heart failure.
3.  Hypoxia.
4.  Pulmonary capillary hemangiomatosis.

MEDICATIONS ON DISCHARGE:
1.  Vitamin D 800 once daily.
2.  Digoxin 0.125 mg once daily.
3.  Amitriptyline 50 mg q.h.s.
4.  Furosemide 120 mg twice a day.
5.  Epoprostenol, Flolan, 20 ng/kg/min continuous infusion.
6.  Doxycycline 100 mg twice a day.
7.  Colace 100 mg twice a day.
8.  Percocet one to two tablets q4-6hours p.r.n. incisional
pain.
9.  Potassium Chloride 30 meq twice a day.
10. Coumadin 2.5 mg tablets once daily to be adjusted further
as an outpatient.
11. Miconazole Powder.
12. Home oxygen.

FOLLOW-UP PLANS:  The patient will follow-up with her primary
care physician to have an INR checked and Coumadin dose
changed as needed early in the week following discharge.  In
addition, the patient will follow-up with her pulmonologist,
Dr. [**Last Name (STitle) 2306**].




                          [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 2334**], M.D.  [**MD Number(1) 2335**]

Dictated By:[**Name8 (MD) 2450**]

MEDQUIST36

D:  [**2168-1-2**]  10:20
T:  [**2168-1-2**]  12:31
JOB#:  [**Job Number 8419**]
{'Primary pulmonary hypertension,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Hemangioma of other sites,Long-term (current) use of anticoagulants,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Hypoxia, status post right middle lobe
wedge resection.

PRESENT ILLNESS: This is a 44-year-old female,
with a history of primary pulmonary hypertension diagnosed in
[**2167**], presenting with progressive dyspnea on exertion over
the past year.  The patient states that the dyspnea has
worsened since [**2167-3-7**], for which she was admitted four
months later with a diagnosis of dyspnea.  She was initially
treated with Flolan, given her diagnosis of primary pulmonary
hypertension.  Echo and cardiac catheterization were notable
for increased pulmonary artery hypertension.  At that time,
the patient also had a normal wedge pressure, normal LV
function, normal biventricular diastolic function, and a
normal ejection fraction.

MEDICAL HISTORY: 1. Primary pulmonary hypertension.
2. Herniated disk at L4-L5 diagnosed in [**2166-3-7**].
3. Rosacea.
4. Status post ex. lap 2 years ago to evaluate abdominal
pain.
5. History of negative Holter evaluation.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes hives.

PHYSICAL EXAM: 

FAMILY HISTORY: Negative for any pulmonary processes.
Father is deceased from Alzheimer's disease and pneumonia.
Mother is alive and well.  There is a family history of
coronary artery disease.

SOCIAL HISTORY: The patient is an ex-tobacco user of
approximately 28-pack year.  She quit in [**2166-11-4**].  She
works as a registered nurse [**First Name (Titles) **] [**Hospital3 **].  She lives
with her children and husband.  She reports occasional
alcohol use, but denies IV drug abuse.  At baseline, the
patient is on 4 liters nasal cannula at home.  Her code
status is full. 

### Response:
{'Primary pulmonary hypertension,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Hemangioma of other sites,Long-term (current) use of anticoagulants,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
