CHIEF COMPLAINT: Hypertension.

PRESENT ILLNESS: This is a 68-year-old woman with
history of diabetes type II, with end-stage renal disease,
malignant hypertension, CAD, CHF, CVA, admitted on [**5-2**],
with worsening dyspnea on exertion even at dialysis, improved
with increased ultrafiltration at dialysis.  Stress MIBI
showed new reversible inferior wall defect with decision made
not to re-catheterization.  The patient now presents with
increased shortness of breath x1 day even at rest, worsening
with orthopnea, also complaints of right-sided chest pain, 5-
[**8-8**], different from her myocardial ischemic pain, which is
left-sided at baseline, no anginal symptoms, able to walk 2
blocks before getting short of breath, baseline blood
pressure runs at 170/100, prior to dialysis and 150/80 to 90,
postdialysis.  No change in blood pressure medications
recently.  Taking of about 3 liters of hemodialysis per
session recently.  The patient denies missing any doses of
her blood pressure medications.  No headache, visual change,
dry cough for a day, no fever, positive chronic diarrhea, and
no lower extremity edema.  In the ED, her vitals were
temperature of 98.3 degrees, pulse of 92, blood pressure of
248/118, 80% on room air and 95% on 2 liters.  Labs were
unremarkable.  Initially, received Norvasc dose, aspirin,
nitroglycerin x3, Lopressor IV x3 5 mg doses and 50 mg p.o.,
once, Diovan 160 mg.  Blood pressure still 228/112,
saturations improved to 99% on 2 liters.  She was started on
nitroglycerin drip more than 200 mcg per minute, got at least
40 and 80 IV, little to no output.  Her chest x-ray with
volume overload.  Afterwards, blood pressure still elevated,
improved to 180/90, around her baseline after hydralazine 10
mg IV once, received 0.5 mg morphine.  Chest pain improved to
[**2178-1-31**], brought to the MICU for emergent dialysis.  In the
MICU, the patient was ultrafiltrated with 3 liters, blood
pressure 120-150/70-90.  Chest pain briskly resolved still on
max nitroglycerin drip.

MEDICAL HISTORY: Diabetes type II, diet-controlled, end-
stage renal disease on dialysis q. [**Month/Day/Year 766**], Wednesday, [**Month/Day/Year 2974**],
CHF, EF of 40% in [**8-1**], CAD, 2-vessel disease, RCA, and LAD,
[**2171-6-5**], catheterization unchanged, history of DVT, history
of CVA and TIA, increased homocystine, cervical
spondyloarthropathy, status post C4 and C7 fusion, refractory
hypertension requiring hemodialysis, macrocytic anemia.

MEDICATION ON ADMISSION: 1.  B complex.
2.  Vitamin C.
3.  Folate.
4.  Atropine 2.5 and 0.25 mg 1 tablet b.i.d. p.r.n.
5.  Vioxx 12.5 mg q.d.
6.  Dipyridamole.
7.  Aspirin 325 mg 1 capsule b.i.d.
8.  Valsartan 160 mg p.o. b.i.d.
9.  Atorvastatin 40 mg p.o. q.d.
10. Amlodipine 10 mg p.o. q.d.
11. Sertraline 50 mg p.o. q.d.
12. Metoprolol 75 mg p.o. q.i.d.
13. Isosorbide dinitrate 10 mg b.i.d.
14. Sevelamer 800 mg, three tablets b.i.d.
15. Plavix 75 mg p.o. q.d.
16. Terazosin 1 mg p.o. q.h.s.
17. Nephrocaps.

ALLERGIES: ACE INHIBITOR REACTION CAUSE COUGH.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Widow, retired English professor, lives with
her son and daughter, denies any drinking, drugs, or tobacco.
Ambulates with a cane.
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified
Mal hyp kid w cr kid V,CHF NOS,Crnry athrscl natve vssl,Old myocardial infarct,DMII wo cmp nt st uncntr,Anemia NOS
Admission Date: [**2172-6-28**]        Discharge Date: [**2172-7-2**]

Date of Birth:  [**2103-11-27**]        Sex:  F

Service:  MED

CHIEF COMPLAINT:  Hypertension.

HISTORY OF PRESENT ILLNESS:  This is a 68-year-old woman with
history of diabetes type II, with end-stage renal disease,
malignant hypertension, CAD, CHF, CVA, admitted on [**5-2**],
with worsening dyspnea on exertion even at dialysis, improved
with increased ultrafiltration at dialysis.  Stress MIBI
showed new reversible inferior wall defect with decision made
not to re-catheterization.  The patient now presents with
increased shortness of breath x1 day even at rest, worsening
with orthopnea, also complaints of right-sided chest pain, 5-
[**8-8**], different from her myocardial ischemic pain, which is
left-sided at baseline, no anginal symptoms, able to walk 2
blocks before getting short of breath, baseline blood
pressure runs at 170/100, prior to dialysis and 150/80 to 90,
postdialysis.  No change in blood pressure medications
recently.  Taking of about 3 liters of hemodialysis per
session recently.  The patient denies missing any doses of
her blood pressure medications.  No headache, visual change,
dry cough for a day, no fever, positive chronic diarrhea, and
no lower extremity edema.  In the ED, her vitals were
temperature of 98.3 degrees, pulse of 92, blood pressure of
248/118, 80% on room air and 95% on 2 liters.  Labs were
unremarkable.  Initially, received Norvasc dose, aspirin,
nitroglycerin x3, Lopressor IV x3 5 mg doses and 50 mg p.o.,
once, Diovan 160 mg.  Blood pressure still 228/112,
saturations improved to 99% on 2 liters.  She was started on
nitroglycerin drip more than 200 mcg per minute, got at least
40 and 80 IV, little to no output.  Her chest x-ray with
volume overload.  Afterwards, blood pressure still elevated,
improved to 180/90, around her baseline after hydralazine 10
mg IV once, received 0.5 mg morphine.  Chest pain improved to
[**2178-1-31**], brought to the MICU for emergent dialysis.  In the
MICU, the patient was ultrafiltrated with 3 liters, blood
pressure 120-150/70-90.  Chest pain briskly resolved still on
max nitroglycerin drip.

PAST MEDICAL HISTORY:  Diabetes type II, diet-controlled, end-
stage renal disease on dialysis q. [**Month/Day/Year 766**], Wednesday, [**Month/Day/Year 2974**],
CHF, EF of 40% in [**8-1**], CAD, 2-vessel disease, RCA, and LAD,
[**2171-6-5**], catheterization unchanged, history of DVT, history
of CVA and TIA, increased homocystine, cervical
spondyloarthropathy, status post C4 and C7 fusion, refractory
hypertension requiring hemodialysis, macrocytic anemia.

Admission chest x-ray showed CHF, cannot rule out pneumonia.
EKG normal sinus at 90 beats per minute, normal axis
intervals, possible LVH, [**Street Address(2) 4793**] depressions in V5-V6,
consistent with LV strain.  Stress test from [**5-3**], with 8
minutes on [**Doctor Last Name 4001**] protocol without chest discomfort.  This
study demonstrated what appears to be a new reversible defect
inferior wall perfusion defect.  Her echocardiogram from
[**8-1**], showed EF of 40-50%, catheterization from [**8-1**], EF of
40%, 2-vessel disease as described above, LAD 50% occluded,
RCA totally occluded, unchanged from [**12/2158**].

MEDICATIONS ON ADMISSION:
1.  B complex.
2.  Vitamin C.
3.  Folate.
4.  Atropine 2.5 and 0.25 mg 1 tablet b.i.d. p.r.n.
5.  Vioxx 12.5 mg q.d.
6.  Dipyridamole.
7.  Aspirin 325 mg 1 capsule b.i.d.
8.  Valsartan 160 mg p.o. b.i.d.
9.  Atorvastatin 40 mg p.o. q.d.
10. Amlodipine 10 mg p.o. q.d.
11. Sertraline 50 mg p.o. q.d.
12. Metoprolol 75 mg p.o. q.i.d.
13. Isosorbide dinitrate 10 mg b.i.d.
14. Sevelamer 800 mg, three tablets b.i.d.
15. Plavix 75 mg p.o. q.d.
16. Terazosin 1 mg p.o. q.h.s.
17. Nephrocaps.

ALLERGIES:  ACE INHIBITOR REACTION CAUSE COUGH.

SOCIAL HISTORY:  Widow, retired English professor, lives with
her son and daughter, denies any drinking, drugs, or tobacco.
Ambulates with a cane.

PHYSICAL EXAMINATION:  General, in no acute distress.  Mucous
membranes moist.  Pupils equal, round, reactive to light and
accommodation.  Optic disc not visualized.  No JVD.
Bibasilar crackles, otherwise clear.  Regular rate and
rhythm, no murmurs, rubs or gallops.  Abdomen, soft,
nontender, nondistended, normoactive bowel sounds.
Extremities, no clubbing, cyanosis, edema, warm, 2+ DP pulses
bilaterally.  Left AV fistula intact with thrill.
Neurological, A&O x3, no focal signs.

HOSPITAL COURSE:  Hypertension, the patient was in the MICU
for 2 days.  She was restarted on her home medications and
the nitroglycerin drip was titrated to control blood
pressure.  She had ultrafiltration, which removed 3.1 liters
of fluid, and received 100 mg hydralazine for increased blood
pressure.  She improved, was taken off the nitroglycerin
drip.  Her blood pressure was in the 170s, 160s-190s/70-90,
with goal blood pressure of 140-150/80-90.  She was
transferred to the floor.  She received hemodialysis with
much improved blood pressure control and was euvolemic.  Her
blood pressure was in the 87-120s/40-60s, on the floor after
3 sessions of hemodialysis.  She was continued on the
metoprolol, Isordil, valsartan, Norvasc, as her outpatient
doses and IV hydralazine p.r.n., and was to restart her
terazosin as her blood pressure increased.  The patient also
developed some lightheadedness with her hypervolemia after
the consecutive hemodialysis sessions.  Her blood pressure
medications were held.  She continued to mentate well, and
received no fluids.  Her terazosin was held.  Her ESRD, her
electrolytes were followed.  Hemodialysis as above.  She was
continued on Renagel and Nephrocaps.  Her CAD, she was
continued on aspirin, Plavix, Lipitor, beta-blocker, and [**Last Name (un) **]
given her intolerance of an ACE inhibitor.  CHF, she does not
respond to Lasix, however, responded to taking volume off
with hemodialysis as above.  She was continued on aspirin and
Plavix for a history of CVA, and she had her pain controlled
with Tylenol p.r.n., no NSAIDs watch the CHF.  The patient
was continued on diabetic renal diet and fluid restriction.
Her chest pain was atypical and it was controlled with Maalox
p.r.n.

DISCHARGE DIAGNOSES:  Malignant hypertension.
End-stage renal disease.

FOLLOW UP:  Primary care with Dr. [**Last Name (STitle) **], in renal health
for a dialysis.

CONDITION ON DISCHARGE:  Stable on room air.  Blood pressure
120s to 150 systolic.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg p.o. q.d.
2.  Clopidogrel 75 mg p.o. q.d.
3.  Atorvastatin 40 mg p.o. q.d.
4.  B complex.
5.  Vitamin C.
6.  Folate 1 mg p.o. q.d.
7.  Sevelamer 800 mg, 3 tablets p.o. t.i.d.
8.  Sertraline 50 mg p.o. q.d.
9.  Pantoprazole 40 mg p.o. q.d.
10. Valsartan 160 mg p.o. b.i.d.
11. Metoprolol tartrate 50 mg 3 tablets p.o. t.i.d.
12. Amlodipine 5 mg 2 tablets p.o. q.d.

The patient was discharged to home.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(2) 5614**]

Dictated By:[**Doctor Last Name 98014**]
MEDQUIST36
D:  [**2172-8-4**] 13:18:51
T:  [**2172-8-4**] 14:59:16
Job#:  [**Job Number **]
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified'}


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: Hypertension.

PRESENT ILLNESS: This is a 68-year-old woman with
history of diabetes type II, with end-stage renal disease,
malignant hypertension, CAD, CHF, CVA, admitted on [**5-2**],
with worsening dyspnea on exertion even at dialysis, improved
with increased ultrafiltration at dialysis.  Stress MIBI
showed new reversible inferior wall defect with decision made
not to re-catheterization.  The patient now presents with
increased shortness of breath x1 day even at rest, worsening
with orthopnea, also complaints of right-sided chest pain, 5-
[**8-8**], different from her myocardial ischemic pain, which is
left-sided at baseline, no anginal symptoms, able to walk 2
blocks before getting short of breath, baseline blood
pressure runs at 170/100, prior to dialysis and 150/80 to 90,
postdialysis.  No change in blood pressure medications
recently.  Taking of about 3 liters of hemodialysis per
session recently.  The patient denies missing any doses of
her blood pressure medications.  No headache, visual change,
dry cough for a day, no fever, positive chronic diarrhea, and
no lower extremity edema.  In the ED, her vitals were
temperature of 98.3 degrees, pulse of 92, blood pressure of
248/118, 80% on room air and 95% on 2 liters.  Labs were
unremarkable.  Initially, received Norvasc dose, aspirin,
nitroglycerin x3, Lopressor IV x3 5 mg doses and 50 mg p.o.,
once, Diovan 160 mg.  Blood pressure still 228/112,
saturations improved to 99% on 2 liters.  She was started on
nitroglycerin drip more than 200 mcg per minute, got at least
40 and 80 IV, little to no output.  Her chest x-ray with
volume overload.  Afterwards, blood pressure still elevated,
improved to 180/90, around her baseline after hydralazine 10
mg IV once, received 0.5 mg morphine.  Chest pain improved to
[**2178-1-31**], brought to the MICU for emergent dialysis.  In the
MICU, the patient was ultrafiltrated with 3 liters, blood
pressure 120-150/70-90.  Chest pain briskly resolved still on
max nitroglycerin drip.

MEDICAL HISTORY: Diabetes type II, diet-controlled, end-
stage renal disease on dialysis q. [**Month/Day/Year 766**], Wednesday, [**Month/Day/Year 2974**],
CHF, EF of 40% in [**8-1**], CAD, 2-vessel disease, RCA, and LAD,
[**2171-6-5**], catheterization unchanged, history of DVT, history
of CVA and TIA, increased homocystine, cervical
spondyloarthropathy, status post C4 and C7 fusion, refractory
hypertension requiring hemodialysis, macrocytic anemia.

MEDICATION ON ADMISSION: 1.  B complex.
2.  Vitamin C.
3.  Folate.
4.  Atropine 2.5 and 0.25 mg 1 tablet b.i.d. p.r.n.
5.  Vioxx 12.5 mg q.d.
6.  Dipyridamole.
7.  Aspirin 325 mg 1 capsule b.i.d.
8.  Valsartan 160 mg p.o. b.i.d.
9.  Atorvastatin 40 mg p.o. q.d.
10. Amlodipine 10 mg p.o. q.d.
11. Sertraline 50 mg p.o. q.d.
12. Metoprolol 75 mg p.o. q.i.d.
13. Isosorbide dinitrate 10 mg b.i.d.
14. Sevelamer 800 mg, three tablets b.i.d.
15. Plavix 75 mg p.o. q.d.
16. Terazosin 1 mg p.o. q.h.s.
17. Nephrocaps.

ALLERGIES: ACE INHIBITOR REACTION CAUSE COUGH.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Widow, retired English professor, lives with
her son and daughter, denies any drinking, drugs, or tobacco.
Ambulates with a cane. 

### Response:
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified'}
