CHIEF COMPLAINT: Cardiogenic shock.

PRESENT ILLNESS: 76 yo female with hx of CAD s/p CABG and AVR, HTN,
hypothyroidism who was initially admitted to an OSH on [**2131-4-3**]
after recent TKR [**2131-3-12**] with multiple complications including
abdominal abscess with sepsis, CHF, and DVT now being
transferred for further management. Pt underwent TKR and was at
rehab when she developed diarrhea and was started on PO flagyl.
She had a persistently elevated WBC with worsening dehydration
and was referred to [**Hospital3 **] Hospital on [**2131-4-3**] for further
evaluation. She developed worsening SOB and impaired mentation
with markedly elevated WBC so CT Abd was performed to eval the
degree of her colitis and revealed an abscess near her sigmoid
colon. She underwent CT guided placement of a pigtail catheter
for drainage on [**4-13**] and culture of the fluid grew E.Coli and
Klebsiella and she was treated with Zosyn along with PO
vancomycin and flagyl for resistant Cdiff colitis. SOB and
declining mental status progressed and she was transferred to
the CCU on [**4-16**] for cardiogenic and septic shock. She also
developed a left axillary DVT associated with a PICC and have
noted to have a mottled left foot with absent dp pulse. US of
the LE revealed popliteal stenosis and was started on a heparin
gtt. She was evaluated by interventional cardiology for her
severe heart failure and she was felt not to be a candidate for
cardiac catherization or IABP as this would not be a bridge to
further therapy. Her family wanted her evaluated at a tertiary
care center so she was transferred to [**Hospital1 18**].

MEDICAL HISTORY: hypertension
s/p CABG (LIMA-LAD)and aortic valve replacement [**2-22**]
diverticulitis s/p perforation-[**3-24**]
hypothyroidism
osteoarthritis
hyperlipidemia
bilateral catarct repair
Left TKR

MEDICATION ON ADMISSION: Home meds
Atenolol 100mg qd
Lipitor 10mg qd
Synthroid 37.5mcg qd
ASA 81mg qd
.
Tx Meds
Tylenol 650mg q6h prn
Zofran 4mg IV q8 h prn
Flagyl 500mg IV q8h
Vancomycin 250mg PO qid
ASA 162mg po qd
Protonix 40mg iv qd
Lasix 60mg IV qd
TPN
levothyroxine 50mcg IV qd
Imipenem 500mg IV q8h
Heparin gtt
Neosynephrine gtt.
.
Allergies:
Ivp Dye, Iodine Containing / Penicillins / Ampicillin

ALLERGIES: Ivp Dye, Iodine Containing / Penicillins / Ampicillin

PHYSICAL EXAM: T:98.5 BP: 88/75 HR: 114 AC 500/12 PEEP 5 FIO2 30% O2 Sat 98%
Gen: Appears older than stated age. Arousable to voice.
HEENT: Moon facies. No conjunctival pallor. No icterus. Slightly
dry mucous membranes. Oropharynx clear.
NECK: Supple. No cervical or supraclavicular lymphadenopathy.
Unable to assess JVP.
CV: tachyRRR. Normal S1 and S2. [**1-23**] HSM at apex and LLSB
LUNGS: Crackles at bases bilat.
ABD: absent bowel sounds, diffuse tenderness with no rebound or
guarding, pigtail without surrounding erythema and
serosanguinous drainagae
SKIN: no rashes
NEURO: arousable to command, moving all extrem to command
Extrem-diffuse anasarsa, mottled left foot to mid shin with blue
discoloration of the first 2 digits, absent dp pulse on left,
dopplerable PT on left and right, 1+ rad pulse bilat

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: The patient worked as an activities director in [**Location (un) 3844**].
She is married with 4 children. She has no history of tobacco or
excessive alcohol use.
Acute respiratory failure,Shock, unspecified,Congestive heart failure, unspecified,Acute myocardial infarction of unspecified site, initial episode of care,Peritoneal abscess,Mitral valve disorders,Other primary cardiomyopathies,Diseases of tricuspid valve,Diverticulitis of colon (without mention of hemorrhage),Heart valve replaced by other means,Aortocoronary bypass status,Knee joint replacement,Unspecified acquired hypothyroidism,Unspecified essential hypertension
Acute respiratry failure,Shock NOS,CHF NOS,AMI NOS, initial,Peritoneal abscess,Mitral valve disorder,Prim cardiomyopathy NEC,Tricuspid valve disease,Dvrtcli colon w/o hmrhg,Heart valve replac NEC,Aortocoronary bypass,Joint replaced knee,Hypothyroidism NOS,Hypertension NOS
Admission Date:  [**2131-4-26**]              Discharge Date:   [**2131-4-27**]

Date of Birth:  [**2054-8-24**]             Sex:   F

Service: MEDICINE

Allergies:
Ivp Dye, Iodine Containing / Penicillins / Ampicillin

Attending:[**First Name3 (LF) 3561**]
Chief Complaint:
Cardiogenic shock.

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
76 yo female with hx of CAD s/p CABG and AVR, HTN,
hypothyroidism who was initially admitted to an OSH on [**2131-4-3**]
after recent TKR [**2131-3-12**] with multiple complications including
abdominal abscess with sepsis, CHF, and DVT now being
transferred for further management. Pt underwent TKR and was at
rehab when she developed diarrhea and was started on PO flagyl.
She had a persistently elevated WBC with worsening dehydration
and was referred to [**Hospital3 **] Hospital on [**2131-4-3**] for further
evaluation. She developed worsening SOB and impaired mentation
with markedly elevated WBC so CT Abd was performed to eval the
degree of her colitis and revealed an abscess near her sigmoid
colon. She underwent CT guided placement of a pigtail catheter
for drainage on [**4-13**] and culture of the fluid grew E.Coli and
Klebsiella and she was treated with Zosyn along with PO
vancomycin and flagyl for resistant Cdiff colitis. SOB and
declining mental status progressed and she was transferred to
the CCU on [**4-16**] for cardiogenic and septic shock. She also
developed a left axillary DVT associated with a PICC and have
noted to have a mottled left foot with absent dp pulse. US of
the LE revealed popliteal stenosis and was started on a heparin
gtt. She was evaluated by interventional cardiology for her
severe heart failure and she was felt not to be a candidate for
cardiac catherization or IABP as this would not be a bridge to
further therapy. Her family wanted her evaluated at a tertiary
care center so she was transferred to [**Hospital1 18**].

Past Medical History:
hypertension
s/p CABG (LIMA-LAD)and aortic valve replacement [**2-22**]
diverticulitis s/p perforation-[**3-24**]
hypothyroidism
osteoarthritis
hyperlipidemia
bilateral catarct repair
Left TKR


Social History:
The patient worked as an activities director in [**Location (un) 3844**].
She is married with 4 children. She has no history of tobacco or
excessive alcohol use.

Family History:
Unknown.

Physical Exam:
T:98.5 BP: 88/75 HR: 114 AC 500/12 PEEP 5 FIO2 30% O2 Sat 98%
Gen: Appears older than stated age. Arousable to voice.
HEENT: Moon facies. No conjunctival pallor. No icterus. Slightly
dry mucous membranes. Oropharynx clear.
NECK: Supple. No cervical or supraclavicular lymphadenopathy.
Unable to assess JVP.
CV: tachyRRR. Normal S1 and S2. [**1-23**] HSM at apex and LLSB
LUNGS: Crackles at bases bilat.
ABD: absent bowel sounds, diffuse tenderness with no rebound or
guarding, pigtail without surrounding erythema and
serosanguinous drainagae
SKIN: no rashes
NEURO: arousable to command, moving all extrem to command
Extrem-diffuse anasarsa, mottled left foot to mid shin with blue
discoloration of the first 2 digits, absent dp pulse on left,
dopplerable PT on left and right, 1+ rad pulse bilat


Pertinent Results:
Admission labs:
PTT: 68.6
.
149  113
-------<114
4.0  24
Ca: 7.9 Mg: 2.8 P: 5.7 D
.
LDH: 192
.
    10.7
9.6>----<449
    35.7
N:73.9 L:19.9 M:6.1 E:0 Bas:0
.
CXR [**2131-4-26**]: The patient is after median sternotomy and aortic
valve replacement. The heart size is normal. The ET tube tip is
4.3 cm above the carina. The NG tube tip terminates in the
stomach. The left internal jugular line tip is at the junction
of the brachiocephalic vein with SVC.
The right PICC line tip terminates in superior SVC.
Bilateral pleural effusions are demonstrated at least moderate
in size. Mild perihilar haziness is present which might be
attributed to pulmonary edema although the precise degree of the
congestive heart failure is difficult to appreciate in the
presence of layering bilateral pleural effusions.
.
From [**Hospital3 **] Hospital:
STUDIES:
[**2131-4-15**] TTE EF 30% mid and distal ant wall akinetic apex
akinetic mid and distal ant septum akinetic distal lateral wall
is akinetic, [**1-21**]+ mR, [**1-21**]+ TR
repeat on [**4-20**] unchanged
.
[**2131-4-25**] CT chest-bilateral effusions, diffuse SQ edema, mild
ascites, cholelithiasis
.
[**4-20**] ECG-NSR at 100 nl axis, Q in v1-3, low voltagediffuse TWI,
1mm ST elev v2-3
.
micro-
[**4-3**] cdiff pos
[**4-13**] abscess GNR Kleb pneumo pansens Ecoli pansens and
enterococcus and lactobacillus
[**4-15**] stool cx, no salm shig ecoli and campylobacter
[**4-18**] sputum nl flora
[**4-17**] Ucx ngtd
[**4-19**] UCx 50-[**Numeric Identifier 4856**] yeast
[**4-2**] [**2-21**] ngtd
5/26 [**2-21**] ngtd
5/29 [**2-21**] ngtd
6/1 [**6-27**] ngtd
Hep A B and C serology neg




Brief Hospital Course:
A/P: 76 yo female with hx of CAD s/p CABG and AVR, HTN,
hypothyroidism who was initially admitted to an OSH for TKR with
multiple complications including abdominal abscess with sepsis,
CHF, and DVT now being transferred for further management.
.
On arrival she was assessed and noted to have cardiogenic shock
with 4+ MR [**First Name (Titles) **] [**Last Name (Titles) **] 25%. Additionally she had severe volume
overload from resuscitation and required pressor support with
neosynephrine to maintain her blood pressure. She had
respiratory failure due to her cardiogenic shock but was unable
ot be diuresed due to hypotension. She had multiple abdominal
abscesses on her CT scan from [**Hospital3 **] hospital. She had no
positive blood cultures from [**Hospital3 **] but had abdominal catheter
growing E.coli and Klebsiella. Additionally on arrival she was
noted to have a cold, pulseless left lower extremity. Given her
over-riding cardiogenic shock and inability to be off pressor
medication, she was not a candidate for surgical intevention,
and her additional problems it was determined that she would not
make a meaningful recovery. Her family decided to withdraw
ventilatory and blood pressure support and pursue comfort with
morphine and ativan. She expired 10 hours later.

Medications on Admission:
Home meds
Atenolol 100mg qd
Lipitor 10mg qd
Synthroid 37.5mcg qd
ASA 81mg qd
.
Tx Meds
Tylenol 650mg q6h prn
Zofran 4mg IV q8 h prn
Flagyl 500mg IV q8h
Vancomycin 250mg PO qid
ASA 162mg po qd
Protonix 40mg iv qd
Lasix 60mg IV qd
TPN
levothyroxine 50mcg IV qd
Imipenem 500mg IV q8h
Heparin gtt
Neosynephrine gtt.
.
Allergies:
Ivp Dye, Iodine Containing / Penicillins / Ampicillin


Discharge Medications:
None.

Discharge Disposition:
Expired

Discharge Diagnosis:
Congestive heart failure, mitral valve regurgiation, abdominal
abscesses, peripheral vascular disease.

Discharge Condition:
Deceased.

Discharge Instructions:
.

Followup Instructions:
.
{'Acute respiratory failure,Shock, unspecified,Congestive heart failure, unspecified,Acute myocardial infarction of unspecified site, initial episode of care,Peritoneal abscess,Mitral valve disorders,Other primary cardiomyopathies,Diseases of tricuspid valve,Diverticulitis of colon (without mention of hemorrhage),Heart valve replaced by other means,Aortocoronary bypass status,Knee joint replacement,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}


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: Cardiogenic shock.

PRESENT ILLNESS: 76 yo female with hx of CAD s/p CABG and AVR, HTN,
hypothyroidism who was initially admitted to an OSH on [**2131-4-3**]
after recent TKR [**2131-3-12**] with multiple complications including
abdominal abscess with sepsis, CHF, and DVT now being
transferred for further management. Pt underwent TKR and was at
rehab when she developed diarrhea and was started on PO flagyl.
She had a persistently elevated WBC with worsening dehydration
and was referred to [**Hospital3 **] Hospital on [**2131-4-3**] for further
evaluation. She developed worsening SOB and impaired mentation
with markedly elevated WBC so CT Abd was performed to eval the
degree of her colitis and revealed an abscess near her sigmoid
colon. She underwent CT guided placement of a pigtail catheter
for drainage on [**4-13**] and culture of the fluid grew E.Coli and
Klebsiella and she was treated with Zosyn along with PO
vancomycin and flagyl for resistant Cdiff colitis. SOB and
declining mental status progressed and she was transferred to
the CCU on [**4-16**] for cardiogenic and septic shock. She also
developed a left axillary DVT associated with a PICC and have
noted to have a mottled left foot with absent dp pulse. US of
the LE revealed popliteal stenosis and was started on a heparin
gtt. She was evaluated by interventional cardiology for her
severe heart failure and she was felt not to be a candidate for
cardiac catherization or IABP as this would not be a bridge to
further therapy. Her family wanted her evaluated at a tertiary
care center so she was transferred to [**Hospital1 18**].

MEDICAL HISTORY: hypertension
s/p CABG (LIMA-LAD)and aortic valve replacement [**2-22**]
diverticulitis s/p perforation-[**3-24**]
hypothyroidism
osteoarthritis
hyperlipidemia
bilateral catarct repair
Left TKR

MEDICATION ON ADMISSION: Home meds
Atenolol 100mg qd
Lipitor 10mg qd
Synthroid 37.5mcg qd
ASA 81mg qd
.
Tx Meds
Tylenol 650mg q6h prn
Zofran 4mg IV q8 h prn
Flagyl 500mg IV q8h
Vancomycin 250mg PO qid
ASA 162mg po qd
Protonix 40mg iv qd
Lasix 60mg IV qd
TPN
levothyroxine 50mcg IV qd
Imipenem 500mg IV q8h
Heparin gtt
Neosynephrine gtt.
.
Allergies:
Ivp Dye, Iodine Containing / Penicillins / Ampicillin

ALLERGIES: Ivp Dye, Iodine Containing / Penicillins / Ampicillin

PHYSICAL EXAM: T:98.5 BP: 88/75 HR: 114 AC 500/12 PEEP 5 FIO2 30% O2 Sat 98%
Gen: Appears older than stated age. Arousable to voice.
HEENT: Moon facies. No conjunctival pallor. No icterus. Slightly
dry mucous membranes. Oropharynx clear.
NECK: Supple. No cervical or supraclavicular lymphadenopathy.
Unable to assess JVP.
CV: tachyRRR. Normal S1 and S2. [**1-23**] HSM at apex and LLSB
LUNGS: Crackles at bases bilat.
ABD: absent bowel sounds, diffuse tenderness with no rebound or
guarding, pigtail without surrounding erythema and
serosanguinous drainagae
SKIN: no rashes
NEURO: arousable to command, moving all extrem to command
Extrem-diffuse anasarsa, mottled left foot to mid shin with blue
discoloration of the first 2 digits, absent dp pulse on left,
dopplerable PT on left and right, 1+ rad pulse bilat

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: The patient worked as an activities director in [**Location (un) 3844**].
She is married with 4 children. She has no history of tobacco or
excessive alcohol use. 

### Response:
{'Acute respiratory failure,Shock, unspecified,Congestive heart failure, unspecified,Acute myocardial infarction of unspecified site, initial episode of care,Peritoneal abscess,Mitral valve disorders,Other primary cardiomyopathies,Diseases of tricuspid valve,Diverticulitis of colon (without mention of hemorrhage),Heart valve replaced by other means,Aortocoronary bypass status,Knee joint replacement,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}
