CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 89-year-old
female with CHF, EF of 25%, three vessel coronary disease,
refusing CABG, chronic renal insufficiency,
choledocholithiasis, status post sphincterotomy in [**2151-2-1**].  She was admitted to the [**Hospital1 188**] from [**4-4**] to [**4-17**], was found to have evidence of stones
in gallbladder and cystic duct in the setting of abdominal
pain, nausea and vomiting that stay, noticeable for an ERCP
showing stones that were able to be pushed back into the
gallbladder. The patient was treated successfully with
antibiotics.  During this time the patient also had atrial
fibrillation, congestive heart failure and a small NQWMI.
She was seen by surgery, not felt to be a surgical candidate
but she was improving so then discharged to rehab with plan
for ongoing diuresis, antibiotic treatment.  Since arrival to
rehab she has had nausea and vomiting and abdominal pain.
She was sent to the Emergency Room with a question of
cholecystitis.

MEDICAL HISTORY: Coronary artery disease as above, CHF
with EF as above, chronic renal insufficiency, hep A, B, C
positive, LBBV, history of gallstones, GERD, diverticula,
[**3-5**]+ MR, 3+ TR, moderate pulmonary hypertension.  Paroxysmal
atrial fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives at home with family.
Cholecystitis, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery
Cholecystitis NOS,Atrial fibrillation,CHF NOS,Crnry athrscl natve vssl
Admission Date:  [**2152-4-19**]     Discharge Date:  [**2152-4-20**]


Service:

HISTORY OF PRESENT ILLNESS:  The patient is an 89-year-old
female with CHF, EF of 25%, three vessel coronary disease,
refusing CABG, chronic renal insufficiency,
choledocholithiasis, status post sphincterotomy in [**2151-2-1**].  She was admitted to the [**Hospital1 188**] from [**4-4**] to [**4-17**], was found to have evidence of stones
in gallbladder and cystic duct in the setting of abdominal
pain, nausea and vomiting that stay, noticeable for an ERCP
showing stones that were able to be pushed back into the
gallbladder. The patient was treated successfully with
antibiotics.  During this time the patient also had atrial
fibrillation, congestive heart failure and a small NQWMI.
She was seen by surgery, not felt to be a surgical candidate
but she was improving so then discharged to rehab with plan
for ongoing diuresis, antibiotic treatment.  Since arrival to
rehab she has had nausea and vomiting and abdominal pain.
She was sent to the Emergency Room with a question of
cholecystitis.

PAST MEDICAL HISTORY:  Coronary artery disease as above, CHF
with EF as above, chronic renal insufficiency, hep A, B, C
positive, LBBV, history of gallstones, GERD, diverticula,
[**3-5**]+ MR, 3+ TR, moderate pulmonary hypertension.  Paroxysmal
atrial fibrillation.

MEDICATIONS:  On transfer, Hydralazine, Protonix, Colace,
Dulcolax, Lopressor, Isordil and Lasix.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Lives at home with family.

REVIEW OF SYSTEMS:  Notable for fatigue, lower extremity
edema, nausea, vomiting.

PHYSICAL EXAMINATION:  On admission temperature afebrile.
She was 99% on room air.  Respiratory rate as 20.  She was in
no acute distress.  Her BP was 122 systolic, heart rate 68.
Her neck was supple.  She had no neck or supraclavicular
adenopathy.  Her breathing was comfortable.  There were a few
rales at the bases.  Her heart showed an irregular rate and
rhythm with a 2/6 systolic murmur.  She had 2+ edema
bilaterally.  Her abdomen had some mild soreness in the mid
epigastrium.  There was no rebound, no guarding.  Belly was
soft, normal bowel sounds, non distended.

LABORATORY DATA:  Initial labs showed a sodium of 141,
potassium 4.5, chloride 105, CO2 22, BUN and creatinine 36
and 2.2, up from baseline of 1.7, glucose was 106, white
count was 5.5 with normal diff.  Hematocrit was 34, platelet
count 201,000, AST 45, ALT 29, alkaline phosphatase 149,
total bilirubin 1.3, amylase 53, albumin 3.2, calcium 9.6,
magnesium 2.1, lipase 69.

EKG showed sinus rhythm with IVCD, left bundle branch block,
nonspecific T wave changes with no specific changes compared
to a prior.

HOSPITAL COURSE:  The patient was admitted to the medicine
team on the [**Hospital Ward Name 516**] for abdominal pain, nausea and
vomiting and the presumptive diagnosis of cholecystitis.
Right upper quadrant ultrasound was negative.  KUB was
negative.  On the floor she continued to have some abdominal
pain and nausea which was treated with Maalox and some
Compazine.  She was noted to have atrial fibrillation with a
rapid ventricular rate and was treated with IV Lopressor 15
mg with reportedly good effect.  At approximately 9:15 p.m.
the alarm again went off for atrial fibrillation with a rapid
ventricular rate.  Nursing apparently went in at this time
and found the patient unresponsive and a code was called.
Initially no pulse was obtained.  The patient was thought to
have pulseless electrical activity.  She was given 1 mg of
Epinephrine.  Chest compressions continued.  Central line was
placed.  The patient was intubated.  At this time rhythm
converted on the monitor to ventricular tachycardia which was
shocked three times in succession.  After the third shock the
patient recovered a pulse and was brought to the Medical
Intensive Care Unit. In the MICU her pulse was found to be
systolic of approximately 80 but declining rapidly.  She was
bolused multiple times with fluids.  Her ABG returned with a
PH of 7.08 and a PCO2 of 17, potassium 6.1, and she was given
bicarbonate first as a bolus and then as a drip.  Her PAGH
improved but her blood pressure continued to decline.  Her
Dopamine was increased and Levophed was added.  Both
eventually at maximum doses with continued decline in blood
pressure to the 60's.  EKG throughout this time was only
notable for minimal ST elevation inferiorly.  Right sided
leads were negative and ST elevations did not persist.
Discussions were held with the family and although they
requested efforts be continued, patient was felt too unstable
or unlikely to benefit from any further intervention and she
expired at 1:30 a.m.

FINAL DIAGNOSIS:
1.  Cardiac arrest and hypotension.
2.  Lactic Acidosis.
3.  Known three vessel coronary disease, deferred CABG.
4.  Chronic renal insufficiency.
5.  Atrial fibrillation.




                          DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-981

Dictated By:[**Name8 (MD) 13286**]
MEDQUIST36

D:  [**2152-4-20**]  04:38
T:  [**2152-4-21**]  20:08
JOB#:  [**Job Number **]
{'Cholecystitis, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery'}


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: 

PRESENT ILLNESS: The patient is an 89-year-old
female with CHF, EF of 25%, three vessel coronary disease,
refusing CABG, chronic renal insufficiency,
choledocholithiasis, status post sphincterotomy in [**2151-2-1**].  She was admitted to the [**Hospital1 188**] from [**4-4**] to [**4-17**], was found to have evidence of stones
in gallbladder and cystic duct in the setting of abdominal
pain, nausea and vomiting that stay, noticeable for an ERCP
showing stones that were able to be pushed back into the
gallbladder. The patient was treated successfully with
antibiotics.  During this time the patient also had atrial
fibrillation, congestive heart failure and a small NQWMI.
She was seen by surgery, not felt to be a surgical candidate
but she was improving so then discharged to rehab with plan
for ongoing diuresis, antibiotic treatment.  Since arrival to
rehab she has had nausea and vomiting and abdominal pain.
She was sent to the Emergency Room with a question of
cholecystitis.

MEDICAL HISTORY: Coronary artery disease as above, CHF
with EF as above, chronic renal insufficiency, hep A, B, C
positive, LBBV, history of gallstones, GERD, diverticula,
[**3-5**]+ MR, 3+ TR, moderate pulmonary hypertension.  Paroxysmal
atrial fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives at home with family. 

### Response:
{'Cholecystitis, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery'}
