CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old
lady  with  a history of coronary artery disease, status post
inferior  myocardial  infarction  in  [**2154**],  who awoke on the
morning  of  admission  with  the  sudden onset of difficulty
breathing.  She was found to be tachypneic, tachycardiac, and
hypotensive.  She presented to an outside hospital, where she
was noted to be in atrial fibrillation with heart rate in the
150s  and  blood  pressure  in  the  802.    EKG  revealed ST
elevation in leads V1 to V5.  Cardioversion was attempted and
failed.    Intubation was also unsuccessful.  The patient was
placed  on  Lasix, Cardizem, and started on heparin.  She was
transferred  to  [**Hospital1 35027**] for
management   of   her   cardiogenic   shock   and   potential
catheterization.    Upon arrival in the emergency department,
she was emergently intubated and she was found to be in rapid
atrial   fibrillation.      Amniofusion   was   started   and
cardioversion   was   attempted   again.     This  was  again
unsuccessful.    The  patient was transferred to the Coronary
Care Unit in critical condition.

MEDICAL HISTORY: 1.   Coronary artery disease, status post inferior myocardial
infarction in [**2154**].
2.  Congestive heart failure.
3.  Hypertension.
4.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  Atenolol 100 q.d.
2.  Lisinopril 2.5 q.d.
3.  Isordil 30 t.i.d.
4.  Lasix 20 q.d.
5.  Zantac 150 q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a nonsmoker and nondrinker.
Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Atrial fibrillation,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Blood in stool,Other specified disorders of biliary tract,Diarrhea,Precipitous drop in hematocrit
AMI anterior wall, init,Cardiogenic shock,Atrial fibrillation,CHF NOS,Urin tract infection NOS,Blood in stool,Dis of biliary tract NEC,Diarrhea,Drop, hematocrit, precip
Service:  [**Hospital Unit Name 196**]                      Date:  [**2160-8-13**]


Surgeon:  [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 4786**]

ADMITTING   DIAGNOSIS:     Acute  myocardial  infarction  and
cardiogenic shock.

HISTORY OF THE PRESENT ILLNESS:  The patient is a [**Age over 90 **]-year-old
lady  with  a history of coronary artery disease, status post
inferior  myocardial  infarction  in  [**2154**],  who awoke on the
morning  of  admission  with  the  sudden onset of difficulty
breathing.  She was found to be tachypneic, tachycardiac, and
hypotensive.  She presented to an outside hospital, where she
was noted to be in atrial fibrillation with heart rate in the
150s  and  blood  pressure  in  the  802.    EKG  revealed ST
elevation in leads V1 to V5.  Cardioversion was attempted and
failed.    Intubation was also unsuccessful.  The patient was
placed  on  Lasix, Cardizem, and started on heparin.  She was
transferred  to  [**Hospital1 35027**] for
management   of   her   cardiogenic   shock   and   potential
catheterization.    Upon arrival in the emergency department,
she was emergently intubated and she was found to be in rapid
atrial   fibrillation.      Amniofusion   was   started   and
cardioversion   was   attempted   again.     This  was  again
unsuccessful.    The  patient was transferred to the Coronary
Care Unit in critical condition.

PAST MEDICAL HISTORY:
1.   Coronary artery disease, status post inferior myocardial
infarction in [**2154**].
2.  Congestive heart failure.
3.  Hypertension.
4.  Gastroesophageal reflux disease.

MEDICATIONS ON ADMISSION:
1.  Atenolol 100 q.d.
2.  Lisinopril 2.5 q.d.
3.  Isordil 30 t.i.d.
4.  Lasix 20 q.d.
5.  Zantac 150 q.d.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient is a nonsmoker and nondrinker.

PHYSICAL  EXAMINATION:  Examination on admission revealed the
following:  The patient was afebrile with a blood pressure of
80/40.  The heart rate was 150.  The respiratory rate was 40.
The patient was intubated and in no distress.  HEAD AND NECK:
Examination  was  unremarkable.    The  JVP was not elevated.
CHEST:   Chest was clear to auscultation bilaterally.  HEART:
Heart  rate  was tachycardiac.  S1 and S2 were normal.  There
were   no  murmurs,  rubs,  or  gallops.    ABDOMEN:    Soft,
nontender,  nondistended.   There was no peripheral edema and
peripheral pulses were palpable.

LABORATORY  DATA:    Laboratory  results on admission:  White
count  was  13.6,  hematocrit  38.2,  platelet count 410,000.
Sodium  141, potassium 3.4, chloride 110, bicarbonate 19, BUN
24,  creatinine  1.3, glucose 330.  CK 77, CKMB 8.3, troponin
1.05, ALT 35, alkaline phosphatase 74.

Chest  x-ray  on  admission:   The endotracheal tube was well
situated.    There  were  no  effusions  seen.   There was no
pneumonia.

EKG:    On  admission, there was ST elevation in the anterior
leads,  V1,  and  V2.    There were T-wave inversions in AVL.
There was ST depression in V5 through V6.

HOSPITAL COURSE:

#1.    CARDIOVASCULAR:    The  patient  was  admitted  to the
coronary care unit.  While there she had a bowel movement and
spontaneously  reverted  to  normal  sinus  rhythm.   She was
maintained   on   Amiodarone.    The  blood  pressure  became
normotensive.    She  was  felt  not  to  be  a candidate for
catheterization  given the recent cardiogenic shock.  She was
treated   for  acute  myocardial  infarction  medically  with
aspirin,  beta  blocker,  ACE  inhibitor, statin, and heparin
drip.  She was maintained on Amiodarone while in the coronary
care  unit and remained in sinus rhythm.  She was transferred
to  the  floor on [**8-7**].  On the 21st, she was noted
to be in atrial fibrillation, once again, with a rate of 150.
She  was  transferred  back to the coronary care unit and she
was successfully cardioverted.  She returned to the floor and
remained in sinus rhythm on Amiodarone.

Echocardiogram   done   during  this  admission  revealed  an
ejection  fraction of 25% to 30%.  There was mild-to-moderate
aortic     regurgitation    and    mild-to-moderate    mitral
regurgitation.      There   was   moderate  pulmonary  artery
hypertension.

The patient remained chest pain free throughout the remainder
of her admission.

PULMONARY:    The  patient was extubated in the coronary care
unit   the   day  after  admission.    The  patient  remained
asymptomatic  from the pulmonary point of view throughout the
remainder of the admission.

GASTROINTESTINAL:    The  patient was noted to have a drop in
the  hematocrit  while in the hospital.  She was occult blood
positive.    The  patient  also developed abdominal pain.  GI
consultation   was  obtained.    Ultrasound  of  the  abdomen
revealed  a  dilated common bile duct and biliary tree.  MRCP
was  obtained,  which showed dilation of the common bile duct
to  1.2  cm.    There  was a cut off in the distal bile duct.
This was felt to be secondary to an impacted stone or sludge.
Given  the  patient's multiple other medical problems, it was
felt   that  ERCP  was  not  necessary  at  this  time.    GI
recommendations  were  to  wait  at  least  30 days until the
patient  was  off Plavix to perform ERCP.  The patient became
asymptomatic from her abdominal pain.  Therefore, an ERCP may
not be necessary.

GENITOURINARY:  The   patient  developed  UTI  while  in  the
hospital.    She  was  started on Levofloxacin.  This will be
continued on [**2160-8-18**].

DISCHARGE DIAGNOSES:
1.      Acute   ST   elevation,  myocardial  infarction  with
cardiogenic shock.
2.  Congestive heart failure.
3.  Hypertension.
4.  Atrial fibrillation.
5.  UTI.
6.  Gallstones.
7.  GI bleed.
8.  Gastroesophageal reflux disease.

DISCHARGE MEDICATIONS:
1.  Lopressor 150 PO b.i.d.
2.  Captopril 6.25 PO t.i.d.
3.  Lasix 40 PO b.i.d.
4.  Amiodarone 400 PO b.i.d.
5.  Protonix 40 PO b.i.d.
6.  Plavix 70 PO q.d.
7.  Levofloxacin 500 mg PO q.d. until [**8-18**].
8.  Aspirin 325 mg PO q.d.
9.  Atorvastatin 10 mg PO q.d.
10. Loperamide 2 mg PO q.i.d.p.r.n. diarrhea.












DISCHARGE  FOLLOW  UP:   The patient is being discharged to a
rehabilitation  facility.  Once discharged from that facility
she will follow up with her primary care physician.




                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 4786**]

Dictated By:[**Last Name (NamePattern4) 94152**]

MEDQUIST36

D:  [**2160-8-13**]
T:  [**2160-8-13**]  10:34
JOB#:  [**Job Number 94153**]


Name:  [**Known lastname 11778**], [**Known firstname 1463**]                      Unit No:  [**Numeric Identifier 14889**]

Admission Date:  [**2160-8-4**]     Discharge Date:  [**2160-8-15**]

Date of Birth:   [**2068-10-9**]     Sex:  F

Service:

This is an addendum to the discharge summary from the
admission beginning on [**2160-7-25**].

Discharge medications were as follows:  Lopressor 150 mg po
bid, Lasix 40 mg po bid, amiodarone 400 mg po q day until
[**8-29**], then amiodarone 200 mg po q day, Protonix 40 mg
po bid, Plavix 70 mg po q day, levofloxacin 500 mg po q day
until [**2160-8-18**], aspirin 325 mg po q day,
atorvastatin 10 mg po q day, loperamide 2 mg po qid prn for
diarrhea, potassium chloride 40 mEq po q day.




                  DR,[**Doctor Last Name **],[**Doctor Last Name **] 12-661



Dictated By:[**Last Name (NamePattern1) 1170**]

MEDQUIST36

D:  [**2160-8-15**]  10:07
T:  [**2160-8-18**]  08:12
JOB#:  [**Job Number **]


Name:  [**Known lastname 11778**], [**Known firstname 1463**]                      Unit No:  [**Numeric Identifier 14889**]

Admission Date:  [**2160-8-4**]     Discharge Date:  [**2160-8-15**]

Date of Birth:   [**2068-10-9**]     Sex:  F

Service:

This is an addendum to the discharge summary on [**2160-8-13**].

Please note that the medications have changed prior to
discharge.  Her medications at discharge are as follows:
Lopressor 150 mg po bid, Lasix 40 mg po bid, amiodarone 400
mg po bid, Protonix 40 mg po bid, Plavix 70 mg po q day,
levofloxacin 500 mg po q day until [**8-18**], aspirin
325 mg po q day, atorvastatin 10 mg po q day, loperamide 2 mg
po qid prn for diarrhea, potassium chloride 40 mEq po q day.

Please also note that the patient will follow up in the [**Hospital **]
Clinic.  She will also follow up in Dr.[**Name (NI) 8701**] clinic.






                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1095**]

Dictated By:[**Last Name (NamePattern1) 1170**]

MEDQUIST36

D:  [**2160-8-14**]  10:02
T:  [**2160-8-18**]  07:25
JOB#:  [**Job Number 14890**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Atrial fibrillation,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Blood in stool,Other specified disorders of biliary tract,Diarrhea,Precipitous drop in hematocrit'}


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 a [**Age over 90 **]-year-old
lady  with  a history of coronary artery disease, status post
inferior  myocardial  infarction  in  [**2154**],  who awoke on the
morning  of  admission  with  the  sudden onset of difficulty
breathing.  She was found to be tachypneic, tachycardiac, and
hypotensive.  She presented to an outside hospital, where she
was noted to be in atrial fibrillation with heart rate in the
150s  and  blood  pressure  in  the  802.    EKG  revealed ST
elevation in leads V1 to V5.  Cardioversion was attempted and
failed.    Intubation was also unsuccessful.  The patient was
placed  on  Lasix, Cardizem, and started on heparin.  She was
transferred  to  [**Hospital1 35027**] for
management   of   her   cardiogenic   shock   and   potential
catheterization.    Upon arrival in the emergency department,
she was emergently intubated and she was found to be in rapid
atrial   fibrillation.      Amniofusion   was   started   and
cardioversion   was   attempted   again.     This  was  again
unsuccessful.    The  patient was transferred to the Coronary
Care Unit in critical condition.

MEDICAL HISTORY: 1.   Coronary artery disease, status post inferior myocardial
infarction in [**2154**].
2.  Congestive heart failure.
3.  Hypertension.
4.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  Atenolol 100 q.d.
2.  Lisinopril 2.5 q.d.
3.  Isordil 30 t.i.d.
4.  Lasix 20 q.d.
5.  Zantac 150 q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a nonsmoker and nondrinker. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Atrial fibrillation,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Blood in stool,Other specified disorders of biliary tract,Diarrhea,Precipitous drop in hematocrit'}
