CHIEF COMPLAINT: Pulmonary edema and chest pain.

PRESENT ILLNESS: The patient is a 78 year old
female with known three vessel coronary artery disease,
status post myocardial infarction one week prior to current
admission with a CK of 700 and troponin of 20, now with acute
pulmonary and chest pain.

MEDICAL HISTORY: 1.  Atrial fibrillation.  2.
Congestive heart failure.  3.  Diabetes mellitus.  4.
Coronary artery disease, as described above.  5.  Peripheral
vascular disease.  6.  Hypercholesterolemia.

MEDICATION ON ADMISSION: Aspirin, lisinopril 2.5 mg
p.o.q.d., Toprol 50 mg p.o.b.i.d., multivitamins, insulin NPH
22/14, Aldactone 12.5 mg p.o.q.d., Plavix 75 mg p.o.q.d.,
niacin 100 mg p.o.q.d., Lasix 80 mg p.o.q.d.

ALLERGIES: Penicillin, terbutaline, atenolol and Procardia.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Cardiogenic shock,Coronary atherosclerosis of native coronary artery,Acute myocardial infarction of unspecified site, subsequent episode of care
CHF NOS,Parox ventric tachycard,Acute kidney failure NOS,Thrombocytopenia NOS,Cardiogenic shock,Crnry athrscl natve vssl,AMI NOS, subsequent
Name:  [**Known lastname 15272**], [**Known firstname 6758**]                     Unit No:  [**Numeric Identifier 15273**]

Admission Date:  [**2127-6-20**]     Discharge Date:

Date of Birth:   [**2049-11-14**]     Sex:  F

Service:

ADDENDUM:  The patient does not have an allergy to Atenolol.
Allergies, which are not confirmed, are to PENICILLIN,
AZITHROMYCIN, TETRACYCLINE, TERBUTALINE, NIFEDIPINE, AND
QUESTION EGG PROTEIN.

MEDICATIONS ON DISCHARGE:
1.  Imdur 60 mg PO q.d.
2.  Lisinopril 5 mg PO q.d.
3.  Lasix 80 mg PO q..d
4.  Atenolol 75 mg PO q.d.
5.  Plavix 75 mg PO q.d.
6.  Aspirin 325 mg PO q.d.
7.  Insulin 22 units q.a.m.; 14 units q.p.m.
8.  Tylenol p.r.n..
9.  Niacin 100 mg PO q.d.
10. Multivitamin one tablet PO q.d.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease.
2.  Diabetes mellitus.
3.  Hypertension.
4.  Congestive heart failure.

CONDITION ON DISCHARGE:  Good.  The patient will be
transferred to a rehabilitation facility for a short while to
improve her mobility.



                                       [**Last Name (LF) **],[**Name8 (MD) **] M.D.12-269


Dictated By:[**Doctor Last Name 8051**]

MEDQUIST36

D:  [**2127-6-27**]  09:49
T:  [**2127-6-27**]  10:00
JOB#:  [**Job Number 15274**]


Admission Date:  [**2127-6-20**]       Discharge Date:  [**2127-6-27**]


Service:  C-Medicine

CHIEF COMPLAINT:
Pulmonary edema and chest pain.

HISTORY OF PRESENT ILLNESS:  The patient is a 78 year old
female with known three vessel coronary artery disease,
status post myocardial infarction one week prior to current
admission with a CK of 700 and troponin of 20, now with acute
pulmonary and chest pain.

Per emergency medical technician notes, the patient was
intubated in the field, rhythm, PEA was given, epinephrine in
the field, converted to a wide complex tachycardia; was given
Lidocaine and converted to sinus rhythm at 74.  She was given
Lasix in the Emergency Room with a systolic blood pressure of
60 and was given one liter of intravenous fluids then stopped
and switched to Dopamine and Levophed.

Cardiac catheterization showed three vessel disease, as
before, with a proximal left anterior descending artery
lesion which was worse, with an 85% occlusion.  Left
circumflex was also occluded.  Left main was the same.  No
intervention was performed and cardiothoracic surgery
declined, and the patient developed cardiac arrest during the
procedure.  Successfully resuscitated with initiation of
temporary pacing wires, intra-aortic balloon pump and BPR.

Of note, during the catheterization on [**2127-6-13**], the
proximal left anterior descending artery lesion was attempted
at brachytherapy and the left circumflex had a dissection of
the obtuse marginal one branch.

PAST MEDICAL HISTORY:  1.  Atrial fibrillation.  2.
Congestive heart failure.  3.  Diabetes mellitus.  4.
Coronary artery disease, as described above.  5.  Peripheral
vascular disease.  6.  Hypercholesterolemia.

ALLERGIES:  Penicillin, terbutaline, atenolol and Procardia.

MEDICATIONS ON ADMISSION:  Aspirin, lisinopril 2.5 mg
p.o.q.d., Toprol 50 mg p.o.b.i.d., multivitamins, insulin NPH
22/14, Aldactone 12.5 mg p.o.q.d., Plavix 75 mg p.o.q.d.,
niacin 100 mg p.o.q.d., Lasix 80 mg p.o.q.d.

PHYSICAL EXAMINATION:  On physical examination on admission,
the patient had a temperature of 100, pulse 87 and blood
pressure 125/42.  General:  Intubated and sedated.  Head,
eyes, ears, nose and throat:  Pupils equal, round, and
reactive to light and accommodation.  Neck:  No jugular
venous distention.  Cardiovascular:  Regular rate and rhythm,
normal S1 and S2, systolic murmur.  Lungs:  Coarse bibasilar
crackles.  Abdomen:  Obese, nontender, nondistended, positive
bowel sounds.  Extremities:  Status post toe amputation, no
edema.  Neurologic:  Grossly intact.

LABORATORY DATA:  Admission white blood cell count was 26.7,
hematocrit 34.7, platelet count 208,000, lactate 5.3, sodium
130, potassium 3.6, chloride 97, bicarbonate 17, BUN 33,
creatinine 1.6, glucose 317.  Arterial blood gases:  pH 7.49,
pCO2 25, pO2 247.  CK was 3,684.  Toxicology screen was
negative.  LDL was 125, HDL 43.  Chest x-ray showed increased
pulmonary congestion.

HOSPITAL COURSE:  The patient is a 78 year old female with
severe three vessel coronary artery disease, status post PEA
arrest and cardiac catheterization showing diffuse three
vessel disease.  Cardiothoracic surgery felt the lesions to
be inoperable secondary to high perioperative risk performing
a coronary artery bypass grafting during the peri-myocardial
infarction period.

The patient was admitted to the Coronary Care Unit for
evaluation and treatment of her coronary artery disease.  On
[**2127-6-21**], the patient was extubated.  She initially
required a Dopamine drip to maintain her blood pressure, but
also was weaned off the drips on [**2127-6-21**].

On [**2127-6-22**], the patient was found to be short of
breath and tachypneic.  She was diuresed with Lasix and was
put on two liters of oxygen.  She was also started on BIPAP
which was discontinued after the diuresis.

On [**2127-6-23**], the patient's platelet count was noted to
be 60,000.  Heparin drip was stopped.  She needed
anticoagulation for her intra-aortic balloon pump.  She was
started on bivalirudin and taken to the catheterization
laboratory, where the left anterior descending artery was
angioplastied to 20% to 30% residual and the obtuse marginal
was angioplastied to 30% residual.

The patient was transferred two units of packed red blood
cells for her pre-catheterization hematocrit of 27.  She
tolerated the catheterization well, without complications.
On [**2127-6-24**], the intra-aortic balloon pump was
discontinued.  She was started on her outpatient medications
including lisinopril 2.5 mg daily and Lopressor 50 mg twice a
day as well as Isordil 10 mg three times a day for
symptomatic relief.

1.  Cardiovascular:  The patient's congestive heart failure
was likely secondary to ischemia.  The lesions in her left
anterior descending artery and circumflex were angioplastied;
however, it is unclear if these were the culprit lesions
causing her new onset pulmonary edema.  At the time of
discharge, the patient is chest pain free and improving her
oxygen saturation and symptomatic dyspnea.  She is on a
congestive heart failure of lisinopril 5 mg daily, Imdur 60
mg daily, Lopressor 50 mg twice a day and aspirin, and no
longer is requiring any pressor support.  Of note, her
echocardiogram showed a left ventricular ejection fraction of
20% to 25%, which may represent her new baseline after this
ischemic event on [**2127-6-13**].  The patient also has a
history of atrial fibrillation, however, is now in normal
sinus rhythm.

2.  Thrombocytopenia:  During hospital stay; was likely
heparin induced.  Heparin antibody was sent and is still
pending.  A DIC panel was sent, however, was equivocal and
does not suggest DIC was the primary etiology of her
thrombocytopenia.

3.  Renal:  Acute renal failure with a maximum creatinine to
2.1 was likely secondary to hypotension resulting in prerenal
failure due to decreased perfusion to the kidneys secondary
to the patient's bradycardia, PEA arrest.  Also, the patient
is being aggressively diuresed and this could also increase
her BUN and creatinine.  However, given the fact that her
congestive heart failure is fairly significant, will need to
continue on her diuretics in order to maintain her oxygen
saturation and to have symptomatic relief from her congestive
heart failure.



                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4450**], M.D.  [**MD Number(1) 5226**]

Dictated By:[**Name8 (MD) 4630**]
MEDQUIST36

D:  [**2127-6-26**]  14:30
T:  [**2127-6-26**]  15:06
JOB#:  [**Job Number **]
{'Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Cardiogenic shock,Coronary atherosclerosis of native coronary artery,Acute myocardial infarction of unspecified site, subsequent episode of care'}


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: Pulmonary edema and chest pain.

PRESENT ILLNESS: The patient is a 78 year old
female with known three vessel coronary artery disease,
status post myocardial infarction one week prior to current
admission with a CK of 700 and troponin of 20, now with acute
pulmonary and chest pain.

MEDICAL HISTORY: 1.  Atrial fibrillation.  2.
Congestive heart failure.  3.  Diabetes mellitus.  4.
Coronary artery disease, as described above.  5.  Peripheral
vascular disease.  6.  Hypercholesterolemia.

MEDICATION ON ADMISSION: Aspirin, lisinopril 2.5 mg
p.o.q.d., Toprol 50 mg p.o.b.i.d., multivitamins, insulin NPH
22/14, Aldactone 12.5 mg p.o.q.d., Plavix 75 mg p.o.q.d.,
niacin 100 mg p.o.q.d., Lasix 80 mg p.o.q.d.

ALLERGIES: Penicillin, terbutaline, atenolol and Procardia.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Congestive heart failure, unspecified,Paroxysmal ventricular tachycardia,Acute kidney failure, unspecified,Thrombocytopenia, unspecified,Cardiogenic shock,Coronary atherosclerosis of native coronary artery,Acute myocardial infarction of unspecified site, subsequent episode of care'}
