CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Patient is a [**Age over 90 **] yo Russian speaking woman with hx of AS, CAD (hx
of + stress test, but declined cath because she is DNR/DNI and
wants no invasive interventions), and a recent hospitalization
in [**8-/2139**] for chest pain (ruled out for MI) and CHF who now
presents with several days of worsening LE edema and increased
weight. She had called [**Company 191**] several days ago and had been
adjusting her lasix dose accordingly to 80mg PO Lasix.
.
Over the past few years she has been followed for chest pain,
worse with exertion, somewhat releived with nitroglycerin. Per
patient's family, she has had a positive stress test before;
however, declined cardiac catheterization at that time.
.
In the ED, she was initially in respiratory distress and found
with ST depressions in the lateral leads and new rapid afib.
Troponin 0.24, confirming NSTEMI. She then spontaneously
converted to NSR, rate 80's, at 1PM with some improvement in ST
seg depressions. She was noted to be in heart failure and
received 40 mg IV Lasix X2 with total urine output 500 cc.
.

MEDICAL HISTORY: - Aortic stenosis: TTE [**2136**] showed mild AS with [**Location (un) 109**] 1.1 cm2,
preserved EF
-HTN
-?CAD: Partially reversible inferior wall defect [**12/2132**] MIBI;pt
declining cath or other interventions
-Hyperlipidemia
-osteoarthritis
-CKD (baseline 2.1-2.4)

MEDICATION ON ADMISSION: ASPIRIN E.C. 325 MG--Take one by mouth every day
ATENOLOL 50 MG--Take one by mouth every day
ATORVASTATIN CALCIUM 20 MG--Take one by mouth every day
COLACE 100 MG--Take three by mouth every day
DILTIAZEM XT 120 MG--Take one tablet each day
FUROSEMIDE 80 MG--1 by mouth daily (***note, recently increased
due to increased weight and edema)
LORAZEPAM 1 MG--Take one tablet by mouth at bedtime as needed
for insomnia/anxiety
NITROGLYCERIN 300 MCG (1/200 GR)--As directed
OS-CAL 500+D 500-125--One by mouth three times a day
QUININE SULFATE 260 MG--One by mouth at bedtime as needed for
leg cramps
ULTRAM 50 MG--One by mouth four times a day as needed for pain

ALLERGIES: Naprosyn

PHYSICAL EXAM: VS: ED - BP high 90/70s, HR 80s, O2 sat 99% NRB
Gen: Elderly woman appearing fearful, anxious, struggling to
breathe, moderate distress
HEENT: Engorged EJ, elevated JVP 5-6 cm above sternal angle at
70 degrees, OP moist
Lungs: bilateral basilar crackles, no wheeze, no rhonchi
Heart: irregularly irregular, [**4-6**] SM across precordium.
Abd: distended, prominent abdomen-chest paradoxic movement
Extrem: warm, indurated, 2+ pitting edema to mid shins
bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: SH: lives by herself in elder housing, has visiting RN and son
now visits [**Name (NI) 6089**].
True posterior wall infarction, initial episode of care,Atrial fibrillation,Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Cardiogenic shock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Volume depletion, unspecified,Candidiasis of mouth,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia
True post infarct, init,Atrial fibrillation,Mitral insuf/aort stenos,Rheumatic heart failure,Cardiogenic shock,Hyp kid NOS w cr kid V,Acute kidney failure NOS,Pneumonia, organism NOS,Volume depletion NOS,Thrush,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS
Admission Date:  [**2139-10-13**]              Discharge Date:   [**2139-10-19**]


Service: MEDICINE

Allergies:
Naprosyn

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
NA

History of Present Illness:
Patient is a [**Age over 90 **] yo Russian speaking woman with hx of AS, CAD (hx
of + stress test, but declined cath because she is DNR/DNI and
wants no invasive interventions), and a recent hospitalization
in [**8-/2139**] for chest pain (ruled out for MI) and CHF who now
presents with several days of worsening LE edema and increased
weight. She had called [**Company 191**] several days ago and had been
adjusting her lasix dose accordingly to 80mg PO Lasix.
.
Over the past few years she has been followed for chest pain,
worse with exertion, somewhat releived with nitroglycerin. Per
patient's family, she has had a positive stress test before;
however, declined cardiac catheterization at that time.
.
In the ED, she was initially in respiratory distress and found
with ST depressions in the lateral leads and new rapid afib.
Troponin 0.24, confirming NSTEMI. She then spontaneously
converted to NSR, rate 80's, at 1PM with some improvement in ST
seg depressions. She was noted to be in heart failure and
received 40 mg IV Lasix X2 with total urine output 500 cc.
.

.

Of note, patient and her son understood the risks, but decided
against further work-up (no CTA) and no invasive procedures.
This was discussed with Patient and son via [**Name2 (NI) 59928**]. Also,
in the ED, it was confirmed with [**Name2 (NI) 59928**] that she is
DNR/DNI, but is unsure about DCCV or BIPAP sicne does not know
much about them.

Past Medical History:
- Aortic stenosis: TTE [**2136**] showed mild AS with [**Location (un) 109**] 1.1 cm2,
preserved EF
-HTN
-?CAD: Partially reversible inferior wall defect [**12/2132**] MIBI;pt
declining cath or other interventions
-Hyperlipidemia
-osteoarthritis
-CKD (baseline 2.1-2.4)


Social History:
SH: lives by herself in elder housing, has visiting RN and son
now visits [**Name (NI) 6089**].


Family History:
NC

Physical Exam:
VS: ED - BP high 90/70s, HR 80s, O2 sat 99% NRB
Gen: Elderly woman appearing fearful, anxious, struggling to
breathe, moderate distress
HEENT: Engorged EJ, elevated JVP 5-6 cm above sternal angle at
70 degrees, OP moist
Lungs: bilateral basilar crackles, no wheeze, no rhonchi
Heart: irregularly irregular, [**4-6**] SM across precordium.
Abd: distended, prominent abdomen-chest paradoxic movement
Extrem: warm, indurated, 2+ pitting edema to mid shins
bilaterally


Pertinent Results:
.
.
.
.
.
.
.
.
.
[**2139-10-13**] CXR: IMPRESSION: CHF with bilateral moderate-sized
pleural effusions
.
[**8-6**] Conclusions:
1.The left atrium is normal in size.
2. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%). Intrinsic LV function
may be depressed given the severity of the MR.
3 .Right ventricular chamber size is normal. Right ventricular
systolic
function is normal.
4.The aortic valve leaflets (3) are mildly thickened. There is
moderate aortic valve stenosis. No aortic regurgitation is seen.

5.The mitral valve leaflets are moderately thickened. Moderate
to severe (3+) mitral regurgitation is seen. 6.Moderate [2+]
tricuspid regurgitation is seen. There is moderate pulmonary
artery systolic hypertension.
7.There is no pericardial effusion.
.
12/99 Persantine MIBI:
IMPRESSION:  Partially reversible inferior wall defect with
inferior wall
hypokinesis. Stress: 1. Non-diagnostic persantine. 2. Chest pain
in late recovery period following the infusion.


Brief Hospital Course:
[**Age over 90 **] y/o Russian speaking Female, admitted for medical management
of STEMI, CHF exacerbation (EF =25%, 4+MR) and Acute on chronic
renal failure.   The patient and her family declined
intervention (ie, cath) and were very clear that the patient was
DNR/DNI.  The patient was treated medically with heparin,
plavix, aspirin and a statin.  She also had oliguric ARF upon
admission.  She was started on a dopamine drip to maintain her
blood pressure, natrecor was added which did improve urine
output, however, her Cr remained elevated. On [**10-20**] the patient
was noted to be in distress; an EKG was performed revealing
worsening of ST elevations anteriorly likely representing
further infarct or a new MI.  She became hypotensive and her
respiratory status declined; she refused oxygen.  Her family
decided to focus her care on comfort at this point and she was
started on a morphine drip.  She passed away later in the
morning with her family at her bedside.

Medications on Admission:
ASPIRIN E.C. 325 MG--Take one by mouth every day
ATENOLOL 50 MG--Take one by mouth every day
ATORVASTATIN CALCIUM 20 MG--Take one by mouth every day
COLACE 100 MG--Take three by mouth every day
DILTIAZEM XT 120 MG--Take one tablet each day
FUROSEMIDE 80 MG--1 by mouth daily (***note, recently increased
due to increased weight and edema)
LORAZEPAM 1 MG--Take one tablet by mouth at bedtime as needed
for insomnia/anxiety
NITROGLYCERIN 300 MCG (1/200 GR)--As directed
OS-CAL 500+D 500-125--One by mouth three times a day
QUININE SULFATE 260 MG--One by mouth at bedtime as needed for
leg cramps
ULTRAM 50 MG--One by mouth four times a day as needed for pain


Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
NA

Discharge Condition:
Deceased

Discharge Instructions:
NA

Followup Instructions:
NA
{'True posterior wall infarction, initial episode of care,Atrial fibrillation,Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Cardiogenic shock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Volume depletion, unspecified,Candidiasis of mouth,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia'}


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: chest pain

PRESENT ILLNESS: Patient is a [**Age over 90 **] yo Russian speaking woman with hx of AS, CAD (hx
of + stress test, but declined cath because she is DNR/DNI and
wants no invasive interventions), and a recent hospitalization
in [**8-/2139**] for chest pain (ruled out for MI) and CHF who now
presents with several days of worsening LE edema and increased
weight. She had called [**Company 191**] several days ago and had been
adjusting her lasix dose accordingly to 80mg PO Lasix.
.
Over the past few years she has been followed for chest pain,
worse with exertion, somewhat releived with nitroglycerin. Per
patient's family, she has had a positive stress test before;
however, declined cardiac catheterization at that time.
.
In the ED, she was initially in respiratory distress and found
with ST depressions in the lateral leads and new rapid afib.
Troponin 0.24, confirming NSTEMI. She then spontaneously
converted to NSR, rate 80's, at 1PM with some improvement in ST
seg depressions. She was noted to be in heart failure and
received 40 mg IV Lasix X2 with total urine output 500 cc.
.

MEDICAL HISTORY: - Aortic stenosis: TTE [**2136**] showed mild AS with [**Location (un) 109**] 1.1 cm2,
preserved EF
-HTN
-?CAD: Partially reversible inferior wall defect [**12/2132**] MIBI;pt
declining cath or other interventions
-Hyperlipidemia
-osteoarthritis
-CKD (baseline 2.1-2.4)

MEDICATION ON ADMISSION: ASPIRIN E.C. 325 MG--Take one by mouth every day
ATENOLOL 50 MG--Take one by mouth every day
ATORVASTATIN CALCIUM 20 MG--Take one by mouth every day
COLACE 100 MG--Take three by mouth every day
DILTIAZEM XT 120 MG--Take one tablet each day
FUROSEMIDE 80 MG--1 by mouth daily (***note, recently increased
due to increased weight and edema)
LORAZEPAM 1 MG--Take one tablet by mouth at bedtime as needed
for insomnia/anxiety
NITROGLYCERIN 300 MCG (1/200 GR)--As directed
OS-CAL 500+D 500-125--One by mouth three times a day
QUININE SULFATE 260 MG--One by mouth at bedtime as needed for
leg cramps
ULTRAM 50 MG--One by mouth four times a day as needed for pain

ALLERGIES: Naprosyn

PHYSICAL EXAM: VS: ED - BP high 90/70s, HR 80s, O2 sat 99% NRB
Gen: Elderly woman appearing fearful, anxious, struggling to
breathe, moderate distress
HEENT: Engorged EJ, elevated JVP 5-6 cm above sternal angle at
70 degrees, OP moist
Lungs: bilateral basilar crackles, no wheeze, no rhonchi
Heart: irregularly irregular, [**4-6**] SM across precordium.
Abd: distended, prominent abdomen-chest paradoxic movement
Extrem: warm, indurated, 2+ pitting edema to mid shins
bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: SH: lives by herself in elder housing, has visiting RN and son
now visits [**Name (NI) 6089**]. 

### Response:
{'True posterior wall infarction, initial episode of care,Atrial fibrillation,Mitral valve insufficiency and aortic valve stenosis,Rheumatic heart failure (congestive),Cardiogenic shock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Volume depletion, unspecified,Candidiasis of mouth,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia'}
