CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 76-year-old female
with a cardiac history notable for hypertension and
hyperlipidemia with chronic intermittent atrial fibrillation
who was admitted to [**Hospital1 69**]
earlier days four days status post non-ST-elevation
myocardial infarction with a peak creatine kinase of 600 and
a MB of 39 at the [**Hospital 1474**] Hospital.  She had no prior
coronary artery disease history.

MEDICAL HISTORY: 1.  Hypertension.
2.  Hyperlipidemia.
3.  Low back pain/spinal stenosis.
4.  Chronic intermittent atrial fibrillation.
5.  Osteoarthritis.

MEDICATION ON ADMISSION: (Home medications included)
1.  Coumadin.
2.  Atenolol 50 mg p.o. q.d.
3.  Digoxin 0.125 mg p.o. q.d.
4.  Lipitor 10 mg p.o. q.d.
5.  Xanax p.r.n.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's father had coronary artery
disease in his 70s; otherwise, unremarkable.

SOCIAL HISTORY: The patient is a 1-pack per day smoker times
50 years.  She lives alone and does her own activities of
daily living.  She has the support of her brother and his
wife in terms of activities of daily living.
Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac complications, not elsewhere classified,Cardiac arrest,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Accidental cut, puncture, perforation or hemorrhage during surgical operation
AMI NOS, initial,Crnry athrscl natve vssl,Accidental op laceration,Surg compl-heart,Cardiac arrest,Hyperlipidemia NEC/NOS,Hypertension NOS,Acc cut/hem in surgery
Admission Date:  [**2169-5-15**]     Discharge Date:  [**2169-5-15**]

Date of Birth:   [**2092-8-10**]     Sex:  F

Service:  CCU

ADMISSION REASON:  Observation, status post perforated ramus.

HISTORY OF PRESENT ILLNESS:  This is a 76-year-old female
with a cardiac history notable for hypertension and
hyperlipidemia with chronic intermittent atrial fibrillation
who was admitted to [**Hospital1 69**]
earlier days four days status post non-ST-elevation
myocardial infarction with a peak creatine kinase of 600 and
a MB of 39 at the [**Hospital 1474**] Hospital.  She had no prior
coronary artery disease history.

The patient was admitted to [**Hospital 1474**] Hospital on [**2169-5-11**] with new onset of severe chest pain associated with
shortness of breath and nausea that resolved with morphine
and nitroglycerin.  She had been treated for fatigue and
cough in those two days associated with bronchitis.  There
was no prior history of dyspnea, or lower extremity edema,
paroxysmal nocturnal dyspnea, orthopnea, palpitations, or
dizziness.

At [**Hospital 1474**] Hospital, she remained chest pain free and was
started on nitrates, low-molecular heparin, and Aggrastat.
Her intervention was delayed due to a INR of 3.6 that was
eventually treated with vitamin K.  An echocardiogram
obtained at [**Hospital 1474**] Hospital on [**2169-5-12**], showed an
ejection fraction of 60% with no regional wall motion
abnormalities, mild mitral regurgitation, a normal right
ventricle, and normal left atrium and normal right atrium
dimensions.  The electrocardiogram at the time of admission
to [**Hospital 1474**] Hospital showed normal sinus rhythm at a rate of
65, with an axis of 90 degrees, QRS with 120 msec, prominent
persist R waves throughout the precordium,  Q-R in V1, and a
QRS in V6, T wave inversions in II, III, and F were noted as
in V1 through V4, 1-mm ST depressions were present in I, V5,
and V6.  No prior electrocardiograms were available for
comparison.

On [**2169-5-15**], the patient was transferred to [**Hospital1 346**] for semi-elective cardiac
catheterization in the post non-ST-elevation myocardial
infarction period.  The results were as follows:  The
patient's right atrial pressure was 3, pulmonary artery of
26/10, wedge of 9, cardiac index of 2.2, pulmonary artery
saturation of 61.

A left ventriculography showed a ejection fraction of 70%.
No mitral regurgitation and normal wall motion.  The left
main was normal.  The left anterior descending artery had a
50% ostial.  The ramus had a diffuse 80% proximal that was
stented with 2-mm X 13-mm pixel.  This was complicated by a
distal wire perforation.  No dissection, and brisk flow was
noted through the stent.  First obtuse marginal had a 90%
lesion and was very small.  The second obtuse marginal had a
70% focal stenosis; this received percutaneous transluminal
coronary angioplasty which was complicated by mild
dissection.  Then a 2.5-mm X 9-mm S60 stent was deployed.
This was complicated by proximal spasm leading to a 2.25-mm X
8-mm pixel stent being deployed proximal to the original
stent with 20% residual stenoses in the stent, a 10% residual
stenosis in the 3-mm region between the stent.  The right
coronary artery had diffuse 40% proximal disease.

A bedside echocardiogram in the catheterization laboratory,
after the distal wire perforation of the ramus, showed no
free-flowing effusion, right atrial or right ventricular
compression.  Integrilin and heparin were discontinued in the
laboratory, and the patient was admitted to the Coronary Care
Unit with pleuritic substernal chest pain status post
catheterization with no electrocardiogram changes when
compared to prior catheterization.  Her post catheterization
electrocardiogram showed the following:  She was in normal
sinus rhythm at a rate of 66.  Axis of 91, QRS was 114, ST
depressions and T wave inversions in II, III, F, V1 through
V6, and a 1-mm to 2-mm ST elevations in I and L.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Hyperlipidemia.
3.  Low back pain/spinal stenosis.
4.  Chronic intermittent atrial fibrillation.
5.  Osteoarthritis.

MEDICATIONS ON ADMISSION:  (Home medications included)
1.  Coumadin.
2.  Atenolol 50 mg p.o. q.d.
3.  Digoxin 0.125 mg p.o. q.d.
4.  Lipitor 10 mg p.o. q.d.
5.  Xanax p.r.n.

MEDICATIONS ON TRANSFER:  (Medications on transfer from
[**Hospital 1474**] Hospital included)
1.  Nitroglycerin paste.
2.  Lipitor 10 mg p.o. q.d.
3.  Digoxin 0.25 mg p.o. q.d.
4.  Atenolol 50 mg p.o. q.d.
5.  Lovenox 60 mg subcutaneous b.i.d. (held on the a.m. of
transfer).
6.  Lasix 20 mg p.o. q.d.
7.  Aspirin 325 mg p.o. q.d.

SOCIAL HISTORY:  The patient is a 1-pack per day smoker times
50 years.  She lives alone and does her own activities of
daily living.  She has the support of her brother and his
wife in terms of activities of daily living.

FAMILY HISTORY:  The patient's father had coronary artery
disease in his 70s; otherwise, unremarkable.

PHYSICAL EXAMINATION ON PRESENTATION:   Admission physical
examination revealed vital signs with a temperature of 93.9
(axillary), pulse of 60 in normal sinus rhythm with
occasional premature ventricular contractions, blood pressure
of 115/74, respiratory rate of 18, oxygen saturation of 99%
on 4 liters nasal cannula oxygen.  Head, eyes, ears, nose,
and throat showed pupils were equal, round, and reactive to
light.  Extraocular movements were intact.  Sclerae were
anicteric.  The oropharynx was clear.  Neck was supple.
Jugular venous distention was less than 8 cm.  Chest was
clear to auscultation on anterior examination.
Cardiovascular examination was nondisplaced, normal size
point of maximal impulse, a regular rhythm with normal rate.
No third heart sound and no fourth heart sound.  No murmurs.
Pulsus was between 5 mm and 10 mm.  The abdomen was soft,
nontender, and nondistended, normal active bowel sounds.  No
hepatosplenomegaly.  Groin revealed arteriovenous sheath was
in place on the right, dressing was clean, dry, and intact.
No palpable hematoma, 2+ pulses.  Neurologically, alert and
oriented times three.  Appropriate attention.  Cranial nerves
II through XII were intact.  Strength was [**5-28**] in all four
extremities on limited testing.

HOSPITAL COURSE:   The patient was admitted to the Coronary
Care Unit for observation status post perforation of the
ramus.

Over the next several hours, the patient remained
hemodynamically stable and maintained a rhythm that was
mostly sinus, though she did have periods of accelerated
idioventricular rhythm and junctional escape which
necessitated at least placement of a transcutaneous pacing
pads.

At roughly 8 p.m. (four hours after being admitted to the
Coronary Care Unit), the patient rapidly became hypotensive
with a mean arterial pressure in the 40s and a preserved
sinus rhythm.  The patient was ramped up to high doses of
dopamine without good response and then transcutaneous pacing
was initiated with a subsequent response in the mean arterial
pressure to the 60s.

A bedside echocardiogram was performed which was remarkable
for a large effusion.  Right ventricular and right atrial
collapse could not be observed.  The patient was also noted
to have a pulseless paradoxus on her atrial blood pressure
tracing.  The patient soon began decompensating on maximum
doses on pressors, and so an emergent bedside
pericardiocentesis was performed; roughly 500 cc of
nonclotting dark blood was extracted from the pericardial
space with subsequent restoration of blood pressure.

However, over the next 10 minutes to 15 minutes, the patient
again dropped her blood pressure and another EMD code
occurred.  The patient was then found to be expressing clots
along with fresh blood from her pericardial drain.

Cardiac Surgery was involved at this point, and the patient
was emergently taken to the operating room for repair of a
presumed arterial laceration leading to cardiac tamponade.
The patient was coded on her way down to the operating room
and was coded throughout much of the case.

At 11:32, the patient was declared dead after roughly one
hour of coding of fibrillating myocardia.  After roughly a
half hour of coding of fibrillating myocardia an
intramyocardial was observed on the posterior wall.

The patient was pronounced dead at 11:32.  The patient's
family members were [**Name (NI) 653**], and the decision for a
postmortem examination was pending at the time of this
dictation.






                         DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-661

Dictated By:[**Name8 (MD) 2653**]

MEDQUIST36

D:  [**2169-5-16**]  00:29
T:  [**2169-5-16**]  12:38
JOB#:  [**Job Number 40301**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac complications, not elsewhere classified,Cardiac arrest,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Accidental cut, puncture, perforation or hemorrhage during surgical operation'}


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: This is a 76-year-old female
with a cardiac history notable for hypertension and
hyperlipidemia with chronic intermittent atrial fibrillation
who was admitted to [**Hospital1 69**]
earlier days four days status post non-ST-elevation
myocardial infarction with a peak creatine kinase of 600 and
a MB of 39 at the [**Hospital 1474**] Hospital.  She had no prior
coronary artery disease history.

MEDICAL HISTORY: 1.  Hypertension.
2.  Hyperlipidemia.
3.  Low back pain/spinal stenosis.
4.  Chronic intermittent atrial fibrillation.
5.  Osteoarthritis.

MEDICATION ON ADMISSION: (Home medications included)
1.  Coumadin.
2.  Atenolol 50 mg p.o. q.d.
3.  Digoxin 0.125 mg p.o. q.d.
4.  Lipitor 10 mg p.o. q.d.
5.  Xanax p.r.n.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's father had coronary artery
disease in his 70s; otherwise, unremarkable.

SOCIAL HISTORY: The patient is a 1-pack per day smoker times
50 years.  She lives alone and does her own activities of
daily living.  She has the support of her brother and his
wife in terms of activities of daily living. 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac complications, not elsewhere classified,Cardiac arrest,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Accidental cut, puncture, perforation or hemorrhage during surgical operation'}
