CHIEF COMPLAINT: inferior STEMI

PRESENT ILLNESS: [**Age over 90 **]F with PMH of hypertension and aortic stenosis presents to OSH
with severe epigastric pain, found by EKG to have inferior
[**Hospital **] transferred to [**Hospital1 18**] for cath lab. Patient was last seen
well by family yesterday morning and was at baseline. Family
became concerned when they did not hear from her later in the
day and went to check on her at 6:30pm and found her doubled
over in severe abdominal pain and with altered mental status.
She had not picked up her morning paper, so acute event likely
occurred in AM.
.
At OSH, she was found by EKG to have an inferior STEMI. Labs
showed WBC 15.9, Hct 40.9, Platelets 309. INR 1.8, BUN 28, Cr
2.3, Sodium 140, K 4.4, Cl 98. CK 516, troponin 1.58. She was
transferred to [**Hospital1 18**] for further management of STEMI and cath
lab.
.
At [**Hospital1 18**] ED, she was initially hemodynamically stable on
arrival. On her way to radiology, sbp dropped to 50s and she was
started on dopamine, after which her sbp came up to 100s-130s. A
head CT was also obtained due to AMS, and was negative for acute
intracranial abnormalities. She was transferred to the cardiac
cath lab.
.
In the cath lab, patient was found to have elevated RA pressure
20/24/21, PCWB 16/15/16, LV 186/20, aortic valve gradient 30
(consistent with severe AS), O2 sats - no evidence of shunts, [**MD Number(3) 91869**] venous sat - 70, IVC sat lower than SVC 60 vs 81 (possibly
indicates an inflammatory process in lower torso). LV gram
showed hyperdynamic LV. Systemic vascular resistance is elevated
at 1149. Coronary perfusion shows LMCA ostial 90% lesion,
proximal LAD 70% stenosis. The RCA is proximally totally
occluded, however, this was not thought to be acute because LV
EF was good and LV wall motion was hyperdynamic. Curiously,
however, no collateral vessels were seen, which would be
expected if RCA lesion was thought to be chronic. The patient
was judged to not necessarily benefit from stenting, so an
intra-aortic balloon pump was put in for supportive measures.
.
Patient is intubated and unable to complete a review of systems,
but per family, she does not have hx of prior stroke, TIA, deep
venous thrombosis, pulmonary embolism, bleeding at the time of
surgery, myalgias, joint pains, cough, hemoptysis, black stools
or red stools. She has had no recent fevers, chills or rigors.
She denies exertional buttock or calf pain. All of the other
review of systems were negative.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY: moderate aortic stenosis
3. OTHER PAST MEDICAL HISTORY:
- anxiety
- s/p carotid endarterectomy
- divertulitis
- s/p hysterectomy

MEDICATION ON ADMISSION: diltiazem
lisinopril
buspirone
simvastatin (recently stopped)
aspirin (recently stopped)

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
VS: T= [**Age over 90 **]F (rectal) BP=126/91 HR=92 RR=14 O2 sat= 95% (CMV
ventilation with TV 450, RR 14, FiO2 50%, PEEP 5)
GENERAL: intubated, sedated, no acute distress
HEENT: NCAT. Sclera anicteric. PERRL 3mm to 2mm.
CARDIAC: bradycardic, somewhat irregular, normal S1, S2.
systolic murmur best heard at LUSB radiating to left carotid>
right carotid.
LUNGS: No chest wall deformities, scoliosis or kyphosis. CTAB,
no crackles, wheezes or rhonchi.
ABDOMEN: hypoactive bowel sounds, soft, nondistended. No HSM or
tenderness.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: multiple sebhorreic [**Last Name (LF) 91870**], [**First Name3 (LF) **] stasis dermatitis,
ulcers, scars, or xanthomas.

FAMILY HISTORY: Son with CAD. Brother has valve replacement and pacemaker.

SOCIAL HISTORY: Lives alone, independent and walks with cane, has dementia and
is sometimes confused.
Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure, unspecified,Cardiogenic shock,Acidosis,Delirium due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Other specified cardiac dysrhythmias,Other persistent mental disorders due to conditions classified elsewhere,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia
AMI inferior wall, init,Acute kidney failure NOS,Cardiogenic shock,Acidosis,Delirium d/t other cond,Crnry athrscl natve vssl,Aortic valve disorder,Cardiac dysrhythmias NEC,Mental disor NEC oth dis,Old myocardial infarct,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2201-1-14**]              Discharge Date:   [**2201-1-14**]


Service: MEDICINE

Allergies:
No Allergies/ADRs on File

Attending:[**First Name3 (LF) 1436**]
Chief Complaint:
inferior STEMI

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
[**Age over 90 **]F with PMH of hypertension and aortic stenosis presents to OSH
with severe epigastric pain, found by EKG to have inferior
[**Hospital **] transferred to [**Hospital1 18**] for cath lab. Patient was last seen
well by family yesterday morning and was at baseline. Family
became concerned when they did not hear from her later in the
day and went to check on her at 6:30pm and found her doubled
over in severe abdominal pain and with altered mental status.
She had not picked up her morning paper, so acute event likely
occurred in AM.
.
At OSH, she was found by EKG to have an inferior STEMI. Labs
showed WBC 15.9, Hct 40.9, Platelets 309. INR 1.8, BUN 28, Cr
2.3, Sodium 140, K 4.4, Cl 98. CK 516, troponin 1.58. She was
transferred to [**Hospital1 18**] for further management of STEMI and cath
lab.
.
At [**Hospital1 18**] ED, she was initially hemodynamically stable on
arrival. On her way to radiology, sbp dropped to 50s and she was
started on dopamine, after which her sbp came up to 100s-130s. A
head CT was also obtained due to AMS, and was negative for acute
intracranial abnormalities. She was transferred to the cardiac
cath lab.
.
In the cath lab, patient was found to have elevated RA pressure
20/24/21, PCWB 16/15/16, LV 186/20, aortic valve gradient 30
(consistent with severe AS), O2 sats - no evidence of shunts, [**MD Number(3) 91869**] venous sat - 70, IVC sat lower than SVC 60 vs 81 (possibly
indicates an inflammatory process in lower torso). LV gram
showed hyperdynamic LV. Systemic vascular resistance is elevated
at 1149. Coronary perfusion shows LMCA ostial 90% lesion,
proximal LAD 70% stenosis. The RCA is proximally totally
occluded, however, this was not thought to be acute because LV
EF was good and LV wall motion was hyperdynamic. Curiously,
however, no collateral vessels were seen, which would be
expected if RCA lesion was thought to be chronic. The patient
was judged to not necessarily benefit from stenting, so an
intra-aortic balloon pump was put in for supportive measures.
.
Patient is intubated and unable to complete a review of systems,
but per family, she does not have hx of prior stroke, TIA, deep
venous thrombosis, pulmonary embolism, bleeding at the time of
surgery, myalgias, joint pains, cough, hemoptysis, black stools
or red stools. She has had no recent fevers, chills or rigors.
She denies exertional buttock or calf pain. All of the other
review of systems were negative.

Past Medical History:
1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY: moderate aortic stenosis
3. OTHER PAST MEDICAL HISTORY:
- anxiety
- s/p carotid endarterectomy
- divertulitis
- s/p hysterectomy


Social History:
Lives alone, independent and walks with cane, has dementia and
is sometimes confused.

Family History:
Son with CAD. Brother has valve replacement and pacemaker.

Physical Exam:
ADMISSION PHYSICAL EXAM:
VS: T= [**Age over 90 **]F (rectal) BP=126/91 HR=92 RR=14 O2 sat= 95% (CMV
ventilation with TV 450, RR 14, FiO2 50%, PEEP 5)
GENERAL: intubated, sedated, no acute distress
HEENT: NCAT. Sclera anicteric. PERRL 3mm to 2mm.
CARDIAC: bradycardic, somewhat irregular, normal S1, S2.
systolic murmur best heard at LUSB radiating to left carotid>
right carotid.
LUNGS: No chest wall deformities, scoliosis or kyphosis. CTAB,
no crackles, wheezes or rhonchi.
ABDOMEN: hypoactive bowel sounds, soft, nondistended. No HSM or
tenderness.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: multiple sebhorreic [**Last Name (LF) 91870**], [**First Name3 (LF) **] stasis dermatitis,
ulcers, scars, or xanthomas.


Pertinent Results:
ADMISSION LABS:
[**2201-1-13**] 11:40PM BLOOD WBC-16.1* RBC-4.21 Hgb-12.6 Hct-40.7
MCV-97 MCH-29.9 MCHC-31.0 RDW-13.5 Plt Ct-312
[**2201-1-13**] 11:40PM BLOOD Neuts-86.4* Lymphs-10.4* Monos-2.7
Eos-0.2 Baso-0.2
[**2201-1-14**] 04:26AM BLOOD PT-15.6* PTT-146.0* INR(PT)-1.5*
[**2201-1-13**] 11:40PM BLOOD Glucose-140* UreaN-29* Creat-2.3* Na-145
K-4.7 Cl-103 HCO3-12* AnGap-35*
[**2201-1-14**] 04:26AM BLOOD ALT-62* AST-147* LD(LDH)-501*
CK(CPK)-1033* AlkPhos-80 TotBili-0.6
[**2201-1-14**] 04:26AM BLOOD CK-MB-182* MB Indx-17.6* cTropnT-2.31*
[**2201-1-13**] 11:40PM BLOOD Calcium-9.1 Phos-7.5* Mg-2.3
[**2201-1-13**] 11:43PM BLOOD Type-[**Last Name (un) **] pO2-49* pCO2-36 pH-7.14*
calTCO2-13* Base XS--16 Comment-GREEN TOP
[**2201-1-13**] 11:43PM BLOOD Lactate-11.6* Na-145 K-4.4 Cl-108
.
CARDIAC ENZYMES:
[**2201-1-13**] 11:40PM BLOOD cTropnT-1.90*
[**2201-1-14**] 04:26AM BLOOD CK-MB-182* MB Indx-17.6* cTropnT-2.31*
[**2201-1-14**] 10:00AM BLOOD CK-MB-250* MB Indx-17.2* cTropnT-3.35*
.
ARTERIAL BLOOD GASES:
[**2201-1-13**] 11:43PM BLOOD Type-[**Last Name (un) **] pO2-49* pCO2-36 pH-7.14*
calTCO2-13* Base XS--16 Comment-GREEN TOP
[**2201-1-14**] 01:38AM BLOOD Type-ART Rates-14/ Tidal V-450 FiO2-100
pO2-440* pCO2-27* pH-7.18* calTCO2-11* Base XS--16 AADO2-247 REQ
O2-49 -ASSIST/CON Intubat-INTUBATED
[**2201-1-14**] 04:47AM BLOOD Type-ART pO2-228* pCO2-32* pH-7.23*
calTCO2-14* Base XS--13
[**2201-1-14**] 05:45AM BLOOD Type-ART Temp-35.0 Rates-14/ Tidal V-400
PEEP-5 FiO2-50 pO2-207* pCO2-27* pH-7.33* calTCO2-15* Base XS--9
-ASSIST/CON Intubat-INTUBATED
[**2201-1-14**] 10:14AM BLOOD Type-ART pO2-222* pCO2-30* pH-7.35
calTCO2-17* Base XS--7
[**2201-1-14**] 01:10PM BLOOD Type-ART pO2-178* pCO2-29* pH-7.19*
calTCO2-12* Base XS--15
.
CT HEAD WITHOUT INTRAVENOUS CONTRAST ([**2201-1-13**]): The study is
somewhat limited by motion artifact. There is no acute
intracranial hemorrhage, edema, mass effect or major vascular
territorial infarct. Prominent ventricles and sulci are
compatible with age-related atrophy. There is no shift of the
normally midline structures. Basal cisterns are patent. The
visualized paranasal sinuses, middle ear cavities and mastoid
air cells
are clear. No acute osseous abnormality is identified.
Incidentally noted is bony excrescence emanating from the hard
palate, represent torus palatinus. Patient is status post
bilateral ocular lens surgery.
IMPRESSION: No acute intracranial process.
.
ECHO ([**2201-1-14**]): The left atrium is mildly dilated. The left
atrium is elongated. The estimated right atrial pressure is at
least 15 mmHg. There is moderate symmetric left ventricular
hypertrophy. The left ventricular cavity is unusually small.
Left ventricular systolic function is hyperdynamic (EF>75%).
There is a mild resting left ventricular outflow tract
obstruction. The right ventricular cavity is mildly dilated with
mild global free wall hypokinesis. The ascending aorta is mildly
dilated. The aortic valve leaflets are severely
thickened/deformed. There is severe aortic valve stenosis (valve
area 0.8-1.0cm2). Moderate (2+) aortic regurgitation is seen.
Moderate to severe [3+] tricuspid regurgitation is seen. There
is moderate pulmonary artery systolic hypertension. [In the
setting of at least moderate to severe tricuspid regurgitation,
the estimated pulmonary artery systolic pressure may be
underestimated due to a very high right atrial pressure.] There
is no pericardial effusion.
IMPRESSION: Mild-moderate symmetric left ventricular hypertrophy
with hyperdynamic systolic function and mild LVOT gradient.
Severe aortic stenosis with moderate aortic regurgitation. At
least moderate pulmonary artery systolic hypertension.

Brief Hospital Course:
[**Age over 90 **]F with inferior STEMI, now s/p cardiac catherization found to
have LMCA ostial lesion, LAD lesion and proximal RCA occlusion,
now s/p intra-aortic balloon pump placement.
.
# HYPOTENSION. Patient became hypotensive to systolic 50s while
in the [**Hospital1 18**] ED. She had maintained good SBPs prior to that
time. DDx included cardiogenic vs. septic shock. Elevated
filling pressures on right heart cath were consistent with
cardiogenic shock, and patient had high systemic vascular
resistance and cold peripheries were most consistent with
cardiogenic shock. Given severe lactic acidosis also considered
septic shock, possibly of GI origin given severe [**Last Name (un) 103**] pain on
admission so started vanc/zosyn. Mesenteric ischemic less likely
given guaiac negative. In cath lab, patient found to have LMCA
90% ostial lesion, LAD 80% lesion, and proximal RCA occlusion,
with EKG showing inferior STEMI in RCA distribution. No coronary
intervention performed given level of risk, but IABP was placed
to augment coronary perfusion and heparin gtt started. For
hypotension, patient initially started on dopamine drip to keep
SBP above 100. She remained intubated and sedated and was
admitted to CCU. Patient initially maintained MAPs, but over the
course of several hours in ICU she became progressively
hypotensive, requiring increasing pressors and ultimately
maximum doses of levophed and dopamine. After discussion with
patient's son (her healthcare proxy), family decided to
transition patient to DNR and ultimately CMO. Patient's IABP and
pressors were discontinued, and she expired peacefully shortly
afterward with family at bedside.

Medications on Admission:
diltiazem
lisinopril
buspirone
simvastatin (recently stopped)
aspirin (recently stopped)


Discharge Medications:
N/A (expired)

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired
{'Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure, unspecified,Cardiogenic shock,Acidosis,Delirium due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Other specified cardiac dysrhythmias,Other persistent mental disorders due to conditions classified elsewhere,Old myocardial infarction,Unspecified essential hypertension,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: inferior STEMI

PRESENT ILLNESS: [**Age over 90 **]F with PMH of hypertension and aortic stenosis presents to OSH
with severe epigastric pain, found by EKG to have inferior
[**Hospital **] transferred to [**Hospital1 18**] for cath lab. Patient was last seen
well by family yesterday morning and was at baseline. Family
became concerned when they did not hear from her later in the
day and went to check on her at 6:30pm and found her doubled
over in severe abdominal pain and with altered mental status.
She had not picked up her morning paper, so acute event likely
occurred in AM.
.
At OSH, she was found by EKG to have an inferior STEMI. Labs
showed WBC 15.9, Hct 40.9, Platelets 309. INR 1.8, BUN 28, Cr
2.3, Sodium 140, K 4.4, Cl 98. CK 516, troponin 1.58. She was
transferred to [**Hospital1 18**] for further management of STEMI and cath
lab.
.
At [**Hospital1 18**] ED, she was initially hemodynamically stable on
arrival. On her way to radiology, sbp dropped to 50s and she was
started on dopamine, after which her sbp came up to 100s-130s. A
head CT was also obtained due to AMS, and was negative for acute
intracranial abnormalities. She was transferred to the cardiac
cath lab.
.
In the cath lab, patient was found to have elevated RA pressure
20/24/21, PCWB 16/15/16, LV 186/20, aortic valve gradient 30
(consistent with severe AS), O2 sats - no evidence of shunts, [**MD Number(3) 91869**] venous sat - 70, IVC sat lower than SVC 60 vs 81 (possibly
indicates an inflammatory process in lower torso). LV gram
showed hyperdynamic LV. Systemic vascular resistance is elevated
at 1149. Coronary perfusion shows LMCA ostial 90% lesion,
proximal LAD 70% stenosis. The RCA is proximally totally
occluded, however, this was not thought to be acute because LV
EF was good and LV wall motion was hyperdynamic. Curiously,
however, no collateral vessels were seen, which would be
expected if RCA lesion was thought to be chronic. The patient
was judged to not necessarily benefit from stenting, so an
intra-aortic balloon pump was put in for supportive measures.
.
Patient is intubated and unable to complete a review of systems,
but per family, she does not have hx of prior stroke, TIA, deep
venous thrombosis, pulmonary embolism, bleeding at the time of
surgery, myalgias, joint pains, cough, hemoptysis, black stools
or red stools. She has had no recent fevers, chills or rigors.
She denies exertional buttock or calf pain. All of the other
review of systems were negative.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY: moderate aortic stenosis
3. OTHER PAST MEDICAL HISTORY:
- anxiety
- s/p carotid endarterectomy
- divertulitis
- s/p hysterectomy

MEDICATION ON ADMISSION: diltiazem
lisinopril
buspirone
simvastatin (recently stopped)
aspirin (recently stopped)

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
VS: T= [**Age over 90 **]F (rectal) BP=126/91 HR=92 RR=14 O2 sat= 95% (CMV
ventilation with TV 450, RR 14, FiO2 50%, PEEP 5)
GENERAL: intubated, sedated, no acute distress
HEENT: NCAT. Sclera anicteric. PERRL 3mm to 2mm.
CARDIAC: bradycardic, somewhat irregular, normal S1, S2.
systolic murmur best heard at LUSB radiating to left carotid>
right carotid.
LUNGS: No chest wall deformities, scoliosis or kyphosis. CTAB,
no crackles, wheezes or rhonchi.
ABDOMEN: hypoactive bowel sounds, soft, nondistended. No HSM or
tenderness.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: multiple sebhorreic [**Last Name (LF) 91870**], [**First Name3 (LF) **] stasis dermatitis,
ulcers, scars, or xanthomas.

FAMILY HISTORY: Son with CAD. Brother has valve replacement and pacemaker.

SOCIAL HISTORY: Lives alone, independent and walks with cane, has dementia and
is sometimes confused. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure, unspecified,Cardiogenic shock,Acidosis,Delirium due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Other specified cardiac dysrhythmias,Other persistent mental disorders due to conditions classified elsewhere,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
