CHIEF COMPLAINT: respiratory distress

PRESENT ILLNESS: [**Age over 90 **] year-old woman with a history of HTN who is now transferred
to the CCU with respiratory distress. She initially presented to
the ED on [**2102-8-18**] with one day of chest pain; she wsa found to
have a-fib with RVR to the 120s in the ED and was thought to
have ST elevations in V2-V4 so she was taken urgently to the
cath lab. At cath, she was found to have mild 3-vessel disease
and no intervention was performed. Her pre- and
post-catheterization labs were notable for a creatinine of 2.2
(baseline unknown). She was given a total of 3 L of IV fluids
today due to her elevated creatinine and urine electrolytes
consistent with prerenal azotemia; she reportedly put out only
about 300cc of urine to this throughout the day.
.
Cardiac review of systems cannot be obtained at this time due to
respiratory distress and acuit of the situation.

MEDICAL HISTORY: ypertension
.
Cardiac Risk Factors: Hypertension
.
Cardiac History:
Percutaneous coronary intervention, on [**2102-8-18**] anatomy as
follows:
Selective coronary angiography of this co-dominant system
demonstrates moderate three vessel coronary artery disease. The
LMCA
has 30% proximal stenosis. The LAD has moderate luminal
irregularities with serial 40% elsions and mid vessle 50%
stenosis. The mLCx artery has 50% stenosis with streaming
artifact. The LPLV has 70% stenosis. The pRCA has 60% stenosis
with 50% stenosis in the mid vessel. Limited resting hemodynamic
measurement reveals normal central aortic pressure of
122/79mmHg.

MEDICATION ON ADMISSION: aspirin 325mg daily
pantoprazole 40mg daily
metoprolol 12.5mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 96.1, BP 110/75, HR 110, RR 36, O2 % unable to check with
pulse oximeter (PaO2 117 on 4L n.c.)
Gen: Elderly hispanic woman in respiratory distress, answering
questions appropriately
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa; dry mucous
membranes.
Neck: Supple with JVP of 12 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
Tachycardic, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were markedly labored, with accessory muscle use. Crackles were
noted throughout both lung fields.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: Modertaley cool with mild cyanosis. No clubbing or edema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; trace
DP
Left: Carotid 2+ without bruit; Femoral 2+ without bruit; trace
DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use (quit 20 yrs ago). There is no history of alcohol abuse.
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Acidosis,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Atrial fibrillation,Unspecified septicemia,Coronary atherosclerosis of native coronary artery
Subendo infarct, initial,Acute kidney failure NOS,Chronic kidney dis NOS,Acidosis,SIRS-noninf w/o ac or ds,Atrial fibrillation,Septicemia NOS,Crnry athrscl natve vssl
Admission Date:  [**2102-8-18**]              Discharge Date:   [**2102-8-20**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
respiratory distress

Major Surgical or Invasive Procedure:
Cardiac catherization.


History of Present Illness:
[**Age over 90 **] year-old woman with a history of HTN who is now transferred
to the CCU with respiratory distress. She initially presented to
the ED on [**2102-8-18**] with one day of chest pain; she wsa found to
have a-fib with RVR to the 120s in the ED and was thought to
have ST elevations in V2-V4 so she was taken urgently to the
cath lab. At cath, she was found to have mild 3-vessel disease
and no intervention was performed. Her pre- and
post-catheterization labs were notable for a creatinine of 2.2
(baseline unknown). She was given a total of 3 L of IV fluids
today due to her elevated creatinine and urine electrolytes
consistent with prerenal azotemia; she reportedly put out only
about 300cc of urine to this throughout the day.
.
Cardiac review of systems cannot be obtained at this time due to
respiratory distress and acuit of the situation.


Past Medical History:
ypertension
.
Cardiac Risk Factors: Hypertension
.
Cardiac History:
Percutaneous coronary intervention, on [**2102-8-18**] anatomy as
follows:
Selective coronary angiography of this co-dominant system
demonstrates moderate three vessel coronary artery disease. The
LMCA
has 30% proximal stenosis. The LAD has moderate luminal
irregularities with serial 40% elsions and mid vessle 50%
stenosis. The mLCx artery has 50% stenosis with streaming
artifact. The LPLV has 70% stenosis. The pRCA has 60% stenosis
with 50% stenosis in the mid vessel. Limited resting hemodynamic
measurement reveals normal central aortic pressure of
122/79mmHg.


Social History:
Social history is significant for the absence of current tobacco
use (quit 20 yrs ago). There is no history of alcohol abuse.

Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
VS: T 96.1, BP 110/75, HR 110, RR 36, O2 % unable to check with
pulse oximeter (PaO2 117 on 4L n.c.)
Gen: Elderly hispanic woman in respiratory distress, answering
questions appropriately
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa; dry mucous
membranes.
Neck: Supple with JVP of 12 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
Tachycardic, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were markedly labored, with accessory muscle use. Crackles were
noted throughout both lung fields.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: Modertaley cool with mild cyanosis. No clubbing or edema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; trace
DP
Left: Carotid 2+ without bruit; Femoral 2+ without bruit; trace
DP


Pertinent Results:
[**2102-8-18**] 05:45PM BLOOD WBC-9.4 RBC-3.83* Hgb-12.2 Hct-36.9
MCV-96 MCH-31.9 MCHC-33.2 RDW-14.4 Plt Ct-230
[**2102-8-20**] 06:48AM BLOOD WBC-10.2 RBC-3.24* Hgb-10.2* Hct-32.6*
MCV-101* MCH-31.6 MCHC-31.4 RDW-14.8 Plt Ct-152
[**2102-8-18**] 05:45PM BLOOD Neuts-87.1* Bands-0 Lymphs-7.6* Monos-4.3
Eos-0.7 Baso-0.3
[**2102-8-20**] 06:48AM BLOOD Neuts-87* Bands-1 Lymphs-10* Monos-2
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2102-8-20**] 12:01AM BLOOD Fibrino-90*
[**2102-8-20**] 06:48AM BLOOD FDP-320-640*
[**2102-8-20**] 04:00AM BLOOD Glucose-197* UreaN-64* Creat-2.2* Na-143
K-4.1 Cl-99 HCO3-11* AnGap-37*
[**2102-8-19**] 09:10PM BLOOD ALT-113* AST-152* LD(LDH)-833*
AlkPhos-237* Amylase-134* TotBili-2.1*
[**2102-8-18**] 05:45PM BLOOD cTropnT-0.10*
[**2102-8-19**] 09:10PM BLOOD CK-MB-7 cTropnT-0.11*
[**2102-8-20**] 04:00AM BLOOD CK-MB-9 cTropnT-0.09*
[**2102-8-18**] 05:45PM BLOOD Calcium-9.4 Phos-4.4 Mg-2.3
[**2102-8-20**] 04:00AM BLOOD Albumin-2.5* Calcium-6.9* Phos-7.9*
Mg-2.4
[**2102-8-19**] 05:45AM BLOOD Triglyc-47 HDL-60 CHOL/HD-1.9 LDLcalc-45
[**2102-8-20**] 04:00AM BLOOD Hapto-168
[**2102-8-18**] 05:50PM BLOOD Comment-GREEN TOP
[**2102-8-19**] 09:29PM BLOOD Type-ART pO2-255* pCO2-19* pH-7.24*
calTCO2-9* Base XS--17
[**2102-8-20**] 12:45AM BLOOD Type-ART pO2-554* pCO2-27* pH-7.08*
calTCO2-8* Base XS--21
[**2102-8-20**] 02:02AM BLOOD Type-ART pO2-264* pCO2-26* pH-7.18*
calTCO2-10* Base XS--17 -ASSIST/CON Intubat-INTUBATED
[**2102-8-20**] 04:08AM BLOOD Type-ART pO2-156* pCO2-29* pH-7.25*
calTCO2-13* Base XS--12
[**2102-8-20**] 07:21AM BLOOD Type-ART Temp-36.7 FiO2-40 pO2-154*
pCO2-29* pH-7.33* calTCO2-16* Base XS--9 Intubat-INTUBATED
[**2102-8-19**] 08:38PM BLOOD Lactate-14.9* K-4.6
[**2102-8-20**] 12:45AM BLOOD Lactate-16.3*
[**2102-8-20**] 07:21AM BLOOD Glucose-235* Lactate-11.4*

Brief Hospital Course:
   Patient had a cardiac catherization without finding occlusive
disease.  She tolerated the procedure well.  One day following,
the patient was [**Last Name (un) 4662**] the CCU in respiratory distress.  Patient
was intubated, and ventilation was stabilized.  She had a
progressive lactic acidosis.  She eventually had a cardiac
arrested and was unsucessfully coded.  On autopsy, patient was
found to have multiple thrombosis, including large pumonary
embolisms.

Medications on Admission:
aspirin 325mg daily
pantoprazole 40mg daily
metoprolol 12.5mg [**Hospital1 **]


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Cardiopulmonary collapse

Discharge Condition:
Expired
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Acidosis,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Atrial fibrillation,Unspecified septicemia,Coronary atherosclerosis of native coronary artery'}


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: respiratory distress

PRESENT ILLNESS: [**Age over 90 **] year-old woman with a history of HTN who is now transferred
to the CCU with respiratory distress. She initially presented to
the ED on [**2102-8-18**] with one day of chest pain; she wsa found to
have a-fib with RVR to the 120s in the ED and was thought to
have ST elevations in V2-V4 so she was taken urgently to the
cath lab. At cath, she was found to have mild 3-vessel disease
and no intervention was performed. Her pre- and
post-catheterization labs were notable for a creatinine of 2.2
(baseline unknown). She was given a total of 3 L of IV fluids
today due to her elevated creatinine and urine electrolytes
consistent with prerenal azotemia; she reportedly put out only
about 300cc of urine to this throughout the day.
.
Cardiac review of systems cannot be obtained at this time due to
respiratory distress and acuit of the situation.

MEDICAL HISTORY: ypertension
.
Cardiac Risk Factors: Hypertension
.
Cardiac History:
Percutaneous coronary intervention, on [**2102-8-18**] anatomy as
follows:
Selective coronary angiography of this co-dominant system
demonstrates moderate three vessel coronary artery disease. The
LMCA
has 30% proximal stenosis. The LAD has moderate luminal
irregularities with serial 40% elsions and mid vessle 50%
stenosis. The mLCx artery has 50% stenosis with streaming
artifact. The LPLV has 70% stenosis. The pRCA has 60% stenosis
with 50% stenosis in the mid vessel. Limited resting hemodynamic
measurement reveals normal central aortic pressure of
122/79mmHg.

MEDICATION ON ADMISSION: aspirin 325mg daily
pantoprazole 40mg daily
metoprolol 12.5mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 96.1, BP 110/75, HR 110, RR 36, O2 % unable to check with
pulse oximeter (PaO2 117 on 4L n.c.)
Gen: Elderly hispanic woman in respiratory distress, answering
questions appropriately
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa; dry mucous
membranes.
Neck: Supple with JVP of 12 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
Tachycardic, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were markedly labored, with accessory muscle use. Crackles were
noted throughout both lung fields.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: Modertaley cool with mild cyanosis. No clubbing or edema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; trace
DP
Left: Carotid 2+ without bruit; Femoral 2+ without bruit; trace
DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use (quit 20 yrs ago). There is no history of alcohol abuse. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Acidosis,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Atrial fibrillation,Unspecified septicemia,Coronary atherosclerosis of native coronary artery'}
