CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 47645**] was a 60-year-old
gentleman who presented to [**Hospital6 3872**] on
[**2119-5-8**] with complaints of shortness of breath lasting
approximately a few hours prior to arrival.  He had a
productive cough as well with no fever.  He arrived to the
Emergency Department at [**Hospital3 1280**] pale and diaphoretic.  The
patient had been previously healthy with no known cardiac
disease however upon interrogation at [**Hospital6 3874**] it was discovered that he had been having chest pain
for a number of days intermittently prior to admission to the
hospital.  The morning of admission he awoke with significant
shortness of breath, chest pain and diaphoresis.  On arrival
to the Emergency Department he was noted to be in sinus
tachycardia.  He had ST elevations in the inferior leads as
well as ST depression in his anterior leads of his EKG.
Chest x-ray at that time revealed marked pulmonary edema.
His oxygen saturation was 84%.  His blood pressure was 80/50
in atrial fibrillation with a heart rate of 110 per minute.
The patient ruled in by cardiac enzymes as well as EKG for an
inferior myocardial infarction with right ventricular
involvement.  The patient also had hemoptysis upon admission
to the Emergency Department.  The patient was emergently
transferred from [**Hospital6 3872**] to [**Hospital1 346**] early afternoon on [**2119-5-8**] where he
was taken emergently to the cardiac catheterization
laboratory.

MEDICAL HISTORY: Deafness.

MEDICATION ON ADMISSION: He was taking no regular
medications prior to admission to the hospital.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Acute respiratory failure,Mitral valve disorders,Cardiogenic shock,Acidosis,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery
AMI inferior wall, init,CHF NOS,Atrial fibrillation,Acute respiratry failure,Mitral valve disorder,Cardiogenic shock,Acidosis,Acute kidney failure NOS,Crnry athrscl natve vssl
Admission Date:  [**2119-5-8**]       Discharge Date:  [**2119-5-11**]

Date of Birth:   [**2058-6-23**]       Sex:  M

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 47645**] was a 60-year-old
gentleman who presented to [**Hospital6 3872**] on
[**2119-5-8**] with complaints of shortness of breath lasting
approximately a few hours prior to arrival.  He had a
productive cough as well with no fever.  He arrived to the
Emergency Department at [**Hospital3 1280**] pale and diaphoretic.  The
patient had been previously healthy with no known cardiac
disease however upon interrogation at [**Hospital6 3874**] it was discovered that he had been having chest pain
for a number of days intermittently prior to admission to the
hospital.  The morning of admission he awoke with significant
shortness of breath, chest pain and diaphoresis.  On arrival
to the Emergency Department he was noted to be in sinus
tachycardia.  He had ST elevations in the inferior leads as
well as ST depression in his anterior leads of his EKG.
Chest x-ray at that time revealed marked pulmonary edema.
His oxygen saturation was 84%.  His blood pressure was 80/50
in atrial fibrillation with a heart rate of 110 per minute.
The patient ruled in by cardiac enzymes as well as EKG for an
inferior myocardial infarction with right ventricular
involvement.  The patient also had hemoptysis upon admission
to the Emergency Department.  The patient was emergently
transferred from [**Hospital6 3872**] to [**Hospital1 346**] early afternoon on [**2119-5-8**] where he
was taken emergently to the cardiac catheterization
laboratory.

PAST MEDICAL HISTORY:  Deafness.

MEDICATIONS ON ADMISSION:  He was taking no regular
medications prior to admission to the hospital.

ALLERGIES:  The patient has no known drug allergies.

HOSPITAL COURSE:  In the cardiac catheterization laboratory
the patient was found to have significant three-vessel
coronary artery disease as well as 4+ severe mitral
regurgitation with a left ventricular ejection fraction
estimated at 75%.  He was hemodynamically unstable and in
cardiogenic shock with severe mitral regurgitation.  An
intra-aortic balloon pump was placed emergently and the
patient was also emergently taken to the operating room for
mitral valve replacement and coronary artery bypass grafting.
The patient was emergently intubated in the cardiac
catheterization laboratory for oxygen saturation of about 60%
with pulmonary edema which was treated with Lasix, 100%
oxygen and PEEP.

The patient was taken to the operating room by Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] where the patient underwent emergency coronary artery
bypass grafting x 2 with saphenous vein to the right
posterior descending coronary artery and saphenous vein to
the left anterior descending coronary artery.  He also had a
mitral valve replacement with a #29 mm [**Last Name (un) 3843**]-[**Doctor Last Name **]
valve.  Postoperatively the patient was in profound hypoxic
state and pulmonary edema on epinephrine, Neo-Synephrine,
vasopressin and Levophed IV drips, with an intra-aortic
balloon pump in place.  He was transported from the operating
room to the cardiac surgery recovery unit profoundly hypoxic.
Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **] placed arterial and venous cannulas to
place the patient on ECMO in the intensive care unit, which
was initiated the night of surgery.

On [**2119-5-9**], postoperative day one the patient remained
critical.  He remained profoundly fluid overloaded.  His
pressors were weaned somewhat but remained on Levophed and
vasopressin at that time.  The patient remained on full ECMO
support with ventilator and intra-aortic balloon pump in
place.  The patient was kept paralyzed and sedated to
facilitate ventilation.  Later in the day on [**2119-5-9**] the
patient was begun on CVVH due to massive fluid overload with
attempt to remove large volume of fluid in the hope that the
patient would be able to be weaned from the ECMO circuit and
be able to oxygenate adequately.  The patient remained on
full support throughout the course of that night and on the
morning of [**2119-5-10**], remained on full ventilator support,
full ECMO support with CVVH for fluid removal.  He remained
on cisatracurium IV drip for paralysis, fentanyl and Ativan
for sedation, Levophed, Neo-Synephrine and Pitressin drips to
maintain adequate blood pressure assistance.

The patient underwent bronchoscopy also on [**2119-5-10**] at
approximately 3 PM which was unremarkable.  The patient's
intra-aortic balloon pump was removed on [**2119-5-10**] as well.

On the evening of [**2119-5-10**] the patient was taken to the
cardiac catheterization laboratory due to continued
hemodynamic instability, where he underwent an atrial
septostomy to decompress the left atrium.  A transseptal
puncture was performed and the atrial septum was dilated and
there was successful left to right shunting after the
procedure.  From the catheterization laboratory the patient
was transported again to the cardiac surgery recovery unit in
critical condition, remained on the previously mentioned
vasoactive drips and it was noted that the patient had an
ischemic left leg which is the leg that his ECMO cannulas had
been placed into.

The patient was take to the operating room in the evening of
[**2119-5-10**] where he underwent removal of the ECMO cannulas from
the left, replacement of those cannulas into the right,
repair of the common femoral artery with a graft on the
right, repair of the left femoral artery, left fasciotomy as
well.  The patient was returned to the cardiac surgery
recovery unit early on the morning of [**2119-5-11**] where he
continued to decline from a hemodynamic standpoint.  He also
had worsening metabolic acidosis treated with multiple amps
of sodium bicarbonate throughout the course of the night.  He
was noted to have a severely distended abdomen which worsened
overnight as well as large volumes of guaiac positive watery
stool being expelled.  His lactate had risen to the low 20s
at this time.

In the early morning of [**2119-5-11**] a discussion took place with
the patient's son and daughter-in-law who stated that they
felt the patient would not want any further surgical
procedures.  They also stated that the patient would not want
to continue on the present amount of support that he remained
on at this time due to his worsening condition.  After
discussion with Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **] he concurred with the
family's wishes and at 8:40 to 8:50 in the morning the
patient's vasoactive drips as well as ECMO were weaned to off
and the patient ceased spontaneous respirations as well as
heart rhythm at 8:55 this morning and was pronounced dead.





                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 964**]
MEDQUIST36

D:  [**2119-5-11**]  09:26
T:  [**2119-5-11**]  10:07
JOB#:  [**Job Number 47646**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Acute respiratory failure,Mitral valve disorders,Cardiogenic shock,Acidosis,Acute kidney failure, unspecified,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: 

PRESENT ILLNESS: Mr. [**Known lastname 47645**] was a 60-year-old
gentleman who presented to [**Hospital6 3872**] on
[**2119-5-8**] with complaints of shortness of breath lasting
approximately a few hours prior to arrival.  He had a
productive cough as well with no fever.  He arrived to the
Emergency Department at [**Hospital3 1280**] pale and diaphoretic.  The
patient had been previously healthy with no known cardiac
disease however upon interrogation at [**Hospital6 3874**] it was discovered that he had been having chest pain
for a number of days intermittently prior to admission to the
hospital.  The morning of admission he awoke with significant
shortness of breath, chest pain and diaphoresis.  On arrival
to the Emergency Department he was noted to be in sinus
tachycardia.  He had ST elevations in the inferior leads as
well as ST depression in his anterior leads of his EKG.
Chest x-ray at that time revealed marked pulmonary edema.
His oxygen saturation was 84%.  His blood pressure was 80/50
in atrial fibrillation with a heart rate of 110 per minute.
The patient ruled in by cardiac enzymes as well as EKG for an
inferior myocardial infarction with right ventricular
involvement.  The patient also had hemoptysis upon admission
to the Emergency Department.  The patient was emergently
transferred from [**Hospital6 3872**] to [**Hospital1 346**] early afternoon on [**2119-5-8**] where he
was taken emergently to the cardiac catheterization
laboratory.

MEDICAL HISTORY: Deafness.

MEDICATION ON ADMISSION: He was taking no regular
medications prior to admission to the hospital.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Acute respiratory failure,Mitral valve disorders,Cardiogenic shock,Acidosis,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery'}
