CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 77 year old
female with a history of significant coronary artery disease,
status post numerous interventions, aortic valve replacement,
hypertension, hypercholesterolemia, who presented to an
outside hospital intubated after she was found to have
hypoxic respiratory failure which required intubation by EMS
in the field.  Post intubation EMS noted the patient had an
episode of asystole requiring resuscitation.  The patient was
brought to the outside hospital where EKG noted the patient
had new wide left bundle branch block morphology.  The
patient was also significantly acidotic.  The patient's
acidemia was reversed and the patient was transferred to
[**Hospital1 18**] for acute cardiac intervention.  The patient arrived at
[**Hospital1 18**] at approximately 7:30 a.m. by Life Flight.  She was
intubated, but responsive.  Her abdomen was benign.  Her EKG
changes had resolved with resolution of acidemia.  However,
the patient ruled in significantly with cardiac enzymes,
positive CKMB and positive troponin.  Given the known tenuous
nature of her previous vein grafts, specifically patent SVG
to D1 which was supplying the majority of the myocardium,
plan was made to take the patient to cardiac catheterization.
In addition, the patient was noted to have a new wall motion
abnormality in the inferior lateral walls which further
supported the decision to take the patient to the cardiac
cath lab.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acute respiratory failure,Ventricular fibrillation,Cardiogenic shock,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of autologous vein bypass graft,Anemia, unspecified
Subendo infarct, initial,CHF NOS,Acute respiratry failure,Ventricular fibrillation,Cardiogenic shock,Hypertension NOS,Pure hypercholesterolem,Crn ath atlg vn bps grft,Anemia NOS
Admission Date:  [**2124-4-1**]     Discharge Date:  [**2124-4-1**]

Date of Birth:   [**2046-8-6**]     Sex:  F

Service:  CARD ICU

HISTORY OF PRESENT ILLNESS:  The patient is a 77 year old
female with a history of significant coronary artery disease,
status post numerous interventions, aortic valve replacement,
hypertension, hypercholesterolemia, who presented to an
outside hospital intubated after she was found to have
hypoxic respiratory failure which required intubation by EMS
in the field.  Post intubation EMS noted the patient had an
episode of asystole requiring resuscitation.  The patient was
brought to the outside hospital where EKG noted the patient
had new wide left bundle branch block morphology.  The
patient was also significantly acidotic.  The patient's
acidemia was reversed and the patient was transferred to
[**Hospital1 18**] for acute cardiac intervention.  The patient arrived at
[**Hospital1 18**] at approximately 7:30 a.m. by Life Flight.  She was
intubated, but responsive.  Her abdomen was benign.  Her EKG
changes had resolved with resolution of acidemia.  However,
the patient ruled in significantly with cardiac enzymes,
positive CKMB and positive troponin.  Given the known tenuous
nature of her previous vein grafts, specifically patent SVG
to D1 which was supplying the majority of the myocardium,
plan was made to take the patient to cardiac catheterization.
In addition, the patient was noted to have a new wall motion
abnormality in the inferior lateral walls which further
supported the decision to take the patient to the cardiac
cath lab.

HOSPITAL COURSE:  In the cardiac cath lab, the patient's vein
graft from SVG to D1 was noted to be patent.  There was mild
ostial lesion, but no clear obstruction of the flow.  The
patient became hypotensive in the middle of the
catheterization.  The patient required initiation of three
pressor agents.  In addition, decision was made to place an
intra-aortic balloon pump.  In order to place the
intra-aortic balloon pump, several stents had to be placed in
the iliac artery.  The balloon pump was successfully placed
which transiently improved her cardiac output.  However, the
patient continued to deteriorate.

At this point labs showed that the patient was acutely
bleeding, given that her hematocrit had dropped from
approximately 33 on admission to 12.9 post procedure.  The
patient was taken for CT scan for visualization of possible
retroperitoneal or femoral bleed.  During the CT scan, the
patient became hemodynamically unstable.  Pressure had
dropped.  Attempts were made to resuscitate the patient with
multiple units of blood.  She required multiple doses of
epinephrine.

At one point the patient's rhythm was noted to ventricular
fibrillation and she required cardioversion back to paced
rhythm.  The CT scan did not demonstrate an obvious source of
bleeding.  However, it did note evidence of mesenteric
ischemia with portal venous gas.  Vascular surgery was
consulted regarding whether or not acute surgical
intervention would benefit the patient.  Given her
deteriorating condition on three pressors, it was felt that
she was an extremely poor surgical candidate.

At this time the patient's family was consulted regarding her
deteriorating clinical status and the decision was made to
withdraw care.  The patient was transferred back to the
cardiac intensive care unit where pressure support was
discontinued.  The patient passed away within the hour at
approximately 9:00 p.m.  The medical examiner was notified of
this case and declined autopsy.






                          [**First Name4 (NamePattern1) 610**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3812**]

Dictated By:[**Name8 (MD) 3482**]

MEDQUIST36

D:  [**2124-4-2**]  12:26
T:  [**2124-4-3**]  14:26
JOB#:  [**Job Number 49977**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acute respiratory failure,Ventricular fibrillation,Cardiogenic shock,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of autologous vein bypass graft,Anemia, unspecified'}


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: The patient is a 77 year old
female with a history of significant coronary artery disease,
status post numerous interventions, aortic valve replacement,
hypertension, hypercholesterolemia, who presented to an
outside hospital intubated after she was found to have
hypoxic respiratory failure which required intubation by EMS
in the field.  Post intubation EMS noted the patient had an
episode of asystole requiring resuscitation.  The patient was
brought to the outside hospital where EKG noted the patient
had new wide left bundle branch block morphology.  The
patient was also significantly acidotic.  The patient's
acidemia was reversed and the patient was transferred to
[**Hospital1 18**] for acute cardiac intervention.  The patient arrived at
[**Hospital1 18**] at approximately 7:30 a.m. by Life Flight.  She was
intubated, but responsive.  Her abdomen was benign.  Her EKG
changes had resolved with resolution of acidemia.  However,
the patient ruled in significantly with cardiac enzymes,
positive CKMB and positive troponin.  Given the known tenuous
nature of her previous vein grafts, specifically patent SVG
to D1 which was supplying the majority of the myocardium,
plan was made to take the patient to cardiac catheterization.
In addition, the patient was noted to have a new wall motion
abnormality in the inferior lateral walls which further
supported the decision to take the patient to the cardiac
cath lab.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acute respiratory failure,Ventricular fibrillation,Cardiogenic shock,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of autologous vein bypass graft,Anemia, unspecified'}
