CHIEF COMPLAINT: 

PRESENT ILLNESS: Mrs. [**Known lastname 37682**] is an 81 year old
woman with a history of type 2 diabetes mellitus and seizure
disorder without known coronary artery disease presenting
initially to [**Hospital **] Hospital with neck pain.  She was found
to have an [**Street Address(2) 37683**] elevation and was transferred to the [**Hospital1 1444**] for primary percutaneous
transluminal coronary angiography.  The patient initially
developed neck and jaw pain at 07:30 the morning of
admission.  She reported nausea as well as shortness of
breath and anxiety.  She denied fever or chills,
lightheadedness or dysuria.  At the outside hospital, she was
found to be hypotensive with a blood pressure of 68/24 and a
heart rate of 58.  EKG showed anterior [**Street Address(2) 37683**] elevations.
She was placed on Integrilin, heparin, aspirin, and Atropine,
and transported to [**Hospital1 69**].  She
had also been placed on a Dopamine drip at the outside
hospital.

MEDICAL HISTORY: 1.  Type 2 diabetes mellitus.
2.  Seizure disorder.
3.  Hypothyroidism.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Accidental puncture or laceration during a procedure, not elsewhere classified,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Acute kidney failure, unspecified
AMI anterolateral, init,Cardiogenic shock,Accidental op laceration,CHF NOS,Food/vomit pneumonitis,Acidosis,Acute kidney failure NOS
Admission Date:  [**2115-1-28**]     Discharge Date:  [**2115-2-3**]

Date of Birth:              Sex:  F

Service:  CCU

HISTORY OF PRESENT ILLNESS:  Mrs. [**Known lastname 37682**] is an 81 year old
woman with a history of type 2 diabetes mellitus and seizure
disorder without known coronary artery disease presenting
initially to [**Hospital **] Hospital with neck pain.  She was found
to have an [**Street Address(2) 37683**] elevation and was transferred to the [**Hospital1 1444**] for primary percutaneous
transluminal coronary angiography.  The patient initially
developed neck and jaw pain at 07:30 the morning of
admission.  She reported nausea as well as shortness of
breath and anxiety.  She denied fever or chills,
lightheadedness or dysuria.  At the outside hospital, she was
found to be hypotensive with a blood pressure of 68/24 and a
heart rate of 58.  EKG showed anterior [**Street Address(2) 37683**] elevations.
She was placed on Integrilin, heparin, aspirin, and Atropine,
and transported to [**Hospital1 69**].  She
had also been placed on a Dopamine drip at the outside
hospital.

On the patient's arrival, a diagnostic angiogram was notable
for critical left main coronary artery disease.  The patient
became hypotensive, requiring an increase in her Dopamine
dose and placement of an intra-aortic balloon pump.  Emergent
cardiac surgery consult was obtained, however, it was felt
that the patient was a poor candidate for a coronary artery
bypass graft given her Integrilin bolus and cardiogenic
shock.  The patient thus underwent a left main intervention
as well as a proximal left anterior descending artery
intervention.  After this the patient was stabilized
hemodynamically and transferred to the Coronary Care Unit.

PAST MEDICAL HISTORY:
1.  Type 2 diabetes mellitus.
2.  Seizure disorder.
3.  Hypothyroidism.

ALLERGIES:   No known drug allergies.

MEDICATIONS:
1.  Glucotrol 10 mg p.o. twice a day.
2.  Synthroid 50 micrograms p.o. q. day.
3.  DPH, 100 mg p.o. three times a day.

PHYSICAL EXAMINATION:  In general, the patient was an 81 year
old woman, awake, alert, in no acute distress.  Temperature
is 95.5 F.; heart rate 85; blood pressure 116/60; respiratory
rate 19; oxygen saturation 97% on five liters face mask.
HEENT:  Normocephalic, atraumatic.  Pupils equally round and
reactive to light.  Oral mucosa was moist.  The neck was
supple with a 2.0 by 5.0 palpable hematoma and no bruit.  The
chest was clear to auscultation bilaterally.  Cardiovascular
examination indicated distant heart sounds; normal S1 and S2,
no murmurs, rubs or gallops.  The abdomen was soft and
nontender, not distended with normal bowel sounds.  Extremity
examination indicated no edema; peripheral pulses were
Doppler-able.  Neurologic examination was nonfocal.

LABORATORY:  On admission indicated a white blood cell count
of 20.0, hematocrit of 31.9, platelets of 246.  Chem-7 was
remarkable for a bicarbonate of 17, BUN of 35, creatinine of
1.3 and glucose of 297.  Magnesium was 1.5.  CK was 8,301
with an MB fraction of 870 and an MB index of 10.5.

Electrocardiogram indicated normal sinus rhythm, [**Street Address(2) 37683**]
elevations at leads V3 through V5.  A subsequent
electrocardiogram on arrival to [**Hospital1 188**] indicated a new right bundle branch block and leftward
axis.

Cardiac catheterization indicated a 90% proximal left main
coronary artery lesion, diffusely diseased left anterior
descending artery with a total occlusion beyond a small first
septal.  The obtuse marginal 2 was diffusely diseased with a
maximal stenosis of 70% proximally.  The dominant right
coronary artery was diffusely diseased with a maximum
stenosis of 60% proximally and 50% in the mid-vessel and it
was totally occluded distally.

Resting hemodynamics of same after placement of the
intra-aortic balloon pump revealed a mean rate atrial
pressure of 7 mm of Mercury with mild pulmonary hypertension
with pulmonary artery pressures of 38/17.  Left sided filling
pressures were severely elevated with a mean pulmonary
capillary wedge pressure of 22 mm of Mercury and a pulmonary
capillary wedge pressure A wave of 26 mm of Mercury.  Cardiac
output was mildly depressed with cardiac index of 2.3 liters
per minute per liter squared.

Echocardiogram indicated mild symmetric left ventricular
hypertrophy with an apical left ventricular aneurysm,
ejection fraction of 30% and severely hypokinetic anterior
septum and anterior free wall.  There was moderate
hypokinesis of the inferior septum and lateral wall.  There
is extensive apical akinesis and dyskinesis.

HOSPITAL COURSE:  The patient was admitted to the Coronary
Care Unit following cardiac catheterization and placement of
an intra-aortic balloon pump.  On hospital day number one,
she was started on aspirin, Plavix, heparin and Integrilin
drip.  She was also started on Lipitor.  CKs continued to
cycle and were trending down.  Digoxin was held given the
patient's potential arrhythmia risk.  On hospital day number
two, the patient was noted to have an expanding right
internal jugular hematoma with a hematocrit drop of 31 to 28.
She was transfused one unit of packed red blood cells.
Dopamine was weaned and Integrilin drip was discontinued
after 18 hours.

On hospital day number three, the patient's urine output was
noted to drop to 18 cc per hour, however, her urine output
improved in response to fluid boluses.  Her fractional
excretion of sodium was found to be 1.1% and she was thought
to have a possible type 4 renal tubular acidosis.  Her
intra-aortic balloon pump was changed from 2 to 1.

On hospital day number four, the patient was noted to have a
sudden episode of hypoxia, hypotension and increased
pulmonary artery pressure to the 70s over 30s as well as ST
elevations above her baseline in the interior leads
consistent with acute pulmonary edema.  She was given Lasix,
morphine, intravenous Nitroglycerin and sublingual
Nitroglycerin, all without relief.  Arterial blood gas
indicated a pH of 7.05, pACO2 of 31, pAO2 of 8.2.  Her
potassium was found to be 7.4.  EKG indicated new
wide-complex tachycardia consistent with AIVR.  The patient
was emergently intubated and started again on Dopamine drip
as well as Levophed drip.  She was given calcium chloride,
insulin and bicarbonate.

After being evaluated by the Interventional Cardiology
fellow, the patient was taken emergently to the
Catheterization Laboratory with a concern over stent
re-stenosis and left anterior descending dissection.  An
emergent echocardiogram obtained prior to the
re-catheterization, indicated left ventricular dysfunction
without any acute mechanical event.  Catheterization
indicated a patent left main stent as well as a 25 mm
dissection in the left anterior descending artery.  The left
circumflex artery presented for a dissection and flap at the
origin.  The patient had TIMI-III flow in her left anterior
descending and left circumflex arteries, and intra-aortic
balloon pump was reinserted.  CK was found to be 665 with an
MB fraction of 21.

The patient was maintained on pressors and intra-aortic
balloon pump and continued on pressors.  Lasix was continued
for diuresis.  On hospital day number five, the patient
became febrile with a temperature of 101.3 F.; she was
started on Vancomycin, Metronidazole, and Levofloxacin.
Chest x-ray indicated a possible left lower lobe infiltrate.

Blood cultures were sent and found to be positive in one out
of four bottles for Gram positive pairs and clusters.  Sputum
culture was sent and found to be growing out moderate
Staphylococcus aureus.  Repeat EKG indicated a new left
bundle branch concerning for possible new ischemia.

On hospital day number five, the patient was noted to have an
asystolic arrest on Telemetry.  She was given 1 mg of
Atropine and transcutaneous pacing with restitution of heart
rate to 100 and systolic blood pressure of 150.  Subsequent
EKG indicated an IVR with a rate of 85.  Her blood pressure
stabilized and she was weaned off of transcutaneous pacing.
Dopamine drip was reduced.  The asystolic arrest was thought
to be secondary to respiratory compromise and possible mucous
plugging.

A family meeting was held on hospital day number six and
given the patient's extremely poor prognosis, the decision
was made to discontinue pressors and reduce the intra-aortic
balloon pump to 1 to 4.  The patient was also made "DO NOT
RESUSCITATE".  On hospital day number seven, the patient had
a second asystolic arrest for a total of ten minutes.  She
was unresponsive to voice and painful stimuli.  Her pupils
were not reactive to light.  No heart sounds or breath or
lung sounds were heard for one minute and the patient was
pronounced deceased at 10 p.m. on [**2115-2-3**].

The family and attending physician were notified.  The family
declined a post-mortem examination.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease.
2.  Large anterior wall myocardial infarction.
3.  Respiratory failure secondary to cardiogenic shock.
4.  Type 2 diabetes mellitus.
5.  Seizure disorder.
6.  Hypothyroidism.

CONDITION AT DISCHARGE:   Deceased.



                          DR.[**Last Name (STitle) 2052**],[**First Name3 (LF) 2053**] 12-462

Dictated By:[**Last Name (NamePattern1) 194**]

MEDQUIST36

D:  [**2115-3-31**]  10:34
T:  [**2115-4-2**]  09:55
JOB#:  [**Job Number 37684**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Accidental puncture or laceration during a procedure, not elsewhere classified,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Acute kidney failure, 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: Mrs. [**Known lastname 37682**] is an 81 year old
woman with a history of type 2 diabetes mellitus and seizure
disorder without known coronary artery disease presenting
initially to [**Hospital **] Hospital with neck pain.  She was found
to have an [**Street Address(2) 37683**] elevation and was transferred to the [**Hospital1 1444**] for primary percutaneous
transluminal coronary angiography.  The patient initially
developed neck and jaw pain at 07:30 the morning of
admission.  She reported nausea as well as shortness of
breath and anxiety.  She denied fever or chills,
lightheadedness or dysuria.  At the outside hospital, she was
found to be hypotensive with a blood pressure of 68/24 and a
heart rate of 58.  EKG showed anterior [**Street Address(2) 37683**] elevations.
She was placed on Integrilin, heparin, aspirin, and Atropine,
and transported to [**Hospital1 69**].  She
had also been placed on a Dopamine drip at the outside
hospital.

MEDICAL HISTORY: 1.  Type 2 diabetes mellitus.
2.  Seizure disorder.
3.  Hypothyroidism.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Accidental puncture or laceration during a procedure, not elsewhere classified,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Acidosis,Acute kidney failure, unspecified'}
