CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 81 year-old
male with a history of hypertension, coronary artery disease,
status post antral septal myocardial infarction in [**2173**],
moderate AI, preserved EF, thoracic aneurysm, left CEA,
tobacco use transferred from outside hospital for
thoracoabdominal 7.5 cm aneurysm.  Patient symptomatic
yesterday when awoke at 2:00 a.m. with sharp cutting pain in
mid to lower back that persisted prompting admission to
outside hospital.  At outside hospital received Lopresor and
nitro drip for blood pressures in the 170s.  Of note the
patient stopped taking his medications approximately four to
five years ago.  On arrival at [**Hospital1 188**] Emergency Department the blood pressure was 167/82,
heart rate 87.  The patient titrated on a nitro drip and
started on Esmolol drip. The patient was pain free.  The
patient was evaluated by both Vascular Surgery and
Cardiovascular Surgery and transferred to the Coronary Care
Unit.

MEDICAL HISTORY: 1.  Coronary artery disease status post myocardial infarction
[**2173**].
2.  Chronic renal insufficiency baseline creatinine of 1.3.
3.  Cerebrovascular accident in [**2166**] with right hemiparesis
and dysarthria status post left CEA.
4.  Chronic obstructive pulmonary disease.
5.  Hypertension.
6.  Degenerative hip disease.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: He lives alone, approximately 130 pack year
smoking history.  The patient reports approximately one beer
per day, but per discharge summary the patient with chronic
alcohol use.
Thoracoabdominal aneurysm, without mention of rupture,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Congestive heart failure, unspecified,Cardiogenic shock,Unspecified essential hypertension,Personal history of other diseases of circulatory system,Old myocardial infarction
Thracabd anurysm wo rupt,Chr airway obstruct NEC,Alcohol abuse-unspec,CHF NOS,Cardiogenic shock,Hypertension NOS,Hx-circulatory dis NEC,Old myocardial infarct
Admission Date:  [**2177-10-23**]     Discharge Date:  [**2177-10-29**]


Service:  CCU

HISTORY OF PRESENT ILLNESS:  The patient is an 81 year-old
male with a history of hypertension, coronary artery disease,
status post antral septal myocardial infarction in [**2173**],
moderate AI, preserved EF, thoracic aneurysm, left CEA,
tobacco use transferred from outside hospital for
thoracoabdominal 7.5 cm aneurysm.  Patient symptomatic
yesterday when awoke at 2:00 a.m. with sharp cutting pain in
mid to lower back that persisted prompting admission to
outside hospital.  At outside hospital received Lopresor and
nitro drip for blood pressures in the 170s.  Of note the
patient stopped taking his medications approximately four to
five years ago.  On arrival at [**Hospital1 188**] Emergency Department the blood pressure was 167/82,
heart rate 87.  The patient titrated on a nitro drip and
started on Esmolol drip. The patient was pain free.  The
patient was evaluated by both Vascular Surgery and
Cardiovascular Surgery and transferred to the Coronary Care
Unit.

PAST MEDICAL HISTORY:
1.  Coronary artery disease status post myocardial infarction
[**2173**].
2.  Chronic renal insufficiency baseline creatinine of 1.3.
3.  Cerebrovascular accident in [**2166**] with right hemiparesis
and dysarthria status post left CEA.
4.  Chronic obstructive pulmonary disease.
5.  Hypertension.
6.  Degenerative hip disease.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  The patient is not taking any regular
medications.

SOCIAL HISTORY:  He lives alone, approximately 130 pack year
smoking history.  The patient reports approximately one beer
per day, but per discharge summary the patient with chronic
alcohol use.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION:  Vital signs 97.1, blood pressure 94/41
on right and 97/43 on left on Esmolol drip, heart rate 59,
respiratory rate 12.  General, the patient appears older then
stated age, appears fatigue, but speaking with a clear voice.
HEENT unrevealing.  Cardiovascular regular rate and rhythm.
Normal S1 and S2. No murmurs.  No S3 or S4 appreciated.
Lungs clear to auscultation.  No rales, wheezes or rhonchi.
Abdomen positive bowel sounds, soft, nontender, no palpable
pulsatile mass.  Extremities no edema.  Extremities warm
throughout.  2+ radial and femoral pulses bilaterally.  1+
dorsalis pedis pulses and posterior tibial pulses
bilaterally.

DATA:  Hematocrit 43.3, BUN 19, creatinine 1.2.
Electrocardiogram normal sinus rhythm, left axis deviation,
PR .2 seconds, left ventricular hypertrophy, with left strain
pattern, T wave inversion V4 through V6, evidence of old
anteroseptal myocardial infarction.  Echocardiogram report
from outside hospital preserved left ventricular function,
moderate AI, minimal left ventricular hypokinesis.






                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5214**]

Dictated By:[**Last Name (NamePattern1) 8478**]

MEDQUIST36

D:  [**2178-2-2**]  11:26
T:  [**2178-2-4**]  11:48
JOB#:  [**Job Number 53783**]


Name: [**Known lastname 3205**],[**Known firstname 856**] F.        Unit No:  [**Numeric Identifier 9980**]

Admission Date: [**2177-10-23**]     Discharge Date: [**2177-10-29**]

Date of Birth:                  Sex:

Service:

ADDENDUM:  This is a continuation of previously interrupted
Discharge Summary.

Magnetic resonance imaging revealed thoracoabdominal aorta
with maximum dimensions of 7.7 cm X 5.8 cm at level of
diaphragm.  At the level of diaphragm, there is an intramural
hematoma, also noting multilevel penetrating ulcers.  There
is a near occlusion of the left common iliac artery just
distal to the origin.  The right common iliac artery had a
maximum measurement of 1.4 cm.  The right external iliac
artery had a proximal mild aneurysmal dilation of 1.2 cm.

BRIEF SUMMARY OF HOSPITAL COURSE:  The patient is an
81-year-old male transferred from an outside hospital with
large complicated thoracoabdominal aneurysm.

The patient was maintained on an esmolol drip in the Coronary
Care Unit with strict blood pressure and heart rate control.
The patient was determined to be a poor surgical candidate.
Therefore, the plan was for an endovascular repair of the
patient's aneurysm.

The plans for repair were complicated by the patient's mental
status and concerns regarding his ability to consent for the
procedure.  Despite extraordinary measures by the Case
Manager, no family members were able to be located or
[**Year (4 digits) 178**].  Evaluation of the benefits of the procedure and
the patient's inability to consent for the procedure were
ongoing.  The patient subsequently became suddenly
hypotensive and experienced respiratory distress.  The
patient was intubated, and aggressive resuscitation measures
were initiated with heavy fluid anatropes and chest
compression.

An electrocardiogram revealed precordial lead ST depressions,
and a bedside transthoracic echocardiogram revealed extremely
depressed left ventricular function.  His systolic blood
pressures remained low.  The etiology of the patient's
hypotension was felt likely to be cardiogenic.

Discussions amongst the Coronary Care Unit team and
Cardiothoracic surgeons resulted in the decision that further
aggressive resuscitation measures, including cardiac
catheterization or surgery, would be unlikely to improve the
patient's prognosis.  Therefore, further cardiopulmonary
resuscitation and resuscitation were deemed to be medically
futile.

Time of death was [**2177-10-29**] at 10:06 a.m.

Of note, again, extensive measures were taken to locate the
patient's family and friends; however, these were
unsuccessful.  Given that no family was able to be [**Name (NI) 178**],
and autopsy could not be obtained.  Therefore, the exact
cause of death was unknown.








Dictated By:[**Last Name (NamePattern1) 9981**]

MEDQUIST36

D:  [**2178-2-2**]  11:36
T:  [**2178-2-4**]  12:16
JOB#:  [**Job Number 9982**]
{'Thoracoabdominal aneurysm, without mention of rupture,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Congestive heart failure, unspecified,Cardiogenic shock,Unspecified essential hypertension,Personal history of other diseases of circulatory system,Old myocardial infarction'}


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 an 81 year-old
male with a history of hypertension, coronary artery disease,
status post antral septal myocardial infarction in [**2173**],
moderate AI, preserved EF, thoracic aneurysm, left CEA,
tobacco use transferred from outside hospital for
thoracoabdominal 7.5 cm aneurysm.  Patient symptomatic
yesterday when awoke at 2:00 a.m. with sharp cutting pain in
mid to lower back that persisted prompting admission to
outside hospital.  At outside hospital received Lopresor and
nitro drip for blood pressures in the 170s.  Of note the
patient stopped taking his medications approximately four to
five years ago.  On arrival at [**Hospital1 188**] Emergency Department the blood pressure was 167/82,
heart rate 87.  The patient titrated on a nitro drip and
started on Esmolol drip. The patient was pain free.  The
patient was evaluated by both Vascular Surgery and
Cardiovascular Surgery and transferred to the Coronary Care
Unit.

MEDICAL HISTORY: 1.  Coronary artery disease status post myocardial infarction
[**2173**].
2.  Chronic renal insufficiency baseline creatinine of 1.3.
3.  Cerebrovascular accident in [**2166**] with right hemiparesis
and dysarthria status post left CEA.
4.  Chronic obstructive pulmonary disease.
5.  Hypertension.
6.  Degenerative hip disease.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: He lives alone, approximately 130 pack year
smoking history.  The patient reports approximately one beer
per day, but per discharge summary the patient with chronic
alcohol use. 

### Response:
{'Thoracoabdominal aneurysm, without mention of rupture,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Congestive heart failure, unspecified,Cardiogenic shock,Unspecified essential hypertension,Personal history of other diseases of circulatory system,Old myocardial infarction'}
