CHIEF COMPLAINT: Acute mycardial infarction

PRESENT ILLNESS: This 71 year old white male presents with a one week history of
chest burning and reflux like symptoms. He states that
approximately one week ago he noticed that he had more symptoms
of acid reflux. He also stated that he had a burning chest
discomfort while at rest and occasionally with exertion.

MEDICAL HISTORY: hypertension
hyperlipidemia
Noninsulin dependent diabetes mellitus
benign prostatic hypertrophy
spinal stenosis

MEDICATION ON ADMISSION: - metformin (dose unknown)
- glipizide (dose unknown)
- finasteride (dose unknown)
- lisinopril (dose unknown)
- simvastatin (dose unknown)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: denies
-ETOH: quit 30yrs ago, used to drink occasionally on weekends
-Illicit drugs: denies
Acute myocardial infarction of other anterior wall, initial episode of care,Acute respiratory failure,Acute kidney failure, unspecified,Acquired cardiac septal defect,Aneurysm of heart (wall),Acidosis,Cardiac arrest,Cardiogenic shock,Other chronic pulmonary heart diseases,Tachypnea,Oliguria and anuria,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Spinal stenosis, unspecified region,Encounter for palliative care
AMI anterior wall, init,Acute respiratry failure,Acute kidney failure NOS,Acq cardiac septl defect,Aneurysm of heart,Acidosis,Cardiac arrest,Cardiogenic shock,Chr pulmon heart dis NEC,Tachypnea,Oliguria & anuria,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,BPH w/o urinary obs/LUTS,Spinal stenosis NOS,Encountr palliative care
Admission Date:  [**2112-1-8**]              Discharge Date:   [**2112-1-12**]

Date of Birth:  [**2040-9-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Acute mycardial infarction

Major Surgical or Invasive Procedure:
Right and left heart catheterization, coronary
angioplasty/stent,placement of intraaortic balloon pump [**2112-1-8**]

Emergent coronary artery artey bypass graft
x2(SVG-LAD,SVG-DG),closure of ventricular septal defect,
resection of right ventricular aneurysm [**2112-1-10**]

Right and left heart catheterization,placement of intraaortic
balloon pump [**2112-1-10**]

History of Present Illness:
This 71 year old white male presents with a one week history of
chest burning and reflux like symptoms. He states that
approximately one week ago he noticed that he had more symptoms
of acid reflux. He also stated that he had a burning chest
discomfort while at rest and occasionally with exertion.

On the night of [**1-7**], the patient stated that his heartburn
became unbearable and he decided to seek treatment at [**Hospital1 18**]
Neeham. Records are not available from his presentation, but he
reportedly was found to have ST elevation inferiorly. He was
given ASA 325mg, a Heparin bolus and drip, high dose statin, IV
Lopressor, and Plavix 600mg and transferred to [**Hospital1 18**] for
catheterization. Hisvital signs were reportedly stable, with BP
in low 100s systolic.

On transfer, he was found to have a systolic BP in 70s and was
started on Dopamine. At catheterization he was found to have an
occluded proximal RCA and recieved three drug eluting stents.
70% LAD and 60% Diag lesions were not intervened upon. He was
found to have elevated right sided pressures with an elevated
wedge pressure.

On transfer to the CCU, he complained of persistent [**2-17**] mid
sternal chest pain. EKG showed inferior Q waves and pain was
resolved with morphine.


Past Medical History:
hypertension
hyperlipidemia
Noninsulin dependent diabetes mellitus
benign prostatic hypertrophy
spinal stenosis


Social History:
-Tobacco history: denies
-ETOH: quit 30yrs ago, used to drink occasionally on weekends
-Illicit drugs: denies


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
Admission:

GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Unable to appropriately assess JVP as patient recumbent.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR. Unable to assess for m/r/g as IABP in plae.
LUNGS: CTA anterolaterally
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: Multiple tatoos on arms and chest
PULSES:
Right: Carotid 2+ DP/PT dopplerable
Left: Carotid 2+ DP/PT dopplerable


Pertinent Results:
Cardiac catheterization [**2112-1-8**]:
1. Two vessel coronary artery disease.
2. Successful placement of an intra-aortic balloon pump.
3. Successful suction thrombectomy, PTCA, and stenting of the
proximal
RCA.

Echo [**2112-1-8**]: The left atrium is mildly dilated. Left
ventricular wall thicknesses are normal. The left ventricular
cavity size is normal for the patient's body size. There is mild
regional left ventricular systolic dysfunction with inferior,
inferolateral and basal inferoseptal akinesis. The remaining
segments contract normally (LVEF = 40%). There is no ventricular
septal defect. The right ventricular cavity is moderately
dilated with severe global free wall hypokinesis. The aortic
root is moderately dilated at the sinus level. The ascending
aorta is mildly dilated. Trace aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. An eccentric, posteriorly-directed jet of
moderate (2+) mitral regurgitation is seen. There is mild
pulmonary artery systolic hypertension. There is no pericardial
effusion.

[**2112-1-8**] 03:05AM BLOOD WBC-10.6 RBC-3.85* Hgb-11.4* Hct-33.2*
MCV-86 MCH-29.7 MCHC-34.4 RDW-14.2 Plt Ct-241
[**2112-1-8**] 03:05AM BLOOD PT-13.2 PTT-46.8* INR(PT)-1.1
[**2112-1-8**] 03:05AM BLOOD Glucose-404* UreaN-17 Creat-0.8 Na-137
K-4.0 Cl-107 HCO3-20* AnGap-14
[**2112-1-8**] 03:05AM BLOOD CK(CPK)-553*
[**2112-1-8**] 11:13AM BLOOD CK(CPK)-805*
[**2112-1-8**] 03:05AM BLOOD CK-MB-60* MB Indx-10.8* cTropnT-2.46*
[**2112-1-8**] 11:13AM BLOOD CK-MB-89* MB Indx-11.1*
[**2112-1-8**] 03:05AM BLOOD Calcium-7.9* Phos-3.5 Mg-1.9 Cholest-137
[**2112-1-8**] 03:05AM BLOOD %HbA1c-6.2*

Brief Hospital Course:
Following admission on the 28th Dopamaine was begun and he went
to the cath lab where stenting to the RCA was performed with
three stents and an intraaortic balloon pump was placed for
hypotension.  His hemodynamics stablized somewhat, however, he
remained Dopamine dependent.  He continued to have stuttering
angina treated with Morphine. The balloon pump was removed on
the 30th.

An echo on the 31st demonstrated a VSD.  He remained in
cardiogenic-shock.  He was hemodynamically unstable on pressors.
 He was acidotic with a pH 7.18 and lactate over 11.  He went
emergently to the cath lab again where another balloon pump was
placed, then taken to the Operating Room.  The ventricular
septal defect was repaired, the right ventricular aneurysm was
resected and two vein grafts were performed.  He weaned from
bypass on high dose pressors.  The chest was left open. See
operative note for details.

He remained in cardiogenic shock after surgery on high dose
Epinephrine, Levophed, Neo-Synephrine and Vasopressin as well as
the intraaortic balloon pump. He was paralyzed and sedated due
to the open chest.

Lactates rose, fell and rose again. His extremeties were cold
and mottled, he was profoundly acidotic, despite bicarbonate
boluses, THAM infusions.  His LFTs continued to rise and he was
auto-anticoagulated with an INR of 4.6 and PTT in the 70s. The
lactate rose to 15.2 with persistent LFT increases by 0200 on
[**1-12**].

Transplant surgery was consulted for the persisitent acidosis
with elevated LFTs and felt that there was no role for
laparoscopy given his shock and the unlikelihood of finding a
discreet reparable source.  Vascular surgery saw him for the
cold extremeties.

Despite high dose pressors and other manipulations he remained
hypotensive and in cardiogenic-shock. His son visited the
bedside and he was aware of the grave nature of the patient's
condition.  After discussion with the family, it was decided to
not initiate CPR.  The patient did expire surrounded by family.


Medications on Admission:
- metformin (dose unknown)
- glipizide (dose unknown)
- finasteride (dose unknown)
- lisinopril (dose unknown)
- simvastatin (dose unknown)


Discharge Disposition:
Expired

Discharge Diagnosis:
Acute myocardial infarction with cardiogenic shock
Post infarct ventricular septal defect
post infarct right ventricular aneurysm
hypertension
hyperlipidemia
Intraaortic balloon insertion x2
s/p emergent coronary artery bypass graft x 2,closure of
ventricular septal defect, resection right ventricular aneurysm
s/p coronary angioplasty and stent
Noninsulin dependent diabetes mellitus
benign prostatic hypertrophy
spinal stenosis


Discharge Condition:
expired


Completed by:[**2112-1-12**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute respiratory failure,Acute kidney failure, unspecified,Acquired cardiac septal defect,Aneurysm of heart (wall),Acidosis,Cardiac arrest,Cardiogenic shock,Other chronic pulmonary heart diseases,Tachypnea,Oliguria and anuria,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Spinal stenosis, unspecified region,Encounter for palliative care'}


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: Acute mycardial infarction

PRESENT ILLNESS: This 71 year old white male presents with a one week history of
chest burning and reflux like symptoms. He states that
approximately one week ago he noticed that he had more symptoms
of acid reflux. He also stated that he had a burning chest
discomfort while at rest and occasionally with exertion.

MEDICAL HISTORY: hypertension
hyperlipidemia
Noninsulin dependent diabetes mellitus
benign prostatic hypertrophy
spinal stenosis

MEDICATION ON ADMISSION: - metformin (dose unknown)
- glipizide (dose unknown)
- finasteride (dose unknown)
- lisinopril (dose unknown)
- simvastatin (dose unknown)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: denies
-ETOH: quit 30yrs ago, used to drink occasionally on weekends
-Illicit drugs: denies 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute respiratory failure,Acute kidney failure, unspecified,Acquired cardiac septal defect,Aneurysm of heart (wall),Acidosis,Cardiac arrest,Cardiogenic shock,Other chronic pulmonary heart diseases,Tachypnea,Oliguria and anuria,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Spinal stenosis, unspecified region,Encounter for palliative care'}
