CHIEF COMPLAINT: 

PRESENT ILLNESS: 

MEDICAL HISTORY: 1. Coronary artery disease.  He had a
catheterization in [**11-15**] which revealed three vessel disease,
at which time it was determined to medically manage.  2.
Hypertension.  3. Hyperlipidemia.  4. Aortic regurgitation.
5. Mitral regurgitation.  6. Lung cancer status post right
pneumonectomy.  7. Hypothyroidism.  8. Bladder cancer treated
with BCG.  9. Anemia.  10. Macular degeneration.  11.
Bilateral hearing loss.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of unspecified site, initial episode of care,Mitral valve insufficiency and aortic valve insufficiency,Rheumatic heart failure (congestive),Pneumonitis due to inhalation of food or vomitus,Acidosis,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension
AMI NOS, initial,Mitral/aortic val insuff,Rheumatic heart failure,Food/vomit pneumonitis,Acidosis,Pure hypercholesterolem,Hypothyroidism NOS,Hypertension NOS
Admission Date:  [**2141-3-18**]     Discharge Date:  [**2141-3-26**]


Service:

HISTORY:  This is a [**Age over 90 **]-year-old male originally admitted to
the C-Med service.  He was later transferred to the CCU.
This is a [**Age over 90 **]-year-old gentleman with a past medical history
of three vessel coronary artery disease which included a 90%
stenosis of the right coronary artery, a 70% proximal lesion,
along with a 90% distal lesion in the LAD, and a 100% lesion
in the circumflex, who was admitted to the C-Med service
following a one day history of chest pain.  He also reported
shortness of breath, but denied nausea, vomiting, and
diaphoresis.  At home, before coming to the hospital, the
patient took three doses of sublingual nitro with minimal
relief and the pain started to increase and radiate down his
left arm, at which point he decided to go to the Emergency
Room.  In the Emergency Room, his cardiac enzymes showed flat
CK's, but his troponins were slightly elevated with values of
4.4 and 4.1.  He was then transferred to the C-Med service
for further evaluation.  While on the floor he was extremely
hypertensive with a blood pressure of approximately 200
systolic.  At that time, he was given a dose of hydralazine
and became hypotensive and complained of severe stabbing
chest pain.  A stat EKG showed ST depressions in leads V3
through V6 and it was determined to transfer the patient to
the CCU.  An arterial line and a femoral line were placed
emergently.  He was started up on dopamine and an Integrilin
drip.  During the initial few minutes of his time in CCU, he
vomited twice and he became bradycardiac down into the range
of 20's to 30's.  It was determined to intubate the patient
to protect his airway.  He was sedated with fentanyl and
Versed.

PAST MEDICAL HISTORY:  1. Coronary artery disease.  He had a
catheterization in [**11-15**] which revealed three vessel disease,
at which time it was determined to medically manage.  2.
Hypertension.  3. Hyperlipidemia.  4. Aortic regurgitation.
5. Mitral regurgitation.  6. Lung cancer status post right
pneumonectomy.  7. Hypothyroidism.  8. Bladder cancer treated
with BCG.  9. Anemia.  10. Macular degeneration.  11.
Bilateral hearing loss.

ALLERGIES:  He has no known drug allergies.

MEDICATIONS:  Aspirin, 81 q d; Lopressor, 50 b.i.d.; Levoxyl,
100 mcg; Detrol; Lipitor; Imdur, 60 q d; Zestril, 10 q d.

CARDIAC HISTORY:  He had a catheterization in [**11-15**] which
showed his left ventricular ejection fraction to be
approximately 46%.  His anterior and apical walls were
hypokinetic.  His inferior wall was mildly hypokinetic.  The
proximal RCA was 90% stenosed.  His right PDA was 90%
stenosed.  His left main showed 30% stenosis.  His LAD showed
a proximal 70% lesion and a distal 90% lesion.  His first
diagonal showed a 60% lesion.  His proximal circumflex was
100% occluded.

LABORATORY/DIAGNOSTICS:  His initial labs upon admission
showed a white blood count of 6.1, a hematocrit of 37.1, a
platelet count of 231.  PT of 12, PTT of 24.6, an INR of 1.
His first two CK values were 88 and 74.  His first two
troponins were 4.1 and 4.4.

His EKG showed a sinus rhythm at 90 beats per minute, left
axis deviated, with ST depressions in leads I, II, and III,
AVL, and V3 through V6.

PHYSICAL EXAMINATION:  He was afebrile with a blood pressure
of 90/43 for a MAP of 50 on levo and dopamine.  His heart
rate was 110, his respiratory rate was 13.  His oxygen
saturations were 96% on room air.  In general, this is a
frail appearing gentleman who was sedated, intubated, and
unresponsive.  His cardiac exam revealed a heart that was
tachycardiac, had a II/VI systolic ejection murmur that
radiated to the axilla and also to the carotids.  His
pulmonary exam, he was without breath sounds on the right.
He had decreased breath sounds on the left consistent with
COPD.  His abdomen was soft, nontender, nondistended.  His
extremities showed +1 pulses bilaterally without edema,
cyanosis or clubbing.

HOSPITAL COURSE:  This [**Age over 90 **]-year-old man with a history of
three vessel coronary artery disease, aortic regurgitation,
mitral regurgitation was admitted emergently following a
hypotensive episode on the floor.  He showed ST depressions
in leads V4 through V6 following a dose of hydralazine.  His
problems included the following:  1. Cardiac.  The patient
was continued on aspirin, Lipitor, and a low dose beta
blocker, during his stay.  He had several episodes of
supraventricular tachycardia and he was placed on amiodarone
which controlled the SVT.  2. Pulmonary.  The patient was
ventilated throughout his stay.  On [**3-25**], an attempt was made
to wean him off the ventilator.  He became hypotensive,
tachycardiac, and his oxygen saturations dropped
significantly.  He was placed back on BIPAP.  Following a
discussion with his family, it was determined that they would
make him a Do No Resuscitate, Do Not Intubate.  A chest x-ray
revealed a likely aspiration pneumonia in the lower lobe of
his left lung.  3. Infection.  The patient was placed on a
broad-spectrum of antibiotics to cover his infection.
Unfortunately, the patient continues to decompensate and he
passed away on [**2141-3-26**].  He was in the CCU from [**3-18**] to [**3-26**]
when he passed away likely secondary to a combination of
sepsis and respiratory arrest.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1211**], M.D.  [**MD Number(1) 1212**]

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

MEDQUIST36

D:  [**2141-4-12**]  10:04
T:  [**2141-4-12**]  10:14
JOB#:  [**Job Number **]
{'Acute myocardial infarction of unspecified site, initial episode of care,Mitral valve insufficiency and aortic valve insufficiency,Rheumatic heart failure (congestive),Pneumonitis due to inhalation of food or vomitus,Acidosis,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}


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: 

MEDICAL HISTORY: 1. Coronary artery disease.  He had a
catheterization in [**11-15**] which revealed three vessel disease,
at which time it was determined to medically manage.  2.
Hypertension.  3. Hyperlipidemia.  4. Aortic regurgitation.
5. Mitral regurgitation.  6. Lung cancer status post right
pneumonectomy.  7. Hypothyroidism.  8. Bladder cancer treated
with BCG.  9. Anemia.  10. Macular degeneration.  11.
Bilateral hearing loss.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Mitral valve insufficiency and aortic valve insufficiency,Rheumatic heart failure (congestive),Pneumonitis due to inhalation of food or vomitus,Acidosis,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}
