CHIEF COMPLAINT: ST segment elevation myocardial infarction

PRESENT ILLNESS: 72 year old man DM2, HTN, hyperlipidemia, A-fib (but not taking
coumadin for the past week), ASD, h/o PE s/p IVC filter
placement, mild LV global dysfunction, mod MR, mild RV
dysfunction, developed dizziness starting 8am (no chest pain).
Went to OSH ER at 10:45 am- by this time symptoms resolved.
Found to have ST elevation in inferior leads with reciprocal
changes in in Av1 and AVL, anterior leads. BP 90's HR 60's in
a-fib. ETA 30 minutes (from [**Hospital 882**] hospital). cath reealed
multivessesl sx- midLAD 80%, D1 80-90%, mLCx 95-99%, mRCA 100%.
C-[**Doctor First Name **] decided not to take to OR related to prior sternotomy and
chronic venous disease.
In CCU- bradycardic , hypotensive --> PEA arrest-->
fluids/dopamine--> hypertensive and tachy --> Vtach--> lidocaine
--> BP high, SVT --> pt was coded for > 1hr --> taken back to
cath lab--> rec'd three RCA stents, IABP, transvenous pacer.

MEDICAL HISTORY: 1. chronic AFib/aflutter
2. ASD s/p repair [**2112**]
3. HTN
4. Hypercholesterolemia
5. DMII
6. previous DVT w/ recurrent PE; s/p filter placement in [**2095**]
c/b migration and urgent sternotomy w/ repair of atrial
perforations x2
7. Recurrent LE venous stasis ulcers s/p failed skin grafts to
site

MEDICATION ON ADMISSION: Sotalol 80 PO TID
Amlodipine 5mg daily
Coumadin
glyburide 2.5 PO twice daily
fosamax
zestril 5
lipitor 10
HCTZ 25
Tamsulosin 0.4

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: critically ill, unresponsive
HEENT: vomiting
Cards: Irregular distant sounds
Pulm: Diffusely rhoncorous, on vent
Abd: soft, no HSM
Extrem: hemosideran deposition anterior tibia B.

FAMILY HISTORY: n/c

SOCIAL HISTORY: He lives with his sister and brother-in-law.  Formerly worked
for [**Company 2318**].  Denies alcohol, drug, or tobacco use.
Cardiac complications, not elsewhere classified,Acute myocardial infarction of inferolateral wall, initial episode of care,Cardiac arrest,Cardiogenic shock,Hematemesis,Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Peripheral vascular disease, unspecified
Surg compl-heart,AMI inferolateral, init,Cardiac arrest,Cardiogenic shock,Hematemesis,Food/vomit pneumonitis,Ac systolic hrt failure,Acute kidney failure NOS,Acute respiratry failure,Chronic kidney dis NOS,Urin tract infection NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx-ven thrombosis/embols,Periph vascular dis NOS
Admission Date:  [**2118-9-4**]              Discharge Date:   [**2118-9-10**]

Date of Birth:  [**2046-8-18**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4765**]
Chief Complaint:
ST segment elevation myocardial infarction

Major Surgical or Invasive Procedure:
Heart Catheterization x2
Mechanical Ventilation
Intraaortic Balloon Pump
Thransvenous pacermaker wire

History of Present Illness:
72 year old man DM2, HTN, hyperlipidemia, A-fib (but not taking
coumadin for the past week), ASD, h/o PE s/p IVC filter
placement, mild LV global dysfunction, mod MR, mild RV
dysfunction, developed dizziness starting 8am (no chest pain).
Went to OSH ER at 10:45 am- by this time symptoms resolved.
Found to have ST elevation in inferior leads with reciprocal
changes in in Av1 and AVL, anterior leads. BP 90's HR 60's in
a-fib. ETA 30 minutes (from [**Hospital 882**] hospital). cath reealed
multivessesl sx- midLAD 80%, D1 80-90%, mLCx 95-99%, mRCA 100%.
C-[**Doctor First Name **] decided not to take to OR related to prior sternotomy and
chronic venous disease.
In CCU- bradycardic , hypotensive --> PEA arrest-->
fluids/dopamine--> hypertensive and tachy --> Vtach--> lidocaine
--> BP high, SVT --> pt was coded for > 1hr --> taken back to
cath lab--> rec'd three RCA stents, IABP, transvenous pacer.


Past Medical History:
1. chronic AFib/aflutter
2. ASD s/p repair [**2112**]
3. HTN
4. Hypercholesterolemia
5. DMII
6. previous DVT w/ recurrent PE; s/p filter placement in [**2095**]
c/b migration and urgent sternotomy w/ repair of atrial
perforations x2
7. Recurrent LE venous stasis ulcers s/p failed skin grafts to
site

Social History:
He lives with his sister and brother-in-law.  Formerly worked
for [**Company 2318**].  Denies alcohol, drug, or tobacco use.


Family History:
n/c

Physical Exam:
Gen: critically ill, unresponsive
HEENT: vomiting
Cards: Irregular distant sounds
Pulm: Diffusely rhoncorous, on vent
Abd: soft, no HSM
Extrem: hemosideran deposition anterior tibia B.


Pertinent Results:
[**2118-9-4**] 03:00PM   PT-16.9* PTT-62.2* INR(PT)-1.6*
[**2118-9-4**] 03:00PM   GLUCOSE-126* UREA N-19 CREAT-1.3* SODIUM-138
POTASSIUM-4.6 CHLORIDE-104 TOTAL CO2-26 ANION GAP-13
[**2118-9-4**] 05:30PM   HYPOCHROM-1+ ANISOCYT-NORMAL POIKILOCY-1+
MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL OVALOCYT-1+
[**2118-9-4**] 05:30PM   WBC-20.3*# RBC-3.55* HGB-11.1* HCT-33.9*
MCV-96 MCH-31.4 MCHC-32.9 RDW-16.0*
[**2118-9-4**] 09:42PM   WBC-21.1* RBC-3.31* HGB-10.5* HCT-29.6*
MCV-89# MCH-31.8 MCHC-35.6* RDW-16.3*
[**2118-9-4**] 09:42PM   CK-MB-196* MB INDX-12.0* cTropnT-10.02*
[**2118-9-4**] 09:54PM   LACTATE-2.7*
[**2118-9-4**] 09:54PM   TYPE-ART PO2-169* PCO2-38 PH-7.43 TOTAL
CO2-26 BASE XS-1

ECHOCARDIOGRAM [**2118-9-5**]
Conclusions:
The left atrium is moderately dilated. The left ventricular
cavity size is  normal. Overall left ventricular systolic
function is moderately depressed.  Resting regional wall motion
abnormalities include inferior akinesis and  inferolateral
hypokinesis (estimated ejection fraction ?40%). The right
ventricular cavity is dilated. Right ventricular systolic
function appears  depressed. [Intrinsic right ventricular
systolic function is likely more depressed given the severity of
tricuspid regurgitation.] There is abnormal  septal
motion/position consistent with right ventricular
pressure/volume  overload. The aortic root is mildly dilated.
The ascending aorta is mildly  dilated. The aortic valve
leaflets are mildly thickened. There is no aortic  valve
stenosis. Mild (1+) aortic regurgitation is seen. The mitral
valve  leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. The  tricuspid valve leaflets are mildly
thickened. Moderate [2+] tricuspid  regurgitation is seen. There
is mild pulmonary artery systolic hypertension.  There is no
pericardial effusion.

Compared to the prior study of [**2118-9-4**], findings are similar.
Aortic
regurgitation now may be slightly more prominent.

CARDIAC CATHETERIZATION [**2118-9-4**]
COMMENTS:
1) Initial angiography was unchanged from previous
catherization.  The
RCA had a 100% mid vessel occlusion with collaterals to the
distal
vessel from the left system. The LAD and CX had high grade
lesions.
2) Successful PTCA, thrombectomy, and stenting of the distal,
mid, and
ostial RCA with multiple Cypher stents.  A 2.75x16 mm Taxus was
deployed
in the distal RCA and was postdilated with a 2.75 mm NC balloon.

Overlapping 3.0x16 mm and 3.5x28 mm Taxus stents were placed in
the mid
RCA and the 3.5 mm stent was postdilated with a 3.5 mm NC
balloon.  A
3.5x16 mm Taxus stent was placed in the ostial RCA and
postdilated with
a 4.0 mm NC balloon.  Final angiography revealed <10 % residual
stenosis, no dissection, and TIMI 3 flow.  (see PTCA comments)
3) Successful placement of an IABP and transvenous pacemaker
given the
bradycardic arrest and cardiogenic shock.
4) Resting hemodynamics revealed severely elevated right and
left sided
filling pressures, moderate pulmonary hypertension, and normal
cardiac
outputs.

FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Cardiogenic shock with severely elevated left and right sided
filling
pressures with normal cardiac outputs on IABP support.
3. Acute inferior myocardial infarction, managed by acute ptca,
temporary pacemaker, and IABP.
4. PTCA of RCA vessel with multiple drug eluting stents.


Brief Hospital Course:
72yo M with multiple cardiac risk factors presented with STEMI,
found to have 3VD awaiting CABG, became HD unstable, coded >
1hr, brought back to cath lab and received four taxus stents to
RCA. Patient was stabilized in the CCU on two pressors,
intraortic balloon pump and transvenous pacer wire. These were
all weened over the course of 4 days. Through discussions of
risks and benefits with CT surgery, the patient's family, and
primary cardiologist Dr. [**Last Name (STitle) 73**] it was decided to not undergo
CABG for multivessel disease. The family decided on DNR/DNI code
status at that time. With the patient stable off IABP and
pressors he was extubated on [**2118-9-9**] however developed pulmonary
edema and increased oxygen requirement. Was placed on BiPAP as
temporizing measure. Further discussion with family confirmed
DNR/DNI status, and they later decided to make the patient
comfort measures only. Morphine drip was titrated for comfort
and air hunger. The patient was pronounced dead at 11:25am on
[**2118-9-10**].

Medications on Admission:
Sotalol 80 PO TID
Amlodipine 5mg daily
Coumadin
glyburide 2.5 PO twice daily
fosamax
zestril 5
lipitor 10
HCTZ 25
Tamsulosin 0.4


Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
ST elevation MI

Discharge Condition:
Pt Expired
{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of inferolateral wall, initial episode of care,Cardiac arrest,Cardiogenic shock,Hematemesis,Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Peripheral vascular disease, 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: ST segment elevation myocardial infarction

PRESENT ILLNESS: 72 year old man DM2, HTN, hyperlipidemia, A-fib (but not taking
coumadin for the past week), ASD, h/o PE s/p IVC filter
placement, mild LV global dysfunction, mod MR, mild RV
dysfunction, developed dizziness starting 8am (no chest pain).
Went to OSH ER at 10:45 am- by this time symptoms resolved.
Found to have ST elevation in inferior leads with reciprocal
changes in in Av1 and AVL, anterior leads. BP 90's HR 60's in
a-fib. ETA 30 minutes (from [**Hospital 882**] hospital). cath reealed
multivessesl sx- midLAD 80%, D1 80-90%, mLCx 95-99%, mRCA 100%.
C-[**Doctor First Name **] decided not to take to OR related to prior sternotomy and
chronic venous disease.
In CCU- bradycardic , hypotensive --> PEA arrest-->
fluids/dopamine--> hypertensive and tachy --> Vtach--> lidocaine
--> BP high, SVT --> pt was coded for > 1hr --> taken back to
cath lab--> rec'd three RCA stents, IABP, transvenous pacer.

MEDICAL HISTORY: 1. chronic AFib/aflutter
2. ASD s/p repair [**2112**]
3. HTN
4. Hypercholesterolemia
5. DMII
6. previous DVT w/ recurrent PE; s/p filter placement in [**2095**]
c/b migration and urgent sternotomy w/ repair of atrial
perforations x2
7. Recurrent LE venous stasis ulcers s/p failed skin grafts to
site

MEDICATION ON ADMISSION: Sotalol 80 PO TID
Amlodipine 5mg daily
Coumadin
glyburide 2.5 PO twice daily
fosamax
zestril 5
lipitor 10
HCTZ 25
Tamsulosin 0.4

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: critically ill, unresponsive
HEENT: vomiting
Cards: Irregular distant sounds
Pulm: Diffusely rhoncorous, on vent
Abd: soft, no HSM
Extrem: hemosideran deposition anterior tibia B.

FAMILY HISTORY: n/c

SOCIAL HISTORY: He lives with his sister and brother-in-law.  Formerly worked
for [**Company 2318**].  Denies alcohol, drug, or tobacco use. 

### Response:
{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of inferolateral wall, initial episode of care,Cardiac arrest,Cardiogenic shock,Hematemesis,Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Acute kidney failure, unspecified,Acute respiratory failure,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Peripheral vascular disease, unspecified'}
