CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 46 year-old
male with a history of dilated cardiomyopathy thought
secondary to chronic Lyme disease versus chronic alcohol use
with an ejection fraction of approximately 10% with clean
coronaries by recent cardiac catheterization, recently
discharged from the Cardiology Service following admission
with decompensated congestive heart failure who now returns
on [**7-6**] with cardiogenic shock.  The patient described a four
to five day history of worsening fatigue, dyspnea on exertion
and increasing chest pain.  On presentation to the outside
hospital on [**Hospital3 **] the patient was hypotensive and
tachycardic complaining of 10 out of 10 chest pain.  He
subsequently became more hypotensive with administration of
nitroglycerin.  He did not respond to morphine.
Electrocardiogram showed a left bundle branch block, which
was old.  Laboratory studies were notable for worsening
creatinine, hyperkalemia and acidosis.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Congestive heart failure, unspecified,Cardiogenic shock,Acute kidney failure, unspecified,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Hyperpotassemia,Hematoma complicating a procedure,Acute and subacute necrosis of liver,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
CHF NOS,Cardiogenic shock,Acute kidney failure NOS,Prim cardiomyopathy NEC,Parox ventric tachycard,Hyperpotassemia,Hematoma complic proc,Acute necrosis of liver,Abn react-surg proc NEC
Admission Date:  [**2134-7-6**]     Discharge Date:  [**2134-7-7**]

Date of Birth:   [**2087-9-20**]     Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 46 year-old
male with a history of dilated cardiomyopathy thought
secondary to chronic Lyme disease versus chronic alcohol use
with an ejection fraction of approximately 10% with clean
coronaries by recent cardiac catheterization, recently
discharged from the Cardiology Service following admission
with decompensated congestive heart failure who now returns
on [**7-6**] with cardiogenic shock.  The patient described a four
to five day history of worsening fatigue, dyspnea on exertion
and increasing chest pain.  On presentation to the outside
hospital on [**Hospital3 **] the patient was hypotensive and
tachycardic complaining of 10 out of 10 chest pain.  He
subsequently became more hypotensive with administration of
nitroglycerin.  He did not respond to morphine.
Electrocardiogram showed a left bundle branch block, which
was old.  Laboratory studies were notable for worsening
creatinine, hyperkalemia and acidosis.

He was treated for a question of an acute coronary syndrome
at the outside hospital with a heparin drip, Plavix and
intravenous Lopressor.  The patient apparently refused an
intrafat balloon pump and placement of a central venous line
at the outside hospital.  He was subsequently transferred to
the [**Hospital1 69**] that evening where
he had his care in the past.

On admission the patient was tachycardic and hypotensive
again complaining of chest pain.  He had minimal urine output
throughout the day.  He was noted to be hyperkalemic to 7.0
and acidotic consistent with a metabolic acidosis.  His liver
function tests and CKs were elevated consistent with
multi-organ failure in the setting of shock.  Venous access
was obtained through a left femoral line.  The patient was
started on inotropic support with Dobutamine and pressor
support with Dopamine.  The patient was given Kayexalate
bicarbonate, insulin and calcium gluconate for hyperkalemia.
Heparin drip was discontinued given the patient's
persistently elevated INR.  The patient was given one dose of
intravenous vitamin K.  We decided not to pursue a internal
jugular line and Swan-Ganz placement given his coagulopathy.
The following morning the patient did receive one unit of
fresh frozen platelets and was taken urgently to the
catheterization laboratory where a PA catheter was placed
revealing elevated biventricular pressures, clean coronary
arteries and a depressed cardiac index consistent with severe
cardiogenic shock.  The patient returned from the
catheterization laboratory on max dose of three pressors.
The patient remained hypotensive to the 60s with maps in the
40s despite the addition of a fourth pressor at max dose.

The patient subsequently experienced asystolic arrest on the
floor from which he was revived with medications and
transcutaneous pacing.  The patient subsequently arrested
again after being made DNR/DNI by his family.  The time of
death was approximately 2:00 p.m. on [**2134-7-7**].






                          [**Last Name (LF) **],[**Name8 (MD) 2064**] M.D.12-ABZ

Dictated By:[**Last Name (NamePattern4) 4689**]

MEDQUIST36

D:  [**2134-7-9**]  12:29
T:  [**2134-7-14**]  08:37
JOB#:  [**Job Number 18638**]
{'Congestive heart failure, unspecified,Cardiogenic shock,Acute kidney failure, unspecified,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Hyperpotassemia,Hematoma complicating a procedure,Acute and subacute necrosis of liver,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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 a 46 year-old
male with a history of dilated cardiomyopathy thought
secondary to chronic Lyme disease versus chronic alcohol use
with an ejection fraction of approximately 10% with clean
coronaries by recent cardiac catheterization, recently
discharged from the Cardiology Service following admission
with decompensated congestive heart failure who now returns
on [**7-6**] with cardiogenic shock.  The patient described a four
to five day history of worsening fatigue, dyspnea on exertion
and increasing chest pain.  On presentation to the outside
hospital on [**Hospital3 **] the patient was hypotensive and
tachycardic complaining of 10 out of 10 chest pain.  He
subsequently became more hypotensive with administration of
nitroglycerin.  He did not respond to morphine.
Electrocardiogram showed a left bundle branch block, which
was old.  Laboratory studies were notable for worsening
creatinine, hyperkalemia and acidosis.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Congestive heart failure, unspecified,Cardiogenic shock,Acute kidney failure, unspecified,Other primary cardiomyopathies,Paroxysmal ventricular tachycardia,Hyperpotassemia,Hematoma complicating a procedure,Acute and subacute necrosis of liver,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
