CHIEF COMPLAINT: ST Elevations s/p fall

PRESENT ILLNESS: 79 y/o M with PMH of DM type II, MI, TIA who presented to OSH
with syncope. Pt reports feeling fatigued for past few weeks.
Was walking back to bed from bathroom this am and fell. Does not
recall lightheadedness of palpatations prior to fall. His wife
heard him fall and called EMS and pt was taken to OSH. No OSH
records available. Per report from [**Name (NI) **] pt was found to have
troponin of 1.06 and ECG with 1mm STE v1-v2, ST depression II
and AVF, V4-v6. Head CT negative. Pt transferred to [**Hospital1 18**] for
further management. In the ED, initial vitals were T 97.4 HR 52
RR 18, O2 sat 100% BP 173/99. Pt evaluated by Cardiology. Given
ASA 325mg. Given INR of 2.4 heparin gtt and plavix was held. As
he was clinically stable and with Cr of 3.3, planned cath in am
with renal consult. Repeat Head CT repeated with no evidence of
acute infarct or bleed.
.
On review of systems, positive for prior history of stroke and
TIA, no hx of deep venous thrombosis, pulmonary embolism,
bleeding at the time of surgery, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. He denies recent fevers,
chills or rigors. All of the other review of systems were
negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. DM(II) c/b neuropathy s/p partial R toe amp ('[**65**])
2. PVD s/p R AK [**Doctor Last Name **]-DP BPG ('[**65**]) and L [**Doctor Last Name **]-DP ('[**63**])
3. HTN
4. lipid
5. seizure d/o
5. Fe deficiency anemia
6. CKD
7. h/o squamous cell carcinoma s/p excision

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] 10 mg daily
FUROSEMIDE [LASIX] - 40 mg Tablet - [**1-13**] tablet Tablet(s) by
mouth twice daily
ISOSORBIDE DINITRATE - 30 mg Tablet - [**1-13**] Tablet(s) by mouth
twice daily
METOPROLOL SUCCINATE - 100 mg Tablet [**Hospital1 **]
NITROGLYCERIN prn
WARFARIN - 5 mg
VITAMIN A-VIT C-VIT E-ZINC-CU

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T 96.1, BP 144/90, HR 50, RR 20, 100% 4L NC
GENERAL: elderly male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NC. Midline frontal scalp laceration. Sclera anicteric.
PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the
oral mucosa. No xanthalesma.
NECK: Supple with JVP to earlobe
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. bibasilar crackles
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
PULSES:
Right: Carotid 2+ Femoral 2+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ DP 1+ PT 1+

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: He quit smoking over 30 years ago and he does not drink
alcoholic
drinks. He currently lives at home with his wife. Retired sales
marketing consultant.
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Acute respiratory failure,Hematoma complicating a procedure,Chronic kidney disease, Stage IV (severe),Chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Cardiac arrest,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hyperpotassemia,Anemia in chronic kidney disease,Epilepsy, unspecified, without mention of intractable epilepsy,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
Subendo infarct, initial,Acute kidney failure NOS,Acute respiratry failure,Hematoma complic proc,Chr kidney dis stage IV,Chr systolic hrt failure,Crnry athrscl natve vssl,Cardiac arrest,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hyperpotassemia,Anemia in chr kidney dis,Epilep NOS w/o intr epil,Hyperlipidemia NEC/NOS,Hy kid NOS w cr kid I-IV
Admission Date:  [**2168-7-26**]              Discharge Date:   [**2168-7-31**]

Date of Birth:  [**2088-10-14**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
ST Elevations s/p fall

Major Surgical or Invasive Procedure:
Transvenous pacing wire
Left femoral central venous line
Right Subclavian venous line

History of Present Illness:
79 y/o M with PMH of DM type II, MI, TIA who presented to OSH
with syncope. Pt reports feeling fatigued for past few weeks.
Was walking back to bed from bathroom this am and fell. Does not
recall lightheadedness of palpatations prior to fall. His wife
heard him fall and called EMS and pt was taken to OSH. No OSH
records available. Per report from [**Name (NI) **] pt was found to have
troponin of 1.06 and ECG with 1mm STE v1-v2, ST depression II
and AVF, V4-v6. Head CT negative. Pt transferred to [**Hospital1 18**] for
further management. In the ED, initial vitals were T 97.4 HR 52
RR 18, O2 sat 100% BP 173/99. Pt evaluated by Cardiology. Given
ASA 325mg. Given INR of 2.4 heparin gtt and plavix was held. As
he was clinically stable and with Cr of 3.3, planned cath in am
with renal consult. Repeat Head CT repeated with no evidence of
acute infarct or bleed.
.
On review of systems, positive for prior history of stroke and
TIA, no hx of deep venous thrombosis, pulmonary embolism,
bleeding at the time of surgery, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. He denies recent fevers,
chills or rigors. All of the other review of systems were
negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.


Past Medical History:
1. DM(II) c/b neuropathy s/p partial R toe amp ('[**65**])
2. PVD s/p R AK [**Doctor Last Name **]-DP BPG ('[**65**]) and L [**Doctor Last Name **]-DP ('[**63**])
3. HTN
4. lipid
5. seizure d/o
5. Fe deficiency anemia
6. CKD
7. h/o squamous cell carcinoma s/p excision

Social History:
He quit smoking over 30 years ago and he does not drink
alcoholic
drinks. He currently lives at home with his wife. Retired sales
marketing consultant.


Family History:
No family history of early MI, otherwise non-contributory.

Physical Exam:
VS: T 96.1, BP 144/90, HR 50, RR 20, 100% 4L NC
GENERAL: elderly male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NC. Midline frontal scalp laceration. Sclera anicteric.
PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the
oral mucosa. No xanthalesma.
NECK: Supple with JVP to earlobe
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. bibasilar crackles
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
PULSES:
Right: Carotid 2+ Femoral 2+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ DP 1+ PT 1+


Pertinent Results:
CXR line placement [**7-30**]:  In comparison with study of [**7-26**],
there is now an endotracheal tube in place with its tip
approximately 6 cm above the carina. Right subclavian catheter
extends to the mid-to-lower portion of the SVC. Nasogastric tube
extends at least to the upper body of the stomach.The cardiac
silhouette remains at the upper limits of normal in size. The
pulmonary vasculature is within normal limits and there is no
acute pneumonia.
.
CXR [**7-31**]: In comparison with the study of [**7-30**], the endotracheal
tube tip
again is well above the carina, about 5.8 cm. Nasogastric tube
and right
jugular catheter remain in place. Little change in the
appearance of the
heart and lungs.
[**2168-7-29**] 07:10AM BLOOD WBC-4.8 RBC-3.58* Hgb-10.7* Hct-33.6*
MCV-94 MCH-30.0 MCHC-31.9 RDW-15.0 Plt Ct-133*
[**2168-7-30**] 07:58PM BLOOD WBC-6.9 RBC-3.31* Hgb-9.9* Hct-31.2*
MCV-94 MCH-29.8 MCHC-31.6 RDW-15.0 Plt Ct-88*
[**2168-7-30**] 08:22PM BLOOD WBC-5.5 RBC-3.11* Hgb-9.4* Hct-30.0*
MCV-97 MCH-30.1 MCHC-31.2 RDW-14.9 Plt Ct-121*
[**2168-7-31**] 05:23AM BLOOD WBC-6.2 RBC-3.08* Hgb-9.3* Hct-28.3*
MCV-92 MCH-30.1 MCHC-32.7 RDW-15.5 Plt Ct-138*
[**2168-7-26**] 07:50PM BLOOD Glucose-102 UreaN-72* Creat-3.3* Na-143
K-4.5 Cl-102 HCO3-28 AnGap-18
[**2168-7-30**] 07:30AM BLOOD Glucose-163* UreaN-85* Creat-3.8* Na-136
K-4.9 Cl-101 HCO3-25 AnGap-15
[**2168-7-30**] 07:58PM BLOOD Glucose-238* UreaN-89* Creat-3.9* Na-134
K-5.8* Cl-101 HCO3-18* AnGap-21*
[**2168-7-31**] 05:23AM BLOOD Glucose-83 UreaN-89* Creat-4.2* Na-137
K-5.7* Cl-105 HCO3-22 AnGap-16
[**2168-7-27**] 05:45AM BLOOD ALT-128* AST-117* CK(CPK)-191*
AlkPhos-217* TotBili-0.6
[**2168-7-27**] 05:45AM BLOOD CK-MB-9 cTropnT-0.45*
[**2168-7-27**] 05:15PM BLOOD CK(CPK)-243*
[**2168-7-27**] 05:15PM BLOOD CK-MB-10 MB Indx-4.1 cTropnT-0.74*
[**2168-7-28**] 03:10PM BLOOD CK(CPK)-293*
[**2168-7-28**] 03:10PM BLOOD CK-MB-10 MB Indx-3.4 cTropnT-0.63*
.
[**2168-7-30**] 08:22PM BLOOD CK(CPK)-216*
[**2168-7-30**] 08:22PM BLOOD CK-MB-11* MB Indx-5.1 cTropnT-0.56*
[**2168-7-31**] 05:23AM BLOOD CK(CPK)-206*
[**2168-7-31**] 05:23AM BLOOD CK-MB-13* MB Indx-6.3* cTropnT-0.71*
.
[**2168-7-30**] 08:21PM BLOOD Type-ART pO2-370* pCO2-35 pH-7.26*
calTCO2-16* Base XS--10
[**2168-7-30**] 09:44PM BLOOD Type-ART Temp-36.7 pO2-394* pCO2-31*
pH-7.43 calTCO2-21 Base XS--2 Intubat-INTUBATED
[**2168-7-31**] 12:33AM BLOOD Type-ART Temp-35.6 Rates-20/20 Tidal
V-500 PEEP-8 FiO2-50 pO2-100 pCO2-32* pH-7.45 calTCO2-23 Base
XS-0 -ASSIST/CON Intubat-INTUBATED
[**2168-7-31**] 05:22AM BLOOD Type-ART Temp-35.6 Rates-14/8 Tidal V-500
PEEP-8 FiO2-50 pO2-164* pCO2-36 pH-7.43 calTCO2-25 Base XS-0
-ASSIST/CON Intubat-INTUBATED
[**2168-7-31**] 09:31AM BLOOD Type-ART pO2-64* pCO2-40 pH-7.29*
calTCO2-20* Base XS--6
[**2168-7-30**] 08:21PM BLOOD Glucose-258* Lactate-7.7* Na-132* K-5.3
Cl-102
[**2168-7-30**] 09:44PM BLOOD Lactate-3.4* K-5.1
[**2168-7-31**] 05:22AM BLOOD Lactate-1.3
[**2168-7-31**] 09:31AM BLOOD Lactate-10.1* K-5.0

Brief Hospital Course:
79 y/o with PMHx of DMII, CVA, PVD s/p bilateral LE [**Doctor Last Name **]-DP
bypass, CKD & h/o vasovagal syncope who initially presented to
OSH with syncope and was transferred to [**Hospital1 18**] with possible
NSTEMI that was being medically managed due to stage IV CKD &
severe PVD. Pt was also being evaluated by EP for possible
pacemaker placement due to vasovagal syncope and bradycardia.
However, pt had ultimately decided against pacemaker placement.
On the evening of [**7-30**], pt was having a BM & called for
assistance. Pt was initially responding appropriately but wasn't
feeling well and asked for help with getting back to bed. Upon
standing, pt collapsed onto nurse and was unresponsive. Pt was
transferred to bed & code blue was called.
.
Pt was found unresponsive without palpable pulses. CPR was
initiated and first rhythm check revealed PEA. Pt received Epi,
Dextrose & Insulin, next rhythm showed sinus bradycardia in 30s.
Pt received Atropine, and HR came up to 50-60s with palpable
pulses. Pt had already been intubated at this time & pt was
attempting to remove the ETT. PIV had become infiltrated &
surgery had a difficult time with femoral access. Both femoral
groins were attempted for access and ultimately, a right
subclavian line was placed. Left femoral hematoma developped and
groin pressure was being held bilaterally. Pt received propofol
& IM ativan with more appropriate sedation prior to transfer.
.
Initial ABG on arrival to the ICU revealed an elevated lactate,
K of 5.9 and pH of 7.26.  However, pt was oxygenating well on
the vent and his ABG improved overnight with IVF.  Hyperkalemia
was treated with IV calcium and potassium trended down on repeat
labs with insulin, dextrose & kayexalate. Lactate trended down
to normal range & pH normalized. Pt did not require pressors
overnight and maintained BP well despite being in a junctional
rhythm in the 40s.  The am labs revealed at a stable hematocrit
and elevated potassium of 5.8. Pt was again treated with
dextrose, insulin & kayexalate.  However, sBP dropped to the
80-90s and HR began to trend down to 30s, pt was started on
Dopamine gtt & EP called urgently to place transvenous
pacemaker. However, pt became asystolic at 8:45am and PEA code
was initiated.  CPR was delivered continuously and transvenous
pacer was placed at the bedside.  However, despite all
resuscitative efforts, pt expired on the morning of [**2168-7-31**].


Medications on Admission:
ATORVASTATIN [LIPITOR] 10 mg daily
FUROSEMIDE [LASIX] - 40 mg Tablet - [**1-13**] tablet Tablet(s) by
mouth twice daily
ISOSORBIDE DINITRATE - 30 mg Tablet - [**1-13**] Tablet(s) by mouth
twice daily
METOPROLOL SUCCINATE - 100 mg Tablet [**Hospital1 **]
NITROGLYCERIN prn
WARFARIN - 5 mg
VITAMIN A-VIT C-VIT E-ZINC-CU


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
Primary:
Bradycardia
NSTEMI
Pulseless arrest
.
Secondary:
Type II DM
PVD s/p bilateral revascularization
Hypertension
Stage IV CKD
Recurrent Syncope

Discharge Condition:
Expired
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Acute respiratory failure,Hematoma complicating a procedure,Chronic kidney disease, Stage IV (severe),Chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Cardiac arrest,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hyperpotassemia,Anemia in chronic kidney disease,Epilepsy, unspecified, without mention of intractable epilepsy,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or 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 Elevations s/p fall

PRESENT ILLNESS: 79 y/o M with PMH of DM type II, MI, TIA who presented to OSH
with syncope. Pt reports feeling fatigued for past few weeks.
Was walking back to bed from bathroom this am and fell. Does not
recall lightheadedness of palpatations prior to fall. His wife
heard him fall and called EMS and pt was taken to OSH. No OSH
records available. Per report from [**Name (NI) **] pt was found to have
troponin of 1.06 and ECG with 1mm STE v1-v2, ST depression II
and AVF, V4-v6. Head CT negative. Pt transferred to [**Hospital1 18**] for
further management. In the ED, initial vitals were T 97.4 HR 52
RR 18, O2 sat 100% BP 173/99. Pt evaluated by Cardiology. Given
ASA 325mg. Given INR of 2.4 heparin gtt and plavix was held. As
he was clinically stable and with Cr of 3.3, planned cath in am
with renal consult. Repeat Head CT repeated with no evidence of
acute infarct or bleed.
.
On review of systems, positive for prior history of stroke and
TIA, no hx of deep venous thrombosis, pulmonary embolism,
bleeding at the time of surgery, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. He denies recent fevers,
chills or rigors. All of the other review of systems were
negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. DM(II) c/b neuropathy s/p partial R toe amp ('[**65**])
2. PVD s/p R AK [**Doctor Last Name **]-DP BPG ('[**65**]) and L [**Doctor Last Name **]-DP ('[**63**])
3. HTN
4. lipid
5. seizure d/o
5. Fe deficiency anemia
6. CKD
7. h/o squamous cell carcinoma s/p excision

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] 10 mg daily
FUROSEMIDE [LASIX] - 40 mg Tablet - [**1-13**] tablet Tablet(s) by
mouth twice daily
ISOSORBIDE DINITRATE - 30 mg Tablet - [**1-13**] Tablet(s) by mouth
twice daily
METOPROLOL SUCCINATE - 100 mg Tablet [**Hospital1 **]
NITROGLYCERIN prn
WARFARIN - 5 mg
VITAMIN A-VIT C-VIT E-ZINC-CU

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T 96.1, BP 144/90, HR 50, RR 20, 100% 4L NC
GENERAL: elderly male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NC. Midline frontal scalp laceration. Sclera anicteric.
PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the
oral mucosa. No xanthalesma.
NECK: Supple with JVP to earlobe
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. bibasilar crackles
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
PULSES:
Right: Carotid 2+ Femoral 2+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ DP 1+ PT 1+

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: He quit smoking over 30 years ago and he does not drink
alcoholic
drinks. He currently lives at home with his wife. Retired sales
marketing consultant. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Acute respiratory failure,Hematoma complicating a procedure,Chronic kidney disease, Stage IV (severe),Chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Cardiac arrest,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hyperpotassemia,Anemia in chronic kidney disease,Epilepsy, unspecified, without mention of intractable epilepsy,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}
