CHIEF COMPLAINT: Transfer from OSH, STEMI

PRESENT ILLNESS: 84 y/o M with a history of diet-controlled diabetes,
hypertension presented to [**Hospital **] hospital from PCP's office
earlier today with cough productive of yellow sputum, sinus
congestion, chest pain with coughing, and shortness of breath
for the last several days, no fever.  PCP subsequently sent
patient to the Emergency room on 2L O2.  Patient's initial
vitals on arrival to ED were HR 102 BP 116/81 RR 20 92% 2L.  CXR
done showed "diffuse asymmetric interstitial and alveolar
process, worse on the right," pulmonary edema vs. pneumonia.
Initial ECG showed NSR, LVH, TWI/STD in Leads V4-V6, Q wave III.
 He received 40 mg IV Lasix.  He then desated to 80% when on the
commode and was intubated for hypoxic respiratory failure. ECG
showed [**Street Address(2) 1766**] elevation in V3, 1 mm V2, Trop I 10.  He was
given another 40 mg IV Lasix, started on a heparin gtt, given
aspirin 325, plavix 300, and taken urgently to the cath lab.
Prior to cath, he was started on a dopamine gtt after SBPs were
in the 40s, after recieving multiple doses of propofol/fentanyl
during intubation.
.
Cath showed 90% distal left main disease, 80% mid-LAD, 80% D2,
80% Circumflex, totally occluded distal RCA.  Right heart cath
was performed (on dopamine and with IABP placed), showing CO
6.38, CI 3.4, SVR 709, PCWP 18, PAP 39/20 (25).  Patient was
transferred to [**Hospital1 18**] via [**Location (un) 7622**] for evaluation for urgent
CABG.
.
On arrival to [**Hospital1 18**], he had been weaned off dopamine gtt.
Initial vitals were HR 69 BP 94/52 RR 24 RR 100% on CMV 500 100%
14 5.  IABP was in place.
.
Remainder of review of systems unobtainable as patient intubated
and sedated.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes (diet controlled),
Hypertension
2. CARDIAC HISTORY:
none
3. OTHER PAST MEDICAL HISTORY:
-  allergic rhinitis
-  anxiety
- osteoarthritis
- olecranon bursitis [**2103-12-28**]

MEDICATION ON ADMISSION: -  MVI daily
- [**Doctor First Name **] 180mg daily
Patanol 0.1% Eye drops- 1 gtt both eyes [**Hospital1 **]
Fluticasone 50mcg nasal spray 2 sprays each nostil daily
amlodipine 7.5mg daily

ALLERGIES: Tetracycline / Amoxicillin / Penicillins

PHYSICAL EXAM: VS: HR 69 BP 94/52 RR 24 RR 100% on CMV 500 100% 14 5
79 kg
GENERAL: Intubated, sedated.  Unresponsive.
HEENT: Sclera anicteric. PERRL.
NECK: Supple with JVP of 8 cm at 10 degrees.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR,, occassional premature beat. normal S1, S2, left-sided
S3. No murmurs.
LUNGS: Coarse breath sounds in ant fields bilaterally.
ABDOMEN: Soft, NTND. No HSM or tenderness
EXTREMITIES: 1+ Distal pulses b/l.  No edema. Warm.
SKIN: + stasis dermatitis

FAMILY HISTORY: - Mother:  died of cervical cancer at 58 yo
- Father: died of "old age" at 88 yo
-brother has hypertension

SOCIAL HISTORY: - Tobacco history:  quit [**2066-12-21**]
- ETOH:  yes
Subendocardial infarction, initial episode of care,Acute respiratory failure,Cardiogenic shock,Acute systolic heart failure,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other secondary thrombocytopenia
Subendo infarct, initial,Acute respiratry failure,Cardiogenic shock,Ac systolic hrt failure,Acute kidney failure NOS,Surg compl-heart,Mitral valve disorder,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Atrial fibrillation,Abn react-anastom/graft,Sec thrombocytpenia NEC
Admission Date:  [**2104-1-7**]              Discharge Date:   [**2104-1-18**]

Date of Birth:  [**2019-8-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Tetracycline / Amoxicillin / Penicillins

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Transfer from OSH, STEMI

Major Surgical or Invasive Procedure:
[**2104-1-11**]  urgent cabg x3 (LIMA to LAD, SVG to OM, SVG to PDA)/
 MV repair  (28 mm CE ring)/IABP


History of Present Illness:
84 y/o M with a history of diet-controlled diabetes,
hypertension presented to [**Hospital **] hospital from PCP's office
earlier today with cough productive of yellow sputum, sinus
congestion, chest pain with coughing, and shortness of breath
for the last several days, no fever.  PCP subsequently sent
patient to the Emergency room on 2L O2.  Patient's initial
vitals on arrival to ED were HR 102 BP 116/81 RR 20 92% 2L.  CXR
done showed "diffuse asymmetric interstitial and alveolar
process, worse on the right," pulmonary edema vs. pneumonia.
Initial ECG showed NSR, LVH, TWI/STD in Leads V4-V6, Q wave III.
 He received 40 mg IV Lasix.  He then desated to 80% when on the
commode and was intubated for hypoxic respiratory failure. ECG
showed [**Street Address(2) 1766**] elevation in V3, 1 mm V2, Trop I 10.  He was
given another 40 mg IV Lasix, started on a heparin gtt, given
aspirin 325, plavix 300, and taken urgently to the cath lab.
Prior to cath, he was started on a dopamine gtt after SBPs were
in the 40s, after recieving multiple doses of propofol/fentanyl
during intubation.
.
Cath showed 90% distal left main disease, 80% mid-LAD, 80% D2,
80% Circumflex, totally occluded distal RCA.  Right heart cath
was performed (on dopamine and with IABP placed), showing CO
6.38, CI 3.4, SVR 709, PCWP 18, PAP 39/20 (25).  Patient was
transferred to [**Hospital1 18**] via [**Location (un) 7622**] for evaluation for urgent
CABG.
.
On arrival to [**Hospital1 18**], he had been weaned off dopamine gtt.
Initial vitals were HR 69 BP 94/52 RR 24 RR 100% on CMV 500 100%
14 5.  IABP was in place.
.
Remainder of review of systems unobtainable as patient intubated
and sedated.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes (diet controlled),
Hypertension
2. CARDIAC HISTORY:
none
3. OTHER PAST MEDICAL HISTORY:
-  allergic rhinitis
-  anxiety
- osteoarthritis
- olecranon bursitis [**2103-12-28**]

Social History:
- Tobacco history:  quit [**2066-12-21**]
- ETOH:  yes

Family History:
- Mother:  died of cervical cancer at 58 yo
- Father: died of "old age" at 88 yo
-brother has hypertension


Physical Exam:
VS: HR 69 BP 94/52 RR 24 RR 100% on CMV 500 100% 14 5
79 kg
GENERAL: Intubated, sedated.  Unresponsive.
HEENT: Sclera anicteric. PERRL.
NECK: Supple with JVP of 8 cm at 10 degrees.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR,, occassional premature beat. normal S1, S2, left-sided
S3. No murmurs.
LUNGS: Coarse breath sounds in ant fields bilaterally.
ABDOMEN: Soft, NTND. No HSM or tenderness
EXTREMITIES: 1+ Distal pulses b/l.  No edema. Warm.
SKIN: + stasis dermatitis

Pertinent Results:
ADMISSION LABS:
.
[**2104-1-7**] 11:55PM BLOOD WBC-12.6* RBC-4.07* Hgb-12.9* Hct-36.6*
MCV-90 MCH-31.7 MCHC-35.2* RDW-14.7 Plt Ct-159
[**2104-1-7**] 11:55PM BLOOD PT-14.0* PTT-105.9* INR(PT)-1.2*
[**2104-1-7**] 11:55PM BLOOD CK-MB-213* MB Indx-13.2* cTropnT-2.43*
[**2104-1-7**] 11:55PM BLOOD Calcium-8.1* Phos-4.2 Mg-2.0
.
CARDIAC CATH:
90% distal left main disease, 80% mid-LAD, 80% D2, 80%
Circumflex, totally occluded distal RCA.  Right heart cath was
performed showing CO 6.38, CI 3.4, SVR 709, PCWP 18, PAP 39/20
(25)

Pre-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage.
Overall left ventricular systolic function is moderately
depressed (LVEF= 25 - 30 %) with preserved basal segments but
hypokinetic mid segments and akinesis of the apex.
There is moderate global RV hypokinesis.
There are complex (>4mm) atheroma in the descending thoracic
aorta. There is an IABP 3 cm distal to the left subclavian
artery.
The aortic valve leaflets are moderately thickened. Mild (1+)
aortic regurgitation is seen.
The mitral valve leaflets are moderately thickened. Moderate to
severe (3+) mitral regurgitation is seen. The jet is central and
reflects poor co-aptation of the leaflet tips which is worsened
by provocation with Trendelenburg position.
There is no pericardial effusion.

Post-CPB:
The patient is AV-Paced on no inotropes.
LV systolic fxn is improved to an EF of 35 - 40%.
There is a partial mitral ring prosthesis with no leak, no MR
and a residual mean gradient of 4 mmHg.
AI remains trace - 1+.
IABP in good position. Aorta intact.

Brief Hospital Course:
CAD/Cardiogenic Shock: Cath showing severe 3-vessel disease
amenable to CABG.  Echo [**1-8**]  showing hypokinesis distal
anterior/septal segments and the apex (mid-LAD distribution).
LVEF = 40%.  As he was having ongoing ECG changes, he was
started on an integrillin gtt.  He was diuresed due to pulmonary
edema on CXR and high wedge on PA catheter tracings.  Patient
was plavix loaded at OSH; Plavix was held prior to CABG.
Patient remained on IABP on 1:1, as urine output decreased when
pump was weaned.  He was weaned of a dopamine drip, started on a
beta blocker.
# Acute on chronic renal failure: Baseline Cr .9.  Likely
secondary to renal hypoperfusion from cardiogenic
shock/hypotension.  Cr 1.6 on arrival, trended down to 1.3 prior
to CABG.

Taken urgently for surgery on [**1-11**]. Transferred to the CVICU in
stable condition. IABP removed on POD #1. PICC placed for access
and removed before discharge. Went into A Fib on [**1-12**] also and
was started on amiodarone. Remained in ICU for BP and
respiratory mgmt. Extubated on POD #2. Amiodarone stopped per
cardiology due to conversion pauses and managed with beta
blockade.Evaluated for aspiration risk. Chest tubes and pacing
wires removed per protocol. Coumadin started for A Fib.
Transferred to the floor on POD #5 to begin increasing his
activity level. He was gently diuresed toward his perop weight.
Continued to make good progress and was cleared for discharge to
[**Hospital 19771**] Rehab in [**Location (un) 2624**]. Target INR 2.0-2.5 for A Fib.

Medications on Admission:
-  MVI daily
- [**Doctor First Name **] 180mg daily
Patanol 0.1% Eye drops- 1 gtt both eyes [**Hospital1 **]
Fluticasone 50mcg nasal spray 2 sprays each nostil daily
amlodipine 7.5mg daily

Discharge Medications:
1. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. fexofenadine 180 mg Tablet Sig: One (1) Tablet PO once a day.

3. fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal DAILY (Daily).
4. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
5. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
7. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 2 weeks.
8. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
9. warfarin 1 mg Tablet Sig: rehab provider to order
daily;target INR 2.0-2.5 for AFib Tablets PO DAILY (Daily) as
needed for AF: target INR 2.0-2.5; dose for today [**1-18**] only 0.5
mg; all further dosing per rehab provider.
10. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. insulin fixed dose and sliding scale ( see attached)
see attached


Discharge Disposition:
Extended Care

Facility:
Hellenic - [**Location (un) 2624**]

Discharge Diagnosis:
CAD s/p cabg x3/MV repair
cardiogenic shock
NSTEMI
postop A Fib
diet-controlled diabetes mellitus
hypertension
anxiety
osteoarthritis
olecranon bursitis [**2103-12-28**]


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema - 1+ BLE



Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **]  Thursday [**2-7**] @ 1:15 pm
Cardiologist:Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ( his office will call you
with appt)

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 19772**] in [**3-25**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication A Fib
Goal INR 2.0-2.5
First draw tomorrow [**1-19**]
Please arrange for coumadin/INR f/u prior to discharge from
rehab



Completed by:[**2104-1-18**]
{'Subendocardial infarction, initial episode of care,Acute respiratory failure,Cardiogenic shock,Acute systolic heart failure,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other secondary thrombocytopenia'}


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: Transfer from OSH, STEMI

PRESENT ILLNESS: 84 y/o M with a history of diet-controlled diabetes,
hypertension presented to [**Hospital **] hospital from PCP's office
earlier today with cough productive of yellow sputum, sinus
congestion, chest pain with coughing, and shortness of breath
for the last several days, no fever.  PCP subsequently sent
patient to the Emergency room on 2L O2.  Patient's initial
vitals on arrival to ED were HR 102 BP 116/81 RR 20 92% 2L.  CXR
done showed "diffuse asymmetric interstitial and alveolar
process, worse on the right," pulmonary edema vs. pneumonia.
Initial ECG showed NSR, LVH, TWI/STD in Leads V4-V6, Q wave III.
 He received 40 mg IV Lasix.  He then desated to 80% when on the
commode and was intubated for hypoxic respiratory failure. ECG
showed [**Street Address(2) 1766**] elevation in V3, 1 mm V2, Trop I 10.  He was
given another 40 mg IV Lasix, started on a heparin gtt, given
aspirin 325, plavix 300, and taken urgently to the cath lab.
Prior to cath, he was started on a dopamine gtt after SBPs were
in the 40s, after recieving multiple doses of propofol/fentanyl
during intubation.
.
Cath showed 90% distal left main disease, 80% mid-LAD, 80% D2,
80% Circumflex, totally occluded distal RCA.  Right heart cath
was performed (on dopamine and with IABP placed), showing CO
6.38, CI 3.4, SVR 709, PCWP 18, PAP 39/20 (25).  Patient was
transferred to [**Hospital1 18**] via [**Location (un) 7622**] for evaluation for urgent
CABG.
.
On arrival to [**Hospital1 18**], he had been weaned off dopamine gtt.
Initial vitals were HR 69 BP 94/52 RR 24 RR 100% on CMV 500 100%
14 5.  IABP was in place.
.
Remainder of review of systems unobtainable as patient intubated
and sedated.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes (diet controlled),
Hypertension
2. CARDIAC HISTORY:
none
3. OTHER PAST MEDICAL HISTORY:
-  allergic rhinitis
-  anxiety
- osteoarthritis
- olecranon bursitis [**2103-12-28**]

MEDICATION ON ADMISSION: -  MVI daily
- [**Doctor First Name **] 180mg daily
Patanol 0.1% Eye drops- 1 gtt both eyes [**Hospital1 **]
Fluticasone 50mcg nasal spray 2 sprays each nostil daily
amlodipine 7.5mg daily

ALLERGIES: Tetracycline / Amoxicillin / Penicillins

PHYSICAL EXAM: VS: HR 69 BP 94/52 RR 24 RR 100% on CMV 500 100% 14 5
79 kg
GENERAL: Intubated, sedated.  Unresponsive.
HEENT: Sclera anicteric. PERRL.
NECK: Supple with JVP of 8 cm at 10 degrees.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR,, occassional premature beat. normal S1, S2, left-sided
S3. No murmurs.
LUNGS: Coarse breath sounds in ant fields bilaterally.
ABDOMEN: Soft, NTND. No HSM or tenderness
EXTREMITIES: 1+ Distal pulses b/l.  No edema. Warm.
SKIN: + stasis dermatitis

FAMILY HISTORY: - Mother:  died of cervical cancer at 58 yo
- Father: died of "old age" at 88 yo
-brother has hypertension

SOCIAL HISTORY: - Tobacco history:  quit [**2066-12-21**]
- ETOH:  yes 

### Response:
{'Subendocardial infarction, initial episode of care,Acute respiratory failure,Cardiogenic shock,Acute systolic heart failure,Acute kidney failure, unspecified,Cardiac complications, not elsewhere classified,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other secondary thrombocytopenia'}
