CHIEF COMPLAINT: cardiogenic shock s/p MI with post infarct VSD

PRESENT ILLNESS: 83 year old female with positive myocardial infarct x 1 week
ago, admitted to OSH intensive care unit. Hemodynamic
instability ensued requiring the initiation of multiple
pressors. Cardiac cath done at OSH->RCA=Total occlusion.
VSD post MI. IABP inserted for cardiogenic shock. Patient
transferred to [**Hospital1 18**] for percutaneous Left ventricular device
insertion and coronary revascularization.

MEDICAL HISTORY: HTN
STEMI
palpitations
benign neoplasm of colon [**2183-4-12**]
varicose veins
generalized osteoarthritis
renal cysts
corneal dystrophy
esophageal reflux
hypothyroidism
cataract
vitreous degeneration
syncopal episode  [**10-20**]
osteoporosis
compression FX of spine '[**83**]
allergic rhinitis
Rhip replacement/revision [**1-/2178**]
leg/ankle surgery
total hip replacement '[**86**]

MEDICATION ON ADMISSION: Calcitonin 1 spray each nostril daily
Lisinopril 10 mg daily
MVI
Tylenol prn pain
Norvasc 2.5 mg daily
Levothyroxine 50 mcg daily
Prilosec 20 mg daily
Calcium carbonate-Vitamin D 500/200 mg-unit daily

ALLERGIES: Codeine / Fosamax / Levaquin / Cephalexin

PHYSICAL EXAM: Pulse:99  Resp:  O2 sat:
B/P  Right: 91/54   Left:
Height:4'[**89**]     Weight:52Kg

FAMILY HISTORY: Father + MI 58yo, deceased age 61 2' prostate ca,
Mother-deceased age [**Age over 90 **] 2' CVA

SOCIAL HISTORY: Lives with:widowed 15 yo, lives at [**Hospital1 89603**]independent
living
Tobacco:denies
ETOH:denies
Acquired cardiac septal defect,Acute myocardial infarction of other inferior wall, initial episode of care,Cardiogenic shock,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Hip joint replacement,Tricuspid valve disorders, specified as nonrheumatic
Acq cardiac septl defect,AMI inferior wall, init,Cardiogenic shock,Osteoporosis NOS,Hypothyroidism NOS,Hypertension NOS,Joint replaced hip,Nonrheum tricusp val dis
Admission Date:  [**2190-1-20**]              Discharge Date:   [**2190-1-21**]

Date of Birth:  [**2106-2-20**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Fosamax / Levaquin / Cephalexin

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
cardiogenic shock s/p MI with post infarct VSD


Major Surgical or Invasive Procedure:
None

History of Present Illness:
83 year old female with positive myocardial infarct x 1 week
ago, admitted to OSH intensive care unit. Hemodynamic
instability ensued requiring the initiation of multiple
pressors. Cardiac cath done at OSH->RCA=Total occlusion.
VSD post MI. IABP inserted for cardiogenic shock. Patient
transferred to [**Hospital1 18**] for percutaneous Left ventricular device
insertion and coronary revascularization.


Past Medical History:
HTN
STEMI
palpitations
benign neoplasm of colon [**2183-4-12**]
varicose veins
generalized osteoarthritis
renal cysts
corneal dystrophy
esophageal reflux
hypothyroidism
cataract
vitreous degeneration
syncopal episode  [**10-20**]
osteoporosis
compression FX of spine '[**83**]
allergic rhinitis
Rhip replacement/revision [**1-/2178**]
leg/ankle surgery
total hip replacement '[**86**]


Social History:
Lives with:widowed 15 yo, lives at [**Hospital1 89603**]independent
living
Tobacco:denies
ETOH:denies


Family History:
Father + MI 58yo, deceased age 61 2' prostate ca,
Mother-deceased age [**Age over 90 **] 2' CVA


Physical Exam:
Pulse:99  Resp:  O2 sat:
B/P  Right: 91/54   Left:
Height:4'[**89**]     Weight:52Kg

General:A&Ox3
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular []  Murmur: IV/VI holosystolic
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused []  Edema Varicosities:
(B)LE [x]chronic venous stasis changes
Neuro: Grossly intact
Pulses:
Femoral      Right:   Left:
DP           Right:doppler   Left:intermittent doppler
PT           [**Name (NI) 167**]:   Left:
Radial       Right:   Left:

Carotid Bruit        Right:    Left:


Pertinent Results:
[**2190-1-21**] 10:27AM BLOOD Hct-30.7*# Plt Ct-133*
[**2190-1-21**] 07:27AM BLOOD Hct-23.1* Plt Ct-178
[**2190-1-20**] 11:43AM BLOOD WBC-7.7 RBC-3.37* Hgb-9.7* Hct-28.0*
MCV-83 MCH-28.7 MCHC-34.5 RDW-14.6 Plt Ct-244
[**2190-1-21**] 03:27AM BLOOD Neuts-83.6* Lymphs-10.4* Monos-5.1
Eos-0.5 Baso-0.5
[**2190-1-21**] 10:27AM BLOOD Plt Ct-133*
[**2190-1-21**] 07:27AM BLOOD PT-17.0* PTT-150* INR(PT)-1.5*
[**2190-1-20**] 11:43AM BLOOD Plt Ct-244
[**2190-1-20**] 11:43AM BLOOD PT-14.5* PTT-119.8* INR(PT)-1.3*
[**2190-1-21**] 03:27AM BLOOD Glucose-128* UreaN-41* Creat-1.2* Na-131*
K-3.7 Cl-107 HCO3-16* AnGap-12
[**2190-1-20**] 11:43AM BLOOD Glucose-344* UreaN-47* Creat-1.4* Na-131*
K-4.6 Cl-103 HCO3-16* AnGap-17
[**2190-1-21**] 03:27AM BLOOD ALT-252* AST-203* LD(LDH)-588*
AlkPhos-199* TotBili-0.6
[**2190-1-20**] 11:43AM BLOOD ALT-286* AST-320* LD(LDH)-796*
AlkPhos-328* Amylase-30 TotBili-0.4
[**2190-1-21**] 03:27AM BLOOD CK-MB-18* cTropnT-6.11*
[**2190-1-20**] 11:49PM BLOOD CK-MB-17* cTropnT-4.18*
[**2190-1-21**] 07:27AM BLOOD Mg-1.5*
[**2190-1-20**] 11:49PM BLOOD CK-MB-17* cTropnT-4.18*
[**2190-1-20**] 11:43AM BLOOD Albumin-2.8*
[**2190-1-20**] 11:43AM BLOOD %HbA1c-6.3* eAG-134*
[**2190-1-21**] 12:00PM BLOOD Type-ART pO2-435* pCO2-56* pH-7.18*
calTCO2-22 Base XS--7
[**2190-1-21**] 10:37AM BLOOD Type-ART pO2-458* pCO2-56* pH-7.18*
calTCO2-22 Base XS--7
[**2190-1-20**] 12:15PM BLOOD Type-ART pO2-125* pCO2-24* pH-7.46*
calTCO2-18* Base XS--4
[**2190-1-20**] 12:17PM BLOOD Type-MIX pO2-50* pCO2-27* pH-7.43
calTCO2-19* Base XS--4

[**Known lastname 89604**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 89605**]Portable TTE
(Complete) Done [**2190-1-20**] at 12:23:06 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2106-2-20**]
Age (years): 83 F  Hgt (in):
BP (mm Hg): 98/68  Wgt (lb): 114
HR (bpm): 101  BSA (m2):
Indication: Left ventricular function. VSD.
ICD-9 Codes: 745.4, 424.1, 424.0, 424.2
Test Information
Date/Time: [**2190-1-20**] at 12:23    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD

Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**First Name4 (NamePattern1) 1022**] [**Last Name (NamePattern1) **],
RDCS
Doppler: Full Doppler and color Doppler Test Location: West
SICU/CTIC/VICU
Contrast: None Tech Quality: Suboptimal
Tape #: 2011W000-0:00 Machine: Vivid q-1
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  3.2 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  5.1 cm  <= 5.2 cm
Left Atrium - Peak Pulm Vein S:  0.5 m/s
Left Atrium - Peak Pulm Vein D:  0.7 m/s
Right Atrium - Four Chamber Length:  5.0 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  3.5 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  2.4 cm
Left Ventricle - Fractional Shortening:  0.31  >= 0.29
Left Ventricle - Ejection Fraction:  55%  >= 55%
Left Ventricle - Stroke Volume:  35 ml/beat
Left Ventricle - Cardiac Output:  3.49 L/min
Left Ventricle - Lateral Peak E':  *0.07 m/s  > 0.08 m/s
Left Ventricle - Septal Peak E':  *0.05 m/s  > 0.08 m/s
Left Ventricle - Ratio E/E':  *17  < 15
Aorta - Sinus Level:  3.5 cm  <= 3.6 cm
Aorta - Ascending:  2.9 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  *2.3 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *22 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  9 mm Hg
Aortic Valve - LVOT VTI:  11
Aortic Valve - LVOT diam:  2.0 cm
Aortic Valve - Valve Area:  *1.0 cm2  >= 3.0 cm2
Mitral Valve - E Wave:  1.0 m/sec
Mitral Valve - A Wave:  1.1 m/sec
Mitral Valve - E/A ratio:  0.91
Mitral Valve - E Wave deceleration time:  236 ms  140-250 ms
TR Gradient (+ RA = PASP):  *33 mm Hg  <= 25 mm Hg
Findings
LEFT ATRIUM: Normal LA size.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Normal
interatrial septum. No ASD by 2D or color Doppler.
LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Overall normal LVEF (>55%). No resting LVOT gradient. Post
infarction VSD.
RIGHT VENTRICLE: Mildly dilated RV cavity. Moderate global RV
free wall hypokinesis.
AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter.
AORTIC VALVE: Moderate AS (area 1.0-1.2cm2) Trace AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP. No
MS. Trivial MR.
TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. No
TS. Moderate [2+] TR. Mild PA systolic hypertension.
PUMONIC VALVE/PULMONARY ARTERY: No PS.
PERICARDIUM: No pericardial effusion.
GENERAL COMMENTS: Suboptimal image quality - poor echo windows.

REGIONAL LEFT VENTRICULAR WALL MOTION:
Conclusions
Poor image quality.The left atrium is normal in size. No atrial
septal defect is seen by 2D or color Doppler. Left ventricular
wall thicknesses are normal. The left ventricular cavity size is
normal. There is a focal aneurysm of the basal inferior and
infero-septal LV segments. The remaining segments are
hyperdynamic. Overall left ventricular systolic function is
preserved (LVEF=55%). There is a post infarction ventricular
septal defect (VSD) is suspected but not confirmed (appears
small). The right ventricular cavity is mildly dilated with
moderate global free wall hypokinesis. There is probably
moderate aortic valve stenosis (valve area 1.0-1.2cm2). Trace
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Trivial
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.

If indicated, a TEE would better characterize the presence and
severity of a VSD.


Brief Hospital Course:
Patient was admitted from [**Hospital 5279**] hospital in cardiogenic shock
s/p MI with post infarct VSD.  She was admitted on
Dobutamine/Levo/IABP 1:1 with SBP 80's, mentating well on nasal
canula.  Echo revealed small inferior VSD.  After discussion
with cardiologist and cardiac surgeon, the decision was made to
take the patient to the operating room for percutaneous closure
of VSD with backup of tandem heart.  All options were explained
to patient and she agreed to proceed.  See operative note for
full details. Percutaneous VSD was unable to be placed and the
decision was made to place the patient on ECMO for hemodynamic
support.  Echo showed a large VSD and severe TR.  She was on
Levophed drip as well as full ECMO support with SBP 80's.  A
fmily meeting was held with HCP [**Name (NI) **] (friend) and nephew [**Name (NI) **].
The decision was made to withdraw support.  She was continued on
Fentanyl and Versed drips  -  pressors,IABP and ECMO were all
stopped at 12:25 PM.  She was asystolic with no blood pressure
at 12:59 PM and pronounced by Dr [**Last Name (STitle) 5856**].  Family was not present
but notified and denied post.

Medications on Admission:
Calcitonin 1 spray each nostril daily
Lisinopril 10 mg daily
MVI
Tylenol prn pain
Norvasc 2.5 mg daily
Levothyroxine 50 mcg daily
Prilosec 20 mg daily
Calcium carbonate-Vitamin D 500/200 mg-unit daily


Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2190-1-21**]
{'Acquired cardiac septal defect,Acute myocardial infarction of other inferior wall, initial episode of care,Cardiogenic shock,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Hip joint replacement,Tricuspid valve disorders, specified as nonrheumatic'}


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: cardiogenic shock s/p MI with post infarct VSD

PRESENT ILLNESS: 83 year old female with positive myocardial infarct x 1 week
ago, admitted to OSH intensive care unit. Hemodynamic
instability ensued requiring the initiation of multiple
pressors. Cardiac cath done at OSH->RCA=Total occlusion.
VSD post MI. IABP inserted for cardiogenic shock. Patient
transferred to [**Hospital1 18**] for percutaneous Left ventricular device
insertion and coronary revascularization.

MEDICAL HISTORY: HTN
STEMI
palpitations
benign neoplasm of colon [**2183-4-12**]
varicose veins
generalized osteoarthritis
renal cysts
corneal dystrophy
esophageal reflux
hypothyroidism
cataract
vitreous degeneration
syncopal episode  [**10-20**]
osteoporosis
compression FX of spine '[**83**]
allergic rhinitis
Rhip replacement/revision [**1-/2178**]
leg/ankle surgery
total hip replacement '[**86**]

MEDICATION ON ADMISSION: Calcitonin 1 spray each nostril daily
Lisinopril 10 mg daily
MVI
Tylenol prn pain
Norvasc 2.5 mg daily
Levothyroxine 50 mcg daily
Prilosec 20 mg daily
Calcium carbonate-Vitamin D 500/200 mg-unit daily

ALLERGIES: Codeine / Fosamax / Levaquin / Cephalexin

PHYSICAL EXAM: Pulse:99  Resp:  O2 sat:
B/P  Right: 91/54   Left:
Height:4'[**89**]     Weight:52Kg

FAMILY HISTORY: Father + MI 58yo, deceased age 61 2' prostate ca,
Mother-deceased age [**Age over 90 **] 2' CVA

SOCIAL HISTORY: Lives with:widowed 15 yo, lives at [**Hospital1 89603**]independent
living
Tobacco:denies
ETOH:denies 

### Response:
{'Acquired cardiac septal defect,Acute myocardial infarction of other inferior wall, initial episode of care,Cardiogenic shock,Osteoporosis, unspecified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Hip joint replacement,Tricuspid valve disorders, specified as nonrheumatic'}
