CHIEF COMPLAINT: Inferior myocardial infarction, status post
cardiac arrest.

PRESENT ILLNESS: The patient is a 44 year old
female with a history of insulin dependent diabetes mellitus,
asthma and seizure disorder, who presented to an outside
hospital with complaints of shortness of breath, difficulty
breathing which began the night prior to admission.  The
patient did not have a cough, no chest pain, no
light-headedness and no weakness.  The patient was given
Combivent in the ambulance with improvement.  She had run out
of her medications a couple days prior to admission.

MEDICAL HISTORY: 1.  Insulin dependent diabetes mellitus.
2.  Asthma.
3.  Seizure disorder.
4.  Irregular heart rate.
5.  Bronchitis.

MEDICATION ON ADMISSION: 

ALLERGIES: Aspirin and Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a two pack per day smoker.
Acute myocardial infarction of other anterior wall, initial episode of care,Other convulsions,Cardiogenic shock,Hematemesis,Anoxic brain damage,Acidosis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Precipitous drop in hematocrit
AMI anterior wall, init,Convulsions NEC,Cardiogenic shock,Hematemesis,Anoxic brain damage,Acidosis,DMII wo cmp nt st uncntr,Drop, hematocrit, precip
Admission Date:  [**2187-10-27**]       Discharge Date:  [**2187-10-31**]

Date of Birth:   [**2143-1-6**]       Sex:  F

Service:  CCU

CHIEF COMPLAINT:  Inferior myocardial infarction, status post
cardiac arrest.

HISTORY OF PRESENT ILLNESS:  The patient is a 44 year old
female with a history of insulin dependent diabetes mellitus,
asthma and seizure disorder, who presented to an outside
hospital with complaints of shortness of breath, difficulty
breathing which began the night prior to admission.  The
patient did not have a cough, no chest pain, no
light-headedness and no weakness.  The patient was given
Combivent in the ambulance with improvement.  She had run out
of her medications a couple days prior to admission.

In the Emergency Department, she had an asystolic arrest and
was given Atropine multiple times which converted her to
ventricular fibrillation arrest and then to ventricular
tachycardia.  At this time, the patient was intubated and put
on a ventilator.  The patient also received Epinephrine,
Amiodarone, and Morphine.  She became hypotensive and was
started on Dopamine subsequently.  There was a question of
whether the patient had had a seizure prior to her cardiac
arrest.

PAST MEDICAL HISTORY:
1.  Insulin dependent diabetes mellitus.
2.  Asthma.
3.  Seizure disorder.
4.  Irregular heart rate.
5.  Bronchitis.

MEDICATIONS:
1.  Insulin.
2.  Tegretol.
3.  Zocor.
4.  Combivent.
5.  Theophylline.
6.  Avandia.
7.  Zantac.

ALLERGIES: Aspirin and Penicillin.

SOCIAL HISTORY:  The patient is a two pack per day smoker.

PHYSICAL EXAMINATION: Vital signs on admission were 99.2
temperature, blood pressure 90/50, heart rate 80s with normal
sinus rhythm, respiratory rate approximately 25 on an assist
control ventilator with FIO2 of 0.6, tidal volume 600 and
PEEP 5 with pressure support 22.  In general, the patient was
intubated and on the ventilator.  Head, eyes, ears, nose and
throat examination - Multiple freckles, skin discoloration on
eyelids.  The pupils are equal, round, and reactive to light
and accommodation.  Eyes midline when open.  Neck - jugular
venous distention not appreciated, no lymphadenopathy.  No
carotid bruits.  Cardiovascular - regular rate and rhythm, no
murmurs, rubs or gallops.  Pulmonary - good breath sounds
with ventilation, decreased breath sounds at the bases
bilaterally.  Abdomen reveals positive bowel sounds, soft,
obese.  Extremities - no cyanosis, clubbing or edema.  Good
pulses bilaterally.  Bilateral groin lines.  No bleeding,
hematomas or bruits.

LABORATORY DATA:  On admission, laboratories were significant
for a white blood cell count of 22.3, hemoglobin 10.8,
hematocrit 36.4 and platelet count 296,000.  Coagulation
studies showed partial thromboplastin time of 26.5 and INR of
1.0.  Potassium 4.6, blood urea nitrogen 14, creatinine 0.9.
Tegretol level was subtherapeutic at 1.9 and Theophylline
level was less than 0.8.  The patient's cardiac enzymes,
haptoglobin and lipid panel were pending.

Cardiac catheterization showed right dominant system with
normal left main coronary artery, normal left anterior
descending, normal left circumflex.  Her right coronary
artery was occluded and was stented.  The electrocardiogram
was consistent with this and showed left axis deviation,
possible left bundle branch block, ST elevations in leads II,
III and aVF, reciprocal depressions in I, aVL and V1 through
V6.

CT of the head at the outside hospital was negative per
report.

HOSPITAL COURSE:  The patient was admitted to the CCU service
and was slowly weaned off Dopamine and weaned off the
ventilator.

The remainder of her hospital course is to be addended.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15176**], M.D.  [**MD Number(1) 15177**]

Dictated By:[**Name8 (MD) 10249**]
MEDQUIST36

D:  [**2187-10-31**]  17:11
T:  [**2187-10-31**]  18:34
JOB#:  [**Job Number 46758**]


Name:  [**Known lastname **], IVADEAN                     Unit No:  [**Numeric Identifier 8618**]

Admission Date:  [**2187-10-27**]     Discharge Date:  [**2187-11-2**]

Date of Birth:   [**2143-1-6**]     Sex:  F

Service:

Please change initial portion of the dictation summary to
discharge date [**2187-11-2**].  This is a stat dictation
addendum.

HOSPITAL COURSE BY SYSTEMS:
1.  Cardiovascular:  The patient was transferred from an
outside hospital intubated and sent for emergent cardiac
catheterization.  On catheterization, the patient was found
to have total occlusion of the mid portion of the right
coronary artery.  The patient underwent angioplasty and stent
placement with no residual stenosis.  The hemodynamics on
catheterization demonstrated a right atrial pressure of 15,
pulmonary capillary wedge pressure is 23, cardiac output of
5.57, and cardiac index of 2.91.

Post catheterization, the patient became hypotensive and
required dopamine for blood pressure support.  The patient
was subsequently transferred to the Cardiac Intensive Care
Unit.  The patient received 18 hours of Integrilin and was
started on Plavix 75 mg p.o. q.day for a 30 day course.  The
patient ruled in for a ST elevation inferior wall myocardial
infarction with a peak creatinine kinase of 3,219 and
creatinine kinase MB of 258.

The patient remained hemodynamically stable and the dopamine
was weaned off on hospital day #2.  The patient continued
without further chest pain or EKG changes throughout the
remainder of the hospitalization.

A post myocardial infarction transthoracic echocardiogram
demonstrated decreased left ventricular systolic function
with an ejection fraction of 40 to 50% secondary to moderate
hypokinetic basal and mid ventricular segments of the
inferior and posterior free wall of the left ventricle.  The
echocardiogram also demonstrated 1+ mitral regurgitation,
normal left ventricular size and wall thickness, and normal
right ventricular size and function.  The post myocardial
infarction Telemetry demonstrated consistent normal sinus
rhythm with occasional premature ventricular contractions.

The patient had a lipid panel which demonstrated
hypertriglyceridemia with a normal low density lipoprotein on
Zocor.  The patient continued on Zocor and was started on
Lopid with a goal to increase the patient's high density
lipoprotein.  The patient continued with low systolic blood
pressures from ranging in the 90's to 100's, however, was
able to tolerate a low dose beta blocker for post myocardial
infarction protection.  The patient continues on aspirin and
Plavix on discharge.

2.  Pulmonary:  The patient was transferred intubated and was
initially maintained on assist control ventilation with
adequate oxygenation and ventilation.  The patient completed
a CPAP wean and was extubated on hospital day #2.  The
patient has a known history of asthma and required minimal
nebulizer treatments throughout the admission.  The patient
was maintained on adequate oxygenation saturation post
extubation without supplemental oxygen.

3.  Hematology:  The patient has no known history of gastric
or duodenal ulcer disease.  However, on hospital day #2 the
patient had coffee ground emesis from the gastric tube.  The
patient was lavaged one liter of normal saline with clearing.
The patient's hematocrit at the time was 34.1 and the
hematocrit subsequently trended down to 27.4 on hospital day
#6.  There was no obvious source of bleeding, however, the GI
tract was suspected.  The patient was transfused one unit of
packed red blood cells on hospital day #6 for a goal
hematocrit greater than 28.0.  The repeat hematocrit is
pending at time of this dictation.  Iron studies are also
pending at time of this dictation.

4.  GI:  The patient developed an upper GI bleed with one
episode of coffee ground emesis on hospital day #2.  The
patient was subsequently started on high dose Protonix with
no further evidence of GI bleed.  Stool guaiacs are negative
to date.

5.  Endocrine:  The patient was found on admission to have
hyperglycemia (blood glucose in the 400's), ketonuria, and
metabolic acidosis with a pH at the outside hospital of 6.98,
consistent with diabetic ketoacidosis.  The patient was
started on an insulin drip with a maximum rate of 10 units
per hour.  The insulin drip was discontinued on hospital day
#2 with continued one to two hour fingerstick glucose checks
and sliding scale insulin.

The patient had a hemoglobin A1c of 9.0 measured on
admission.  The patient's blood glucose remained poorly
controlled during the hospitalization on sliding scale
insulin with blood glucoses ranging in the 200's to 300's.
The patient was started on standing NPH and regular insulin
and [**Last Name (un) 616**] consult was requested.  The consult
recommendations are pending at time of this dictation.

6.  Neuro:  Status post extubation, the patient demonstrated
new mental status changes with inattentiveness and poor short
term memory.  The patient has a known seizure disorder,
however, there was no evidence of seizure activity during the
hospitalization.  The patient was maintained on Tegretol as
per outpatient regimen.  Neurology was consulted on hospital
day #4 for a persistent change in mental status.  Per
Neurology recommendations, a head MRI / MRA as well as EEG
were obtained.  The head MRI / MRA was without evidence of
infarction, mass, or flow abnormality.  The EEG is pending at
time of this dictation.  Pending a normal EEG, the most
likely cause of the patient's change in mental status is
anoxic encephalopathy.

7.  Renal:  The patient maintained adequate urine output
throughout the admission with normal renal function.

SUMMARY:  The patient is a 44 year-old female with a history
of insulin dependent diabetes mellitus, hypercholesterolemia,
asthma, and seizure disorder who presented from an outside
hospital status post asystolic arrest in the setting of an
inferior wall myocardial infarction.  The patient underwent
cardiac catheterization with total occlusion of the right
coronary artery and is now status post stent angioplasty and
stent placement.  The patient is now five days status post
asystolic arrest with myocardial infarction and demonstrates
persistent mental status changes likely consistent with
anoxic brain injury.

CONDITION AT DISCHARGE:  Good.

MEDICATIONS ON DISCHARGE:
1.  Lopid 600 mg p.o. b.i.d.
2.  Aspirin 325 milligrams p.o. q. day.
3.  Plavix 75 mg p.o. q. day.
4.  Protonix 40 mg p.o. b.i.d.
5.  Tegretol 200 mg p.o. t.i.d.
6.  Metoprolol 12.5 mg p.o. b.i.d.
7.  Albuterol 1 to 2 puffs inhaler, q. 4 hours p.r.n.
8.  Atrovent 2 puffs inhaler, q. 4 to 6 hours p.r.n.
9.  Nicotine 14 mg patch transdermal q. day.
10. Simvastatin 20 mg p.o. q. day.
11. Insulin regular 3 units q. AM, 3 units q. PM
    NPH 6 units q. AM, 3 units q. PM.
12. Sliding scale insulin.

DIAGNOSES ON DISCHARGE:
1.  Asystolic arrest status post inferior wall myocardial
infarction.
2.  Diabetic ketoacidosis.
3.  Insulin dependent diabetes mellitus.
4.  Seizure disorder.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Asthma.
8.  Coronary artery disease status post right coronary artery
stent placement on [**10-27**].
9.  Anemia.
10. Upper GI bleed.

DISCHARGE INSTRUCTIONS:
1.  The patient is to be discharged to rehab for physical
therapy, occupational therapy, and neuro / psych therapy.
2. The patient was instructed to follow up with a new primary
care physician, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at the [**Hospital 112**] Clinic on [**11-26**]
at 1:30.
3.  The patient was also scheduled to follow up with
Neurology, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**12-3**] at 9:30 AM.
4.  Follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 8619**] at the [**Hospital 616**] Clinic for
diabetes management at 10 AM.



                          [**First Name8 (NamePattern2) 77**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 715**]

Dictated By:[**Name8 (MD) 2285**]

MEDQUIST36

D:  [**2187-11-1**]  17:12
T:  [**2187-11-7**]  09:15
JOB#:  [**Job Number 8620**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Other convulsions,Cardiogenic shock,Hematemesis,Anoxic brain damage,Acidosis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Precipitous drop in hematocrit'}


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: Inferior myocardial infarction, status post
cardiac arrest.

PRESENT ILLNESS: The patient is a 44 year old
female with a history of insulin dependent diabetes mellitus,
asthma and seizure disorder, who presented to an outside
hospital with complaints of shortness of breath, difficulty
breathing which began the night prior to admission.  The
patient did not have a cough, no chest pain, no
light-headedness and no weakness.  The patient was given
Combivent in the ambulance with improvement.  She had run out
of her medications a couple days prior to admission.

MEDICAL HISTORY: 1.  Insulin dependent diabetes mellitus.
2.  Asthma.
3.  Seizure disorder.
4.  Irregular heart rate.
5.  Bronchitis.

MEDICATION ON ADMISSION: 

ALLERGIES: Aspirin and Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a two pack per day smoker. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Other convulsions,Cardiogenic shock,Hematemesis,Anoxic brain damage,Acidosis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Precipitous drop in hematocrit'}
