CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 80-year-old
man with a long history of coronary artery disease who for
the past several weeks has experienced increasing chest pain
which in retrospect was  angina and
has taken increased nitroglycerine. He
was taking care of his ill wife and therefore did not want to
come to the hospital. The patient has a history of chronic
obstructive pulmonary disease, peripheral vascular disease,
and shortness of breath. He presented to the hospital and was
felt initially to have pneumonia. He was admitted to the
medical intensive care unit, however review of the EKG showed
severe EKG changes. He was taken for emergent catheterization
that showed 90% left main, 90% ostial LAD stenosis,
circumflex disease and moderate right coronary artery
disease. The patient was hypotensive and hemodynamically
unstable. Surgery was consulted because the patient developed
cardiogenic shock acidosis and hypotension and intraaortic
balloon pump was placed which stabilized his hemodynamics
although he continued to be somewhat hypotensive and acidotic.
On physical examination, his BP was 90/50 on the intraaortic
ballon pump with elevated filling pressures, HR was 90 BPM. He
was not intubated. Lung exam
showed bilateral rales. Abdomen was soft and nontender.
Cardiac exam showed distant heart sounds. The patient had
non-papable distal extremity pulses, suggesting peripheral
vascular disease. Neurologic exam was grossly normal.
He was taken for emergency bypass surgery where coronary
artery bypass grafting x3 was performed. The conduits were
extremely poor. The LIMA was placed to the OM, veins were
placed to the LAD and RCA. Ejection fraction initially was
20-30% with pulmonary hypertension and 1+ mitral
regurgitation. His mixed venous oxygen saturation
was approximately 48%, suggesting poor peripheral perfusion
and shock. His filling pressures were elevated with a CVP of
about 25 mmHg. He has rather severe pulmonary
hypertension prior to surgery (55/27 mmHg). After surgery
initially he did feel well with moderate inotropic support and
intraaortic balloon pump support. However his condition
gradually and progressively deteriorated.
He developed severe episode of ventricular tachycardia prior
to chest closure. His chest was reopened but his hemodynamics
did not significantly change. The sternum was left open but
the skin was closed. His poor hemodynamic condition was felt
most likely to be due to poor underlying cardiac function,
poor bypass targets and poor vein
conduit. His acidosis may be in part been due to the IABP and
peripheral vascular disease.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Acidosis,Unspecified pleural effusion,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Peripheral vascular disease, unspecified,Chronic pulmonary heart disease, unspecified,Paroxysmal supraventricular tachycardia,Unspecified disorder of kidney and ureter,Anxiety state, unspecified
AMI anterior wall, init,Cardiogenic shock,Chr airway obstruct NEC,CHF NOS,Acidosis,Pleural effusion NOS,Pneumonia, organism NOS,Crnry athrscl natve vssl,Mitral valve disorder,Periph vascular dis NOS,Chr pulmon heart dis NOS,Parox atrial tachycardia,Renal & ureteral dis NOS,Anxiety state NOS
Admission Date: [**2177-8-16**]        Discharge Date: [**2177-8-16**]

Date of Birth:  [**2097-3-17**]        Sex:  M

Service: Cardiac Surgery


HISTORY OF PRESENT ILLNESS:  The patient is an 80-year-old
man with a long history of coronary artery disease who for
the past several weeks has experienced increasing chest pain
which in retrospect was  angina and
has taken increased nitroglycerine. He
was taking care of his ill wife and therefore did not want to
come to the hospital. The patient has a history of chronic
obstructive pulmonary disease, peripheral vascular disease,
and shortness of breath. He presented to the hospital and was
felt initially to have pneumonia. He was admitted to the
medical intensive care unit, however review of the EKG showed
severe EKG changes. He was taken for emergent catheterization
that showed 90% left main, 90% ostial LAD stenosis,
circumflex disease and moderate right coronary artery
disease. The patient was hypotensive and hemodynamically
unstable. Surgery was consulted because the patient developed
cardiogenic shock acidosis and hypotension and intraaortic
balloon pump was placed which stabilized his hemodynamics
although he continued to be somewhat hypotensive and acidotic.
On physical examination, his BP was 90/50 on the intraaortic
ballon pump with elevated filling pressures, HR was 90 BPM. He
was not intubated. Lung exam
showed bilateral rales. Abdomen was soft and nontender.
Cardiac exam showed distant heart sounds. The patient had
non-papable distal extremity pulses, suggesting peripheral
vascular disease. Neurologic exam was grossly normal.
He was taken for emergency bypass surgery where coronary
artery bypass grafting x3 was performed. The conduits were
extremely poor. The LIMA was placed to the OM, veins were
placed to the LAD and RCA. Ejection fraction initially was
20-30% with pulmonary hypertension and 1+ mitral
regurgitation. His mixed venous oxygen saturation
was approximately 48%, suggesting poor peripheral perfusion
and shock. His filling pressures were elevated with a CVP of
about 25 mmHg. He has rather severe pulmonary
hypertension prior to surgery (55/27 mmHg). After surgery
initially he did feel well with moderate inotropic support and
intraaortic balloon pump support. However his condition
gradually and progressively deteriorated.
He developed severe episode of ventricular tachycardia prior
to chest closure. His chest was reopened but his hemodynamics
did not significantly change. The sternum was left open but
the skin was closed. His poor hemodynamic condition was felt
most likely to be due to poor underlying cardiac function,
poor bypass targets and poor vein
conduit. His acidosis may be in part been due to the IABP and
peripheral vascular disease.

He was transported to the cardiac surgical recovery unit. He
continues to have low cardiac output syndrome and acidosis
despite maximal inotropic support and intraaortic balloon
pump support. Consideration for left ventricular assist
device was given however because of his advanced age and poor
chances for recovery this was not placed. The situation was
discussed with the family. The patient's family were at his
bedside when he died.

FINAL DIAGNOSIS:
1.  Acute myocardial infarction.
2.  Cardiogenic shock, treated with IABP and emergency CABG x
3.  Congestive heart failure, pulmonary edema.
4.  Mild renal insufficiency, peripheral vascular disease.
5.  Moderate chronic obstructive pulmonary disease.
6.  Status post coronary artery bypass grafting.
7.  Death following emergent CABG.


                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**]

Dictated By:[**Last Name (NamePattern1) 5297**]
MEDQUIST36
D:  [**2177-8-16**] 22:35:21
T:  [**2177-8-17**] 04:35:09
Job#:  [**Job Number 74285**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Acidosis,Unspecified pleural effusion,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Peripheral vascular disease, unspecified,Chronic pulmonary heart disease, unspecified,Paroxysmal supraventricular tachycardia,Unspecified disorder of kidney and ureter,Anxiety state, 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: 

PRESENT ILLNESS: The patient is an 80-year-old
man with a long history of coronary artery disease who for
the past several weeks has experienced increasing chest pain
which in retrospect was  angina and
has taken increased nitroglycerine. He
was taking care of his ill wife and therefore did not want to
come to the hospital. The patient has a history of chronic
obstructive pulmonary disease, peripheral vascular disease,
and shortness of breath. He presented to the hospital and was
felt initially to have pneumonia. He was admitted to the
medical intensive care unit, however review of the EKG showed
severe EKG changes. He was taken for emergent catheterization
that showed 90% left main, 90% ostial LAD stenosis,
circumflex disease and moderate right coronary artery
disease. The patient was hypotensive and hemodynamically
unstable. Surgery was consulted because the patient developed
cardiogenic shock acidosis and hypotension and intraaortic
balloon pump was placed which stabilized his hemodynamics
although he continued to be somewhat hypotensive and acidotic.
On physical examination, his BP was 90/50 on the intraaortic
ballon pump with elevated filling pressures, HR was 90 BPM. He
was not intubated. Lung exam
showed bilateral rales. Abdomen was soft and nontender.
Cardiac exam showed distant heart sounds. The patient had
non-papable distal extremity pulses, suggesting peripheral
vascular disease. Neurologic exam was grossly normal.
He was taken for emergency bypass surgery where coronary
artery bypass grafting x3 was performed. The conduits were
extremely poor. The LIMA was placed to the OM, veins were
placed to the LAD and RCA. Ejection fraction initially was
20-30% with pulmonary hypertension and 1+ mitral
regurgitation. His mixed venous oxygen saturation
was approximately 48%, suggesting poor peripheral perfusion
and shock. His filling pressures were elevated with a CVP of
about 25 mmHg. He has rather severe pulmonary
hypertension prior to surgery (55/27 mmHg). After surgery
initially he did feel well with moderate inotropic support and
intraaortic balloon pump support. However his condition
gradually and progressively deteriorated.
He developed severe episode of ventricular tachycardia prior
to chest closure. His chest was reopened but his hemodynamics
did not significantly change. The sternum was left open but
the skin was closed. His poor hemodynamic condition was felt
most likely to be due to poor underlying cardiac function,
poor bypass targets and poor vein
conduit. His acidosis may be in part been due to the IABP and
peripheral vascular disease.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Acidosis,Unspecified pleural effusion,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Peripheral vascular disease, unspecified,Chronic pulmonary heart disease, unspecified,Paroxysmal supraventricular tachycardia,Unspecified disorder of kidney and ureter,Anxiety state, unspecified'}
