CHIEF COMPLAINT: CP, abd discomfort.

PRESENT ILLNESS: Mr. [**Known lastname 14223**] is a 70 yo man w pmh of a HTN, right carotid stent,
angina, GERD, severe OSA who presented to an OSH with c/o CP,
heartburn, diaphoresis, nausea, belching that awoke him from
sleep. At the OSH, he was hypertensive to the 250's/110's, he
was given ASA 81mg x 4, lopressor IV, dilaudid, NTG drip. His
EKG showed ST elevation in aVR, diffuse T wave invasion, ST
depression in v1-v6. He was started on heparin GTT, integrilin
and medflighted to [**Hospital1 18**].
Upon transfer, his vital were BP 111/88 hr 113 02 sat of 73% on
non-rebreather. Pt. was intubated for resp. distress. He has a
h/o difficult intubation, however, he was not wearing his
bracelet and did not have any other documentation relaying this
and was intubated with an adult tube (6.5 F). In the ED he was
given amiodarone 300 IV for a WCT with rate in the 120's (EKG
also showed new LBBB), His HR dropped to 20-30's and per ED
nursing report progressed to asystole, he was given EPI,
Atropine and CPR was initiated (for 5 minutes). His HR improved
to 100's. He was hypokalemic (2.1) which was repleted. He was
started on a dopamine drip and transferred to the Cath lab. In
the cath lab a temporary wire was placed as well as an IABP, he
was started on levo GTT, neo GTT, lasix GTT. The cath showed
LMCA with mild disease, 99% proximal LAD stenosis, w/ TIMI 1
flow, 90% OM1 stenosis, total occlusion of the RCA w/ left and
right collaterals. Right heart cath showed: RV 46/13, PCW mean
of 25, PA 45/24 mean 33. A BM stent (3.0x18mm) was placed in the
LAD, A BM (3x18mm) to the OM and 3 2.5mm stents ot the RCA. He
was then transferred to the CCU.
.
His initial ABG was 7.24/54/37. His initial lactate was was 7.2.
Initial CK was 138, TnI 0.48.
In the CCU his ABG was 7.08/51/58 lactate of 6.4
.
Review of systems could not be obtained due to pt. being
intubated.

MEDICAL HISTORY: PAST MEDICAL HISTORY: angina, GERD, OSA s/p surgical correction,
HTN, right carotid stent
.
Cardiac Risk Factors: Hypertension
.
Cardiac History: CABG, in anatomy as follows: NA
.
Percutaneous coronary intervention: no prior interventions
.

MEDICATION ON ADMISSION: 

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: VS: T 97.3, BP 107/75 on IABP as. systole: 106, [**Month (only) **]. diastole
126, HR 126, intubated AC TV 500 PEEP 18 RR 30 Fi02 100%
Drips: levo, neo, dopamine, lasix, insulin
Gen: intubated, sedated on
HEENT: intubated
Neck: cannot assess JVP
CV:tachycardic, regular, no MRG
chest: CTA anteriorly, posterior exam deferred.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits. hypoactive BS
Ext: [**Last Name (un) **]. No femoral bruits.
Pulses: radial pulses dopplerable, pedal pulses not palpable or
dopplerable.
MEDICAL DECISION MAKING

FAMILY HISTORY: 

SOCIAL HISTORY: married, 3 children, currently a accountent.
Tobacco: quit 30years ago, prior smoked 1ppd x 20years. no ETOH,
no drug use.
Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Cardiac complications, not elsewhere classified,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux
AMI anterior wall, init,Cardiogenic shock,Surg compl-heart,Acute respiratry failure,Acute kidney failure NOS,Acidosis,Crnry athrscl natve vssl,Hypertension NOS,Esophageal reflux
Admission Date:  [**2147-10-13**]              Discharge Date:   [**2147-10-14**]

Date of Birth:  [**2077-8-10**]             Sex:   M

Service: MEDICINE

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
CP, abd discomfort.

Major Surgical or Invasive Procedure:
Cardiac catheterization with placement of multple stents and
intraortic balloon pumpt, intubation

History of Present Illness:
Mr. [**Known lastname 14223**] is a 70 yo man w pmh of a HTN, right carotid stent,
angina, GERD, severe OSA who presented to an OSH with c/o CP,
heartburn, diaphoresis, nausea, belching that awoke him from
sleep. At the OSH, he was hypertensive to the 250's/110's, he
was given ASA 81mg x 4, lopressor IV, dilaudid, NTG drip. His
EKG showed ST elevation in aVR, diffuse T wave invasion, ST
depression in v1-v6. He was started on heparin GTT, integrilin
and medflighted to [**Hospital1 18**].
Upon transfer, his vital were BP 111/88 hr 113 02 sat of 73% on
non-rebreather. Pt. was intubated for resp. distress. He has a
h/o difficult intubation, however, he was not wearing his
bracelet and did not have any other documentation relaying this
and was intubated with an adult tube (6.5 F). In the ED he was
given amiodarone 300 IV for a WCT with rate in the 120's (EKG
also showed new LBBB), His HR dropped to 20-30's and per ED
nursing report progressed to asystole, he was given EPI,
Atropine and CPR was initiated (for 5 minutes). His HR improved
to 100's. He was hypokalemic (2.1) which was repleted. He was
started on a dopamine drip and transferred to the Cath lab. In
the cath lab a temporary wire was placed as well as an IABP, he
was started on levo GTT, neo GTT, lasix GTT. The cath showed
LMCA with mild disease, 99% proximal LAD stenosis, w/ TIMI 1
flow, 90% OM1 stenosis, total occlusion of the RCA w/ left and
right collaterals. Right heart cath showed: RV 46/13, PCW mean
of 25, PA 45/24 mean 33. A BM stent (3.0x18mm) was placed in the
LAD, A BM (3x18mm) to the OM and 3 2.5mm stents ot the RCA. He
was then transferred to the CCU.
.
His initial ABG was 7.24/54/37. His initial lactate was was 7.2.
Initial CK was 138, TnI 0.48.
In the CCU his ABG was 7.08/51/58 lactate of 6.4
.
Review of systems could not be obtained due to pt. being
intubated.


Past Medical History:
PAST MEDICAL HISTORY: angina, GERD, OSA s/p surgical correction,
HTN, right carotid stent
.
Cardiac Risk Factors: Hypertension
.
Cardiac History: CABG, in anatomy as follows: NA
.
Percutaneous coronary intervention: no prior interventions
.


Social History:
married, 3 children, currently a accountent.
Tobacco: quit 30years ago, prior smoked 1ppd x 20years. no ETOH,
no drug use.


Physical Exam:
VS: T 97.3, BP 107/75 on IABP as. systole: 106, [**Month (only) **]. diastole
126, HR 126, intubated AC TV 500 PEEP 18 RR 30 Fi02 100%
Drips: levo, neo, dopamine, lasix, insulin
Gen: intubated, sedated on
HEENT: intubated
Neck: cannot assess JVP
CV:tachycardic, regular, no MRG
chest: CTA anteriorly, posterior exam deferred.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits. hypoactive BS
Ext: [**Last Name (un) **]. No femoral bruits.
Pulses: radial pulses dopplerable, pedal pulses not palpable or
dopplerable.
MEDICAL DECISION MAKING


Pertinent Results:
1. Coronary angiography of this right dominant system revealed
mild
diffuse disease in the LMCA. The LAD had a 99% proximal stenosis
with
TIMI 1 flow. The LCX had a 99% proximal stenosis at the level of
OM1.
The RCA had a 100% total occlusion distally with left to right
collaterals.
2. Resting hemodynamics revealed an initial systolic blood
pressure of
60 mm Hg on a dopamine drip. The patient was placed on levophed
and
neosynephrine and the SBP rose to 133 mm Hg. Right-sided filling

pressures were elevated with an RA mean of 20 mm Hg. The RVESP
was 46 mm
Hg. The PCWP was elevated at 25 mm Hg. The PASP was 45 mm Hg.
The
cardiac output was 5.5 with an index of 2.76 lmin/m2 on multiple

pressors which was suggestive of cardiogenic shock.
3. Left ventriculography was deferred.
4. Successful stenting of the mid LAD with a 3.0 X 15 mm
Minivision
baremetal stent without residual stenosis. Successful stenting
of the
proximal LCX 90% lesion with a 2.5 X 18 mm MiniVision baremetal
stent
without residual stenosis. Successful stenting of the long 80%
RCA
lesion with a 2.5 X 28 mm MiniVision baremetal stent witout
residual
stenosis.
5. Acute anterior myocardial infarction treated with placement
of IABP
and primary angioplasty and stenting of the culprit LAD and well
as LCX
and RCA vessels, given profound cardiogenic shock.

FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Severe systolic and diastolic ventricular dysfunction.
3. Acute anterior myocardial infarction, managed by acute ptca
and
intraaortic balloon placement.
4. PTCA and stenting of the LAD vessel.
5. PTCA and stenting of the LCX.
6. PTCA and stenting of the RCA.

Technically very limited study due to mechanical ventilation and
suboptimal
positioning. The left atrium is normal in size. There is
symmetric left
ventricular hypertrophy. The left ventricular cavity is
unusually small. LV
systolic function appears depressed. Right ventricular chamber
size is normal.
Right ventricular systolic function appears depressed. The
aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. The
mitral valve leaflets are mildly thickened. There is no
pericardial effusion.
There is an anterior space which most likely represents a fat
pad.


Brief Hospital Course:
#STEMI: ST elevation in AVR with depressions laterally, also
with [**Last Name (un) **] TW. Found to have 3VD (99%LAD, 90%OM1, totally
occluded RCA) s/p stents to all three vessels.  Patient was
continued on ASA, plavix 75, heparin drip, integrilin. Bedside
echo showed was suboptimal, but showed depressed LV function and
small LV.  Patient was continued on pressure support on
levophed, dopaine, and vasopressin in addition to the intraortic
balloon pump.
.
#Cardiogenic shock: [**3-10**] to massive MI and 3VD. CI (1.23)
severely depressed. S/P PCI. IABP placed.   Over the night of
hospitalization, the patients exited sinus tachycardia, and had
a HR of 50 and sbp fell to 30s.  Was paced with transveous
pacing wire.  Despite maximum doses of pressure support, patient
has sbp of 75.  pH continued to fall as patient developed a
worsened lactic acidosis, with pH of 6.96 and LA of 16.
Patients family was called to see if wished to start CVVH to
reduce systemic acid burden.  After lengthy discussion, patients
family declined CVVH, and additionally wished to withraw current
level of care, opting for CMO.  The patient had pressures
stopped, IABP turned off, and pacing d/c'd.  Within five
minutes, patient became asystolic, and expired with family
present.
.
#Respiratory distress: Pt. was intubated in the ED for hypoxia.
He has a hx. of difficult intubation and was apparently told he
needed to be intubated with a pediatric tube. However, he did
not have his bracelet nor any information relaying this. He was
intubated with a small adult tube. His CXR shows pulmonary
edema/ ?ARDS (awaiting official read). Despite intubation, his
Pa02 remained in the 50's with ph in range of 7.08 to 7.19.
Cisatracurium for paralysis was intiated to allow for better
oxygenation as pt. agitated on the vent.  Pulm was consulted,
who began ventillating with ARDS net protocol.
.
# leukocytosis: elevated probably in the setting of stress.
However, in setting of severe illness, we cannot r/o infection
as a co-contributor to leukocytosis. Pt received 1 dose of vanc
and cefepine in cath lab.
- pan-cx.
- cover broadly with vanc and zosyn.
.

Discharge Disposition:
Expired

Discharge Diagnosis:
Cardiopulmonary collapse

Discharge Condition:
deceased
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Cardiac complications, not elsewhere classified,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux'}


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: CP, abd discomfort.

PRESENT ILLNESS: Mr. [**Known lastname 14223**] is a 70 yo man w pmh of a HTN, right carotid stent,
angina, GERD, severe OSA who presented to an OSH with c/o CP,
heartburn, diaphoresis, nausea, belching that awoke him from
sleep. At the OSH, he was hypertensive to the 250's/110's, he
was given ASA 81mg x 4, lopressor IV, dilaudid, NTG drip. His
EKG showed ST elevation in aVR, diffuse T wave invasion, ST
depression in v1-v6. He was started on heparin GTT, integrilin
and medflighted to [**Hospital1 18**].
Upon transfer, his vital were BP 111/88 hr 113 02 sat of 73% on
non-rebreather. Pt. was intubated for resp. distress. He has a
h/o difficult intubation, however, he was not wearing his
bracelet and did not have any other documentation relaying this
and was intubated with an adult tube (6.5 F). In the ED he was
given amiodarone 300 IV for a WCT with rate in the 120's (EKG
also showed new LBBB), His HR dropped to 20-30's and per ED
nursing report progressed to asystole, he was given EPI,
Atropine and CPR was initiated (for 5 minutes). His HR improved
to 100's. He was hypokalemic (2.1) which was repleted. He was
started on a dopamine drip and transferred to the Cath lab. In
the cath lab a temporary wire was placed as well as an IABP, he
was started on levo GTT, neo GTT, lasix GTT. The cath showed
LMCA with mild disease, 99% proximal LAD stenosis, w/ TIMI 1
flow, 90% OM1 stenosis, total occlusion of the RCA w/ left and
right collaterals. Right heart cath showed: RV 46/13, PCW mean
of 25, PA 45/24 mean 33. A BM stent (3.0x18mm) was placed in the
LAD, A BM (3x18mm) to the OM and 3 2.5mm stents ot the RCA. He
was then transferred to the CCU.
.
His initial ABG was 7.24/54/37. His initial lactate was was 7.2.
Initial CK was 138, TnI 0.48.
In the CCU his ABG was 7.08/51/58 lactate of 6.4
.
Review of systems could not be obtained due to pt. being
intubated.

MEDICAL HISTORY: PAST MEDICAL HISTORY: angina, GERD, OSA s/p surgical correction,
HTN, right carotid stent
.
Cardiac Risk Factors: Hypertension
.
Cardiac History: CABG, in anatomy as follows: NA
.
Percutaneous coronary intervention: no prior interventions
.

MEDICATION ON ADMISSION: 

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: VS: T 97.3, BP 107/75 on IABP as. systole: 106, [**Month (only) **]. diastole
126, HR 126, intubated AC TV 500 PEEP 18 RR 30 Fi02 100%
Drips: levo, neo, dopamine, lasix, insulin
Gen: intubated, sedated on
HEENT: intubated
Neck: cannot assess JVP
CV:tachycardic, regular, no MRG
chest: CTA anteriorly, posterior exam deferred.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits. hypoactive BS
Ext: [**Last Name (un) **]. No femoral bruits.
Pulses: radial pulses dopplerable, pedal pulses not palpable or
dopplerable.
MEDICAL DECISION MAKING

FAMILY HISTORY: 

SOCIAL HISTORY: married, 3 children, currently a accountent.
Tobacco: quit 30years ago, prior smoked 1ppd x 20years. no ETOH,
no drug use. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Cardiac complications, not elsewhere classified,Acute respiratory failure,Acute kidney failure, unspecified,Acidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux'}
