CHIEF COMPLAINT: Hypoxia/Hypoternsion at rehab

PRESENT ILLNESS: Patient is an 83 year-old Russian-speaking female with HTN,
known CAD (3VD per daughter per cath done at [**Hospital3 **] 2
years ago), DMII, Alzheimer's dementia, CVA (5.5 years ago) who
awoke this morning with desaturation to 70s on RA. Patient was
noted to be pale, cold and clammy, unclear if she experienced
chest pain given baseline dementia. Initial EKG with
anterolateral ST depressions, and later EKG showed ST elevations
in V1 - V3. In the ED, patient hypotensive to 70s necessitating
Levophed support.
.
Patient's daughter at bedside, gave history and served as
translator. Patient without complaints of chest pain, shortness
of breath, abdominal pain, nausea, or vomiting, though difficult
to assess given dementia. Daughter re-iterated that she does not
want patient to be resuscitated or intubaed, but supportive
measures including blood draws and pressors are ok.

MEDICAL HISTORY: 1. HTN
2. CAD
3. DMII
4. HL
5. Hx CVA 11y ago
6. Alzheimer's dementia

MEDICATION ON ADMISSION: ASA 325
Plavix 75
Quetiapine 100mg PO qAM, 200 PO qhs
Zocor 20
Tylenol
Lorazepam 0.5 [**Hospital1 **]
Metoprolol 25mg PO BID
Glyburide 1.25 [**Hospital1 **]
Imdur 30mg PO qd
Metformin 250 [**Hospital1 **]
Depakote Sprinkles 125mg PO BID
Colace 250mg PO qd
Albuterol nebs PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: P 103; BP 101/65; RR 32; O2 Sat 95% RA
GEN: NAD, pleasant, baseline dementia
HEENT: MMM. JVP 11cm. Trachea midline. No carotid bruits
CV: S1S2 irregular. +S4. No M/R
LUNGS: Diffuse crackles B/L
ABD: soft, NT/ND. BS normoactive.
EXT: DPs symmetric, 1+, weak. No femoral bruits.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at [**Hospital 100**] Rehab. No ETOH, tobacco, IVDA. Daughter
healthcare proxy, very involved in care.
Acute myocardial infarction of unspecified site, initial episode of care,Cardiogenic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Unspecified essential hypertension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery
AMI NOS, initial,Cardiogenic shock,Acute kidney failure NOS,CHF NOS,Hypertension NOS,Alzheimer's disease,Dementia w/o behav dist,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl
Admission Date:  [**2194-11-11**]              Discharge Date:   [**2194-11-14**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Hypoxia/Hypoternsion at rehab

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Patient is an 83 year-old Russian-speaking female with HTN,
known CAD (3VD per daughter per cath done at [**Hospital3 **] 2
years ago), DMII, Alzheimer's dementia, CVA (5.5 years ago) who
awoke this morning with desaturation to 70s on RA. Patient was
noted to be pale, cold and clammy, unclear if she experienced
chest pain given baseline dementia. Initial EKG with
anterolateral ST depressions, and later EKG showed ST elevations
in V1 - V3. In the ED, patient hypotensive to 70s necessitating
Levophed support.
.
Patient's daughter at bedside, gave history and served as
translator. Patient without complaints of chest pain, shortness
of breath, abdominal pain, nausea, or vomiting, though difficult
to assess given dementia. Daughter re-iterated that she does not
want patient to be resuscitated or intubaed, but supportive
measures including blood draws and pressors are ok.


Past Medical History:
1. HTN
2. CAD
3. DMII
4. HL
5. Hx CVA 11y ago
6. Alzheimer's dementia

Social History:
Lives at [**Hospital 100**] Rehab. No ETOH, tobacco, IVDA. Daughter
healthcare proxy, very involved in care.


Family History:
NC

Physical Exam:
VS: P 103; BP 101/65; RR 32; O2 Sat 95% RA
GEN: NAD, pleasant, baseline dementia
HEENT: MMM. JVP 11cm. Trachea midline. No carotid bruits
CV: S1S2 irregular. +S4. No M/R
LUNGS: Diffuse crackles B/L
ABD: soft, NT/ND. BS normoactive.
EXT: DPs symmetric, 1+, weak. No femoral bruits.

Pertinent Results:
[**2194-11-11**] 07:06PM   PT-14.1* PTT-64.4* INR(PT)-1.4
[**2194-11-11**] 01:30PM URINE  HOURS-RANDOM
[**2194-11-11**] 01:30PM URINE  GR HOLD-HOLD
[**2194-11-11**] 01:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.026
[**2194-11-11**] 01:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-TR KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG
[**2194-11-11**] 10:55AM   GLUCOSE-259* UREA N-46* CREAT-1.2* SODIUM-142
POTASSIUM-5.1 CHLORIDE-107 TOTAL CO2-19* ANION GAP-21*
[**2194-11-11**] 10:55AM   CK(CPK)-430*
[**2194-11-11**] 10:55AM   CK-MB-84* MB INDX-19.5* cTropnT-0.82*
[**2194-11-11**] 10:55AM   WBC-12.5* RBC-4.07* HGB-11.9* HCT-33.6*
MCV-83 MCH-29.1 MCHC-35.3* RDW-13.6
[**2194-11-11**] 10:55AM   NEUTS-86.9* BANDS-0 LYMPHS-9.8* MONOS-3.0
EOS-0.2 BASOS-0.1
[**2194-11-11**] 10:55AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2194-11-11**] 10:55AM   PLT SMR-NORMAL PLT COUNT-286
[**2194-11-11**] 10:55AM   PT-12.7 PTT-24.1 INR(PT)-1.1
.
ECHO ([**2194-11-14**])
1. The left ventricular cavity is mildly dilated. There is
severe global left
ventricular hypokinesis to akinesis with some preservation of
lateral wall
motion. Overall left ventricular systolic function is severely
depressed.
2. The aortic valve leaflets (3) are mildly thickened. Trace
aortic
regurgitation is seen.
3. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral
regurgitation is seen.
.
CXR:
A single portable AP upright view is compared to previous
examination of [**2194-11-11**]. Since the previous exam there
is partial resolution of the pulmonary edema. There are
bilateral pleural effusions. The heart size is mildly enlarged.
There is increased interstitial marking in right apex without
definite evidence of mass.


Brief Hospital Course:
Patient is an 83 year-old female with HTN, DMII, HL, CVA, CAD
who presented to the Emergency Department from [**Hospital 100**] Rehab with
an acute ST elevation MI in the anterior leads. Patient was
admitted to the cardiac care unit and the following issues were
addressed during her hospital course:

1. CARDIOVASCULAR: Patient with known 3V disease presented with
acute ST elevation MI. Extensive discussion took place between
patient's daughter (health care proxy) and cardiology team, and
it was decided that given comorbidities, risks/benefits or
coronary intervention, and most importantly, goals of
care/patient's wishes, medical management of MI was pursued.
Patient received Plavix load, Aspirin, and was started on
heparin and integrillin drips. Patient had been started on
Levophed drip in ED for blood pressure support which was weaned
off in the CCU. Heparin and Integrillin gtts were discontinued
after CPKs trended down. Patient received 10-20mg IV Lasix on
admission days 1 and 2 for diuresis, given marked crackles on
exam and elevated JVP. Patient was without chest pain during
hospital stay, though difficult to assess completely given
baseline dementia. The day after admission, patient's
hemodynamic status improved significantly (with significant
improvement in lung exam after diuresis), and blood pressure
medications were restored. Patient received an inpatient ECHO
for prognostic value, her EF was severely depressed (EF 25%)
[see full report in Results section].
.
2. MILD LEUKOCYTOSIS/HYPOTENSION ?SEPSIS
Patient presented with mild leukocytosis and hypotension in
setting of acute MI. Other sources of possible sepsis were
pursued and were unrevealing (UA, Blood Cxs, CXR). CXR with 6cm
opactiy in R apex, to be followed as outpatient (Patient's PCP's
office, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 14959**] at [**Hospital 100**] Rehab, notified on
[**2194-11-15**]); clinically, patient without signs/symptoms of PNA -
they will follow. Leukocytosis resolved without antibiotic
therapy, and patient remained afebrile.
.
3. PSYCHIATRIC
Patient with baseline dementia, who was initially agitated after
admission to CCU. Per daughter, this was likely due to change in
setting. Patient required Haldol for sedation on admission day
1, and was not required on subsequent hospital days. Patient's
EKGs did not manifest QT prolongation. Outpatient Seroquel was
continued, and patient was started on low dose Zyprexa in the
evenings; [**Hospital 100**] Rehab to decide whether continuation of this
therapy will be necessary.
.
4. CVA history
Continue Depakote for seizure prophylaxis
.
5. DIABETES
Strict glycemic control was maintained with QID fingersticks and
insulin sliding scale.


Medications on Admission:
ASA 325
Plavix 75
Quetiapine 100mg PO qAM, 200 PO qhs
Zocor 20
Tylenol
Lorazepam 0.5 [**Hospital1 **]
Metoprolol 25mg PO BID
Glyburide 1.25 [**Hospital1 **]
Imdur 30mg PO qd
Metformin 250 [**Hospital1 **]
Depakote Sprinkles 125mg PO BID
Colace 250mg PO qd
Albuterol nebs PRN

Discharge Medications:
1. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Quetiapine 100 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
5. Quetiapine 200 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime): Please have your EKG checked to ensure no QT
prolongation while on this medication.
6. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
7. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Divalproex Sodium 125 mg Capsule, Sprinkle Sig: One (1)
Capsule, Sprinkle PO BID (2 times a day).
10. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
11. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO QHS (once a day (at bedtime)) as needed.
12. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
13. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Glyburide 1.25 mg Tablet Sig: One (1) Tablet PO twice a day.

15. Metformin 500 mg Tablet Sig: 0.5 Tablet PO twice a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - LTC

Discharge Diagnosis:
Primary
1. Acute ST elevation MI

Secondary
1. HTN
2. Alzheimers Dementia
3. Prior CVA
4. Hyperlipidemia
5. Diabetes Mellitus Type II


Discharge Condition:
mental status at baseline, without chest pain or shortness of
breath, clinically and hemodynamically stable


Discharge Instructions:
1. Please take all medications as prescribed
2. Please make all follow-up appointments.
3. If you develop chest pain, shortness of breath,
lightheadedness, or any other concerning signs/symptoms, please
contact your PCP or report to the Emergency Department
immediately.

Followup Instructions:
Please make an appointment to see your PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 14959**]
([**Telephone/Fax (1) 14960**]) in [**4-26**] days.



Completed by:[**2194-11-17**]
{"Acute myocardial infarction of unspecified site, initial episode of care,Cardiogenic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Unspecified essential hypertension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery"}


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: Hypoxia/Hypoternsion at rehab

PRESENT ILLNESS: Patient is an 83 year-old Russian-speaking female with HTN,
known CAD (3VD per daughter per cath done at [**Hospital3 **] 2
years ago), DMII, Alzheimer's dementia, CVA (5.5 years ago) who
awoke this morning with desaturation to 70s on RA. Patient was
noted to be pale, cold and clammy, unclear if she experienced
chest pain given baseline dementia. Initial EKG with
anterolateral ST depressions, and later EKG showed ST elevations
in V1 - V3. In the ED, patient hypotensive to 70s necessitating
Levophed support.
.
Patient's daughter at bedside, gave history and served as
translator. Patient without complaints of chest pain, shortness
of breath, abdominal pain, nausea, or vomiting, though difficult
to assess given dementia. Daughter re-iterated that she does not
want patient to be resuscitated or intubaed, but supportive
measures including blood draws and pressors are ok.

MEDICAL HISTORY: 1. HTN
2. CAD
3. DMII
4. HL
5. Hx CVA 11y ago
6. Alzheimer's dementia

MEDICATION ON ADMISSION: ASA 325
Plavix 75
Quetiapine 100mg PO qAM, 200 PO qhs
Zocor 20
Tylenol
Lorazepam 0.5 [**Hospital1 **]
Metoprolol 25mg PO BID
Glyburide 1.25 [**Hospital1 **]
Imdur 30mg PO qd
Metformin 250 [**Hospital1 **]
Depakote Sprinkles 125mg PO BID
Colace 250mg PO qd
Albuterol nebs PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: P 103; BP 101/65; RR 32; O2 Sat 95% RA
GEN: NAD, pleasant, baseline dementia
HEENT: MMM. JVP 11cm. Trachea midline. No carotid bruits
CV: S1S2 irregular. +S4. No M/R
LUNGS: Diffuse crackles B/L
ABD: soft, NT/ND. BS normoactive.
EXT: DPs symmetric, 1+, weak. No femoral bruits.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at [**Hospital 100**] Rehab. No ETOH, tobacco, IVDA. Daughter
healthcare proxy, very involved in care. 

### Response:
{"Acute myocardial infarction of unspecified site, initial episode of care,Cardiogenic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Unspecified essential hypertension,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery"}
