CHIEF COMPLAINT: Anterior STEMI

PRESENT ILLNESS: 63 M with CAD s/p MI 2 years ago with RCA stent. Presented to
[**Hospital3 35813**] Center in [**State 792**]on [**2156-1-13**] with acute
respiratory distress and hypotension. An ECG showed sinus tach
with RBBB and Qs in II, III, and aVF with STE v1-v5. CXR showed
pulmonary edema. He was taken to the cath lab where he found to
have 3vd with left main disease. An IABP was placed. He was seen
by cardiac surgery emergently and admitted to the ICU.
.
Labs notable for peak CK 8591, with CK-MB of 436 and Trop I 359
(nl 0-0.03; >0.5 MI) on [**2156-1-13**] at 22:08. Also of note, WBC 24
and glucose 400, but without acidosis or an elevated anion gap.
He was started on Zosyn and insulin gtt.

MEDICAL HISTORY: DM2
CAD, s/p MI 2 yr ago with RCA stent

MEDICATION ON ADMISSION: Zosyn 3.375 Q6h
Dopamine gtt
Heparin gtt
Insulin gtt
Nitro gtt
Propofol gtt
Lasix gtt
Levophed gtt
Atrovent Q6h
Albuterol A6h
Colace 100 [**Hospital1 **]
Tylenol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 100.3, BP 69/49, HR 93, O2 100% on AC 450x14/0.5/5.0
Gen: Asian male, intubated & sedated.
HEENT: NCAT. Sclera anicteric. PERRL. ETT in place.
Neck: Supple. Left subclav sheath w/ Swann cathether.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Coarse
ventilated breath sounds.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: Bilat feet cool, but without edema. Right femoral sheath
intact with IABP. bilat DP & PT pulses dopplerable.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with girlfriend of 25 years. Active smoker, [**2-22**]
packs/week. No known EtOH.
Acute myocardial infarction of other anterior wall, initial episode of care,Acute respiratory failure,Other complications due to other cardiac device, implant, and graft,Pneumonitis due to inhalation of food or vomitus,Paroxysmal ventricular tachycardia,Cardiogenic shock,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Thrombocytopenia, unspecified,Congestive heart failure, unspecified
AMI anterior wall, init,Acute respiratry failure,Comp-oth cardiac device,Food/vomit pneumonitis,Parox ventric tachycard,Cardiogenic shock,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Old myocardial infarct,Abn react-artif implant,Thrombocytopenia NOS,CHF NOS
Admission Date:  [**2156-1-14**]              Discharge Date:   [**2156-1-20**]

Date of Birth:  [**2092-5-23**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
Anterior STEMI


Major Surgical or Invasive Procedure:
Coronary catheterization [**2156-1-16**]

History of Present Illness:
63 M with CAD s/p MI 2 years ago with RCA stent. Presented to
[**Hospital3 35813**] Center in [**State 792**]on [**2156-1-13**] with acute
respiratory distress and hypotension. An ECG showed sinus tach
with RBBB and Qs in II, III, and aVF with STE v1-v5. CXR showed
pulmonary edema. He was taken to the cath lab where he found to
have 3vd with left main disease. An IABP was placed. He was seen
by cardiac surgery emergently and admitted to the ICU.
.
Labs notable for peak CK 8591, with CK-MB of 436 and Trop I 359
(nl 0-0.03; >0.5 MI) on [**2156-1-13**] at 22:08. Also of note, WBC 24
and glucose 400, but without acidosis or an elevated anion gap.
He was started on Zosyn and insulin gtt.

Past Medical History:
DM2
CAD, s/p MI 2 yr ago with RCA stent


Social History:
Lives with girlfriend of 25 years. Active smoker, [**2-22**]
packs/week. No known EtOH.


Family History:
NC

Physical Exam:
VS: T 100.3, BP 69/49, HR 93, O2 100% on AC 450x14/0.5/5.0
Gen: Asian male, intubated & sedated.
HEENT: NCAT. Sclera anicteric. PERRL. ETT in place.
Neck: Supple. Left subclav sheath w/ Swann cathether.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Coarse
ventilated breath sounds.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: Bilat feet cool, but without edema. Right femoral sheath
intact with IABP. bilat DP & PT pulses dopplerable.


Pertinent Results:
Cardiac Catheterization:
1. Initial angiography revealed a 70% proximal rca
in-stent restenosis and a 90% focal rca stenosis. Right dominant

circulation. The LM had a 50% tubular lesion. The ostial and
proximal
Lad had an 80% stenosis before tapering down to a small
diffusely
diseased vessel. The Lcx was a very small but free of
significant
disease.
2. Limited hemodynamics revealed a central aortic prssure of
100/60 with
1:1 iabp support and dopamine as the patient entered the lab in
cardiogenic shock.
3. Successful PTCA and stenting of the proximal rca with a
3x18mm vision
stent and of the mid rca with a 3x30mm driver stent which were
post
dilated to 3.0mm. Successful ptca and stenting of the proximal
lad with
a 2.25x18mm mini vision stent.
FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
.
.
Echocardiogram
The left atrium is normal in size. The left ventricular cavity
size is normal. There is moderate regional left ventricular
systolic dysfunction with anteroseptal/apical akinesis and
inferoseptal hypokinesis. Tissue Doppler imaging suggests an
increased left ventricular filling pressure (PCWP>18mmHg). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets appear structurally normal with good
leaflet excursion. The aortic valve is not well seen. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Physiologic mitral regurgitation is seen (within
normal limits). The tricuspid valve leaflets are mildly
thickened. There is a very small pericardial effusion. There are
no echocardiographic signs of tamponade.
.
.


Brief Hospital Course:
This is a 63 year old gentleman who was transferred to the [**Hospital1 18**]
after sustaining a large anterior STEMI.  He underwent cardiac
catheterization on [**2156-1-15**] during which three stents were
successfully placed.  His hospital course was complicated by
cardiogenic shock requiring an intra-aortic balloon pump and a
dopamine drip; and respiratory failure of unknown etiology for
which the patient was intubated on transfer.  He was
successfully weaned off of the IABP and dopamine drip, and
extubated on [**2161-1-17**].  Over the next 2 days he developed
significant pulmonary edema requiring CPAP, lasix drip, and
pressor support with dobutamine and milrinone.  On [**2155-1-20**], he
went into pulseless ventricular tachycardia for which a code
blue was called.  The patient was coded for 29 minutes without
resuscitation, and was pronounced dead at 7:49 PM on [**2156-1-20**].
.
.
Active issues during his hospitalization were as follows:
1. CAD/Ischemia: Past medical history of known CAD with a prior
MI s/p RCA stent.  On this admission, he presented with a large
anterior STEMI and two-vessel disease on cardiac catheterization
where Mid RCA 90% lesion, proximal RCA in-stent [**18**]% re-stenosis,
and 80% proximal LAD lesion were stented.  The patient was
treated with a high-dose statin, aspirin, plavix, and a heparin
gtt.  His heparin gtt was discontinued on [**1-20**] as he was guaiac
positive and on multiple blood thinners.  We were holding
captopril and beta blocker for low BP
.
2. Cardiogenic shock: His hospital course was complicated by
cardiogenic shock, requiring IABP and dopamine gtt for pressure
support.  Echocardiogram on [**1-15**] showing EF 35% with
anteroseptal and apical akinesis and inferoseptal hypokinesis.
He was weaned off of pressors and IABP on [**1-17**], but developed
new pulmonary edema requiring high flow mask with FiO2 of 1.00
on [**2155-1-20**].  We treated him with a lasix drip and CPAP, and
attempted to improve forward flow with dobutamine and milrinone.
 Just prior to his death, we prepared to re-insert his PA
catheter to further delineate his shock profile.
.
3. Atrial fibrillation: The patient had atrial fibrillation with
intermittent RVR, which initially responded well to an
amiodarone load. He was transitioned to a po regimen of
amiodarone 400mg po qday and monitored on telemetry.
.
4. DM: Managed with insulin gtt
.
5. Fever & leukocytosis: unclear source. Was being treated for
presumed PNA at OSH, though CXR did not clearly show an
infiltrate here, though difficult to visualize in setting of
pulmonary edema. Aspiration PNA was also on the differential as
the patient is not fully able to protect his airway and was s/p
extubation. His UA was positive and urine cultures were pending.
 Blood and sputum cultures were negative. Line infection
unlikely as he had fever and white count on presentation.  His
PA catheter was pulled and the tip cultured.  His stool was sent
for C. diff toxin.  We continued with vancomycin and zosyn for
broad coverage as his clinical status was tenuous.
.
6. Respiratory failure: S/p extubation on [**1-18**], since then with
a respiratory alkalosis and hypoxemia on ABG, which as responded
to high flow oxygen mask initially, and then required CPAP.  His
CXR was c/w pulmonary edema.  We attempted to treat this with
CPAP, lasix gtt, and dobutamine/milrinone to improve forward
flow.
.
7. Thrombocytopenia: Improved with removal of IABP, likely
caused by shearing effect.  HIT work-up sent, but with low
suspicion.  Blood smear wnl.
.


Medications on Admission:
Zosyn 3.375 Q6h
Dopamine gtt
Heparin gtt
Insulin gtt
Nitro gtt
Propofol gtt
Lasix gtt
Levophed gtt
Atrovent Q6h
Albuterol A6h
Colace 100 [**Hospital1 **]
Tylenol prn


Discharge Medications:
Patient deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient deceased

Discharge Condition:
Patient deceased

Discharge Instructions:
Patient deceased

Followup Instructions:
Patient deceased
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute respiratory failure,Other complications due to other cardiac device, implant, and graft,Pneumonitis due to inhalation of food or vomitus,Paroxysmal ventricular tachycardia,Cardiogenic shock,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Thrombocytopenia, unspecified,Congestive heart failure, 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: Anterior STEMI

PRESENT ILLNESS: 63 M with CAD s/p MI 2 years ago with RCA stent. Presented to
[**Hospital3 35813**] Center in [**State 792**]on [**2156-1-13**] with acute
respiratory distress and hypotension. An ECG showed sinus tach
with RBBB and Qs in II, III, and aVF with STE v1-v5. CXR showed
pulmonary edema. He was taken to the cath lab where he found to
have 3vd with left main disease. An IABP was placed. He was seen
by cardiac surgery emergently and admitted to the ICU.
.
Labs notable for peak CK 8591, with CK-MB of 436 and Trop I 359
(nl 0-0.03; >0.5 MI) on [**2156-1-13**] at 22:08. Also of note, WBC 24
and glucose 400, but without acidosis or an elevated anion gap.
He was started on Zosyn and insulin gtt.

MEDICAL HISTORY: DM2
CAD, s/p MI 2 yr ago with RCA stent

MEDICATION ON ADMISSION: Zosyn 3.375 Q6h
Dopamine gtt
Heparin gtt
Insulin gtt
Nitro gtt
Propofol gtt
Lasix gtt
Levophed gtt
Atrovent Q6h
Albuterol A6h
Colace 100 [**Hospital1 **]
Tylenol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 100.3, BP 69/49, HR 93, O2 100% on AC 450x14/0.5/5.0
Gen: Asian male, intubated & sedated.
HEENT: NCAT. Sclera anicteric. PERRL. ETT in place.
Neck: Supple. Left subclav sheath w/ Swann cathether.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Coarse
ventilated breath sounds.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: Bilat feet cool, but without edema. Right femoral sheath
intact with IABP. bilat DP & PT pulses dopplerable.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with girlfriend of 25 years. Active smoker, [**2-22**]
packs/week. No known EtOH. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute respiratory failure,Other complications due to other cardiac device, implant, and graft,Pneumonitis due to inhalation of food or vomitus,Paroxysmal ventricular tachycardia,Cardiogenic shock,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Thrombocytopenia, unspecified,Congestive heart failure, unspecified'}
