CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient was a 59-year-old male with
complex multiple medical problems including severe pulmonary
hypertension and CHF who presents with increasing shortness
of breath and dyspnea on exertion and obstructive disease,
which was felt secondary to obesity.  In [**2181**], the patient
was diagnosed with pulmonary hypertension and a cardiac
catheterization at that time showed left heart failure.  In
[**2184**], the patient had a bout of hemoptysis with unknown
etiology.  CT scan, chest x-ray revealed small mediastinal
nodes.  The VAT procedure was done, the following year,
showing nodes with hemosiderin and no evidence of chronic PE.
Catheterization on [**3-17**] showed pulmonary artery pressure
104/50 with cardiac output of 1.6.  The patient did not
respond to O2 supplementation or to nitroprusside, second
right heart catheterization was done later and it was shown
that there was no response to nitric oxide.  Four days ago,
the patient was told his potassium was too low.  He took 4
times as much than he was supposed to by mistake.  Since that
time, he has had increasing shortness of breath and generally
he feels fatigued.  Today, the patient had a near syncopal
event and came to the emergency department for further
evaluation.

MEDICAL HISTORY: Includes hypertension, pseudogout,
atrial fibrillation, osteoarthritis, obesity, lower extremity
cellulitis, and acute renal failure.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke and does not
drink alcohol.
Unspecified septicemia,Congestive heart failure, unspecified,Cardiogenic shock,Acute respiratory failure,Cardiac arrest,Acidosis,Acute kidney failure, unspecified,Ulcer of lower limb, unspecified
Septicemia NOS,CHF NOS,Cardiogenic shock,Acute respiratry failure,Cardiac arrest,Acidosis,Acute kidney failure NOS,Ulcer of lower limb NOS
Unit No:  [**Numeric Identifier 8458**]
Admission Date: [**2187-3-1**]
Discharge Date: [**2187-3-2**]
Date of Birth:  [**2128-2-15**]
Sex:  M
Service:  MEDICAL ICU


PRESENT ILLNESS:  The patient was a 59-year-old male with
complex multiple medical problems including severe pulmonary
hypertension and CHF who presents with increasing shortness
of breath and dyspnea on exertion and obstructive disease,
which was felt secondary to obesity.  In [**2181**], the patient
was diagnosed with pulmonary hypertension and a cardiac
catheterization at that time showed left heart failure.  In
[**2184**], the patient had a bout of hemoptysis with unknown
etiology.  CT scan, chest x-ray revealed small mediastinal
nodes.  The VAT procedure was done, the following year,
showing nodes with hemosiderin and no evidence of chronic PE.
Catheterization on [**3-17**] showed pulmonary artery pressure
104/50 with cardiac output of 1.6.  The patient did not
respond to O2 supplementation or to nitroprusside, second
right heart catheterization was done later and it was shown
that there was no response to nitric oxide.  Four days ago,
the patient was told his potassium was too low.  He took 4
times as much than he was supposed to by mistake.  Since that
time, he has had increasing shortness of breath and generally
he feels fatigued.  Today, the patient had a near syncopal
event and came to the emergency department for further
evaluation.

PAST MEDICAL HISTORY:  Includes hypertension, pseudogout,
atrial fibrillation, osteoarthritis, obesity, lower extremity
cellulitis, and acute renal failure.

MEDICATIONS:
1. Oxycodone.
2. Toprol.
3. Allopurinol.
4. Lasix.
5. Indomethacin.
6. Aspirin.
7. Neurontin.
8. Trazodone.


SOCIAL HISTORY:  The patient does not smoke and does not
drink alcohol.

INITIAL PHYSICAL EXAMINATION:  Vitals included temperature of
98, pulse of 79, blood pressure 76/49, respiratory rate 30,
and saturation of 76 percent on room air and 100 percent of
FiO2.  The patient upon arrival with the MICU team was
intubated and sedated.  Regular rate and rhythm.  S1 and S2.
No murmurs, rales, rubs, or gallops.  Abdomen was soft,
nontender, and nondistended.  Lungs were clear to
auscultation bilaterally.  Right lower extremity with chronic
venostasis, cyanosis.  No other abnormalities were seen.

LABORATORY DATA:  Initial laboratory values included sodium
125, potassium of 5.1, chloride of 88, bicarbonate of 11, BUN
of 106, creatinine of 3.4, and glucose of 94.  White blood
cell count of 10.2, hemoglobin of 19.3, hematocrit of 57.8,
and platelets of 169,000.  ALT was 82, AST was 379, and
alkaline phosphatase 6.2.  Initial blood gas on the patient
was 7.28, 24, 118, and 12 with lactate of 6.6 on 100 percent
O2.  Initial troponin was 0.03 and initial CK was 65.  Chest
x-ray number one showed cardiomegaly, no pneumothorax or
effusion or infiltrate.

HOSPITAL COURSE:  Upon arrival to the emergency department,
the patient was already intubated and sedated.  The patient
was then brought to the MICU for further monitoring.  In the
MICU, the patient remained in a critical condition with very
labile blood pressures and multiple fluid boluses were used
to attempt to keep his blood pressure at a adequate level,
ultimately multiple vasopressors were utilized to help the
patient's blood pressure including vasopressin, Levophed, and
Neo-Synephrine.  There was moderate improvement with the use
of the vasopressors.  Around 5 a.m., the patient had
worsening difficulty with his blood pressure, which remained
lower than desired.  At that point, the patient became
bradycardic with the heart rate in the 30s.  Atropine was
initially used with no improvement.  The pulses were unable
to be felt at approximately 05:36 and CPR was begun.
Immediately after, a code was called.  The patient was given
bicarbonate twice, atropine and epinephrine twice as well.
At this point, the rhythm was asystole.  The CPR was
continued for approximately 12 minutes according to the SLS
guidelines.  Due to being lack of response, at this point,
the resuscitation efforts were terminated.  The patient was
pronounced dead at 05:49.  The patient's wife was at the
bedside, attending was notified, and the wife agreed to an
autopsy.

CONDITION ON DISCHARGE:  Deceased.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:  Hypotension.

Congestive heart failure.

Pulmonary hypertension.

Atrial fibrillation.

DISCHARGE MEDICATIONS:  None.

FOLLOWUP PLANS:  None.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8459**], MD [**MD Number(2) 8460**]

Dictated By:[**Last Name (NamePattern1) 8461**]
MEDQUIST36
D:  [**2187-6-25**] 14:14:55
T:  [**2187-6-26**] 00:35:11
Job#:  [**Job Number 8462**]
{'Unspecified septicemia,Congestive heart failure, unspecified,Cardiogenic shock,Acute respiratory failure,Cardiac arrest,Acidosis,Acute kidney failure, unspecified,Ulcer of lower limb, 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 was a 59-year-old male with
complex multiple medical problems including severe pulmonary
hypertension and CHF who presents with increasing shortness
of breath and dyspnea on exertion and obstructive disease,
which was felt secondary to obesity.  In [**2181**], the patient
was diagnosed with pulmonary hypertension and a cardiac
catheterization at that time showed left heart failure.  In
[**2184**], the patient had a bout of hemoptysis with unknown
etiology.  CT scan, chest x-ray revealed small mediastinal
nodes.  The VAT procedure was done, the following year,
showing nodes with hemosiderin and no evidence of chronic PE.
Catheterization on [**3-17**] showed pulmonary artery pressure
104/50 with cardiac output of 1.6.  The patient did not
respond to O2 supplementation or to nitroprusside, second
right heart catheterization was done later and it was shown
that there was no response to nitric oxide.  Four days ago,
the patient was told his potassium was too low.  He took 4
times as much than he was supposed to by mistake.  Since that
time, he has had increasing shortness of breath and generally
he feels fatigued.  Today, the patient had a near syncopal
event and came to the emergency department for further
evaluation.

MEDICAL HISTORY: Includes hypertension, pseudogout,
atrial fibrillation, osteoarthritis, obesity, lower extremity
cellulitis, and acute renal failure.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke and does not
drink alcohol. 

### Response:
{'Unspecified septicemia,Congestive heart failure, unspecified,Cardiogenic shock,Acute respiratory failure,Cardiac arrest,Acidosis,Acute kidney failure, unspecified,Ulcer of lower limb, unspecified'}
